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on Health Economics |
| By: | Liam Sigaud; Markus Bjoerkheim; Vitor Melo |
| Abstract: | Under the ACA, the federal government paid a substantially larger share of medical costs of newly eligible Medicaid enrollees than previously eligible ones. States could save up to 100% of their per-enrollee costs by reclassifying original enrollees into the newly eligible group. We examine whether this fiscal incentive changed states' enrollment practices. We find that Medicaid expansion caused large declines in the number of beneficiaries enrolled in the original Medicaid population, suggesting widespread reclassifications. In 2019 alone, this phenomenon affected 4.4 million Medicaid enrollees at a federal cost of $8.3 billion. Our results imply that reclassifications inflated the federal cost of Medicaid expansion by 18.2%. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2407.07217 |
| By: | Costa-Font, Joan; Cowell, Frank |
| Abstract: | An individual’s inequality aversion (IA) is a central preference parameter that captures the welfare sacrifice from exposure to inequality. However, it is far from trivial how to best elicit IA estimates. Also, little is known about the behavioural determinants of IA and how they differ across domains such as income and health. Using representative surveys from England, this paper elicits comparable estimates of IA in the health and income domains using two alternative elicitation techniques: a direct trade-off and an indirect “imaginary-grandchild” approach that results from the choices between hypothetical lotteries. We make three distinct contributions to the literature. First, we show that IA systematically differs between income and health domains. Average estimates are around 0.8 for income IA and range from 0.8 to 1.5 for health IA. Second, we find that risk aversion and locus of control are central determinants of IA in both income and health domains. Finally, we present evidence suggesting that the distribution and comparison of IA vary depending on the elicitation method employed. |
| Keywords: | inequality and efficiency trade-offs; locus of control; inequality aversion; income inequality aversion; health inequality aversion; imaginary grandchild; risk attitudes |
| JEL: | H10 I18 |
| Date: | 2024–03–24 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:124423 |
| By: | Juergen Jung (Department of Economics, Towson University); Vinish Shrestha (Department of Economics, Towson University) |
| Abstract: | We use an overlapping generations model with labor supply decisions, health risk, and health insurance choices to investigate the impact of proposed work requirements for Medicaid eligibility. Calibrating the model to US data, we simulate counterfactual experiments with a minimum weekly work hours requirement. Our partial and general equilibrium results indicate that Medicaid work requirements increase labor force participation, reduce hours worked, and boost output. However, most scenarios show overall welfare losses, mitigated somewhat by general equilibrium effects. Welfare losses are higher among low-income households, smaller for middle-income households, and result in gains for high-income households. The smallest welfare loss occurs when the reform targets healthy individuals, allowing sicker individuals to remain on Medicaid regardless of their work status. |
| Keywords: | The Patient Protection and Affordable Care Act (ACA), Medicaid expansion, Labor supply, Labor market distortions, Health risk. |
| JEL: | H51 I13 I14 I38 J21 D58 |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:tow:wpaper:2024-10 |
| By: | Adamopoulou, Effrosyni; Colombo, Mattia; Triviza, Eleftheria |
| Abstract: | This study examines how early-life exposure to food scarcity influences individuals' long-term time preferences and savings behavior. To this end, we analyze hand-collected historical data on livestock availability during World War II at the provincial level, alongside detailed survey data on elicited time preferences and household savings. By leveraging differences across cohorts and provinces in a difference-in-differences framework, we find that individuals who experienced more severe scarcity during early childhood develop higher levels of patience later in life and tend to hold more (precautionary) savings, conditional on income. Our findings suggest that exposure to protein scarcity during the first years of life and in utero can instigate a lasting increase in prudent behavior in the form of a coping mechanism. |
| Keywords: | patience, precautionary savings, scarcity, early life experiences |
| JEL: | D14 N44 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:300679 |
| By: | Lindsey Lacey; Nirajana Mishra; Priya Mukherjee; Nikhilesh Prakash; Nishith Prakash; Diane Quinn; Shwetlena Sabarwal; Deepak Saraswat |
