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on Health Economics |
| By: | Cremer, Helmuth; Lozachmeur, Jean-Marie |
| Abstract: | We study the design of nonlinear reimbursement rules for expenses on secondary pre- ventive and on therapeutic care. With some probability individuals are healthy and do not need any therapeutic health care. Otherwise they become ill and their health status (the severity of their disease) is realized and identifies their ex post type. Preventive care is determined ex ante, that is before the health status is determined while curative care is chosen ex post. Insurance benefits depend on preventive and curative care in a possibly nonlinear way, and marginal benefits can be positive or negative. In the first best, achieved when health status is ex post publicly observable, insurance benefits are fiat (lump sum payments) and do not depend on expenditures. When the severity of the disease is not observable, so that there is ex post moral hazard, this solution is not incentive compatible (for more healthy individuals). The optimal insurance then implies benefits that increase with both types of care. This is because health expenditures reduce informational rents and they are upward distorted. This relaxes the incentive constraint because less healthy individuals value care more than healthy individuals. Even though preventive care is chosen ex ante, when there is no asymmetry of in- formation, it does have an impact on the incentive constraint and thus on informational rents. This is due to two concurring effects. First, prevention is more effective for the more severely ill. Second, these individuals also have a lower marginal utility of income so that a given level of expenditure on preventive care has less impact on their utility. |
| Keywords: | ex post moral hazard; health insurance; secondary prevention |
| JEL: | I11 I13 I18 |
| Date: | 2024–04–26 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:129305&r=hea |
| By: | Lozachmeur, Jean-Marie; Borsenberger, Claire; Cremer, Helmuth; Joram, Denis; Malavolti, Estelle |
| Abstract: | We study the design of optimal (private and/or social) insurance schemes for formal home care and institutional care. We consider a three period model. Individuals are either in good health, lightly dependent or heavily dependent. Lightly dependent individuals can buy formal home care which reduces the severity of dependency and reduces the probability to become severely dependent in the next period. Severely dependent individuals pay for nursing home care. In both states of dependency individuals can receive a (private or public) insurance benefit (transfers). These benefits can be flat or depend on the formal care consumed (or a combination of the two). These benefits are financed by a premium (or a tax). Individuals may be alive until the end of period 2 or die at the beginning of periods 1 or 2 with a certain probability which may depend on their state of health. The laissez faire is inefficient because individuals consume a too low level of formal home care and are not insured. The first-best insurances scheme requires a transfer to lightly dependent individuals that, (under some conditions) increases with the amount of formal home care consumed. Severely dependent individuals, on the other hand, must receive a flat transfer (from private or social insurance). The theoretical analysis is illustrated by a calibrated numerical example which show that the expressions have the expected signs under plausible conditions. |
| Keywords: | Long-term care insurance; formal home care; nursing home; care |
| JEL: | I13 I18 H51 |
| Date: | 2024–04–29 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:129309&r=hea |
| By: | Bruce D. Meyer; Angela Wyse; Gillian Meyer; Alexa Grunwaldt; Derek Wu |
| Abstract: | Homelessness is arguably the most extreme hardship associated with poverty in the United States, yet people experiencing homelessness are excluded from official poverty statistics and much of the extreme poverty literature. This paper provides the most detailed and accurate portrait to date of the level and persistence of material disadvantage faced by this population, including the first national estimates of income, employment, and safety net participation based on administrative data. Starting from the first large and nationally representative sample of adults recorded as sheltered and unsheltered homeless taken from the 2010 Census, we link restricted-use longitudinal tax records and administrative data on the Supplemental Nutrition Assistance Program (SNAP), Medicare, Medicaid, Disability Insurance (DI), Supplemental Security Income (SSI), veterans’ benefits, housing assistance, and mortality. Nearly half of these adults had formal employment in the year they were observed as homeless, and nearly all either worked or were reached by at least one safety net program. Nevertheless, their incomes remained low for the decade surrounding an observed period of homelessness, suggesting that homelessness tends to arise in the context of long-term, severe deprivation rather than large and sudden losses of income. People appear to experience homelessness because they are very poor despite being connected to the labor market and safety net, with low permanent incomes leaving them vulnerable to the loss of housing when met with even modest disruptions to life circumstances. |
| JEL: | H0 I00 J0 R0 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32323&r=hea |
| By: | Jacob H. Bor; David M. Cutler; Edward L. Glaeser; Ljubica Ristovska |
