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on Health Economics |
| By: | Jonathan Gruber; Mengyun M. Lin; Haoming Liu; Junjian Yi |
| Abstract: | A marked feature of health insurance plan choice is inconsistent choices through the overweighting of premiums relative to out-of-pocket spending. We show that this source of inconsistency disappears when both types of spending come from the same source of designated funds. We focus on the MediSave program in Singapore, whereby residents can pay their health insurance premiums with cash or MediSave funds, but are subject to limits that vary by age and over time. By exploiting variations in those limits, we consistently find that when individuals are able to pay their health insurance premiums with MediSave funds, they are less price sensitive and more willing to enroll in more generous plans—which results in lower spending levels and variance, and lower adverse selection in the market. The results suggest a strong role for mental accounting in insurance decisions. |
| JEL: | I13 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32331&r=hea |
| By: | Raymond Kluender; Neale Mahoney; Francis Wong; Wesley Yin |
| Abstract: | Two in five Americans have medical debt, nearly half of whom owe at least $2, 500. Concerned by this burden, governments and private donors have undertaken large, high-profile efforts to relieve medical debt. We partnered with RIP Medical Debt to conduct two randomized experiments that relieved medical debt with a face value of $169 million for 83, 401 people between 2018 and 2020. We track outcomes using credit reports, collections account data, and a multimodal survey. There are three sets of results. First, we find no impact of debt relief on credit access, utilization, and financial distress on average. Second, we estimate that debt relief causes a moderate but statistically significant reduction in payment of existing medical bills. Third, we find no effect of medical debt relief on mental health on average, with detrimental effects for some groups in pre-registered heterogeneity analysis. |
| Keywords: | debt relief, medical debt, health care, mental health, access to credit |
| JEL: | G51 I10 I18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11074&r=hea |
| By: | Colleen Carey; Michael Daly; Jing Li |
| Abstract: | Physicians commonly receive marketing-related transfers from drug firms. We examine the impact of these relationships on the prescribing of physician-administered cancer drugs in Medicare. We find that prescribing of the associated drug increases 4\% in the twelve months after a payment is received, with the increase beginning sharply in the month of payment and fading out within a year. A marketing payment also leads physicians to begin treating cancer patients with lower expected mortality. While payments result in greater expenditure on cancer drugs, there are no associated improvements in patient mortality. |
| JEL: | I11 L15 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32336&r=hea |
| By: | Sofia Amaral-Garcia; Mattia Nardotto; Carol Propper; Tommaso Valletti; Tommaso M. Valletti |
| Abstract: | We examine the effect of internet diffusion on the uptake of an important public health intervention: the measles, mumps and rubella (MMR) vaccine. We study England between 2000 and 2011 when internet diffusion spread rapidly and there was a high profile medical article (falsely) linking the MMR vaccine to autism. OLS estimates suggest internet diffusion led to an increase in vaccination rates. This result is reversed after allowing for endogeneity of internet access. The effect of internet diffusion is sizable. A one standard deviation increase in internet penetration led to around a 20% decrease in vaccination rates. Localities characterised by higher proportions of high skilled individuals and lower deprivation levels had a larger response to internet diffusion. These findings are consistent with higher skilled and less deprived parents responding faster to false information that the vaccine could lead to autism. |
| Keywords: | vaccines, vaccine hesitancy, internet |
| JEL: | D80 I12 L82 L86 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11065&r=hea |
| By: | Perry Singleton (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244) |
| Abstract: | In a model of occupational safety, biased perceptions of risk decrease welfare, which may justify government regulation. Bias is examined empirically by the correlation between subjective and objective risk, the former measured by self-reported exposure to death on the job. The correlation is negligible among workers with no high school diploma, consistent with underestimating risk in more dangerous occupations, and strongest among more educated workers when objective risk is specific to harmful and noxious substances, which in psychological studies rank high in dread. Biased perceptions of risk may also lead to biased estimates of value of statistical life. VSL estimates are negligible across all education levels using the all cause fatality rate, but consistently greater among more educated workers using the fatality rate due to harmful and noxious substances, upwards of $70 million and more. Optimal policy is considered, including an illustrative simulation of a risk ceiling. |
| Keywords: | Compensating wage differentials, value of statistical life, occupational safety, risk perception |
| JEL: | J31 J81 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:max:cprwps:263&r=hea |
| By: | Costa-Font, Joan; D'Amico, Francesco; Vilaplana-Prieto, Cristina |
