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on Health Economics |
| By: | Denis Agniel; Jonathan H. Cantor; Johanna Catherine Maclean; Kosali I. Simon; Erin Taylor |
| Abstract: | Opioid overdose deaths in older adults have increased substantially over the past two decades. This increase has occurred despite the availability of effective treatments. Methadone, one of just three medications approved by the Food & Drug Administration for opioid use disorder (OUD) treatment, was not covered by Medicare — the primary insurer of older Americans — for OUD until 2020. We study the response of opioid treatment programs (OTPs), the only healthcare providers that can dispense methadone for OUD in the U.S., to this landmark policy change using administrative data and a difference—in—differences framework. We examine two outcomes: provider acceptance of Medicare payment and the number of treatment episodes, before and after the policy change, in OTPs relative to other substance use disorder treatment facilities. Our findings show a surge in Medicare acceptance by OTPs and an increase in the number of treatment episodes post−policy. We also test for potential spillovers of the Medicare policy change to other insurance markets, provision of charity care, and service offerings. |
| JEL: | I1 I11 I18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31884&r=hea |
| By: | Hannes Ullrich; Michael Allan Ribers |
| Abstract: | We analyze how machine learning predictions may improve antibiotic prescribing in the context of the global health policy challenge of increasing antibiotic resistance. Estimating a binary antibiotic treatment choice model, we find variation in the skill to diagnose bacterial urinary tract infections and in how general practitioners trade off the expected cost of resistance against antibiotic curative benefits. In counterfactual analyses we find that providing machine learning predictions of bacterial infections to physicians increases prescribing efficiency. However, to achieve the policy objective of reducing antibiotic prescribing, physicians must also be incentivized. Our results highlight the potential misalignment of social and heterogeneous individual objectives in utilizing machine learning for prediction policy problems. |
| Date: | 2023–11–13 |
| URL: | http://d.repec.org/n?u=RePEc:bdp:dpaper:0027&r=hea |
| By: | Iris Arbogast (Federal Reserve Bank of St. Louis); Anna Chorniy (Northwestern University); Janet Currie (Princeton University) |
| Abstract: | Following decades of increasing child access to public health insurance, pre-pandemic enrollments fell in many states after 2016 and the number of uninsured children increased. This study provides the first national, quantitative assessment of the role of administrative burdens in driving this drop in child health insurance coverage. In addition, we identify the demographic groups of children who were most affected. We show that regulations that increased administrative burdens placed on families reduced public health insurance coverage by a mean of 5.9% within six months following the implementation of these changes. Declines were largest for Hispanic children, children with non-citizen parents, and children whose parents reported that they did not speak English well. These reductions were separate from and in addition to enrollment declines among Hispanic children following the announcement of a new public charge rule in Sept. 2018. |
| Keywords: | Health Insurance, Children |
| JEL: | I13 |
| Date: | 2023–09 |
| URL: | http://d.repec.org/n?u=RePEc:pri:econom:2023-09&r=hea |
| By: | Karlsson, Martin; Wang, Yulong; Ziebarth, Nicolas R. |
| Abstract: | Health expenditure data almost always include extreme values, implying that the underlying distribution has heavy tails. This may result in infinite variances as well as higher-order moments and bias the commonly used least squares methods. To accommodate extreme values, we propose an estimation method that recovers the right tail of health expenditure distributions. It extends the popular two-part model to develop a novel three-part model. We apply the proposed method to claims data from one of the biggest German private health insurers. Our findings show that the estimated age gradient in health care spending differs substantially from the standard least squares method. |
| Keywords: | heavy tails, health expenditures, claims data, nonlinear model |
| JEL: | C10 C13 I10 I13 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:279812&r=hea |
| By: | Seema Jayachandran |
