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on Health Economics |
| By: | Ravi B. Sojitra; Vasilis Syrgkanis |
| Abstract: | We consider Dynamic Treatment Regimes (DTRs) with one sided non-compliance that arise in applications such as digital recommendations and adaptive medical trials. These are settings where decision makers encourage individuals to take treatments over time, but adapt encouragements based on previous encouragements, treatments, states, and outcomes. Importantly, individuals may choose to (not) comply with a treatment recommendation, whenever it is made available to them, based on unobserved confounding factors. We provide non-parametric identification, estimation, and inference for Dynamic Local Average Treatment Effects, which are expected values of multi-period treatment contrasts among appropriately defined complier subpopulations. Under standard assumptions in the Instrumental Variable and DTR literature, we show that one can identify local average effects of contrasts that correspond to offering treatment at any single time step. Under an additional cross-period effect-compliance independence assumption, which is satisfied in Staggered Adoption settings and a generalization of them, which we define as Staggered Compliance settings, we identify local average treatment effects of treating in multiple time periods. |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2405.01463&r= |
| By: | Hannah Schuster; Axel Polleres; Amin Anjomshoaa; Johannes Wachs |
| Abstract: | The impact of hot weather on health outcomes of a population is mediated by a variety of factors, including its age profile and local green infrastructure. The combination of warming due to climate change and demographic aging suggests that heat-related health outcomes will deteriorate in the coming decades. Here, we measure the relationship between weekly all-cause mortality and heat days in Austrian districts using a panel dataset covering $2015-2022$. An additional day reaching $30$ degrees is associated with a $2.4\%$ increase in mortality per $1000$ inhabitants during summer. This association is roughly doubled in districts with a two standard deviation above average share of the population over $65$. Using forecasts of hot days (RCP) and demographics in $2050$, we observe that districts will have elderly populations and hot days $2-5$ standard deviations above the current mean in just $25$ years. This predicts a drastic increase in heat-related mortality. At the same time, district green scores, measured using $10\times 10$ meter resolution satellite images of residential areas, significantly moderate the relationship between heat and mortality. Thus, although local policies likely cannot reverse warming or demographic trends, they can take measures to mediate the health consequences of these growing risks, which are highly heterogeneous across regions, even in Austria. |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2405.00540&r= |
| By: | Torres-Higuera, Paula (Universidad de los Andes) |
| Abstract: | This paper is the first to estimate the causal effect of extreme temperatures on time reallocation from a gender perspective. To this end, I exploit exogenous variation in temperature over 12 years within Colombian municipalities. I find that men increase the time allocated to childcare by around 13.4% in the presence of children ages 0 to 5, and by 8% in the presence of children ages 6 to 11 when exposed to heat waves. Meanwhile, women’s time is unresponsive to extreme temperatures. The results suggest that men reallocate time from paid labor to childcare when exposed to extreme heat since fatherhood is leisure-based while motherhood is still deeply linked to routine care. Given that recreational activities are not a substitute for routine care, the increase in men’s childcare hours does not reduce women’s unpaid work load. |
| Keywords: | Time Allocation; Extreme Temperatures; Unpaid Care Work. |
| JEL: | D13 J16 J22 Q54 |
| Date: | 2024–05–03 |
| URL: | http://d.repec.org/n?u=RePEc:col:000089:021133&r= |
| By: | Thoa Hoang; Van Thinh Le; Ilan Noy |
