nep-hea New Economics Papers
on Health Economics
Issue of 2023‒11‒27
twelve papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. Impacts of Home-Care Subsidies: Evidence from Quasi-Random Assignment By Ofek-Shanny, Yuval; Strulov-Shlain, Avner; Zeltzer, Dan
  2. The Long-Term Impact of Parental Migration on the Health of Young Left-Behind Children By Jinkai Li; Erga Luo; Bart Cockx
  3. Effects of Parental Death on Labor Market Outcomes and Gender Inequalities By Mathias Jensen; Ning Zhang
  4. Estimating Intergenerational Health Transmission in Taiwan with Administrative Health Records By Chang, Harrison; Halliday, Timothy J.; Lin, Ming-Jen; Mazumder, Bhashkar
  5. How should we model health as a dynamic process? By Alexandra Elizabeth Brown
  6. Ageing Unequally in Latin America By Javier Olivera
  7. Trust and social preferences in times of acute health crisis * By Fortuna Casoria; Fabio Galeotti; Marie Claire Villeval
  8. Social Insurance against a Short Life: Ante-Mortem versus Post-Mortem Policies By Ponthiere, Gregory
  9. Navigating the Landscape of Digital Health - United Kingdom By Simon Brassel;Priscila Radu;Eleanor Bell;Martina Garau
  10. Infant feeding and post-weaning health: evidence from turn-of-the-century London By Arthi, Vellore; Schneider, Eric B.
  11. Urban and rural disparities in life expectancy drops during the COVID-19 pandemic were not uniform across European countries By Kashnitsky, Ilya; Trias-Llimós, Sergi; Villavicencio, Francisco
  12. Scaling Behavioral Interventions in the Presence of Spillover: Implications for Randomized Controlled Trials and Evidence-Based Policy Making By Ternovski, John; Keppeler, Florian; Jilke, Sebastian; Vogel, Dominik

  1. By: Ofek-Shanny, Yuval (FAU, Erlangen Nuremberg); Strulov-Shlain, Avner (University of Chicago Booth School of Business); Zeltzer, Dan (Tel Aviv University)
    Abstract: We study the impact of subsidizing home-based long-term care on recipients' health and the labor supply of their working-age children. We use administrative data from Israel on the universe of welfare benefit applications linked with tax records of applicants and their adult children. To address the endogeneity of benefit recipients' health status, we instrument for benefit receipt using the leniency of randomly assigned evaluators who assess the applicant's functional status and determine benefit eligibility. We find that for compliers - applicants who receive subsidies only from more lenient evaluators - subsidizing home-based care has large adverse effects on recipient health but no detectable effects on the labor market outcomes of their children. The results are consistent with the crowd-out of self-care for the marginal recipient, highlighting the need to assess the heterogeneous eects of home-care subsidies.
    Keywords: home-based long-term care, labor supply
    JEL: I13 I18 J22 H53
    Date: 2023–10
  2. By: Jinkai Li; Erga Luo; Bart Cockx (-)
    Abstract: In 2015, 15% of all children in China were left behind in the countryside because at least one of their parents migrated to a city. We implement an event study analysis between 2010 and 2018 on five waves of the China Family Panel Studies (CFPS) to investigate the dynamic effects of parental migration on the health of left behind young children (LBC). While we find a gradual increase in medical expenditures, we do not detect any significant impact on the incidence of sickness. Furthermore, the analysis shows that the incidence of overweight declines gradually since their parents’ first migration and reports suggestive evidence for mental health improvement. We argue that these long-term positive effects on health and health consumption can be explained by the transitory nature of migration, the high-quality substitution of the caregiver role by grandparents, and by a reorientation in family expenditures, partly induced by government policy.
    Keywords: young left-behind children; parental migration; Hukou system; long-term impact on health; event study analysis; mechanisms analysis
    JEL: C83 C91 J22 J88
    Date: 2023–11
  3. By: Mathias Jensen; Ning Zhang
    Abstract: Nearly everyone experiences the death of a parent in adulthood, but little is known about the effects of parental death on adult children’s labor market outcomes and the underlying mechanisms. In this paper, we utilize Danish administrative data to examine the effects of losing a parent on individual labor market outcomes and its contribution to gender earnings inequalities. Our empirical design leverages the timing of sudden, first parental deaths, al lowing us to focus on the health and family support channels. Our findings reveal that the death of a parent has enduring negative effects on the earnings of both adult sons and daughters, with the effects being more pronounced for daughters. Moreover, the negative impact of mothers’ deaths on daughters’ earnings outweighs that of fathers’ deaths. Consequently, mothers’ deaths can account for 10% of the aggregate gender earnings gap. Our analysis demonstrates that both the mental health and family support channels are at play. Specifically, we observe that women are relatively more inclined to seek psychological assistance, while men tend to receive more mental health-related and opioid prescriptions following the loss of a parent. Additionally, we find that women with young children experience a comparatively larger drop in earnings after parental death due to the loss of informal childcare.
