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on Health Economics |
| By: | Claudia Allende; Juan Pablo Atal; Rodrigo Carril; Jose Ignacio Cuesta; Andrés González Lira |
| Abstract: | This paper examines the determinants of public procurement prices using comprehensive data on pharmaceutical purchases by the Chilean public sector. We start by estimating the extent to which different public agencies pay different prices for the same product. These buyer effects are sizable, and the difference between average prices paid by buyers at the 10th and 90th percentiles is 16%. Our main set of results is related to the role of market structure. The variation in market structure explains three times more variation in procurement prices than buyer effects. Moreover, using exogenous variation from patent expirations, we estimate that the entry of an additional vendor decreases average procurement prices by 11.7%, which is 72% of the gap between average prices paid by buyers at the 10th and 90th percentiles of the distribution of buyer effects. These results suggest that supply-side factors are key determinants of public procurement prices and that their quantitative importance may exceed that of demand-side factors previously emphasized in the literature. |
| Keywords: | Procurement, Bureaucracy, competition, pharmaceutical drugs |
| JEL: | D44 D73 H57 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:upf:upfgen:1874&r=hea |
| By: | Haan, Peter (DIW Berlin); Wnuk, Izabela (DIW Berlin) |
| Abstract: | This paper examines the effect of increasing foreign staffing on the labor market outcomes of native workers in the German long-term care sector. Using administrative social security data covering the universe of long-term care workers and policy-induced exogenous variation, we find that increased foreign staffing reduces labor shortages but has diverging implications for the careers of native workers in the sector. While it causes a transition of those currently employed to jobs with better working conditions, higher wages, and non-manual tasks, it simultaneously diminishes re-employment prospects for the unemployed natives with LTC experience. |
| Keywords: | immigration, shift-share instrument, long-term care, EU enlargement |
| JEL: | J61 I11 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16749&r=hea |
| By: | David M. Cutler; J. Travis Donahoe |
| Abstract: | Opioid overdose death rates in the United States have risen continuously for over three decades, increasing 2, 142 percent in total from 1990 to 2020. This is surprising. One might expect drug epidemics to be self-limiting, as policy and individual behavior reacts to observed deaths. We study why opioid deaths have risen so greatly and for so long. We consider three reasons for a prolonged epidemic: exogenous and continuing changes in demand or supply, and spillovers in demand for opioids across users, which we term “thick market externalities.” We show there is no evidence of sufficiently large exogenous changes in the demand or supply of opioids that could explain such a prolonged increase in death rates. We test for spillovers using county-level data on opioid deaths from 1991–2018 and opioid shipments from 2006–2009, combined with data on friendships and distance between counties. Estimating a model with addiction and spatial spillovers, we find large spillovers in opioid use and deaths across areas. A shock that increases opioid death rates by 1 in an index county causes 0.38 to 0.76 more deaths in other counties because of spillovers. Because opioids are addictive, this leads to even more deaths and spillovers in future years. In some specifications, these effects are large enough to generate a continuously increasing epidemic without any ongoing changes in demand or supply. We estimate spillovers explain 84 to 92 percent of opioid deaths from 1990 to 2018 and are the main reason deaths have increased for so long. |
| JEL: | D62 I12 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32055&r=hea |
| By: | Homma, Kirara; Islam, Abu Hayat Md. Saiful; Matsuura, Masanori; Legesse Debela, Bethelhem |
| Abstract: | Despite substantial efforts to improve food and nutrient intake in the last decades, child undernutrition remains a daunting challenge, particularly in developing countries' rural areas. Today, frequent extreme weather events harm agricultural production, exacerbating the food shortage problem in these regions. Although off-farm labor is found to be an ex-ante strategy for mitigating weather shocks, little is known about how households' labor reallocation in response to weather shocks is associated with child nutritional status as an ex-post strategy. We investigate how different forms of labor activity mitigate the effect of rainfall shocks on children's nutritional status, using three waves of nationally representative panel data from rural households in Bangladesh, in conjunction with historical monthly precipitation and temperature data. Our findings show that less rainfall during the main cropping season in the year before the survey is associated with a lower weight for age z-score (WAZ score) of children