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on Health Economics |
| By: | Donald S. Kenkel; Alan D. Mathios; Grace N. Phillips; Revathy Suryanarayana; Hua Wang; Sen Zeng |
| Abstract: | Australia had adopted a novel approach to e-cigarette policy by requiring a physician’s prescription to lawfully obtain nicotine e-cigarettes. We conducted an online discrete choice experiment to gauge how adult Australian smokers made hypothetical choices between cigarettes, prescription e-cigarettes, non-prescription e-cigarettes, and quitting. We estimate a mixed logit model, which allows us to predict the market shares under different policy scenarios. The mixed logit model also provides estimates of consumer willingness to pay for the benefits from the prescription status of e-cigarettes and the costs of illegal e-cigarette markets. We estimate that the average utility loss from an illegal retail market is worth AU$7.90 per pack-equivalent. We use the corresponding estimates of the compensating variations in income to conduct cost-benefit analyses of possible reforms to Australian e-cigarette regulation. In aggregate, we estimate that the benefits of allowing but not requiring prescriptions of e-cigarettes are AU$1.8 billion per year. Our paper provides a novel contribution to research on e-cigarette regulation and provides a case-study for the policy implementation in Australia. Our paper is also part of our research agenda to explore and develop methods to conduct policy analysis and cost-benefit analysis of regulatory policies that might create illegal markets. |
| JEL: | I12 I18 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32654&r= |
| By: | Christopher S. Carpenter; Brandyn F. Churchill |
| Abstract: | We provide novel evidence on the role of social comparisons in shaping adolescent body misperception. Using an instrumental variables approach leveraging variation in relative age generated by school entry cutoff months and data from the Health Behaviour in School-Aged Children study, we show that relatively older students are more likely to misperceive their weight harshly relative to their BMIs compared to their same-age counterparts who are relatively younger within their classrooms. Meanwhile, relatively younger students are more likely to misperceive their weight leniently relative to their BMIs. We then show that relatively older students are less likely to be overweight or obese, consume more low-calorie foods, and report higher levels of physical activity. Overall, our results suggest that relatively older students base their weight-related expectations and behaviors on their younger peers, while relatively younger students compare themselves to their older peers. |
| JEL: | I1 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32629&r= |
| By: | Sundberg, Anton (IFAU and Uppsala University) |
| Abstract: | This paper examines the impact of parenthood on labor market outcomes for both men and women using population-wide annual income data from 1960 to 2021 in Sweden. First, I document the contemporary child penalties across several labor market outcomes. Second, I show that while the motherhood penalty in earnings declined significantly during the 1960s, 1970s, and early 1980s, the rate of decline slowed from the late 1980s onwards. Third, I identify a fatherhood penalty emerging since the 1980s, particularly pronounced among men in more gender-egalitarian households (proxied by the father’s share of parental leave) and among fathers who have sons relative to daughters. |
| Keywords: | Parenthood; child penalties; gender earnings gap |
| JEL: | J13 J16 J22 J31 |
| Date: | 2024–07–09 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:ifauwp:2024_012&r= |
| By: | Roxana Guti\'errez-Romero |
| Abstract: | This paper evaluates the effectiveness of femicide laws in combating gender-based killings of women, a major cause of premature female mortality globally. Focusing on Mexico, a pioneer in adopting such legislation, the paper leverages variations in the enactment of femicide laws and associated prison sentences across states. Using the difference-in-difference estimator, the analysis reveals that these laws have not significantly affected the incidence of femicides, homicides of women, or reports of women who have disappeared. These findings remain robust even when accounting for differences in prison sentencing, whether states also implemented unilateral divorce laws, or decriminalized abortion alongside femicide legislation. The results suggest that legislative measures are insufficient to address violence against women in settings where impunity prevails. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2407.06722&r= |
| By: | Boone, Christopher (University of Massachusetts Amherst); Kaila, Heidi (World Bank); Sahn, David E. (Cornell University) |
| Abstract: | We examine the impact of a six-fold increase in the global vanilla price on smallholder vanilla-farming households in Madagascar. The price increase leads to sizable gains in household assets and significant improvements in adult psychological well-being, cognitive performance, and optimism about the economy. In contrast, we find no significant effects on children's health or schooling. Given substantial evidence from the literature that improvements in household economic resources can have large effects on children over the long run, the lack of shorterterm effects in this setting may reflect the time-varying nature of the impact or the need for additional complementary investments. |
| Keywords: | export commodities, agriculture, human capital, crime |