| Abstract: | People are sometimes forced to move, and it has often been hypothesised that such relocation involves significant psychological costs. The challenge in identifying the mental health consequences of moving is that most moves are (partly) voluntary. We use a natural experiment, the mandated relocation of some households after an exogenous shock, to identify the causal impact of moving on people’s mental health. The event we focus on is the 2011 Christchurch (New Zealand) earthquake, and the consequent decision of the central government to relocate about 8000 households from some of the affected area. We use a comprehensive administrative dataset that includes health records with information on hospital attendance, specialist services, and prescribed medications for (almost) every resident in the city. We find a statistically significant increase in the likelihood and frequency of receiving treatment for moderate mental health problems among individuals compelled to relocate, when compared to other residents of the earthquake-affected city who were allowed to remain in situ. This increase persisted to December 2013 for everyone but remained significant for the elderly across the whole examined period to the end of 2018. We found no such increase for more severe mental health incidents that required more acute interventions. |
| Keywords: | mental health, managed retreat, disaster risk, relocation, difference-in-difference |
| JEL: | I10 Q54 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11085&r= |
| By: | Elena Pisanelli |
| Abstract: | This paper examines the impact of the 2014 Italian divorce law on help-seeking behavior of domestic violence victims and femicides. I find that contrary to expectations, the reform, which aimed to make divorce cheaper while requiring mutual consent, led to a decrease in help-seeking behavior among intimate partner violence (IPV) survivors and an increase in femicides perpetrated by husbands. These findings suggest that while reducing the cost of divorce may empower individuals to leave abusive relationships, the requirement for mutual consent may inadvertently escalate violence as husbands seek to assert control and prevent separation. The study underscores the importance of considering the unintended consequences of divorce legislation and prioritizing the safety of IPV survivors in family policy interventions. |
| JEL: | J12 J16 I10 I31 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:bol:bodewp:wp1195&r= |
| By: | Courtin, Emilie; Rieckmann, Andreas; Bengtsson, Jessica; Nafilyan, Vahe; Melchior, Maria; Berkman, Lisa; Hulvej Rod, Naja |
| Abstract: | Background: Parental leave policies have been hypothesized to benefit mothers’ mental health. We assessed the impact of a 6-week extension of parental leave in Denmark on maternal mental health. Methods: We linked individual-level data from Danish national registries on maternal sociodemographic characteristics and psychiatric diagnoses. A regression discontinuity design was applied to study the increase in parental leave duration after 26 March 1984. We included women who had given birth between 1 January 1981 and 31 December 1987. Our outcome was a first psychiatric diagnosis following the child’s birth, ascertained as the first day of inpatient hospital admission for any psychiatric disorder. We presented cumulative incidences for the 30-year follow-up period and reported absolute risk differences between women eligible for the reform vs not, in 5-year intervals. Results: In all, 291 152 women were followed up until 2017, death, emigration or date of first psychiatric diagnosis. The median follow-up time was 29.99 years, corresponding to 10 277 547 person-years at risk. The cumulative incidence of psychiatric diagnoses at 30 years of follow-up was 59.5 (95% CI: 57.4 to 61.6) per 1000 women in the ineligible group and 57.5 (95% CI: 55.6 to 59.4) in the eligible group. Eligible women took on average 32.85 additional days of parental leave (95% CI: 29.20 to 36.49) and had a lower probability of having a psychiatric diagnosis within 5 years [risk difference (RD): 2.4 fewer diagnoses per 1000 women, 95% CI: 1.5 to 3.2] and up to 20 years after the birth (RD: 2.3, 95% CI: 0.4 to 4.2). In subgroup analyses, the risk reduction was concentrated among low-educated, low-income and single women. Conclusions: Longer parental leave may confer mental health benefits to women, in particular to those from disadvantaged backgrounds. |
| Keywords: | social determinants of health; women’s health; parental leave; mental disorders; quasi-experiment; MR/T032499/1 |
| JEL: | R14 J01 |
| Date: | 2023–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122771&r= |
| By: | Shuhei Nishitateno and Paul J. Burke |
| Abstract: | In October 2003 four contiguous prefectures in Greater Tokyo introduced Low Emission Zones (LEZs) from which diesel trucks and buses without particulate filters have been banned from entering. This paper analyzes the effects of this large-scale intervention on air quality, new vehicle registrations, and birthweights. We use a matching approach to construct a control group comparable to the designated areas in terms of propensity scores based on municipality characteristics during the pre-intervention period and apply a difference-in-differences design. We find evidence that the intervention led to reductions in hourly particulate matter concentrations and the incidence of low birthweights in the Greater Tokyo LEZ relative to the control group. We also find that the LEZs led to increases in registrations of new trucks and buses. This is not the case for passenger cars, which were exempt from the regulations. Our paper provides the first evidence of a significant link between LEZs and reduced incidence of low birthweights. |