| Abstract: | We study the effect of long-term care subsidies and supports on the well-being of unpaid caregivers. We draw on evidence from a policy intervention, which universalized previously means-tested caregiving supports in Scotland, known as free personal care (FPC). We document causal evidence of an increase in the well-being (happiness) of unpaid carers after the introduction of FPC. Our estimates suggest economically relevant improvements in happiness (12 percentage point increase in subjective well-being) among caregivers exposed to FPC and who provide at least 35 hours of care per week. Consistently, these results are larger among women and non-actively employed caregivers (17 percentage point increase in happiness). Estimates are not driven by selection into caregiving; they are explained by income effects of FPC among caregivers. |
| Keywords: | caregiving; long-term care subsidies; Scotland; caregiver’s well-being; subjective well-being |
| JEL: | I18 J22 |
| Date: | 2023–10–23 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:116940&r=hea |
| By: | Ha Trong Nguyen; Le, Huong Thu; Blyth, Christopher; Connelly, Luke; Mitrou, Francis |
| Abstract: | The examination of the causal impact of health insurance coverage on healthcare utilisation is a critical endeavour in both academic research and policy formulation. However, this endeavour faces challenges, notably the endogenous selection into coverage and prevalent misreporting of coverage status. This study pioneers an investigation into the effects of private health insurance (PHI) coverage on healthcare utilisation, considering the intricacies of misreporting and endogeneity. To address misreporting, we analyse linked survey and administrative data with a precise coverage indicator. For endogeneity, we employ four established methodologies, including an instrumental variable approach leveraging an age-based policy discontinuity to construct an instrument. Our findings unveil that individuals with PHI coverage tend to access healthcare services more frequently, particularly primary care visits and specialist consultations. Nonetheless, the magnitude and statistical significance of these effects exhibit variability across different healthcare services and methodological approaches. Additionally, we discern notable disparities in the magnitude of PHI estimates between survey-based and administrative PHI indicators, with varying discrepancies across services and methodologies. Notably, our preferred specification underscores that utilising a self-reported PHI indicator with a 10% misreporting rate would result in a substantial overestimation of PHI's impact on the two most commonly utilised healthcare services. |
| Keywords: | Health Insurance, Measurement Error, Health Care Demand, Australia |
| JEL: | C18 C81 C83 H31 I12 I13 I18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1432&r=hea |
| By: | Baten, Jörg; Batinti, Alberto; Costa-Font, Joan; Radatz, Laura |
| Abstract: | Health insurance expansions can improve health outcomes by increasing access to healthcare. This is especially true among the poorer segments of the population, who may not be able to afford the cost of healthcare, or might lack the information about where to seek proper medical care. In this paper we examine whether increased access to health insurance has historically reduced height inequality by promoting body growth, particularly among poorer individuals, and so enhanced their height, a widely used and well-established anthropometric health and well-being indicator. We draw on evidence from a panel of countries for which we could measure height inequality. Our evidence document clear evidence that indeed within-country differences in height inequality decreased following health insurance expansions towards near-universal coverage. |
| Keywords: | health insurance expansions; heights; health inequality; inequality; economic development |
| JEL: | N34 I10 J15 |
| Date: | 2024–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122716&r=hea |
| By: | Petkov, Ivan (Northeastern University); Ortega, Francesc (Queens College, CUNY) |
| Abstract: | Many studies have investigated flood risk and insurance coverage in the 100-year flood zone, but much less is known about the periphery of the flood zone. We present a new approach to estimate flood risk and insurance take-up in the vicinity of the flood zone based on building-level inundation data. We illustrate our approach using data for New York after hurricane Sandy. We show that flood risk falls rapidly as we move away from the flood zone, but remains fairly high for properties located within 250 meters of the flood zone. We also document substantial voluntary insurance take-up in this area prior to the storm, reflecting homeowners' perception of flood risk. Next, we show that experiencing flooding during Sandy led to large increases in flood insurance coverage in the flood zone and its periphery. But, while in the flood zone the increase vanished after 3 years, it was highly persistent in the periphery. By using information on the types of insurance policies purchased by homeowners, we provide evidence that strongly suggests that periphery residents who experienced flooding revised upwardly their beliefs about flood risk and adapted by purchasing (affordable) flood insurance. |
| Keywords: | flood risk, flood insurance, FEMA, NFIP, hurricane Sandy |
| JEL: | Q54 G22 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16922&r=hea |
| By: | Ugarte, Ana C. Gomez; Acosta, Enrique (Max Planck Institute for Demographic Research); Basellini, Ugofilippo; Alburez-Gutierrez, Diego |