| JEL: | O12 O13 I15 I31 Q12 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17085&r= |
| By: | Luis F. Faundez; Robert Kaestner |
| Abstract: | In this article, we examine the association between family wealth and academic achievement and socioemotional behaviors of children ages 5 to 12. We examine whether wealth prior to birth and at ages 4 or 5 affects academic test scores and behavioral problems during two periods of childhood, ages 5 to 8 and ages 9 to 12, for a large and relatively recent cohort of children. We also examine associations between different forms of wealth (e.g., home equity) and child achievement and behaviors. Finally, we assess whether wealth prior to birth mediates racial/ethnic disparities in child achievement and disparities in achievement by maternal education/ability (AFQT). Results of our analysis indicate that wealth, particularly financial wealth that is the most liquid, has a modest positive association with achievement test scores. We also find that wealth is associated with fewer behavioral problems, but these results are less robust. |
| JEL: | H40 I24 I30 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32628&r= |
| By: | Charles Yuji Horioka (Research Institute for Economics & Business Administration (RIEB), Kobe University, Institute of Social and Economic Research, Osaka University, Asian Growth Research Institute, and National Bureau of Economic Research, JAPAN); Emin Gahramanov (School of Business Administration, Department of Economics, American University of Sharjah, UAE); Xueli Tang (Faculty of Business and Law, Deakin University, AUSTRALIA) |
| Abstract: | The purpose of this paper is to conduct a theoretical and empirical analysis of the nexus between long-term care insurance (LTCI), formal care, informal (family) care, and bequests. In our empirical analysis, we use micro data from the Japan Household Panel Survey on Consumer Preferences and Satisfaction (JHPS-CPS), formerly known as the Preference Parameter Study, conducted by Osaka University. Japan is an interesting case to analyze because a public LTCI system was introduced there in 2000. Our analysis shows that, in the case of Japan, if parents are eligible for public LTCI benefits, their children will be less likely to be their primary caregiver and that this, in turn, will reduce their children's perceived likelihood of receiving a bequest from them. This result implies that bequests are selfishly or strategically motivated (i.e., that parents leave bequests to their children in order to elicit care from them) and that the introduction of a public LTCI system will reduce the likelihood of children providing care to their parents and through this channel reduce their perceived likelihood of receiving a bequest from them. |
| Keywords: | Altruistic bequests; Bequests; Caregiving; Elderly care; Family care; Formal care; Informal care; Long-term care; Long-term care insurance; Parental care; Selfish bequests; Strategic bequests |
| JEL: | D11 D12 D15 D64 E21 I13 J14 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:kob:dpaper:dp2024-24&r= |
| By: | Carolin Bauerhenne; Jonathan Bard; Rainer Kolisch |
| Abstract: | The global home healthcare market is growing rapidly due to aging populations, advancements in healthcare technology, and patient preference for home-based care. In this paper, we study the multi-day planning problem of simultaneously deciding patient acceptance, assignment, routing, and scheduling under uncertain travel and service times. Our approach ensures cardinality-constrained robustness with respect to timely patient care and the prevention of overtime. We take into account a wide range of criteria including patient time windows, caregiver availability and compatibility, a minimum time interval between two visits of a patient, the total number of required visits, continuity of care, and profit. We use a novel systematic modeling scheme that prioritizes health-related criteria as hard constraints and optimizes cost and preference-related criteria as part of the objective function. We present a mixed-integer linear program formulation, along with a nested branch-and-price technique. Results from a case study in Austin, Texas demonstrate that instances of realistic size can be solved to optimality within reasonable runtimes. The price of robustness primarily results from reduced patient load per caregiver. Interestingly, the criterion of geographical proximity appears to be of secondary priority when selecting new patients and assigning them to caregivers. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2407.06215&r= |
| By: | Miele, Kai R. |
| Abstract: | Exploiting future exposure to job termination in the UK, this paper finds that sharply increased job loss expectations before job termination significantly increase mental distress. This anticipation effect is largest in tight labor markets but does not spill over within couples. In contrast, anticipating job termination allows workers to switch positions without suffering unemployment. Leveraging variation in the industry-specific labor market tightness before the job termination, this paper shows that switching from a terminated position before its closure offsets over 70 percent of the negative labor market effects of the job termination, and mitigates its entire mental burden. |
| Keywords: | job loss, anticipation, mental health, unemployment, JEL classification: D84, I18, J28, J63 |
| Date: | 2024–07–08 |
| URL: | https://d.repec.org/n?u=RePEc:ajt:wcinch:82169&r= |
| By: | Elizabeth U. Cascio; Paul Cornell; Ethan G. Lewis |