| Abstract: | This article discusses son preference in India, including both greater investment in sons and the fertility preference for sons. Regarding differential investment, I focus on child health and show that gender gaps in inputs and outcomes have narrowed in recent years. Nonetheless, girls remain disadvantaged in important ways, and making health services free is unlikely to be enough to close these remaining gaps. In addition to gender gaps, there are also stark health gaps between eldest sons, whom parents favor, and other sons. Fertility preferences likewise center on eldest sons. The desire to have at least one son — who can fill that eldest son role in the family — drives the skewed sex ratio, and this preference shows little sign of abating. In fact, the downward trend in family size is exacerbating how the desire for a son translates into sex-selection. Families’ quest for a son also imposes collateral damage on sisters’ health. The policy challenge, particularly around reducing the desire for sons, is large. Empowering women is not a panacea, and offering financial incentives to have daughters risks further concentrating girls in poorer families. While we do not know which policies will erase the disadvantages girls face, some that might advance this goal are public pensions as an alternative to old-age support from sons, increased delivery of health services through schools, and norm-change interventions that aim to increase the intrinsic value that Indian families place on girls. |
| JEL: | J13 O12 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31883&r=hea |
| By: | adiid, hibanan |
| Abstract: | The integration of artificial intelligence (AI) in healthcare is poised to revolutionize diagnostics, treatment, and patient care. However, this rapid advancement raises ethical concerns related to patient privacy, data security, and the potential for bias in AI algorithms. This paper delves into the ethical implications of AI in healthcare, scrutinizing the fine balance between harnessing AI's potential for innovation and safeguarding patient privacy. Through an in-depth exploration of the ethical challenges and regulatory frameworks, this study strives to provide insights for stakeholders in healthcare, technology, and policy domains. |
| Date: | 2023–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:aw6g3&r=hea |
| By: | Andrés Ramasco (University of Notre Dame) |
| Abstract: | Curtailing alcohol-related traffic fatalities is especially important for policymakers. I study whether there is an effect on Health Outcomes related to traffic accidents caused by Zero-Tolerance Laws and the mechanism driving these effects. Using Fatalities and Injuries counts at the county level. I exploit time and geographic variation in adopting the laws in a Difference-in-Differences framework. I find no sizeable reductions in various health outcomes, including traffic fatalities. I also test for heterogeneity across age groups, finding no significant differences. I propose and evaluate the persistence of drinking behavior and alcohol-related Hospitalizations as mechanisms explaining the null effects, finding no significant changes in several measures of alcohol consumption |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:aoz:wpaper:289&r=hea |
| By: | Maria Gueltzow (Max Planck Institute for Demographic Research, Rostock, Germany); Hannu Lahtinen; Maarten J. Bijlsma (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany); Pekka Martikainen (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | This study explored the interplay between genetic predisposition, partnership status and depression by examining the association of a polygenic risk score (PGS) for depression with time to antidepressant purchasing and the moderating role of partnership status. We analysed data from 30, 192 Finnish individuals with an accelerated failure time model. While the cumulative hazard of antidepressant purchasing varied across PGS and partnership status – with the highest cumulative hazard in the widowed group, followed by divorced, single, married and cohabiting – we found no evidence for an interaction between PGS and partnership status. Results were robust to different model specifications, gender stratification, choice of PGS, and endogenous selection. Although antidepressant purchasing correlated with both PGS and partnership status, we found no evidence that partnership status could partially offset or amplify the association between the PGS for depression and depression incidence. |
| Keywords: | Finland, genetics, marital status, mental health |
| JEL: | J1 Z0 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2023-049&r=hea |
| By: | Lusher, Lester (University of Pittsburgh); Ruberg, Tim (University of Hohenheim) |
| Abstract: | In 2020, Japan introduced a comprehensive heat-health warning system where daily alerts were issued by region when forecasted wet bulb globe temperature (WBGT) exceeded a threshold (33 °C). Utilizing plausibly exogenous region-day variation in the difference between actual and forecasted WBGT (i.e. forecasting errors), we find that the alerts led to a large and precisely estimated increase in heat stroke counts. Paired with data from Google Trends, Google Mobility Reports, and the population of ambulance records, we identify potential mechanisms, including increased reporting of heat stroke cases and "adverse" behavioral responses (e.g. people spending more time outdoors) when alerts were issued, while ruling out potential substitution in health diagnoses away from other sudden illnesses. |