| Abstract: | The Israel-Hamas war, triggered by the October 7th 2023 Hamas-led attack in Israel, has caused extensive mortality and sparked a major humanitarian crisis in the region. Direct conflict mortality has been mostly concentrated among non-combatants in the Gaza Strip. Here, most of the population has been internally displaced and faces limited access to food, water, shelter, sanitation, and essential health services. We aim to assess the impact of conflict deaths reported between October and December 2023 on life expectancy at birth (LE) in Palestine —including Gaza, the West Bank, and East Jerusalem. For this, we combine multiple sources of data on combatant and non-combatant fatalities and use demographic methods to impute the missing sex and age distribution of conflict mortality. We focus on LE because it is a widely used mortality indicator that is not affected by the population's age distribution and can be meaningfully compared across populations and over time. |
| Date: | 2024–04–25 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:8smy2&r=hea |
| By: | Mill, Wladislaw; Ebert, Tobias; Berkessel, Jana; Jonsson, Thorsteinn; Lehmann, Sune; Gebauer, Jochen |
| Abstract: | Does war make people more religious? Answers to this classic question are dominated by the lack of causality. We exploit the Vietnam Draft Lottery -- a natural experiment that drafted male U.S. citizens into military service during the Vietnam War -- to conclusively show that war increases religiosity. We measure religiosity via religious imagery on web-scraped photographs of hundreds of thousands of gravestones of deceased U.S. Americans using a tailor-made convolutional neural network. Our analysis provides compelling and robust evidence that war indeed increases religiosity: people who were randomly drafted into war are at least 20 % more likely to have religious gravestones. This effect sets in almost immediately, persists even after 50 years, and generalizes across space and societal strata. |
| Date: | 2024–04–17 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:9se4r&r=hea |
| By: | E. Jason Baron; Richard Lombardo; Joseph P. Ryan; Jeongsoo Suh; Quitze Valenzuela-Stookey |
| Abstract: | In many market-design applications, a new mechanism is introduced to reform an existing institution. Compared to the design of a mechanism in isolation, the presence of a status-quo system introduces both challenges and opportunities for the designer. We study this problem in the context of reforming the mechanism used to assign Child Protective Services (CPS) investigators to reported cases of child maltreatment in the U.S. CPS investigators make the consequential decision of whether to place a child in foster care when their safety at home is in question. We develop a design framework built on two sets of results: (i) an identification strategy that leverages the status-quo random assignment of investigators—along with administrative data on previous assignments and outcomes—to estimate investigator performance; and (ii) mechanism-design results allowing us to elicit investigators’ preferences and efficiently allocate cases. This alternative mechanism can be implemented by setting personalized non-linear rates at which each investigator can exchange various types of cases. In a policy simulation, we show that this mechanism reduces the number of investigators’ false positives (children placed in foster care who would have been safe in their homes) by 10% while also decreasing false negatives (children left at home who are subsequently maltreated) and overall foster care placements. Importantly, the mechanism is designed so that no investigator is made worse-off relative to the status quo. We show that a naive approach which ignores investigator preference heterogeneity would generate substantial welfare losses for investigators, with potential adverse effects on investigator recruitment and turnover. |
| JEL: | D82 H75 J13 J45 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32369&r=hea |
| By: | Kacker, Kanishka (Indian Statistical Institute); Gupta, Ridhima (South Asian University); Ali , Saif (Indraprastha Institute of Information Technology) |
| Abstract: | Will reducing traffic congestion bring health benefits? We use high frequency data from Uber for Delhi – a city that experiences high levels of air pollution and traffic congestion - to answer this question. Exploiting information by time of day for every day of 2018 at the neighborhood level that covers over 16000 possible trips during each of these time periods, we employ an econometric framework that models wind direction together with day, month, time-of-day and trip fixed effects to remove important sources of unobserved heterogeneity. Congestion has a non-linear, dynamic impact on pollution raising it sharply by over a standard deviation. The pattern of response shown by the results is consistent with known information regarding vehicular emissions and ambient air pollution, suggesting bias in the estimates to be low. Simulations using parameters from epidemiological studies suggest congestion may be responsible for up to 40% of all premature deaths from pulmonary and heart disease in Delhi. |
| Keywords: | air pollution; traffic congestion; vehicular regulation |
| JEL: | L91 O18 Q53 R41 |
| Date: | 2023–07–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:gunefd:2023_010&r=hea |
| By: | González González, Diego |
| Abstract: | This study examines the impact of childhood obesity on the academic performance and human capital accumulation of high school students using data from Spain. To address potential endogeneity issues, we exploit the exogenous variation in obesity within peer groups. Specifically, we use the prevalence of obesity by gender in students' classes as an instrumentalvariable for individual obesity. The results indicate that obesity has a negative impact on academic achievement, particularly on general scores for girls, cognitive abilities as measured by CRT scores, financial abilities, and English grades for both boys and girls. In addition, we found a negative impact of obesity on girls' mathematics scores, while boys experienced a positive impact. We identify several key drivers of these effects, including teacher bias, psychological well-being, time preferences, and expectations related to labor market discrimination. Our analysis sheds light on the multiple influences of childhood obesity on academic outcomes and highlights the need for targeted interventions. |