| Abstract: | We estimate the effects of permanent legal status on the health of children born to immigrants in the United States using variation from the Immigration Reform and Control Act of 1986 (IRCA). Our empirical approach compares trends in birth outcomes for foreign-born Mexican mothers across counties with different application rates under IRCA’s large-scale legalization programs. Maternal legalization raised birthweight. Effects arose immediately after the application process began – five years before affected women became Medicaid-eligible – suggesting causal mechanisms besides improved access to early prenatal care. Changes in the composition of births, stemming from changes in fertility and family reunification, contribute to but far from fully explain the birthweight impacts. The more likely mechanisms were instead the increases in family income and reductions in stress that came from gaining legal status. |
| JEL: | I13 I14 I18 J15 J61 K37 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32635&r= |
| By: | Philip DeCicca; Maripier Isabelle; Natalie Malak |
| Abstract: | What happens when the findings of a prominent medical study are overturned? Using a medical trial on breech births, we estimate the effect of the reversal of such a medical study on physician choices and infant health outcomes. Using the United States Birth Certificate Records from 1995-2010, we employ a difference-in-differences estimator for C-sections, low Apgar, and low birth weight measures. We find that the reversal of a multi-site, high profile, randomized control trial on the appropriate delivery of term breech births, the Term Breech Trial (TBT), led to a 15-23 percent decline in C-sections for such births at a time when the overall trend in C-sections was rising. We find our largest estimated effects amongst traditionally disadvantaged groups. However, we do not find that such a change in practice had significant impacts on infant health. Contrary to prior studies, we find that physicians updated their beliefs quickly, and do indeed adjust to new medical research, particularly young physicians, prior to mandatory policy or professional guidelines. |
| JEL: | I11 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32656&r= |
| By: | Nicole Black (Monash University); Johannes S. Kunz (Monash University) |
| Abstract: | Language proficiency is a crucial skill for immigrants that influences their social integration and their children’s development. This study examines the intergenerational effects of limited English proficiency (LEP) on children’s health and health care utilisation. We mitigate potential selection issues arising from insurance coverage by examining Australian-born children who are all covered under a universal public health insurance scheme. We use Australian population Census and longitudinal survey data linked to administrative health care records, and variation in parent’s language acquisition, based on their age at arrival into Australia. We find that parental LEP has a strong and positive effect on children’s use of general practitioners, but no effect on their use of other healthcare services, or on their physical or mental health. We explore several possible supply- and demand-side explanations. |
| Keywords: | Language Proficiency, Health Outcomes, Second-Generation, Parenting Styles, Social Networks |
| JEL: | H40 I12 I20 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:2024-11&r= |
| By: | Boutin, Delphine (University of Bordeaux); Petifour, Laurene (Heidelberg University); Allard, Yvonne; Kontoubré, Souleymane (University of Ouagodougou); Ridde, Valéry (CEPED) |
| Abstract: | Offering health coverage to informal workers and their families is an ongoing and major challenge in most Sub-Saharan countries. As anchoring insurance to employment contracts is not possible and the demand for insurance is too low to deploy voluntarily sustainable schemes, alternative initiatives are needed. Bundling health insurance to microcredit is an option that we evaluate in this paper. We conducted a two-year cluster randomized controlled trial (RCT) to evaluate the impact of a compulsory micro-health insurance scheme integrated into a micro-loan system for informal micro-entrepreneurs in Ouagadougou, Burkina Faso. Our sample comprised 101 microcredit groups of a partner microfinance institution (MFI), among which we surveyed 1200 individuals (mostly female informal workers). The members of the 47 randomly selected treatment groups had to adhere to health insurance to get access to microcredit. In contrast, members of the 54 control groups did not get health insurance. We assessed the impact of subscription to health insurance on financial protection, healthcare utilization, and health out-comes, and estimated both the intention-to-treat effect (ITT) and the local average treatment effect (LATE). We did not identify any selective attrition, therefore there was no rejection of the MFI due to the health insurance product. Our results reveal a significant and positive impact of health insurance on financial protection. Out-of-pocket expenditures are reduced, as are difficulties in paying for healthcare and the adverse effects of healthcare expenses on professional activities. Health insurance encourages respondents to seek care at modern healthcare facilities rather than relying on self-medication and traditional healers. However, we find no significant impact on health outcomes, whether physical or psychological. Compulsory health insurance has the potential to offer financial protection against health risks to MFI members, a population that lacks social protection, without jeopardizing the retention rate of the MFI. It can create incentives for individuals to seek appropriate healthcare when necessary rather than relying on self-medication. However, the potential impacts on health involve indirect and long-term mechanisms, making them challenging to identify. |