| JEL: | Q53 R48 I18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:pas:papers:2024-2&r= |
| By: | Dehos, Fabian T. (RWI); Paul, Marie (University of Duisburg-Essen); Schäfer, Wiebke (Leibniz Institute for Prevention Research and Epidemiology (BIPS)); Süss, Karolin (University of Duisburg-Essen) |
| Abstract: | This paper combines German claims and survey data to provide a comprehensive picture of the health dynamics surrounding the transition into motherhood. Event-study estimates reveal good mental health around birth, but declines afterward, as reflected by increasing mental illness diagnoses and antidepressant and psychotherapy use during the first four years of motherhood. Painkillers, headaches, obesity, and other potentially stress-related physical illnesses, as well as survey evidence on well-being, show a similar pattern. A sustained reduction in sleep, sports, and other leisure activities, coupled with childcare obligations and possible psychosocial distress, may contribute to the long-term adverse effects of motherhood. |
| Keywords: | maternal health, mental health, claims data |
| JEL: | J13 I10 I12 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16942&r= |
| By: | Fontana, S.;; Guccio, C.;; Pignataro, G.;; Romeo, D.; |
| Abstract: | This paper aims to assess the impact of a cash transfer programme implemented in Italy since 2014, known as the '80 euro bonus', on health outcomes as gauged by mortality rates. Using municipality-level data over the period 2010-2019 and a difference-in-differences approach, we find a significant reduction in mortality rates associated with the size of cash transfers and the number of recipients in the municipality. This effect remains robust across several checks. Furthermore, at the provincial level, we observe sustained decreases in mortality rates, especially for cancer and cardiovascular diseases, in the areas with a higher concentration of cash transfer recipients. These results support the positive impact of increased financial resources on health outcomes and highlight the role of cash transfers as effective tools for public health policies. |
| Keywords: | cash transfer; personal income; health outcomes; mortality rate; local communities; difference-in-difference; |
| JEL: | C23 E32 H24 I10 I18 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:24/04&r= |
| By: | Emmanuelle Augeraud-Véron (BSE - Bordeaux sciences économiques - UB - Université de Bordeaux - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Marc Leandri (SOURCE - SOUtenabilité et RésilienCE - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - IRD [France-Nord] - Institut de Recherche pour le Développement, EconomiX - EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | Health Economics published by John Wiley & Sons Ltd.In this contribution to the longstanding risk theory debate on optimal self-protection, we aim to enrich the microeconomic modeling of self-protection, in the wake of Ehrlich and Becker (1972), by exploring the representation of risk perception at the core of the Health Belief Model (HBM), a conceptual framework extremely influential in Public Health studies (Janz and Becker, 1984). In our two-period model, we highlight the crucial role of risk perception in the individual decision to adopt a preventive behavior toward a generic health risk. We discuss the optimal prevention effort engaged by an agent displaying either imperfect knowledge of the susceptibility (probability of occurrence) or the severity (magnitude of the loss) of a health hazard, or facing uncertainty on these risk components. We assess the impact of risk aversion and prudence on the optimal level of self-protection, a critical issue in the risk and insurance economic literature, yet often overlooked in HBM studies. Our results pave the way for the design of efficient information instruments to improve health prevention when risk perceptions are biased. |
| Keywords: | Health Belief Model, Prudence, Risk aversion, Risk perception, Self-protection, Uncertainty |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04557076&r= |
| By: | Linden, Mikael |