| Keywords: | Childhood obesity; Academic performance; Human capital accumulation; Cognitive abilities; Peer effects |
| JEL: | I10 I12 I15 I18 I21 |
| Date: | 2024–04–09 |
| URL: | http://d.repec.org/n?u=RePEc:cte:werepe:43822&r=hea |
| By: | Bor, Jacob; Venkataramani, Atheendar; Williams, David; Tsai, Alexander |
| Abstract: | Our previously published work (Bor, Venkataramani, Williams, and Tsai, 2018) showed that officer-involved killings of unarmed Black people have adverse mental health spillover effects on Black people in the general U.S. population. In a recent preprint, McCrain, Adams, Nix, and Del Pozo (2024) raised concerns about our methods, findings, and the interpretation of our findings. In this reply, we interrogate and address each of their concerns, showing that their replication introduced bias not present in the original. We also use the opportunity to conduct additional robustness checks. We find nothing to reduce confidence in our findings. Further buttressing our confidence are the multiple additional out-of-sample replications of our findings that have accrued in the literature over the past 5 years. |
| Date: | 2024–04–24 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:6hx5p&r=hea |
| By: | Colombier, Carsten; Braendle, Thomas |
| Abstract: | Even before the COVID-19 crisis, rapidly growing healthcare expenditure was calling the sustainabi- lity of public finances into question. The pandemic has reinforced these concerns and also under- lined the importance of resilient healthcare systems. To highlight the need for economic policy action in the healthcare sector, this paper provides expenditure projections for Switzerland up to 2050. The expenditure projections take into account the financial impact of the COVID-19 crisis and foreseeable ageing of the population. The projections show that while COVID-related health- care expenditure is a burden on public budgets in the short term, the ageing of the population will put continued and growing pressure on public budgets and compulsory health insurance until 2050. In the medium to long term, however, healthcare expenditure is driven not only by demogra- phic change, but also by non-demographic factors such as rising income, medical advances and Baumol's cost disease. The projections also suggest that long-term care will be affected by higher cost growth than the rest of the healthcare system. The sensitivity analyses show that the strongest cost pressure comes from alternative assumptions about the effect of the non-demographic cost drivers. In addition, a policy scenario discusses the cost-dampening effects of cost targets. |
| Keywords: | healthcare expenditure growth, population ageing, long-term projections, sustainabi- lity, public finances, health insurance, budgetary target, Baumol's cost disease |
| JEL: | H51 I13 I18 |
| Date: | 2022–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120659&r=hea |
| By: | Zhang, Yunting; Zhao, Jin; Yu, Zhangsheng; Wang, Guanghai; Zhang, Jun; Jiang, Fan; Wu, Saishuang; Zhang, Yue; Zhang, Donglan; Chen, Xi |
| Abstract: | During the first wave of the COVID-19 pandemic, Shanghai implemented lockdown measures to stop transmission of the virus. Over 26 million residents, including 0.8 million children aged 3-6, were confined at home. This study leveraged a city-wide cohort of preschool children - the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool (SCHEDULE-P) - and used a quasi-experimental design to study the impact of lockdown on preschool children's mental health and changes in their home environment and lifestyles. Two cohorts - the pre-pandemic cohort and the pandemic cohort - were investigated and compared using the difference-in-differences approach. The Strengths and Difficulties Questionnaire was used to screen children who were at risk for mental health distress. The Index of Childcare Environment questionnaire was used to evaluate the quality and quantity of stimulation and support available to children in their family environment. Children's screen time, sleep duration, and household socioeconomic status were also queried. The results showed that having experienced lockdown and home confinement was associated with a 3.1% increase in the percentage of children at risk for mental health distress, was associated with 21.2 minutes/day longer screen time, 15.7 minutes/day longer sleep duration, and a less favorable family environment. Children of parents with lower levels of education were more likely to experience mental health challenges associated with the lockdown. |
| Keywords: | Lockdown, Preschoolers, Mental health, Home environment, Lifestyle, China |
| JEL: | I18 I12 H75 I28 C23 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1430&r=hea |
| By: | Gerald J. Pruckner; Flora Stiftinger; Katrin Zocher (Department of Economics, Johannes Kepler University Linz) |
| Abstract: | The share of female physicians has risen in OECD countries in recent decades, but we know little about the effects of physician gender. We exploit quasi-random assignment of primary care providers (PCPs) to patients and estimate the causal effect of female PCPs on health care provision. Using Austrian register data and a difference-in-differences strategy, we find that female PCPs generate 14% less revenue than male PCPs. This gap is driven by a 6% reduction in the number of patients and a 6.5% decrease in services per patient. Our findings are not consistent with discrimination; instead, female PCPs work fewer hours. |
| Keywords: | physician gender, primary care, gender medicine |
| JEL: | I11 I12 J16 J22 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2024-04&r=hea |