| Keywords: | heat stroke, climate change, warning effectiveness, avoidance behavior |
| JEL: | D90 I12 I18 Q54 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16562&r=hea |
| By: | Kai Fischer |
| Abstract: | How do skilled migrant workers affect firms’ performance and output? I estimate the causal effect of EU nurse withdrawal after the Brexit referendum on the performance of English hospitals. Exploiting variation in the reliance on EU workers across hospital providers in pre-referendum years, I find that providers with a mean share of EU nurses before the referendum persistently face 2% more hospital-related deaths after the referendum. This translates to 5, 900 additional hospital-related deaths p.a. in England. Unexpected readmissions of patients increase by 5% and reported incidents with harm to patients by 7% respectively. Providers respond to missing EU nurses by hiring UK nurses and fostering promotions in the short run, and by recruiting non-European nurses in the long run. |
| Keywords: | skilled labour shortage, public healthcare, e-/immigration, Brexit |
| JEL: | J24 J61 I18 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10747&r=hea |
| By: | DeSimone, Jeff; Grossman, Daniel; Ziebarth, Nicolas R. |
| Abstract: | Increases in youth vaping rates and concerns of a new generation of nicotine addicts recently prompted an increase in the federal minimum legal purchase age (MLPA) for tobacco products, including e-cigarettes, to 21 years. This study presents the first regression discontinuity evidence on the effectiveness of e-cigarette MLPA laws. Using data on 12th graders from Monitoring the Future, we obtain robust evidence that federal and state age-18 MLPAs decreased underage e-cigarette use by 15-20% and frequent use by 20-40%. These findings suggest that the age-21 federal MLPA could meaningfully reduce e-cigarette use among 18-20-year-olds. |
| Keywords: | e-cigarettes, minimum legal purchase age (MLPA), Monitoring the Future, regression discontinuity, vaping |
| JEL: | I12 I18 H51 H75 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:279815&r=hea |
| By: | Pablo Garcia-Sanchez (Banque centrale du Luxembourg, Departement Economie et Recherche); Olivier Pierrard (Banque centrale du Luxembourg, Departement Economie et Recherche) |
| Abstract: | We build a life cycle model to study the implications of two types of lifetime uncertainty on investment in health and welfare. We show that when the hazard rate of death depends on age, uncertainty increases health investment. Instead, when hazard rate depends on human frailty, uncertainty decreases health investment. In both cases, uncertainty reduces welfare. The size of the effects depends on an aggregate parameter related to the natural increase in human frailty with age, to the marginal return on health investment and to the rate of time preference. We first derive the main results from a small model which admits an analytical solution, before generalizing them in a larger model using numerical simulations. We conclude that the role of uncertainty depends on how death is modeled; and that if death is linked to frailty, as suggested by empirical evidence, a health policy reducing health uncertainty would stimulate individual investment in health promoting activities and improve welfare. |
| Keywords: | life cycle, uncertainty, health, welfare |
| JEL: | C60 D15 D81 I12 I18 |
| Date: | 2023–11–14 |
| URL: | http://d.repec.org/n?u=RePEc:ctl:louvir:2023020&r=hea |
| By: | Graeber, Daniel (DIW Berlin) |
| Abstract: | We describe the joint permanent health distribution of parents and children in Germany using 25 years of data from the Socio-Economic Panel. We derive three main results: First, a ten percentile increase in parental permanent health is associated with a 2.3 percentile increase in their child's health. Second, employing our anchoring method, we find that a percentile point increase in permanent health ranks is associated with a 0.8% to 1.4% increase in permanent earnings. Additionally, we conclude that health is particularly important for earnings at lower levels of health.We argue that our anchoring method has great potential to enhance the comparability of the literature across data sets and countries. Third, a more favorable socioeconomic status of the parents is predominantly associated with higher upward mobility in health. |
| Keywords: | intergenerational health mobility, health measurement, inequality |
| JEL: | I14 I12 J62 J13 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16567&r=hea |