| Abstract: | We conducted a randomized control trial to study the impact of two information messages aimed at reducing the stigma associated with mental illness on the willingness to seek mental healthcare among adults in Nepal. The first intervention shares information about the prevalence of mental health issues and the efficacy of treatment. The second intervention shares information about the mental health struggles of a Nepali celebrity and how he benefited from treatment. We find three results. First, compared to a no-information control group, both interventions increase participants’ stated willingness to seek mental health treatment. This effect is driven by participants with high personal and anticipated stigma, less severe symptoms of depression and anxiety, and who hold strong beliefs about conformity to masculinity. Second, the impact on participants’ stated willingness to seek mental health treatment mirrors their willingness to pay for counseling. Third, participants are, on average, more likely to report willingness to seek help when the enumerator is female. |
| Keywords: | mental health, stigma, prejudice, seeking help, celebrity, Nepal |
| JEL: | I12 I15 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11241 |
| By: | Luo , Wei (Jinan University); Huang, Wei (Peking University); Park, Albert (Asian Development Bank) |
| Abstract: | We study the influence of social norms in determining the impact of early life exposure to the Great Chinese Famine of 1959–1961 on gender inequality. We model how social norms interact with adverse shocks to affect male and female survival chances and influence subsequent human capital investments. We test these predictions empirically by using the Fifth National Population Census of the People’s Republic of China in 2000 that has information on birthplace and estimate a difference-in-differences model that combines cohort and regional variation in exposure to the famine with regional variation in the culture of son preference. We find that son preference buffers the negative impact of intrauterine famine shocks on cohort male-to-female sex ratios and reduces famine’s impact on gender inequality in health and education. |
| Keywords: | famine; son preference; sex ratios; human capital investment |
| JEL: | I24 I26 J13 J16 |
| Date: | 2024–08–16 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:0738 |
| By: | Mustafa Özer; Jan Fidrmuc |
| Abstract: | Mental health is essential for well-being and quality of life. Yet, our knowledge of the determinants of mental health is limited. We analyze the impact of education on mental health using survey data on self-reported health of Turkish women. To deal with the potential endogeneity, we rely on a natural experiment: an increase in the compulsory education from 5 to 8 years in 1997. The results suggest that education has a favorable effect on mental health, physical health, and being target of abusive behavior. We specifically consider intra-family spillovers, which are important: husband’s education has favorable effects on the wife’s mental health, and both parents’ educational attainments improve mental health of children. We account for the implications of assortative mating whereby the spouses’ educational attainment are correlated. We show that each spouse’s education has a favorable impact on women’s mental health, but the effect of husbands’ education dominates that of wives’ education. These effects are particularly pronounced among women who grew up in low-income provinces and in families without history of childhood abuse. |
| Keywords: | health, mental health, education, instrumental variable, natural experiment |
| JEL: | H51 H52 I12 I26 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11213 |
| By: | Briana Ballis (University of California, Merced) |
| Abstract: | Racial disparities in infant health conditions have persisted for decades. However, there is surprisingly limited evidence regarding the long-term consequences of these disparities. Using novel linked administrative data from Texas and the shift to Medicaid Managed Care (MMC), I show that MMC-driven declines in infant health worsened cognitive and noncognitive outcomes for Black children, while MMC-driven enhancements in infant health improved noncognitive outcomes and educational attainment for Hispanics. Effects concentrate in low-value added districts for either demographic, suggesting that the long run impacts of changes to early life health conditions are more pronounced in less effective schools for one’s demographic. |
| Keywords: | racial disparities, infant health, Medicaid, Medicaid Managed Care, MMC, early life health |
| JEL: | I14 I21 I24 I32 I38 J13 J15 J24 |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:hka:wpaper:2024-016 |