    Date: 2023–08–07
  4. By: Chang, Harrison (University of Toronto); Halliday, Timothy J. (University of Hawaii at Manoa); Lin, Ming-Jen (National Taiwan University); Mazumder, Bhashkar (Federal Reserve Bank of Chicago)
    Abstract: We use population-wide administrative health records from Taiwan to estimate intergenerational persistence in health, providing the first estimates for a middle income country. We measure latent health by applying principal components analysis to a set of indicators for 13 broad ICD categories and quintiles of visits to a general practitioner. We find that the rank-rank slope in health between adult children and their parents is 0.22 which is broadly in line with results from other countries. Maternal transmission is stronger than paternal transmission and sons have higher persistence than daughters. Persistence is also higher at the upper tail of the parent health distribution. Persistence is lower when using inpatient data or when using total medical expenses and may overstate mobility. Health transmission is almost entirely unrelated to household income levels in Taiwan. We also find that that there are small geographic differences in health persistence across townships and that these are modestly correlated with area level income and doctor availability. Finally, by looking at persistence within health conditions that vary in their genetic component, we find little evidence that health persistence is driven by genetic factors.
    Keywords: intergenerational mobility, health, administrative data, genetics
    JEL: I1 J1
    Date: 2023–10
  5. By: Alexandra Elizabeth Brown
    Abstract: Health is a complex dynamic process that impacts many economic decisions in ways that remain poorly understood. This paper comprehensively reviews how health is modelled in the literature, showing that baseline models typically fail to take into account how persistence and frequency of health shocks vary by past health history and magnitude and direction of past shocks. Methods from the earnings dynamics literature are adapted to produce improved health persistence estimates. This paper also investigates how medical biomarker data can be incorporated in dynamic models of health as a proxy for underlying health. There is significant scope for further work in this area as more medical data becomes available to researchers.
    Date: 2023–08–31
  6. By: Javier Olivera
    Abstract: This paper studies active ageing and its distribution among older adults in a sample of 18 Latin American countries. For this purpose, a multidimensional index of active ageing is estimated for each individual, as well as its distribution in each country. This strategy makes it possible to measure inequalities in the ageing process, and also to consider different value judgements in the overall assessment of quality of life during ageing. Thus, the study sheds light on discrepancies in the quality of ageing within and between countries. Furthermore, individual factors associated with the degree of inequality in active ageing are analysed by means of regressions using Gini re-centred influence functions. A higher proportion of people with secondary education and better access to water and sewerage services is found to be associated with reduced inequality in active ageing. Country-level variables — such as health expenditure, pension coverage, access to health care and the poverty rate among older people — are key in explaining between-country differences in active ageing.
    Keywords: Active ageing; Old age; Inequality; Well-being; Latin America
    JEL: H55 I18 I31 J14
    Date: 2023–11
  7. By: Fortuna Casoria (CEREN - Centre de Recherche sur l'ENtreprise [Dijon] - BSB - Burgundy School of Business (BSB) - Ecole Supérieure de Commerce de Dijon Bourgogne (ESC)); Fabio Galeotti; Marie Claire Villeval (GATE Lyon Saint-Étienne - Groupe d'Analyse et de Théorie Economique Lyon - Saint-Etienne - UL2 - Université Lumière - Lyon 2 - UJM - Université Jean Monnet - Saint-Étienne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We combined a natural experiment (the occurrence of the COVID-19 pandemic in 2020) with the tools of laboratory experiments to study whether and how an unprecedented shock on social interactions (the introduction and abrogation of a nationwide lockdown) affected the evolution of individuals' social preferences, and willingness to trust others. In a longitudinal online incentivized experiment during the first lockdown in France, we elicited the same participants' preferences for prosociality, trust and trustworthiness every week for three months. Despite the exposure to long-lasting social distancing, prosocial preferences and the willingness to reciprocate the trust of others remained stable during the whole period under study. In contrast, the lockdown had an immediate negative effect on trust, which remained at lower levels til after the lifting of such measures but recovered its initial level nine months later. The decline in trust was mainly driven by individuals who experienced financial hardship, a lack of outward exposure, and higher anxiety during the lockdown.