| By: | Timothy J. Moore; William W. Olney; Benjamin Hansen |
| Abstract: | The U.S. opioid crisis is now driven by fentanyl, a powerful synthetic opioid that currently accounts for 90% of all opioid deaths. Fentanyl is smuggled from abroad, with little evidence on how this happens. We show that a substantial amount of fentanyl smuggling occurs via legal trade flows, with a positive relationship between state-level imports and drug overdoses that accounts for 15, 000-20, 000 deaths per year. This relationship is not explained by geographic differences in "deaths of despair, '' general demand for opioids, or job losses from import competition. Our results suggest that fentanyl smuggling via imports is pervasive and a key determinant of opioid problems. |
| JEL: | F1 F6 I1 K4 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31885&r=hea |
| By: | Ksenia Panidi; Yaroslava Grebenschikova; Vasily Klucharev |
| Abstract: | In the present study, we use an experimental setting to explore the effects of sugar-free labels on the willingness to pay for food products. In our experiment, participants placed bids for sugar-containing and analogous sugar-free products in a Becker-deGroot-Marschak auction to determine the willingness to pay. Additionally, they rated each product on the level of perceived healthiness, sweetness, tastiness and familiarity with the product. We then used structural equation modelling to estimate the direct, indirect and total effect of the label on the willingness to pay. The results suggest that sugar-free labels significantly increase the willingness to pay due to the perception of sugar-free products as healthier than sugar-containing ones. However, this positive effect is overridden by a significant decrease in perceived sweetness (and hence, tastiness) of products labelled as sugar-free compared to sugar-containing products. As in our sample, healthiness and tastiness are positively related, while healthiness and sweetness are related negatively, these results suggest that it is health-sweetness rather than health-tastiness tradeoff that decreases the efficiency of the sugar-free labelling in nudging consumers towards healthier options. |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2311.09885&r=hea |
| By: | Cinzia Di Novi (European Commission, Joint Research Centre (JRC)); Matija Kovacic (European Commission, Joint Research Centre (JRC), Department of Economics, University Of Venice CÃ Foscari); Cristina Elisa Orso (Department of Law, Economics, and Cultures, University of Insubria) |
| Abstract: | Online health information seeking behavior (e-HISB) is becoming increasingly common and the trend has accelerated as a result of the COVID-19 pandemic when individuals strongly relied upon the Internet to stay informed by becoming exposed to a wider array of health information. Despite e-HISB having become a global trend, very few empirical investigations have analyzed its potential impact on healthcare access and individuals' health status. In this paper, we try to fill this gap. We use data from the second SHARE Corona Survey and estimate a recursive model of e-HISB, healthcare access, and individuals' health status that accounts for individuals' unobserved heterogeneity. The most interesting result concerns the e-HISB indirect effect on individuals' poor health through healthcare access, that is positive. Arguably, patients use information from the Internet to cope with their perceived vulnerability to illness, but they lack the ability to understand the medical information: an incorrect self-diagnosis may increase the likelihood of doctor visits for them, which, in turn, also increases the likelihood of perceiving a poor health status. |
| Keywords: | health information seeking behavior, healthcare access, health status |
| JEL: | I10 I12 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ven:wpaper:2023:26&r=hea |
| By: | Sarah Robinson; Heather Royer; David Silver |
| Abstract: | Analyzing data spanning three decades covering the near universe of births, we study county-level differences in Cesarean section (C-section) rates among first-time mothers of singleton births. Our research reveals persistent geographic variation in C- section rates for both low- and high-risk groups. Counties with elevated C-section rates consistently perform more C-sections across mothers at all levels of appropriateness for the procedure. These elevated rates of C-section in high C-section counties are associated with reduced maternal and infant morbidity. We also find that C-section decisions are less responsive to underlying risks for Black mothers relative to white mothers, suggesting potential welfare-reducing disparities. |
| JEL: | I1 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31871&r=hea |
| By: | Francesco Moscone (Department of Economics, University Of Venice CÃ Foscari; Brunel University London, UK) |