| Keywords: | micro health insurance, financial protection, healthcare utilization, Informal sector, Burkina Faso |
| JEL: | I13 I15 O12 G21 O55 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17094&r= |
| By: | Kumar, Santosh (University of Notre Dame) |
| Abstract: | Exploiting cohort and spatial variation in the exposure to the "Universal Immunization Program", I estimate the program's effects on child mortality and educational attainment in India. Results show that exposure to the program reduced infant mortality by 0.4 percentage points and under-five child mortality by 0.5 percentage points. While the program clearly reduced mortality, it had mixed effects on children's educational outcomes due to changes in the composition of children in the population. I find it had a negative impact on primary school completion, but a positive impact on secondary school completion. The negative effect at low levels of schooling may be due to lower average health among marginal surviving children or a quantity-quality trade-off where the unanticipated survival of children induces families to under-invest in each child. The greater propensity to complete secondary school on the other hand may be due to improved health among children who are farther away from the margin of survival. |
| Keywords: | immunization, health, schooling, India |
| JEL: | I1 I2 J18 O15 O22 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17083&r= |
| By: | Le, Dung D. (Waseda University); Molina, Teresa (University of Hawaii at Manoa); Ibuka, Yoko (Keio University); Goto, Rei (Keio University) |
| Abstract: | Using data from 18 countries, we investigate the effects of child marriage bans on infant and under-5 mortality. We use variation in mothers' exposure to the ban across cohorts within each country and regional variation in "treatment intensity, " calculated based on child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced infant and under-5 mortality, with magnitudes of 14.3 and 19.9 percent corresponding to a one standard deviation change in treatment intensity. Reductions were driven by low-income countries and less wealthy households, primarily due to increases in age at first marriage and birth. |
| Keywords: | child marriage bans, early marriage, child mortality, Demographic and Health Surveys |
| JEL: | I10 I15 J12 J18 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17089&r= |
| By: | Madeline Duhon; Lia Fernald; Joan Hamory; Edward Miguel; Eric Ochieng; Michael W. Walker |
| Abstract: | This study exploits experimental variation in parent human capital (early-life school-based deworming) and a shock to schooling (extended Covid closures) to estimate how these factors interact in the production of child human capital within a sample of 3, 500 Kenyan 3-8 year olds. Parents with additional exposure to childhood deworming have children with improved human capital, including in health, non-cognitive development, and cognition; cognitive scores are +0.26 standard deviation units higher among treated parents' school-age children, only prior to school closures. Findings are interpreted through a model where home-based and school inputs are complements in the production of child cognition. |
| JEL: | I00 J24 O15 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32617&r= |
| By: | Chakrovorty, Sanchita |
| Abstract: | The overall health of a population can be viewed as an indicator of social welfare. Yet, individual health itself is complex and multidimensional, influenced by endogenous choices, as well as exogenous environmental and genetic factors. Moreover, defining a mapping from individual health to social welfare can involve onerous assumptions. This paper adopts a nonparametric approach to ranking individual health as a function of several biomarkers--Body Mass Index (BMI), glycohemoglobin (HbA1c), total cholesterol, alanine aminotransferase (ALT), serum creatinine, white blood cell counts (WBC), etc. With this ranking in hand, we use a nonparametric approach to map individual health into social welfare using minimal assumptions (e.g., monotonicity and concavity). Results show that the distribution of wellbeing became worse-off from 1988 to 2018, although there has been a slight rebound since 2009. Moreover, the distribution has widened: those prone to a higher health status have become better-off while those prone to poorer health have become worse-off which, thereby raising inequality and here policy implications need to be focused on. Finally, we construct counterfactual distributions of wellbeing to explore if the change in the distribution is attributed to socio-demographic factors. Findings show that age, gender and race/ethnicity cells combined with education can explain very little of the negative shift than the attributes without education while leaving a substantial portion unexplained. |
| Keywords: | Consumer/Household Economics |
| Date: | 2024–07–27 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea22:344176&r= |
| By: | Sabhlok, Sanjeev; Frijters, Paul (London School of Economics); Foster, Gigi (University of New South Wales); Bhattacharya, Jay (Stanford University); Joffe, Ari R (University of Alberta) |
