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on Health Economics |
| By: | Liran Einav; Amy Finkelstein; Pietro Tebaldi |
| Abstract: | Health insurance is increasingly provided through managed competition, in which subsidies for consumers and risk adjustment for insurers are key market design instruments. We illustrate that subsidies offer two advantages over risk adjustment in markets with adverse selection. They provide greater flexibility in tailoring premiums to heterogeneous buyers, and they produce equilibria with lower markups and greater enrollment. We assess these effects using demand and cost estimates from the California Affordable Care Act marketplace. Holding government spending fixed, we estimate that subsidies can increase enrollment by 16 percentage points (76%) over risk adjustment, while all consumers are weakly better off. |
| JEL: | G22 G28 H51 I13 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32586&r= |
| By: | Kate Ho; Ariel Pakes |
| Abstract: | Our calculations indicate that currently proposed U.S. policies to reduce pharmaceutical prices, though particularly beneficial for low-income and elderly populations, could dramatically reduce firms’ investment in highly welfare-improving R&D. The U.S. subsidizes the worldwide pharmaceutical market. One reason is U.S. prices are higher than elsewhere. If each drug had a single international price across the highest-income OECD countries, and total pharmaceutical firm profits were held fixed, then U.S. prices would fall by half and every other country’s prices would increase (by 28 to 300%). International prices would maintain firms’ R&D incentives and more equitably share the costs of pharmaceutical research. |
| JEL: | I18 L20 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32606&r= |
| By: | Nahim Bin Zahur; Lucy Xiaolu Wang (University of Massachusetts Amherst) |
| Abstract: | International procurement institutions play an important role in drug supply. We study price, delivery, and procurement lead time of drugs for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007-2017 across procurement institution types. We find that pooled procurement lowers prices: pooling internationally is most effective for small buyers and concentrated markets, while pooling within-country is most effective for large buyers and unconcentrated markets. Pooling can reduce delays, but at the cost of longer anticipated lead times. Finally, pooled procurement is more effective for older-generation drugs, compared to patent pooling institutions that target newer drugs. |
| Keywords: | global drug diffusion, procurement institutions, price and delay, IP and non-IP barriers |
| JEL: | I11 O19 H57 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:qed:wpaper:1519&r= |
| By: | Anna Aizer; Adriana Lleras-Muney; Katherine Michelmore |
| Abstract: | Child poverty fell to historic lows in 2021, in large part due to the temporary expansion of the Child Tax Credit (CTC). We consider the possible implications of this expansion on children’s short- and long-term development. To do so, we review the available short-run evidence from the 2021 expansion and the existing research evidence on the longer run effects of similar income transfers in childhood on child health and human capital. We conclude that the CTC likely improved child health and well-being in the short and long run, with greater impacts for poor children and modest or nonexistent effects for non-poor children. Moreover, the effects might be more substantial for younger children and for those in places with weaker safety nets. |
| JEL: | I24 I30 J38 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32609&r= |
| By: | Benjamin Goldman; Jamie Gracie; Sonya R. Porter |
| Abstract: | Americans rarely marry outside of their race or class group. We distinguish between two possible explanations: a lack of exposure to other groups versus a preference to marry within group. We develop an instrument for neighborhood exposure to opposite-sex members of other race and class groups using variation in sex ratios among nearby birth cohorts in childhood neighborhoods. We then test whether increased exposure results in more interracial (white-Black) and interclass (top-to-bottom parent income quartile) marriages. Increased exposure to opposite-sex members of other class groups generates a substantial increase in interclass marriage, but increased exposure to other race groups has no detectable effect on interracial marriage. We use these results to estimate a spatial model of the marriage market and quantify the impact of reducing residential segregation in general equilibrium. For small changes in exposure, the model implies effects in line with recent estimates from policy experiments. We then use the model to assess the overall contribution of segregation and find that residential segregation has large effects on interclass, but not interracial, marriage. |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:cen:wpaper:24-30&r= |
| By: | Cristina Bellés-Obrero; Sergi Jiménez-Martín; Han Ye |
| Abstract: | This paper studies the mortality effect of delaying retirement by investigating the impacts of the 1967 Spanish pension reform, which affected the general population and exogenously changed the early retirement age, depending on the date individuals started contributing to the pension system. Using the Spanish administrative data, we find that delaying retirement by one year increases the hazard of dying between the ages of 60 and 69 by 38 percent. We show that the reform leads to higher mortality in all subgroups, and the effects are statistically stronger for those employed in sectors with the highest workplace accidents and for those with low self-value jobs. Moreover, we show that allowing flexible retirement mitigates the adverse effects of delaying retirement. |