| Abstract: | Equally educated people are healthier if they live in more educated places. Every 10 percent point increase in an area’s share of adults with a college degree is associated with a decline in all-cause mortality by 7%, controlling for individual education, demographics, and area characteristics. Area human capital is also associated with lower disease prevalence and improvements in self-reported health. The association between area education and health increased greatly between 1990 and 2010. Spatial sorting does not drive these externalities; there is little evidence that sicker people move disproportionately into less educated areas. Differences in health-related amenities, ranging from hospital quality to pollution, explain no more than 17% of the area human capital spillovers on health. Over half of the correlation between area human capital and health is a result of the correlation between area human capital and smoking and obesity. More educated areas have stricter regulations regarding smoking and more negative beliefs about smoking. These have translated over time into a population that smokes noticeably less and that is less obese, leading to increasing divergence in health outcomes by area education. |
| JEL: | I12 I18 I24 I26 R10 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32346&r=hea |
| By: | Kim, Seonghoon (Singapore Management University); Koh, Kanghyock (Korea University); Lyou, Wonjun (Ohio State University) |
| Abstract: | We examine the effects of patient cost-sharing on adolescents' healthcare utilization and out-of-pocket medical expenditures by exploiting the healthcare reform in South Korea that lowered the coinsurance rate for inpatient care from 20% to 5% for children under 16. We apply a difference-in-regression-discontinuities design using administrative claims data. We find that the reform increased adolescents' inpatient care utilization. It also reduced out-of-pocket healthcare expenditures. This effect was larger among low-income households, facilitating income redistribution. However, the lack of evidence on health improvements and household consumption spending responses suggests that generous patient cost-sharing for adolescent healthcare may cause efficiency losses. |
| Keywords: | patient cost-sharing, healthcare utilization, out-of-pocket expenditure, income redistribution, consumption spending, difference in regression discontinuities design |
| JEL: | I12 I13 I18 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16897&r=hea |
| By: | Foltyn, Richard; Olsson, Jonna |
| Abstract: | This paper examines how objective and subjective heterogeneity in life expectancy affects savings behavior of healthy and unhealthy people. Using data from the Health and Retirement Study, we first document systematic biases in survival beliefs across self-reported health: those in poor health not only have a shorter actual lifespan but also underestimate their remaining life time. To gauge the effect on savings behavior and wealth accumulation, we use an overlapping-generations model where survival probabilities and beliefs evolve according to a health and survival process estimated from data. We conclude that differences in life expectancy are important to understand savings behavior, and that the belief biases, especially among the unhealthy, can explain up to a fifth of the observed health-wealth gap. |
| Keywords: | life expectancy, preference heterogeneity, subjective beliefs, life cycle |
| JEL: | D15 E21 G41 I14 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:esprep:294009&r=hea |
| By: | Emmanuelle Auriol (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Alice Mesnard (University of London [London]); Tiffanie Perrault (McGill University = Université McGill [Montréal, Canada]) |
| Abstract: | We model consumer choices for recreational cannabis in a risky environment and its supply under prohibition and legalization. While legalization reduces the profits of illegal providers, it increases cannabis consumption. This trade-off can be overcome by combining legalization with sanctions against the black market, and improvements to the quality of legal products. Numerical calibrations highlight how a policy mix can control the increase in cannabis consumption and throttle the illegal market. In the US, the eviction prices we predict to drive dealers out of business are much lower than the prices of legal cannabis in most of the states that opted for legalization, leaving room for the black market to flourish. Analyzing the compatibility of several policy goals sheds light on the less favorable outcomes of recent legalization reforms and suggests a new way forward. |
| Keywords: | recreational cannabis, legalization, crime, policy, regulation |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04234940&r=hea |
| By: | SATO Kaori; KURODA Sachiko; OWAN Hideo |
| Abstract: | Although theoretical models of job stress have suggested that various worker characteristics and workplace conditions may moderate the effects of occupational burdens on workers' health, few studies have investigated the impact of working hours on mental health while considering individual and workplace characteristics. In this paper, we explore the impact of personality traits on the relationship between job burdens associated with long working hours and workers' mental health and evaluate these impacts over several measurement periods. Our findings are as follows. First, long working hours have more negative effects over long periods of time than over short periods. Second, people who are less extroverted and less open are more susceptible to the mental health effects associated with long overtime hours. These results suggest that company HR personnel and managers should consider the needs of employees who are less extroverted and less open, particularly if they consistently have long working hours. |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:24048&r=hea |
| By: | Lee, Cheuk Ling; Chong, Terence Tai Leung |