| Abstract: | This paper explores regional disparities in avoidable mortalities and hospital discharges, influenced by factors associated with high-risk behaviors such as excessive alcohol consumption, smoking, and inadequate physical activity levels. We gathered data from various official sources (ISTAT and Eurostat) and conducted a comprehensive panel data regression analysis to investigate the intricate relationships between these variables. The study found that a higher prevalence of smokers is associated with increased avoidable mortality and hospital discharges. Specifically, a 1% decrease in the percentage of smokers led to an average reduction of 12.76 hospital discharges per 10, 000 inhabitants. This reduction translated to an estimated total saving of approximately 331 million Euros across all regions in 2020. Similarly, excessive wine consumption was linked to higher rates of preventable mortality and hospital discharges. A one unit drop in the number of heavy drinkers per 1, 000 inhabitants would result in a saving of about 60 million Euros. Furthermore, the variable indicating the prevalence of individuals aged 3 and above who never engage in sports was positively correlated with adverse health outcomes. A 1% decrease in the number of individuals in this category would lead to a saving of approximately 223 million Euros. In parallel, we analyzed pathologies associated with smoking, which include lung cancer, respiratory ailments, and cerebrovascular diseases. Moreover, we explored the potential benefits of transitioning from high-risk to reduced-risk products, aiming at alleviating the strain on the healthcare system while reallocating resources to address critical health needs. The results suggest that if 50 percent of smokers transitioned to reduced-risk products such as e-cigarettes and heat-not-burn tobacco, the NHS could potentially save 722 million Euros in terms of smoking-related illnesses. Among the healthcare systems examined, Lombardy stands to gain the most from this transition, with an estimated annual saving of approximately 140 million Euros. The findings indicate that there is potential for further savings in the National Health Service (Servizio Sanitario Nazionale, NHS) by advocating for a reduction in high-risk behaviors. |
| Keywords: | Smoking; excessive alcohol consumption, inadequate physical activity, health expenditure, avoidable mortality, hospital discharges, Reduced-risk products, regional variations |
| JEL: | I11 I13 I14 I15 I19 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ven:wpaper:2023:22&r=hea |
| By: | Ge, Ge (Department of Health Management and Health Economics); Cheo, Roland (Centre for Behavioural and Implementation Science Interventions,); Liu, Rugang (School of Public Health and Policy, Nanjing Medical University); Wang, Jian (Dong Fureng Institute of Economic and Social Development and Center for Health Economics and Management, Wuhan University); Wang, Qiqi (School of Economics, Xian School of Economics and Finance) |
| Abstract: | This study employs a mystery shopper audit on a random sample of 96 for-profit private clinics in Jinan, China. We investigate two instruments which reflect beneficence among for-profit clinicians in private practice. The first is whether physicians returned a lost wallet “accidentally” left next to the physician’s table; and the second, whether physicians prescribed antibiotics to pseudopatients who displayed no symptoms of any illness but had complained of fever the night before. These measures quantify beneficence under two different valence framing: returning a wallet represents clinicians who “do good” at personal cost to themselves, while not prescribing antibiotics represents a choice “not to do harm” to patients. We look at the correlation between these beneficence measures and the physicians’ prescription behaviours, and their revenues from the consultation. We find that whether doctors return a lost wallet or not, and prescribe antibiotics or not, such physicians are still as likely to prescribe medications which increase their incomes. |
| Keywords: | mystery shopper audit; antibiotic prescription; lost wallet; beneficence; for-profit clinics; physicians |
| JEL: | C93 D64 D91 I18 |
| Date: | 2023–11–16 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2023_006&r=hea |
| By: | Linden, Mikael |