under the age of five years. The findings indicate that there are heterogeneous mitigating impacts of different types of labor allocation affecting the link between rainfall shocks and child health. While maternal labor allocation plays a role as a mitigation factor, household-level labor time and other household members' labor time are not significantly associated with the link between rainfall shocks and child nutritional status. Findings also show that maternal off-farm self-employment mitigates the negative impact of rainfall shortage, whereas maternal on-farm labor exacerbates the rainfall shock impact. Our results therefore underscore the importance of providing sufficient off-farm employment opportunities for mothers and addressing maternal time constraints through targeted policies to cope with rainfall shocks and improve child nutrition. |
| Keywords: | Child nutrition, Labor allocation, Weather shock, Fixed effect model, Bangladesh |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:daredp:281992&r=hea |
| By: | Shishir Shakya; Tulasiram Nepal; Edward Timmons |
| Abstract: | The Maintenance of Certification (MOC) program of the American Board of Medical Specialties (ABMS) requires physicians to pass the MOC exam every ten years to maintain board certification. Proponents argue that MOC enhances patient care and physician competencies. Critics perceive it as an expensive, burdensome, and time-consuming recertification process that may lead to the departure of elderly physicians from the workforce. Notably, some states are adopting Anti-MOC laws. Our analysis, employing a generalized difference-in-difference method and event-study frameworks, demonstrates a statistically significant 3.5-6% increase in actively practicing physicians aged 60 and above in states implementing Anti-MOC laws, with no impact on physicians aged below 60. Our findings have implications for healthcare, offering the potential to improve access to quality care and tackle physician shortages in the United States. Key Words: Scope of Practice, anti-Maintenance of certification, physicians |
| JEL: | J01 J08 J21 J44 J7 K30 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:apl:wpaper:24-02&r=hea |
| By: | Bardey, David (Universidad de los Andes); De Donder , Philippe (TSE - CNRS); Zaporozhets , Vera (TSE - INRAe) |
| Abstract: | This survey deals with the economic academic literature on diagnostic tests, with a focus first on the determinants of the use of these tests by healthcare providers, and then on the incentives to develop new diagnostic tests. It is structured in four parts. The first part provides general results in this literature regarding how healthcare providers (mostly, physicians) react to the (explicit or implicit) incentives embedded in existing health institutions, and especially to payment schemes and reimbursement rules. The second part deals more specifically with the incentives to use diagnostic tests including, among them, biomarker tests. Both sections follow a positive approach, describing individual reactions to various incentives. The third section rather takes a normative approach and tries to ascertain which incentives should be given to providers to better use existing diagnostic tests. Finally, the fourth section studies the development of new diagnostic tests, both from the viewpoint of the health authorities (when should they be developed?) and of the industry (how to incentivize them to develop the right kind of test?). |
| Keywords: | Diagnostic tests; Healthcare systems; Incentives. |
| JEL: | D86 H51 I11 |
| Date: | 2024–02–12 |
| URL: | http://d.repec.org/n?u=RePEc:col:000089:021024&r=hea |
| By: | Neha Agarwal (University of Otago); Anaka Aiyar (University of Vermont); Andrew Bergmann (The Ohio State University); Joseph Cummins (Department of Economics, University of California Riverside); Jingyan Guo (University of California, Riverside); Vaishali Jain (University of California, Riverside) |
| Abstract: | Using the fourth round of the Indian National Family Health Survey (NFHS- 4), and subsequently replicating our results using the fifth round (NFHS-5), we document differential child physical growth patterns across caste groups in India, demonstrating that lower caste children are born shorter and grow less quickly than children from higher-caste households. We then show that, in line with work from previous rounds of the NFHS, these differences are largely explainable by observable covariates, particularly maternal characteristics and household wealth variables. Our research also reveals a previously undocumented dynamic, that the influence of these variables changes as children develop, and suggests that caste- gaps are the result of multiple mechanisms impacting the child growth process at different stages of development. Using age-disaggregated decomposition methods, we demonstrate that health endowment related variables (e.g. maternal height) largely explain birth length gaps, and that variables related to health investments (e.g. household wealth, health care usage) become increasingly influential as children age. Children from lower caste households thus face two margins generating height gaps as they age: a persistent endowment disparity present from birth, and a post birth investment differential that exacerbates the initial deficit. |