    Keywords: Social preferences, Trust, Trustworthiness, Pandemic, COVID-19, Social distancing
    Date: 2023–02–05
  8. By: Ponthiere, Gregory
    Abstract: Welfare States do not insure citizens against the risk of premature death, i.e., the risk of having a short life. Using a dynamic OLG model with risky lifetime, this paper compares two insurance devices reducing well-being volatility due to the risk of early death: (i) an ante-mortem age-based statistical discrimination policy that consists of an allowance given to all young adults (including the unidentified adults who will die early); (ii) a post-mortem subsidy on accidental bequests due to early death. Each policy is financed by taxing old-age consumption. Whereas each device can yield full insurance, the youth allowance is shown to imply a higher lifetime well-being at the stationary equilibrium. The marginal utility of consumption exceeding the marginal utility of giving when being dead, the youth allowances system is, despite imperfect targeting, a more effi cient mechanism of insurance against the risk of early death.
    Keywords: premature death, mortality risk, social insurance, inheritance, lifecycle models
    JEL: J10 J17 I31 E21 H55
    Date: 2023
  9. By: Simon Brassel;Priscila Radu;Eleanor Bell;Martina Garau
    Abstract: Digital Health Technologies are a major trend in health care, and successfully adding them to the wider portfolio of health technologies requires coordinated involvement from various stakeholders. Within this report, we summarise the Digital Health Landscape in the UK. We include areas of regulation, value assessment and reimbursement, and efforts to increase the digital literacy of the general population and the health workforce. We provide lessons learned that may be of value to decision-makers beyond the UK who seek to get their health system digital-ready.
    Keywords: Navigating the Landscape of Digital Health - United Kingdom
    JEL: I1
    Date: 2022–12–16
  10. By: Arthi, Vellore; Schneider, Eric B.
    Abstract: Evidence on the post-weaning benefits of early-life breastfeeding is mixed, and highly context-dependent. Moreover, this evidence is drawn almost exclusively from modern settings, limiting our understanding of the relationship between breastfeeding and subsequent health in the past. We provide novel evidence on the nature and reach of these post-weaning benefits in a historical setting, drawing on a rich new longitudinal dataset covering nearly 1000 children from the Foundling Hospital, an orphanage in turn-of-the-century London. We find that even after the cessation of breastfeeding, ever-breastfed status reduced mortality risk and raised weight-for-age in infancy, that exclusive breastfeeding conferred additional benefits, and that breastfeeding duration had little impact. We also find a U-shaped pattern in weight-for-age by time since weaning, indicating a deterioration in health shortly after weaning, followed by a recovery. The early post-weaning advantages associated with breastfeeding, however, did not persist into mid-childhood. This indicates that any protective effects of earlier breastfeeding attenuated with age, and suggests a strong role for catch-up growth. This study contributes to the data and empirical settings available to explore the relationship between infant feeding and post-weaning health, and helps shed light on the contribution of changing breastfeeding norms to trends in health in twentieth-century Britain.
    Keywords: anthropometric growth; breastfeeding; early-life health; mortality
    JEL: J13 N33
    Date: 2021–12–01
  11. By: Kashnitsky, Ilya (University of Southern Denmark); Trias-Llimós, Sergi; Villavicencio, Francisco (Johns Hopkins Bloomberg School of Public Health)
    Abstract: This paper explores differences in mortality dynamics between urban and rural areas of 20 European countries during the two pandemic years 2020 and 2021. The link between population density and the spread of communicable diseases is a well-established phenomenon, yet to what extent this results in a mortality gap after years of ongoing epidemics is a less explored question. We find pronounced and significant differences, with urban areas being harder hit by COVID-19 mortality in most countries.
    Date: 2023–11–03
  12. By: Ternovski, John; Keppeler, Florian; Jilke, Sebastian (Georgetown University); Vogel, Dominik (University of Hamburg)
    Abstract: Randomized Control Trials (RCTs) are increasingly relied upon by policymakers as part of efforts to incorporate evidence into the policymaking process, a movement known as evidence-based policymaking, or EBPM. Testing possible policy interventions via RCTs before full rollout is commonly thought to be the gold standard of evidence in the EBPM process. However, real-world policy changes do not always scale up as expected. Even large-N RCTs targeting a random sample of policy beneficiaries do not capture the influence of social networks and risk missing consequential spillover effects. We illustrate this issue by assessing the efficacy of monetary incentives to increase COVID-19 vaccination in an RCT over the entire population of a medium-sized European town (~40, 000 residents). We use administrative vaccination data as our primary outcome. Since the entire population was randomized, we are able to estimate spillover effects within households. There were significant negative spillover effects on booster vaccinations that we attribute to a displacement effect, potentially driven by long lines at the vaccination events. Our results illustrate that using a population-level RCT to test whether a policy scales can help avoid costly, ineffective, or even counterproductive policy outcomes.
    Date: 2023–10–25

This nep-hea issue is ©2023 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
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