| Abstract: | Regression discontinuity (RD) analysis of retirement durations and retiree death ages is conducted with the Finnish year 1947 birth cohort. Data consist of observations from the sample follow-up period in 1.1.2007 – 31.12.2019. For the year 1947 cohort the eligible retirement age with old-age pension is between the ages of 63 and 68 years. However, the observed pension ages are quite often less than 63 years although the statutory minimum retirement age regulates persons’ retirement times. This means that for some retirees age of 63 years constitutes a queuing age that is against their retirement intentions, and this affects their retirement spells. We find with RD methods that close after death age of 63 years, the retirement spells discontinuously shortens although the higher death age should give room for the longer retirement spells. The point estimates for regression discontinuity effects on terminated retirement spells are in the range of from –1.09 to –0.56 in loss of year depending on the used sub-samples, covariates, and estimation methods. These findings are interpreted to conflict retirement intentions of retirees retiring at age of 63 years. |
| Keywords: | Regression discontinuity, retirement duration, age of death, statutory minimum retirement |
| JEL: | C21 J10 J26 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:119168&r=hea |
| By: | Mette Gørtz; Bent Jesper Christensen; Nabanita Datta Gupta |
| Abstract: | The population is aging in Denmark, as in many other countries, due to increasing life expectancy and a low total fertility rate. This potentially puts the Danish welfare state under pressure. This paper discusses the demographic and socioeconomic situation of the elderly in Denmark, focusing on the health status and financial situation of the elderly, and the provision of long-term care (LTC). We rely on a combination of survey data, mainly from the Survey of Health and Retirement in Europe (SHARE), and high-quality register data covering the entire Danish population. We find that a large fraction of the elderly is in good health, but that those in the older age group, 85+, face considerably more functional limitations in daily living. One in three of the elderly receives some form of long-term care, and more than half the 85+ group. The paper further identifies a number of current challenges regarding organization of the long-term care sector, including recruitment of personnel for health care and LTC. Finally, the paper sheds light on the extent of informal care provided by family and friends. While informal care is offered voluntarily and is generally unpaid, it represents a substantial opportunity cost to society. |
| JEL: | H51 I1 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31889&r=hea |
| By: | Jonathan Gruber; Kathleen M. McGarry |
| Abstract: | The population of the United States, as with the rest of the world, is aging rapidly, with the most rapid growth occurring among the age 85 and older population, those who rely most on long-term care. In this chapter, we review the delivery and financing of long-term care in the U.S. We show that the resources of most elderly in the U.S. are insufficient to finance these ongoing long-term care needs and the public sector finances the majority of long-term care spending. At the same time, informal care plays a critical role, with the elderly at every age and every disability level receiving informal care more frequently than formal care. Indeed, when properly valued, informal care accounts for more than one-third of the nearly 2 percent of U.S. GDP devoted to long-term care. |
| JEL: | H4 H50 I13 I18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31881&r=hea |
| By: | Jonathan Gruber; Kathleen M. McGarry; Charles Hanzel |
| Abstract: | The developed world is in the midst of an enormous demographic transition, with life expectancy increasing and fertility falling, leading to a rapid aging of the population. This trend has critical implications for long-term care around the world. This paper serves as the introduction to a volume that brings together experts from ten countries to compare long term care systems. We find a number of important similarities: only a minority of those elderly receiving assistance rely solely on formal care (i.e. care in an institution or through paid home care) while the majority of care is provided informally by family or other unpaid caregivers; without public support, the cost of long-term care would be beyond the financial means of a large fraction of the elderly in each country, particularly for the oldest and most disabled; and the public sector bears the majority of the costs of formal long-term care in every country. There are, however, important differences across countries, particularly in the extent to which formal care is delivered in institutions or at home, and in the division between the use of formal and informal care. Given the importance of informal care across all countries studied, we conclude that any estimate of the social costs of long-term care must account for the implicit costs of informal care. In undertaking such an evaluation of informal care, we find that it comprises at least one-third of all long-term care spending for all countries studied, with an average portion of nearly fifty percent. |
| JEL: | H4 I10 I13 I18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31882&r=hea |
| By: | Kevin S. Milligan; Tammy Schirle |