| By: | Diana M Nova Díaz; Aritz Adin; Eduardo Sánchez Iriso |
| Abstract: | Responses on health-related quality of life measured by disease-specific instruments can be mapped onto the EQ-5D-5L to estimate utility values for economic evaluation. San Martin´s Quality of Life Scale (St. MQoL-S) is a preferred measure to obtain health outcomes in adults with cerebral palsy. Nevertheless, it lacks a preference-based health utility score for estimating quality-adjusted life years (QALYs). |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:fda:fdaddt:2024-07 |
| By: | Si, Yafei; Yang, Yuyi; Wang, Xi; An, Ruopeng; Zu, Jiaqi; Chen, Xi; Fan, Xiaojing; Gong, Sen |
| Abstract: | Using simulated patients to mimic nine established non-communicable and infectious diseases over 27 trials, we assess ChatGPT's effectiveness and reliability in diagnosing and treating common diseases in low- and middle-income countries. We find ChatGPT's performance varied within a single disease, despite a high level of accuracy in both correct diagnosis (74.1%) and medication prescription (84.5%). Additionally, ChatGPT recommended a concerning level of unnecessary or harmful medications (85.2%) even with correct diagnoses. Finally, ChatGPT performed better in managing non-communicable diseases compared to infectious ones. These results highlight the need for cautious AI integration in healthcare systems to ensure quality and safety. |
| Keywords: | ChatGPT, Large Language Models, Generative AI, Simulated Patient, Healthcare, Quality, Safety, Low- and Middle-Income Countries |
| JEL: | C0 I10 I11 C90 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1472 |
| By: | Wookun Kim |
| Abstract: | This paper presents novel causal evidence on the effects of pro-natalist cash transfers on fertility, sex ratio at birth, and infant health. In the context of South Korea, I exploit rich spatial and temporal variation in cash transfers provided to families with newborn babies and the universe of birth-, death-, and migrant-registry records. I find that the total fertility rate in 2015 would have been 4.7% lower without the cash transfers. Surprisingly, the cash transfers had an unintended consequence of correcting the unnaturally male-skewed sex ratio at birth. The cash transfers led to reductions in gestational age and birth weight, but no change in early-life mortality. A rich heterogeneity analysis suggests that negative selection into childbearing may explain the health effects and that cash transfers may increase birth weight for low-income families. |
| Keywords: | pro-natalist policies, cash transfer, fertility, infant health, sex ratio at birth, son preference |
| JEL: | H40 H75 J13 J16 J18 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11215 |
| By: | Abhishek Dureja (Plaksha University); Digvijay S. Negi (Ashoka University) |
| Abstract: | Can maternal health-seeking behavior change with subsequent births? We find a 5 percentage point decline in the likelihood of a mother delivering her later born in an institutional facility compared to her first born. We also observe a 4 percentage point decline in medically supervised births for higher birth order children. These effects seem to be driven by changed risk perceptions associated with a complication free first child’s delivery and increased financial constraints. Improvements in roads and banking infrastructure attenuate this negative birth order gradient. Results highlight the importance of birth order as an important determinant of maternal health-seeking behavior. |
| Keywords: | Birth order; India; institutional delivery; prenatal investments |
| Date: | 2024–07–30 |
| URL: | https://d.repec.org/n?u=RePEc:ash:wpaper:118 |
| By: | Gby Atee (Ashoka University); Aparajita Dasgupta (Ashoka University); Sneha Lamba (Ashoka University) |
| Abstract: | How fertility responds to the changes in the disease environment is an important question for understanding population dynamics. We investigate this question in the context of the COVID-19 pandemic in India. We leverage the intensity of the nationwide mobility restrictions in difference-in-differences and event study frameworks to estimate the impact of the pandemic on fertility in the country. To do this, we harmonise district-wise data on lockdown intensity with birth histories from the latest round of the National Family Health Survey 2019-2021 (NFHS-5). We find a 0.2 percentage point increase in the probability of births in the post-COVID period compared to the pre-COVID period — the effect starts at nine months after the first lockdown in India and tapers off ten months later. Strikingly, the rise in fertility is most prominent in states with higher fertility rates at the baseline and in districts which are likely to have high reverse migration during COVID. We also find that the increase in fertility occurred for the higher order births. In contrast, we find a decline in the probability of first order births in districts with most restrictions on mobility. We explore potential mechanisms and find a significant decrease in the use of modern contraceptives in the post-COVID period, which aligns with our main finding. Our results have important implications for understanding fertility behaviour and human capital investments in the face of shocks. |