| Abstract: | A model with special attention on the (subjective) survival probability is proposed to understand salient aspects of retirement age decision. Optimal retirement age results are derived with a death hazard rate function having non-negative duration dependence. At the optimum age, the retiree wants to have a compensation in the form of early retirement for his/her evident non-zero death risk. A retiree with large welfare inputs supporting mortality risk decreasing effects delays his/her retirement time. From policy perspective we need to lower the elderly health costs to reduce the death hazard rates leading to higher optimal retirement ages. Some empirical findings with the birth year 1947 cohort in Finland do not conflict the model results. Death hazard rate function estimates show that gender, health, civil status, incomes, and pension affect the death hazard rates. The retirement age has a longevity increasing effect across the different model specification. |
| Keywords: | Optimal retirement age, survival probabilities, death hazard rate function, survival model estimation, frailty. |
| JEL: | C41 I12 J14 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120786&r= |
| By: | Vallejo, Hernán (Universidad de los Andes) |
| Abstract: | This article presents a theory of lifetime welfare, considering the corresponding cycles, trend, and span. The model suggests that economic agents should focus more on improving, smoothing, and stabilizing the welfare trend of individuals, than on improving, smoothing, and stabilizing their consumption and income, since they are not the same. Given that private and public decisions can generate internalities and externalities, and thus, inefficiencies, these results can justify individual, social, and government interventions, for example in lifestyle, and the education, health, pension, and insurance markets. It is argued that this approach can be a complement to the worldwide efforts to improve the coverage and sustainability of the health and pension systems; help explain the so-called Easterlin paradox, and contribute to the wellness set point debate in psychology. |
| Keywords: | lifetime welfare; individual welfare trend curve; welfare smoothing; marginal rate of welfare trend change; social welfare trends function and frontier; and Easterlin paradox. |
| JEL: | D11 D60 D62 D70 |
| Date: | 2024–05–16 |
| URL: | http://d.repec.org/n?u=RePEc:col:000089:021135&r= |
| By: | Torben S. D. Johansen |
| Abstract: | In optimal policy problems where treatment effects vary at the individual level, optimally allocating treatments to recipients is complex even when potential outcomes are known. We present an algorithm for multi-arm treatment allocation problems that is guaranteed to find the optimal allocation in strongly polynomial time, and which is able to handle arbitrary potential outcomes as well as constraints on treatment requirement and capacity. Further, starting from an arbitrary allocation, we show how to optimally re-allocate treatments in a Pareto-improving manner. To showcase our results, we use data from Danish nurse home visiting for infants. We estimate nurse specific treatment effects for children born 1959-1967 in Copenhagen, comparing nurses against each other. We exploit random assignment of newborn children to nurses within a district to obtain causal estimates of nurse-specific treatment effects using causal machine learning. Using these estimates, and treating the Danish nurse home visiting program as a case of an optimal treatment allocation problem (where a treatment is a nurse), we document room for significant productivity improvements by optimally re-allocating nurses to children. Our estimates suggest that optimal allocation of nurses to children could have improved average yearly earnings by USD 1, 815 and length of education by around two months. |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2404.18268&r= |
| By: | Olivier Thévenon; Chris Clarke; Gaëlle Simard-Duplain |
| Abstract: | While child poverty has decreased significantly in recent years due to increased support for families with children, measures to assist socio-economically disadvantaged children only partially address their challenges. To enhance equality of opportunity and social mobility in Canada, it is crucial to strengthen efforts addressing the root causes of socio-economic disadvantages and bridge gaps in policies aimed at reducing child poverty. This paper presents an overview of child poverty trends in Canada and discusses the challenges associated with the Poverty Reduction Strategy aimed at enhancing equality of opportunity and social mobility. |
| Keywords: | child poverty, childhood disadvantage, children, education, health, inequality |
| JEL: | I31 I32 J13 |
| Date: | 2024–05–24 |
| URL: | http://d.repec.org/n?u=RePEc:oec:wiseaa:25-en&r= |
| By: | Bukari, Chei; Seth, Suman; Yalonetkzy, Gaston |