| Abstract: | This paper contributes a broad overview of the Canadian long-term care system. Taking an economist’s viewpoint, we bring together supply and demand factors to provide an economic analysis of the current and future path for long-term care. Like other OECD countries, the coming demographic wave of older baby boomers will put tremendous stress on the existing financial, organizational, and physical structures of the long-term care system. Unlike other OECD countries, Canada’s system is organized almost entirely at the subnational level, with provinces and territories having by far the largest role in financing and regulating long-term care. We provide institutional and empirical details on the evolution and future of Canada's long-term care system. |
| JEL: | H51 I13 I18 J18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31875&r=hea |
| By: | Bove, Vincenzo (University of Warwick); Di Salvatore, Jessica (University of Warwick); Elia, Leandro (Marche Polytechnic University); Nistico, Roberto (University of Naples Federico II) |
| Abstract: | A considerable body of empirical evidence indicates that conflict affects reproductive behaviour, often resulting in an increased fertility rate due to higher child mortality and limited access to healthcare services. However, we know much less about the effect of peace in a post-conflict setting. This study explores how the external provision of security affects fertility by focusing on the UN intervention in Liberia. Combining DHS birth history data with information on road distance to UN military compounds, we find that women living in the proximity of peacekeepers have lower fertility rates in the deployment period. This is due to parents prioritizing quality over quantity: peacekeepers improve maternal and child health and encourage family planning by enabling donors and humanitarian actors to deliver infrastructures and services and facilitating citizens' access to such services. We also provide evidence that UN mission revitalizes local economic activities, thus increasing the opportunity cost of childbearing. |
| Keywords: | conflict, fertility, maternal health, child health, UN operations |
| JEL: | J16 J24 D74 F50 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16569&r=hea |
| By: | Wu, Derek (University of Virginia); Zhang, Jonathan (McMaster University) |
| Abstract: | Recipients of government transfers are economically disadvantaged, yet little is known about how their circumstances evolve leading up to program receipt. Using twenty-five years of survey data as well as administrative health records, we establish three new stylized facts around enrollment in the largest safety net programs in the United States. While our focus is on SNAP, Medicaid, and Unemployment Insurance, the patterns generalize to nine major programs. First, market incomes decline around enrollment in almost all studied programs. Second, employment rates decline around program receipt and remain lower after receipt, with these patterns coinciding in part with increased disability and worse health. Third, spousal separations begin to increase prior to program enrollment, even for programs without mechanically related eligibility requirements. Taken together, these analyses provide a comprehensive and identically measured look across programs to demonstrate that households "slide" into safety net participation through multiple pathways. |
| Keywords: | social insurance, means-tested transfers, welfare, program receipt |
| JEL: | H53 I38 I18 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16564&r=hea |
| By: | Eric Sutherland; Rishub Keelara; Samuel Eiszele; June Haugrud |
| Abstract: | In response to the increase of cyberattacks in health care settings, the Health Committee of the OECD asked for a paper on Digital Security as part of the OECD ongoing work on health data governance. This working paper emphasizes that as the healthcare industry undergoes digital transformation it brings significant benefits while simultaneously escalating the vulnerability to cyber threats.This working paper summarises survey results based on the OECD framework for digital security risk management. The paper reveals varying levels of digital security alignment among countries, with Ireland and Korea exhibiting full alignment. Countries with specific strategies for digital security in health showed higher alignment to leading practices. The paper identifies key areas for improvement, including fostering a digital security culture through training, strengthening strategy and governance, and embedding risk assessment and treatment.The paper also emphasises the need for collaboration on innovative tools to detect and manage digital security threats, such as multi-factor authentication and encryption. These collaborative efforts are essential to safeguard the digital foundations of modern healthcare systems and ensure the security of health data and services. |