| Keywords: | COVID-19; Fertility; Healthcare; India; Shock |
| Date: | 2024–07–09 |
| URL: | https://d.repec.org/n?u=RePEc:ash:wpaper:115 |
| By: | Pinkney, Connor; Kirkbride, James Bowes (UCL); Boyd, Andy; Zammit, Stanley; Newbury, Joanne |
| Abstract: | Background The first COVID-19 lockdown in the UK was initially hailed as a great leveller. However, given that people were restricted to their homes and immediate neighbourhoods, there were stark inequalities in how different people experienced lockdown. Nevertheless, evidence on the associations of home and neighbourhood conditions in mental health during lockdown is sparce. Methods Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based cohort, we examined associations of home and neighbourhood conditions with anxiety and depression symptoms at two points during the first UK lockdown in 2020 (23/03/20-15/06/20). Questionnaires were sent to the ALSPAC cohort at two timepoints (T1: April; T2: May/June), including validated measures of mental health, and questions about current home conditions and behaviours, including access to nature, garden access, house type, and household composition. Neighbourhood conditions were obtained via a novel linkage, and included neighbourhood deprivation, population density, social fragmentation, and greenspace. Main associations were examined using linear regression. Potential confounders were identified using a directed acyclic graph and included ethnicity, family psychiatric history, maternal social class, financial difficulties before lockdown, and previous anxiety and depression at age 18. Findings At T1, reduced access to nature (B=1.06, 95% CI=0.68-1.45, p<0.001) and neighbourhood deprivation (B=0.25, 95% CI=0.02-0.48) were associated with anxiety. Furthermore, reduced access to nature (B=0.99, 95% CI=0.57-1.40, p<0.001), no garden access (B=0.62, 95% CI=0.04-1.20, p=0.037), living alone (B=1.53, 95% CI=0.63-2.43, p=0.001), and neighbourhood deprivation (B=0.27, 95% CI=0.02-0.52, p=0.033) were associated with depression. Associations were similar, but often weaker, at T2. For example, there was strong evidence of associations only for access nature with anxiety (B=0.74, 95% CI=0.25-1.23, p=0.004); and for access to nature (B=1.06, 95% CI=0.50-1.61, p=0.001) and living alone (B=1.19, 95% CI=0.25-2.13, p=0.013) with depression. Interpretation Disadvantaged home and neighbourhood conditions, especially reduced access to nature and neighbourhood deprivation, were associated with more anxiety and depression symptoms during the first UK lockdown. In the case of future pandemics, mitigation efforts should be tailored to reduce the burden on mental health for those most vulnerable. However, the causality of these observational findings is uncertain. |
| Date: | 2024–07–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:m2wjd |
| By: | Regassa, Mekdim D.; Esenaliev, Damir; Tzvetkova, Milena; Baliki, Ghassan; Schreiner, Monika; Stojetz, Wolfgang; Brück, Tilman |
| Abstract: | We study the impact of exposure to COVID-19 on food security and diet diversity in four African countries (Uganda, Tanzania, Sierra Leone and Mozambique), using phone-based survey data collected throughout 2021. We find that in 2021, one in two households faced moderate-to-severe food insecurity and one in three households had borderline to poor diet diversity score. Food insecurity and poor diet diversity are particularly pronounced among certain groups of households, who characterize with large family sizes, low access to public services, own fewer assets, and mostly have a female, younger, and less educated person as household head. Both food insecurity and poor diet diversity are positively associated with exposure to COVID-19 – either through individual experience of having a virus or having people in their surroundings who had the virus. We show that tighter movement restrictions and a more drastic decline in household income in COVID-19-exposed areas were the main reasons for worsened food insecurity and poorer diet diversity. Vulnerable households rarely received financial support from governments, forcing many of them to use harmful food- related coping strategies and to borrow from other households. |
| Keywords: | Food Security and Poverty, Health Economics and Policy, Labor and Human Capital |
| Date: | 2024–08–07 |
| URL: | https://d.repec.org/n?u=RePEc:ags:cfcp15:344321 |