| Keywords: | Height for Age Z scores, Child Health, Health Disparities, India, Caste, National Family Health Surveys |
| JEL: | I14 I15 O10 O15 O53 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:ucr:wpaper:202401&r=hea |
| By: | Raouf Boucekkine (Centre for Unframed Thinking (CUT), Rennes School of Business (France), and Corresponding Member, IRES-UCLouvain); Shankha Chakraborty (Department of Economics, University of Oregon); Aditya Goenka (Department of Economics, University of Birmingham); Lin Liu (Corresponding author, Management School, University of Liverpool) |
| Abstract: | Prior to the Covid-19 crisis, the integration of epidemiology and economics that is, economic epidemiology modelling (epi-econ) in literature was relatively limited. The first fully integrated general equilibrium model, (Goenka et al., 2014) was published in the Journal of Mathematical Economics (JME). The emergence of the Covid-19 crisis has prompted an unprecedented surge in the epi-econ literature. The JME has actively contributed to this area by publishing a special issue on epi-econ modelling (Volume 93) and publishing papers within this area. This survey primarily explores these JME papers along these lines: macroeconomics and policy, microeconomics and economic behavior, and mathematical advances. The survey looks ahead to some emerging areas in this literature. |
| Keywords: | Economic epidemiology, Covid-19, pandemics, infectious diseases, NPI, optimal control, lockdowns |
| JEL: | E13 E22 D15 D50 D63 I10 I15 I18 O41 C61 |
| Date: | 2024–02–04 |
| URL: | http://d.repec.org/n?u=RePEc:ctl:louvir:2024002&r=hea |
| By: | Esposito, Piero (University of Cassino and Southern Lazio); Mendolia, Silvia (University of Torino); Scicchitano, Sergio (John Cabot University); Tealdi, Cristina (Heriot-Watt University, Edinburgh) |
| Abstract: | In this paper we investigate the effect of working-from home (WFH) on job satisfaction. We use longitudinal data from Italy to estimate a difference-in-differences model, in which the treatment group includes individuals who transitioned to remote work in 2020 due to the COVID-19 pandemic and continued to work from home in 2021. We perform the analysis, which extends to various aspects of self-reported job satisfaction, by gender and personality traits as per the Big-Five framework, encompassing Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. Our findings reveal that WFH exhibits a positive influence on job satisfaction, albeit exclusively among women, and with some heterogeneity, depending on personal characteristics. Specifically, this effect seems more noticeable in women characterized by elevated Openness to Experience, whereas those with heightened conscientiousness or neuroticism levels tend to experience less satisfaction when working remotely. |
| Keywords: | remote working, difference in differences, longitudinal analysis, gender differences, Big-Five framework |
| JEL: | J28 J81 J16 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16751&r=hea |
| By: | Barrero, Jose Maria; Bloom, Nicholas; Davis, Steven J. |
| Abstract: | Many working-age Americans say they will continue some forms of social distancing after the COVID-19 pandemic ends. We uncover this long social distancing phenomenon in our monthly Survey of Working Arrangements and Attitudes. It is stronger among older persons, the less educated, and those who live with or care for persons at high risk from infectious diseases. Regression models fit to individual-level data suggest that social distancing lowered labor force participation by 2.4 percentage points in 2022, 1.2 points on an earnings-weighted basis. Daily interactions with at-risk persons and long COVID experiences lead to larger drags on participation. When combined with simple equilibrium models, our results imply that the social-distancing drag on participation reduced U.S. output by $205 billion in 2022, shrank the college wage premium by 2.1 percentage points, and modestly steepened the cross-sectional age-wage profile. Our data also say that social distancing intentions overlap with, but are broader than, infection worries. Drawing on self-assessed causal effects in a separate analysis, we estimate that infection worries lowered participation by one percentage point as of late 2022. |
| Keywords: | Covid-19; social distancing; working from home; productivity; coronavirus |
| JEL: | J00 |
| Date: | 2023–04–26 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:121379&r=hea |
| By: | Daniel Graeber; Lorenz Meister; Panu Poutvaara |