| Abstract: | This paper aims to study the effect of distance to abortion facilities on the birth rate, abortion ratio and pregnancy rate in the United States. It will further extend the effect of the change in birth statistics on child living conditions, measured by adjusted family income and the percentage of children living below the poverty line in a state. It will correspond to the amendment of the abortion law in the United States in 2022. Our results suggest that an increase in the distance to abortion facilities will reduce the birth rate, abortion ratio and pregnancy rate. However, for the living circumstances, the significant positive effect was shown only in the black children group and the general groupn when the distance increased. In the non-black children group, the effects were only marginally significant or not significant on their living conditions. The results may also imply different reasons for abortions among different races. |
| Keywords: | abortion; distance; US |
| JEL: | I14 I18 J13 K36 |
| Date: | 2024–04–06 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120640&r=hea |
| By: | Sultan Mehmood (NSE - New Economic School of Moscow, AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Avner Seror (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Daniel Chen (Computer Science Department [Stanford] - Stanford University, CFE - CNRS-formation Entreprise - CNRS - Centre National de la Recherche Scientifique, TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, IAST - Institute for Advanced Study in Toulouse) |
| Abstract: | Using data on roughly half a million cases and 10, 000 judges from Pakistan and India, Mehmood et al. estimate the impact of the Ramadan fasting ritual on criminal sentencing decisions. They find that fasting increases judicial leniency and reduces reversals of decisions in higher courts. We estimate the impact of the Ramadan fasting ritual on criminal sentencing decisions in Pakistan and India from half a century of daily data. We use random case assignment and exogenous variation in fasting intensity during Ramadan due to the rotating Islamic calendar and the geographical latitude of the district courts to document the large effects of Ramadan fasting on decision-making. Our sample comprises roughly a half million cases and 10, 000 judges from Pakistan and India. Ritual intensity increases Muslim judges' acquittal rates, lowers their appeal and reversal rates, and does not come at the cost of increased recidivism or heightened outgroup bias. Overall, our results indicate that the Ramadan fasting ritual followed by a billion Muslims worldwide induces more lenient decisions. |
| Keywords: | religious rituals, Ramadan, decision-making, religious rituals Ramadan decision-making |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04371833&r=hea |
| By: | Lisa Capretti (CEIS, University of Rome "Tor Vergata"); Joanna A. Kopinska (University of Rome La Sapienza); Rama Dasi Mariani (University of Roma Tre); Furio Camillo Rosati (CEIS & DEF, University of Rome "Tor Vergata") |
| Abstract: | This paper investigates the impact of migrant-provided home-based care on elderly health in Italy, analysing hospitalisation frequency, duration, and mortality. Using an instrumental variable approach to mitigate endogeneity between local health status and migratory flows, we show that migrant-provided home-based care reduces the frequency of hospital admissions (extensive margin) and their duration (intensive margin). Regarding the former, a one percentage point increase in the immigrant-to-elderly population ratio leads to a 4% decrease in long-term and rehabilitation (LR) stays, with no effect on acute stays. Concerning the latter, we find that a similar change in the migrant inflows translates to a 1.5% reduction in admission duration, with LR admissions reaching a 3.3% decline. These effects primarily stem from traumatic injuries, musculoskeletal disease, and genitourinary disorders, particularly linked to home-based mobility and treatment management. Our back-of-the-envelope calculations suggests that a 1.3 percentage point increase in the migrant-to-elderly population ratio registered in our analysis period could potentially reduce LR elderly hospitalisation costs by approximately 8% and yield annual public budget savings equivalent to around 0.59% of total hospitalisation expenditures |
| Date: | 2024–04–19 |
| URL: | http://d.repec.org/n?u=RePEc:rtv:ceisrp:573&r=hea |
| By: | Mora, Claudio; Prem, Mounu; Rodriguez-Lesmes, Paul; Vargas, Juan F. |
| Abstract: | Healthcare workers are in great deficit worldwide, especially in rural and vulnerable areas of developing countries. By leveraging a permanent ceasefire that ended over five decades of armed conflict between the Colombian government and the FARC insurgency, we study the extent to which conflict termination affected the health workforce gap between areas more exposed to FARC violence and other places. Based on individual-level administrative records of all healthcare workers in Colombia and a difference-in-differences strategy, we find that the ceasefire caused a differential 11.4% decrease in the share of employed healthcare workers per 1, 000 people in places more exposed to FARC violence relative to the rest of the country. We find a stronger decrease among healthcare workers with less human capital levels and open-ended labor contracts. We show that this effect is likely explained by lifting mobility restrictions in previously violent areas, and document that, because the net reduction in healthcare workers increased the within-municipality share of (more productive) physicians, it did not translate into a deterioration of mortality rates or healthcare service provision. |
| Date: | 2024–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:2dwfu&r=hea |
| By: | Boaz Abramson; Job Boerma; Aleh Tsyvinski |