| Keywords: | Delaying retirement, Mortality, Heterogeneity, Work conditions |
| JEL: | I10 I12 J14 J26 |
| Date: | 2023–04 |
| URL: | https://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2023_410v2&r= |
| By: | Luigi Guiso (Einaudi Institute for Economics and Finance (EIEF) and CEPR); Tullio Jappelli (University of Naples Federico II, CSEF, and CEPR) |
| Abstract: | We implement a survey experiment to study whether awareness of the consequences of hydrogeological risk affects people’s willingness to fight it. To do so, we leverage a representative panel of 5, 000 Italian individuals interviewed at quarterly frequency, starting in October 2023. We elicit survey participants’ willingness to contribute to a public fund to finance investment to secure areas exposed to hydrogeological risk under different information treatments. We find that disclosing information about the consequences of hydrogeological risk causes individuals to increase both support for public funding and individual willingness to pay for the policy. Compared to the control group, individuals exposed to the treatment were 9 percentage points more likely to contribute to the fund and more willing to contribute an additional €29. Applying the information treatment to the whole working age population could raise as much as €0.26 billion per year. We provide evidence that individual willingness to pay depends on individual knowledge that the success of the policy depends critically on the willingness to pay of other citizens. |
| Keywords: | Natural Disasters; Willingness to Pay; Insurance. |
| JEL: | H31 H2 H23 |
| Date: | 2024–06–24 |
| URL: | https://d.repec.org/n?u=RePEc:sef:csefwp:723&r= |
| By: | Emily Quiroga; Michael Tanner |
| Abstract: | The study on risk preferences and its potential changes amid natural catastrophes has been subject of recent study, producing contradictory findings. An often proposed explanation specifically distinguishes between the opposite effect of realized and unrealized losses on risk preferences. Moreover, higher-order risk preferences and its relation to post-disaster behaviors remain unexplored, despite potential theoretical implications. We address these gaps in the literature by conducting experiments with 600 individuals post Turkeys 2023 catastrophic earthquake, specifically heavily affected individuals who are displaced, those who are not and a control group. Results indicate higher risk-taking in heavily affected individuals when compared to unaffected individuals. Our results are specifically driven by affected females. We find no pre existing differences in risk preferences between earthquake and control areas using 2012 data. Within the heavily affected group of individuals, higher house damage, our proxy for realized losses, increases risk aversion. Regarding higher-order risk preferences for individuals heavily affected by the earthquake, we find that prudence is positively associated with selfprotective behaviors after the earthquake, specifically internal migration and/or displacement. While precautionary savings shows initially no correlation to prudence, a positive association emerges when considering that prudence is also related to occupational choices, with individuals with stable incomes and who save being more prudent. Our results contribute insights into how disasters influence risk preferences, specifically aiming to address contradictory findings in the literature, while presenting novel evidence on the relationship between prudence and post-natural disaster behaviors. |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2406.15905&r= |
| By: | Atul Gupta; Ambar La Forgia; Adam Sacarny |
| Abstract: | Firms often exploit loopholes in government contracts to boost revenues. The welfare consequences of this behavior depend on how firms use the marginal windfall dollar, yet little evidence exists to guide policymakers. This paper studies how hospitals allocated over $3 billion obtained from gaming a Medicare payment loophole. The average gaming hospital increased both Medicare and total revenue by around 10%, implying large spillovers on other payers. Consistent with theories of organizational behavior, nonprofit hospitals deployed most of the windfall toward operating costs, while for-profits deducted the entire amount off their balance sheet, distributing a substantial portion to executives and shareholders. Accordingly, we detect modest reductions in mortality rates at nonprofits but no changes at for-profits. Our results imply that the consequences of such engineered windfalls vary substantially by hospital ownership. |
| JEL: | I13 I18 L33 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32564&r= |
| By: | Helmuth Cremer; Jean-Marie Lozachmeur |
| Abstract: | We study the design of nonlinear reimbursement rules for expenses on secondary preventive and on therapeutic care. With some probability individuals are healthy and do not need any therapeutic health care. Otherwise they become ill and 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 flat (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 information, 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 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11186&r= |
| By: | Maynou, Laia; McGuire, Alistair; Serra-Sastre, Victoria |
| Abstract: | Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour. |
| Keywords: | complementarity; high-skilled workforce; task reallocation; technological diffusion; workforce elasticity |
| JEL: | R14 J01 |
| Date: | 2024–07–01 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:124065&r= |
| By: | Irving Llamosas-Rosas; Erick Rangel González; Felipe J. Fonseca; Rita Karolina Cantú Zendejas |