| Abstract: | In times of crises, democracies face the challenge of balancing effective interventions with civil liberties. This study examines German states’ response during the early stages of the COVID-19 pandemic, focusing on the interplay between civil liberties and public health goals. Using state-level variation in mobility restrictions, we employ a difference-in-differences design to show that stay-at-home orders notably increased satisfaction with democracy and shifted political support towards centrist parties. Stay-at-home orders increased satisfaction with democracy most among individuals who had been exposed to the authoritarian regime of the German Democratic Republic. A potential explanation is that these individuals had got used to more restrictive state interventions. Moreover, we find suggestive evidence that satisfaction with democracy increases more among individuals who are obese or have low vitality, possibly because their benefit from the mobility restrictions is higher. However, these differences are not statistically significant. |
| Keywords: | perceptions of public policies, satisfaction with democracy, Covid-19 |
| JEL: | D72 H12 I12 I18 P26 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10875&r=hea |
| By: | Rachel Glennerster; Thomas Kelly; Claire T. McMahon; Christopher M. Snyder |
| Abstract: | A booster of the COVID-19 vaccine targeting the prevailing Omicron variant did not become available in the United States until a year after the variant was first detected. This pattern of developing, testing, and distributing a variant-specific booster may become the default response to further waves of COVID-19 caused by new variants. An innovation with realistic scientific potential—a universal COVID-19 vaccine, effective against existing and future variants—could provide much more value by preempting new variants. Averaged across Monte Carlo simulations, we estimate the incremental value to the U.S. population of a universal COVID-19 vaccine to be $1.5–$2.6 trillion greater than variant-specific boosters (depending on how the arrival rate of variants is modeled). This social value eclipses the cost of an advance market commitment to incentivize the universal vaccine by several orders of magnitude. |
| JEL: | H51 I18 L65 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32059&r=hea |
| By: | Jose Aurelio Medina-Garrido; Jose Maria Biedma-Ferrer; Jaime Sanchez-Ortiz |
| Abstract: | Among the main causes of absenteeism are health problems, emotional problems, and inadequate work-family policies (WFP). This paper analyses the impact of the existence and accessibility of WFP on work absenteeism, by considering the mediating role of the well-being, which includes emotional as well as physical or health problems, that is generated by these policies. We differentiate between the existence of the WFP and its accessibility, as the mere existence of the WFP in an organisation is not enough. Additionally, workers must be able to access these policies easily and without retaliation of any kind. The model includes the hierarchy and the gender as moderating variables. To test the proposed hypotheses, a structural equation model based on the partial least squares structural equation modelling (PLS-SEM) approach is applied to a sample of employees in the service sector in Spain. On the one hand, the findings show that the existence of WFP has no direct effect on absenteeism; however, accessibility to these policies does have a direct effect on absenteeism. On the other hand, both the existence and accessibility of WFP have positive direct effects on emotional well-being. In addition, emotional well-being is positively related to physical well-being which, in turn, promotes a reduction in absenteeism. Finally, significant differences in the relationship between the existence of WFP and emotional well-being confirm the special difficulty of female managers in reconciling family life and work life. |
| Date: | 2023–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2401.13678&r=hea |
| By: | Gökçe Manavgat (Toros university); Martine Audibert (CERDI - Centre d'Études et de Recherches sur le Développement International - UCA [2017-2020] - Université Clermont Auvergne [2017-2020] - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | The Covid-19 pandemic has raised concerns about the resilience of health systems. The aim of this study is twofold: i) to measure and compare the resilience of health system efficiency of OECD countries before and during Covid-19 and ii) to determine the healthcare efficiency drivers (e.g., socioeconomic) of health system performance. Using a dataset of 31 OECD countries for 2018 and 2020, we first estimate bias-adjusted efficiency scores, followed by a double bootstrap truncated regression procedure to study the drivers associated with health system efficiency. We find that the health system efficiency overall score decreased among OECD countries during the Covid-19 pandemic compared to before Covid-19. Estonia and Japan retained their full efficiency scoreduring Covid-19. We find a negative association between health system efficiency and unemployment rate, share of health expenditure in GDP, and share of population over 65. Conversely, high vaccination rates contribute positively to health system efficiency during the Covid-19 period. |
| Keywords: | Health system efficiency, Covid-19, DEA Bias-adjusted efficiency scores, Double bootstrap truncated regression |
| Date: | 2024–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04350906&r=hea |