| Abstract: | We develop an economic theory of mental health. The theory is grounded in classic and modern psychiatric literature, is disciplined with micro data, and is formalized in a life-cycle heterogeneous agent framework. In our model, individuals experiencing mental illness have pessimistic expectations and lose time due to rumination. As a result, they work less, consume less, invest less in risky assets, and forego treatment which in turn reinforces mental illness. We quantify the societal burden of mental illness and evaluate the efficacy of prominent policy proposals. We show that expanding the availability of treatment services and improving treatment of mental illness in late adolescence substantially improve mental health and welfare. |
| JEL: | E0 H0 I10 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32354&r=hea |
| By: | David G. Blanchflower; Alex Bryson; Xiaowei Xu |
| Abstract: | Across many studies subjective well-being follows a U-shape in age, declining until people reach middle-age, only to rebound subsequently. Ill-being follows a mirror-imaged hump-shape. But this empirical regularity has been replaced by a monotonic decrease in illbeing by age. The reason for the change is the deterioration in young people’s mental health both absolutely and relative to older people. We reconsider evidence for this fundamental change in the link between illbeing and age with micro data for the United States and the United Kingdom. Beginning around 2011 there is a monotonic and declining cross-sectional association between well-being and age. In the UK the recent COVID pandemic exacerbated the trends by impacting most heavily on the wellbeing of the young, but this was not the case in the United States. We replicate the decrease in illbeing by age across 34 countries, including the United States and the United Kingdom, using five ill-being metrics for the period 2020-2024 and confirm the findings. |
| JEL: | I31 I38 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32337&r=hea |
| By: | Stanislao Maldonado; Deborah Martinez; Lina Diaz |
| Abstract: | We present the results of a large-scale field experiment designed to measure the effect of social norms on parents' decisions to vaccinate their daughters against the human papillomavirus (HPV) in Bogota, Colombia. Because low rates of HPV vaccine adoption are an issue in developed and underdeveloped countries alike, the use of standard social norm marketing strategies to foster vaccination can have the undesirable effect of reinforcing the status quo. In our experiment, parents were exposed to text messages that incorporated variations of static and dynamic social norms. We demonstrate that dynamic social norms and injunctive norms increased the vaccination rate by 23%. Interestingly, we also find that a version of static social norms that uses a loss frame is also effective in fostering vaccination, implying that policy-makers can also benefit from them. Against a common view among academics and practitioners, we found no evidence that static norms reinforce the status quo. Our results highlight the importance of crafting social norms interventions using dynamic and injunctive elements to foster vaccination in settings where the majority has not yet adopted the desired behavior. |
| Keywords: | Social norms, vaccines, human papillomavirus, field experiments |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:apc:wpaper:202&r=hea |
| By: | Kunz, Johannes (Monash University); Propper , Carol (Imperial College London); Trinh, Trong-Anh (Monash University) |
| Abstract: | The coronavirus disease (COVID-19) pandemic has highlighted the crucial role of Internet access in pandemic prevention and response. Internet access has facilitated the rapid dissemination of vital information, provided telemedicine services, and enabled remote work and education. This study uses a wide range of data sources to investigate the geographic variation of Internet access proxied by 3G mobile broadband during the COVID-19 pandemic in Indonesia. We employ several approaches to account for potential confounding factors, including using lightning strikes as an instrumental variable, to confirm the significant role that the Internet played in the spread of COVID-19 cases. Our findings suggest that increasing Internet access could positively impact pandemic prevention and response efforts, particularly in regions with limited connectivity. Therefore, improving Internet infrastructure in developing countries may be crucial in preventing future pandemics. |
| Keywords: | health emergencies; Internet access; information; COVID-19 spread |
| JEL: | H41 I12 I15 I31 L96 O18 |
| Date: | 2024–04–26 |
| URL: | http://d.repec.org/n?u=RePEc:ris:adbewp:0723&r=hea |
| By: | Davide Bosco (University of Milan-Bicocca and Center for European Studies); Luca Portoghese (University of Pavia) |
| Abstract: | This paper studies how private information about health states affects social distancing behaviour in epidemics. We propose a social-interaction game where agents are rational and demographically heterogeneous, and the risk of death post-infection depends on demography. Self-tests and public screening campaigns jointly determine the available information. We find that private information determines how the spatial characteristics of the social environment affect agents’ strategic interplay: if private information is not available, social distancing decisions are strategic substitutes in any environment; if private information is available, complementarity arises in congestionable environments, and substitutability prevails otherwise. Policy implications ensue: if self-tests that detect illness are freely available, mass screening campaigns with tests that detect recoveries are beneficial in congestionable environments, but increase the death toll in the absence of congestion. |
| Keywords: | COVID-19, Contagion, Social distancing, Collective action, Strategic complements and substitutes |
| JEL: | C72 D71 H41 I13 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:pav:demwpp:demwp0218&r=hea |