| Abstract: | According to the World Health Organization, people's exposure to particles 2.5 microns or less in diameter (PM2.5) causes respiratory tract diseases. The measurement of these particles represents a considerable challenge due to the lack of monitoring stations. This research proposes the use of recent advances in adjustments to satellite data to obtain accurate PM2.5 data. Thus, the impact of said pollutant on acute respiratory infections and pneumonia in Mexico in the period 2011 to 2021 is quantified. The results indicate that a 10% increase in the average levels of PM2.5 is reflected in an increase of 0.85% in reported cases of acute respiratory infections, which represents 209, 977 additional annual cases. For pneumonia, an increase of 1.41% was found, equivalent to an annual increase of 1, 998 reported cases. |
| Keywords: | PM2.5;Satellite Data;Acute Respiratory Infections;Profundidad Óptica de Aerosoles |
| JEL: | I15 Q53 O10 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:bdm:wpaper:2024-04&r= |
| By: | Julia Mink (University of Bonn) |
| Abstract: | This study quantifes the financial burden of acute air pollution on the French healthcare system. By combining comprehensive French administrative health data for a nationally representative sample with high-resolution geospatial data on air pollution and meteorological conditions, the healthcare costs of air pollution exposure are estimated more accurately and comprehensively than in the previous literature. I use an instrumental variable approach exploiting weekly variations in local concentrations of nitrogen dioxide, ground-level ozone and particulate matter induced by variations in altitude weather conditions. I find that air pollution causes healthcare costs to the French healthcare system in the order of several billion per year, even though air pollutant concentrations are mostly below the current European air quality standards considered safe for human health. My cost estimates are about 10 times higher than those estimated in previous studies, suggesting that the health costs of air pollution have been severely underestimated. While air pollution has a large effects on overall spending in more polluted and populated urban areas due to the higher number of affected people, the marginal effects appear to be greater in low-pollution and less populated areas. Reducing population exposure even at low air pollution concentrations should therefore be an important public health goal. Even the most stringent 2021 WHO guideline values should not be considered safe for human health. |
| Keywords: | Air pollution, healthcare cost, instrumental variable approach |
| JEL: | I12 J14 Q51 Q53 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:ajk:ajkdps:320&r= |
| By: | Debora Di Gioacchino; Emanuela Ghignoni; Laura Sabani |
| Abstract: | Healthcare typologies are valuable instruments for comparing the similarities and discrepancies in how nations finance, deliver, and structure their healthcare systems. This study concentrates on three distinct aspects of healthcare systems: (1) the overall level of healthcare expenditure; (2) the distribution between public and private funding; (3) the emphasis on primary care versus secondary care. We examine 25 European countries to investigate empirically how these nations cluster based on these three features. To accomplish this goal, we undertake a cluster analysis combining data on healthcare expenditure with metrics on the public-private funding mix and indicators of healthcare sectional orientation, predominantly utilizing OECD Health Data and WHO country reports. The results suggest the identification of at least five distinct healthcare system types. Subsequently, we employ these typologies to examine cross-national differences in health outcomes and health inequalities. Consistent with expectations, our findings show a robust association between healthcare expenditure, particularly public expenditure, and health outcome metrics, alongside a negative correlation with socio-economic health disparities. Primary care emphasis does not appear to correlate with improved health outcomes, nor with reduced health disparities. Finally, our findings challenge the purported decongestion effect associated with voluntary health insurance. |
| Keywords: | healthcare systems, public–private mix, primary vs secondary care, voluntary health insurance, health outcomes. |
| JEL: | H42 I13 I14 C40 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:frz:wpaper:wp2024_08.rdf&r= |
| By: | Resta, Emanuela; Logroscino, Giancarlo; Tafuri, Silvio; Peter, Preethymol; Noviello, Chiara; Costantiello, Alberto; Leogrande, Angelo |
| Abstract: | The following article analyses the relationship between the mental health index and the variables of the Environment, Social and Governance-ESG model in the Italian regions between 2004 and 2023. First of all, a static analysis is proposed aimed at identifying trends relating to mental health in the Italian regions with indication of the regional gaps. Subsequently, a clustering with k-Means algorithm is proposed. Below is a comparison of 11 machine learning algorithms for predicting the performance of the mental health index. Finally, the article offers some economic policy suggestions. The results are critically discussed in light of the scientific literature |
| Keywords: | Mental Health Index, Machine Learning, ESG, Regional Inequalities |
| JEL: | I11 I12 I13 I14 I15 I18 |
| Date: | 2024–06–14 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:121204&r= |
| By: | Khudri, Md Mohsan (Austin Community College); Hussey, Andrew (University of Memphis) |