| Date: | 2023–11–24 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:164-en&r=hea |
| By: | Christian Glitzer; Nalini Prasad |
| Abstract: | Pandemic school closures were widespread but occurred together with COVID-19 health effects. Australia’s successful COVID-19 elimination policies provide a unique setting to study the effect of school closures on learning loss absent significant health effects. We exploit variation in the duration of school closures across Australian regions of 9-157 school days and student-level test score data from a national standardized test with high participation to estimate learning loss. Learning loss was substantially smaller than comparable estimates from the literature, including for disadvantaged socioeconomic groups. |
| Keywords: | student test scores, COVID-19, pandemic, NAPLAN, Australia |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:syd:wpaper:2023-09&r=hea |
| By: | Johnston, Lucy; Malcolm, Cari; Rambabu, Lekaashree; Hockley, Jo; Shenkin, Susan D. |
| Abstract: | The wellbeing of care home staff and the need to support them at work was highlighted with devastating clarity by the COVID pandemic. This small study explores what online and at work wellbeing resources were available to frontline care home workers during the first wave of the pandemic. A mixed methods study was undertaken May and July 2020. A multi-disciplinary team undertook a rapid review of online wellbeing information and resources relevant specifically to the care home sector and its non-nurse staff. Qualitative data comprised of digital recordings of semi-structured interviews with six care home managers of five care homes, and an online survey sent to 55 Scottish care homes with a response rate of 18%. Five overarching lessons were identified from the data. The first two (‘managing information overload’ and ‘medium not appropriate for the message’) relate to the awareness and use of the online wellbeing resources by frontline care workers. Three others (‘visible and supportive leadership’, ‘building team camaraderie’ and ‘maintaining a focus on wellbeing beyond a crisis response’) highlight the in-house, practice-based issues of supporting the wellbeing of staff. Although small, the findings from this study are of relevance and use by those in the UK and beyond working develop and sustain more effective ways to support and retain of this vital workforce. |
| Keywords: | wellbeing; care homes; care home staff; retention; support; Covid-19; coronavirus |
| JEL: | J50 |
| Date: | 2023–10–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:120709&r=hea |
| By: | Jan Bruha; Hana Bruhova Foltynova |
| Abstract: | The outbreak of the COVID-19 pandemic and the subsequent introduction of anti-pandemic measures led to a substantial drop in mobility, including travelling to work and shopping, and an increase in virtual activities, mainly working from home and online shopping. The question addressed in this paper is whether this change is permanent and, if so, to what extent. We use panel data collected in five waves from the Czech adult urban population during and shortly after the COVID-19 pandemic. The data document a substantial switch to online activities during the pandemic. This switch seems to be semi-permanent, i.e., expected to last even after the lifting of the anti-pandemic measures. The main determinants of working from home are job type, industry and education. The main determinants of online shopping are age and education. We conclude that the pandemic and the related measures accelerated the diffusion of online activities among the Czech population, mainly among younger and more educated individuals. |
| Keywords: | Coronavirus pandemic, online shopping, travel behavior, working from home |
| JEL: | O33 Q54 R41 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:cnb:wpaper:2023/9&r=hea |
| By: | Pissarides, Christopher; Garibaldi, Pietro; Moen, Espen R. |
| Abstract: | Several externalities arise when agents shield optimally to avoid infection during an epidemic. We classify externalities into static and dynamic and compare the decentralized and optimal solutions when agents derive utility from social interaction. For low infection costs agents shield too little; for high costs they shield too much because of a “rat race to shield”: they delay social action until other agents contract the disease and society reaches herd immunity. Other externalities drive more wedges between the private and social outcomes. The expectation of a fully effective vaccine that ends the disease faster changes results, reversing excessive shielding. |
| Keywords: | SIR models; matching model; COVID-19; social distancing; rat race; herd immunity; Springer deal |
| JEL: | A12 I10 J18 D61 D62 |
| Date: | 2023–11–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:120572&r=hea |