| Abstract: | The WHO estimates that nearly half of the world's population lacks access to essential healthcare, and that the proportion of the population with catastrophic out-of-pocket health spending (10% or more of the household budget) is on the rise. Meanwhile, the United Nations’ General Assembly has recently identified corruption as a vital factor undermining efforts to accomplish universal health coverage. We examine how corruption may lead to healthcare deprivation in the context of 29 sub-Saharan African countries, employing the fifth, sixth and seventh waves of the Afrobarometer survey spanning 2011–2018. Applying an instrumental variable framework, we find that the experience of corruption in the form of bribe payments as well as the frequency of bribe payments within the healthcare sector increases the likelihood of healthcare deprivation. Moreover, corruption experienced in other sectors, such as education, the police, public utilities and identification authorities, have spill-over effects affecting healthcare deprivation adversely. Further analysis reveals that the experience of corruption in multiple sectors simultaneously worsens healthcare deprivation. Our findings suggest that mitigating corruption in the healthcare sector alone may not be sufficient to end the adverse effect of corruption on effective healthcare access in SSA countries. Finally, through mediation analysis, we show that loss of income and loss of trust are two channels through which corruption influences healthcare deprivation. |
| Keywords: | bribe extortions; corruption; healthcare deprivation; spillovers; Sub-Saharan Africa |
| JEL: | D73 I11 I31 I32 |
| Date: | 2024–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122806&r= |
| By: | Douglas A. Wolf (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Shannon M. Monnat (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Jennifer Karas Montez (Sociology Department, Maxwell School, Syracuse University, 302 Maxwell Hall, Syracuse, NY 13244); Emily Wiemers (Public Administration and International Affairs Department, Maxwell School, Syracuse University, 215 Eggers Hall, Syracuse, NY 13244); Elyse Grossman (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244) |
| Abstract: | Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies helped reduce overdose mortality rates, but not enough to offset the effects of the physical distancing policies. |
| Keywords: | COVID-19, Substance Use, Drug Overdoses, Population Health |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:max:cprpbr:69&r= |
| By: | Julien Bergeot (THEMA - Théorie économique, modélisation et applications - CNRS - Centre National de la Recherche Scientifique - CY - CY Cergy Paris Université); Florence Jusot (Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | The first wave of the COVID-19 pandemic left many people with unmet health care needs, which could have detrimental effects on their health. This paper examines the effects of these unmet needs during the first wave of the pandemic on health outcomes one year later. We combine two waves of the SHARE survey collected during the COVID-19 pandemic (in June/July 2020 and 2021), as well as four waves collected before the pandemic. Our health outcomes are four dummy variables: fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use OLS regression with individual and time fixed effects for our difference-in-difference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial effects of having had unmet healthcare needs during 2020 on the probability of having trouble with fatigue and fear of falling one year later. We particularly find strong effects for general practitioner (GP) and specialist care, and in lower extent of physiotherapist, psychotherapist, and rehabilitation care. |
| Keywords: | COVID-19, Health, Unmet needs, Difference-in-differenc, Méthodes des doubles différences, Besoins de santé, Santé, Pandémie de COVID-19 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04564156&r= |
| By: | Bičáková, Alena (CERGE-EI); Jurajda, Štepán (CERGE-EI) |
| Abstract: | We track the effects of the COVID-19 pandemic on political preferences through 'high' and 'low' phases of the pandemic. We ask about the effects of the health and the economic costs of the pandemic measured at both personal and municipality levels. Consistent with the literature, we estimate effects suggestive of political accountability of leaders during 'high' pandemic phases. However, we also find that the pandemic political accountability effects are mostly short-lived, and do not extend to the first post-pandemic elections. |
| Keywords: | COVID-19, political accountability |
| JEL: | D72 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16939&r= |