| Abstract: | Using data from the Panel Study of Income Dynamics, we estimate the impact of breastfeeding initiation and duration on multiple cognitive, health, and behavioral outcomes spanning early childhood through adolescence. To mitigate the potential bias from misspecification, we employ a doubly robust (DR) estimation method, addressing misspecification in either the treatment or outcome models while adjusting for selection effects. Our novel approach is to use and evaluate a battery of supervised machine learning (ML) algorithms to improve propensity score (PS) estimates. We demonstrate that the gradient boosting machine (GBM) algorithm removes bias more effectively and minimizes other prediction errors compared to logit and probit models as well as alternative ML algorithms. Across all outcomes, our DR-GBM estimation generally yields lower estimates than OLS, DR, and PS matching using standard and alternative ML algorithms and even sibling fixed effects estimates. We find that having been breastfed is significantly linked to multiple improved early cognitive outcomes, though the impact reduces somewhat with age. In contrast, we find mixed evidence regarding the impact of breastfeeding on non-cognitive (health and behavioral) outcomes, with effects being most pronounced in adolescence. Our results also suggest relatively higher cognitive benefits for children of minority mothers and children of mothers with at least some post-high school education, and minimal marginal benefits of breastfeeding duration beyond 12 months for cognitive outcomes and 6 months for non-cognitive outcomes. |
| Keywords: | breastfeeding, human capital, cognitive and non-cognitive outcomes, doubly robust estimation, machine learning |
| JEL: | I12 I18 J13 J24 C21 C63 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17080&r= |
| By: | Bogdan Oancea |
| Abstract: | The term of big data was used since 1990s, but it became very popular around 2012. A recent definition of this term says that big data are information assets characterized by high volume, velocity, variety and veracity that need special analytical methods and software technologies to extract value form them. While big data was used at the beginning mostly in information technology field, now it can be found in every area of activity: in governmental decision-making processes, manufacturing, education, healthcare, economics, engineering, natural sciences, sociology. The rise of Internet, mobile phones, social media networks, different types of sensors or satellites provide enormous quantities of data that can have profound effects on economic research. The data revolution that we are facing transformed the way we measure the human behavior and economic activities. Unemployment, consumer price index, population mobility, financial transactions are only few examples of economic phenomena that can be analyzed using big data sources. In this paper we will start with a taxonomy of big data sources and show how these new data sources can be used in empirical analyses and to build economic indicators very fast and with reduced costs. |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2406.11913&r= |
| By: | Simon K. Schnyder; John J. Molina; Ryoichi Yamamoto; Matthew S. Turner |
| Abstract: | Faced with a dangerous epidemic humans will spontaneously social distance to reduce their risk of infection at a socio-economic cost. Compartmentalised epidemic models have been extended to include this endogenous decision making: Individuals choose their behaviour to optimise a utility function, self-consistently giving rise to population behaviour. Here we study the properties of the resulting Nash equilibria, in which no member of the population can gain an advantage by unilaterally adopting different behaviour. We leverage a new analytic solution to obtain, (1) a simple relationship between rational social distancing behaviour and the current number of infections; (2) new scaling results for how the infection peak and number of total cases depend on the cost of contracting the disease; (3) characteristic infection costs that divide regimes of strong and weak behavioural response and depend only on the basic reproduction number of the disease; (4) a closed form expression for the value of the utility. We discuss how these analytic results provide a deep and intuitive understanding into the disease dynamics, useful for both individuals and policymakers. In particular the relationship between social distancing and infections represents a heuristic that could be communicated to the population to encourage, or "bootstrap", rational behaviour. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2407.04366&r= |
| By: | Erick Rangel González; Irving Llamosas-Rosas; Sara Hutchinson Tovar |
| Abstract: | Using employment microdata from the Mexican Social Security Institute, from January 2019 to June 2021, the impacts of COVID-19 on the probability of job separation and monthly wage variations at the national and regional levels by age and sex groups are analyzed. The results indicate greater increases in the probability of job separation for men than for women in the first months of the health crisis compared to the pre-pandemic period. Likewise, a reduction in wage variations is estimated, which proportionally affected men more than women, although these differences disappear over time. By age group, the results show that workers aged 60 to 65 are the most affected in terms of the probability of job separation, while the youngest group of workers recorded the largest reductions in wage variations. Finally, there is heterogeneity in the results by region. |
| Keywords: | COVID-19;Probability of job separation;Salary variations;Differences by sex and age groups |
| JEL: | J01 J16 J30 J64 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:bdm:wpaper:2024-08&r= |