| Abstract: | This paper reviews the history of the practice of quarantines, rediscovering the 19th century 'Sanitarian' movement in Britain that sprang from a recognition that quarantines had failed to stop the spread of diseases and were not cost-effective. To our knowledge, the key figure among the Sanitarians was Charles Maclean, who conducted the first cost-benefit analysis of quarantines. MacLean heavily influenced, among others, Southwood Smith and Edwin Chadwick, who, together with Jeremy Bentham, championed reforms that form part of the Public Health Act of 1848, which led to the primacy of sanitation efforts (such as pressurised water supply, sewage management, and garbage collection and safe disposal) in public health policy in the UK and elsewhere. Maclean convinced the Sanitarians that quarantines were not grounded in health science but instead formed part of the business model of a public health bureaucracy uninterested in public health and which was prepared to falsify and ignore data to survive. Arguably, the same can be said today with the modern version of quarantines being the Covid lockdowns of 2020-2021. We sketch a few preliminary institutional options for freeing public health efforts from bureaucratic expansion and mission drift and tethering them more robustly to the public interest. |
| Keywords: | public health, quarantines, social distancing, cost-benefit, excess deaths, health bureaucracy, mission drift |
| JEL: | I18 H00 N30 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17100&r= |
| By: | Hessami, Zohal (Ruhr University Bochum); Khasanboev, Temurbek (Ruhr University Bochum) |
| Abstract: | This paper sheds light on a neglected reason for women's underrepresentation in politics: crisis-induced gender gaps in incumbents' reelection with lasting negative effects on female representation. We use hand-collected data on 173, 339 candidates in open-list local council elections (1997-2021) in the German state of Hesse. We exploit the March 2021 election one year into the Covid-19 pandemic and exclusive local Covid-19 mortality data in a continuous DiD framework. In a setting where (individual) councilors had no role in fighting the pandemic, we provide robust evidence for a gender blame attribution gap: at an average of one death/1, 000 inhabitants, an additional death (≈ one SD treatment) leads to a 4.3 and 7.8 ppt lower reelection probability for male and female incumbents, respectively. Further results exclude various alternative mechanisms. Simulations predict persistent negative effects on future female councilor shares of 3-4 ppts. |
| Keywords: | gender, retrospective voting, incumbency, crisis, local elections, political selection |
| JEL: | D72 H12 H70 I18 J16 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17081&r= |
| By: | Sumedha Gupta; Dario Salcedo; Kosali I. Simon |
| Abstract: | Schools enhance the lives of families in various ways, and one potential consequence of their closures is worsened parental well-being. We study the effects of COVID-19 pandemic school closures on parental mental health by measuring consumption of products that are often used to cope with increased stress and depression. Using a cohort based difference in difference (DID) design and commercial claims data, we find an increase in maternal anti-depressant use by 1.5%, in zip codes with above median school closures; there are no statistically significant effects for paternal antidepressant use, and we are able to rule out fairly small values. Some parents may "self-medicate" as a coping mechanism rather than seek formal medical care. Using a county based DID design and retail scanner data, we find alcohol sales increased by 2% in counties with above median school closures. Both anti-depressant prescriptions and alcohol sales returned to base line levels as in-person schooling resumed. We explore whether the burdens of school closures were disparately concentrated in minoritized communities, and find that anti-depressant and alcohol use increases were concentrated in zip codes with above median Black and Asian populations, but not in zip codes with a predominantly White or Hispanic population. Overall, these results suggest that the school system plays an important role in maintaining population mental well-being outcomes and in helping families cope with stress. |
| JEL: | I0 |
| Date: | 2024–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32516&r= |
| By: | Selien De Schryder; Nikolaos Koutounidis; Koen Schoors; Johannes Weytjens (-) |
| Abstract: | The transmission of the pandemic shock to the macroeconomy through the prism of consumer heterogeneity is the focal point of this paper. Based on a rich bank account and transactions micro dataset, we assess the roles of local COVID-19 severity, government measures against the spread of the virus, and vaccination rates for households’ consumption behavior in Belgium. We induce that households living in areas that experienced high COVID-19 positivity rates and more stringent containment measures, decreased their consumption more. The relevance of these effects, however, shifted over the course of the pandemic. Higher local vaccination rates significantly counteracted these negative impacts on household consumption. Furthermore, our study highlights that the impact of these factors on consumption varied distinctly across households with different income, liquid wealth, and age characteristics. |
| Keywords: | COVID-19, pandemic, lockdown, consumption, income, transactions data, heterogeneity |
| JEL: | D12 E21 E65 G51 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:rug:rugwps:24/1090&r= |