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on Health Economics |
| By: | Christopher J. Ruhm |
| Abstract: | Increases in “deaths of despair” have been hypothesized to provide an important source of the adverse mortality experiences of some groups at the beginning of the 21st century. This study examines this possibility and uncovers the following primary findings. First, mental health deteriorated between 1993 and 2019 for all population subgroups examined. Second, these declines raised death rates and contributed to the adverse mortality trends experienced by prime-age non-Hispanic Whites and, to a lesser extent, Blacks from 1999-2019. However, worsening mental health is not the predominant explanation for them. Third, to extent these relationships support the general idea of “deaths of despair”, the specific causes comprising it should be both broader and different than previously recognized: still including drug mortality and possibly alcohol deaths but replacing suicides with fatalities from heart disease, lower respiratory causes, homicides, and conceivably cancer. Fourth, heterogeneity in the consequences of a given increase of poor mental health are generally more important than the sizes of the changes in poor mental health in explaining Black-White differences in the overall effects of mental health on mortality. |
| JEL: | I1 I14 I18 J10 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32978 |
| By: | Itzik Fadlon; Parag Agnihotri; Christopher Longhurst; Ming Tai-Seale |
| Abstract: | Digital technologies are bringing vast improvements to modern society but also carry the risk of perpetuating disparities if adopted at lower rates by underserved communities. We investigate the efficiency and equity aspects of technological advancement in digital health by studying an intervention of “remote patient monitoring” that enabled patients to transmit real-time clinical data for timely treatment. The program was deployed at the Academic Medical Center UC San Diego Health among a diverse population of patients and targeted hypertension management to reduce the risk of cardiovascular disease. From an efficiency standpoint, we find significant and persistent reductions in cardiovascular risk, which are notable across all subgroups of gender, age, race/ethnicity, and geographic affluence. Evidence suggests both reduced frictions in the provision of care and improved health behaviors as mechanisms. The program also led to significant reductions in healthcare utilization costs from improved hypertension control. From an equity standpoint, however, we find that the longer-run health gains from the program fell short among underserved patient subpopulations, inducing inequities in the reductions in cardiovascular risk. The new technology was systematically adopted at lower rates by Black/Hispanic patients and by patients from disadvantaged geographic communities, who were less likely to either take up or adhere to the program. Overall, our analysis highlights the simultaneous promise and hazards of digital health technologies. We further provide evidence that primary care physicians and the nature of their relationship with patients can have a promising role in promoting greater and more equitable adoption of digital health. |
| JEL: | I1 J1 O3 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32992 |
| By: | Guilio Fella; Martin B. Holm; Thomas M. Pugh |
| Abstract: | We use administrative data for Norway to estimate an incomplete-market life-cycle model of retired singles and couples with a bequest motive, health-dependent utility, and uncertain longevity and health. We allow the parameters of the bequest utility to differ between households with and without offspring. Our estimates imply a very strong utility of residual wealth (bequest motive), in line with the estimates by Lockwood (2018). The bequest motive accounts for approximately three-quarters of aggregate wealth at age 85. More surprisingly, we estimate similar utility of residual wealth for households with and without offspring. We interpret this as, prima facie, evidence that the utility of residual wealth represents forces beyond an altruistic bequest motive. |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:bbq:wpaper:0008 |
| By: | Ross Abram; Margherita Borella; Mariacristina De Nardi; Rory McGee; Nicolo Russo |
| Abstract: | We measure health inequality during middle and old age by race, ethnicity, and gender and evaluate the extent to which it can explain inequalities in other key economic outcomes using the Health and Retirement Study data set. Our main measure of health is frailty, which is the fraction of one’s possible health deficits and is related to biological age. We find staggering health inequality: At age 55, Black men and women have the frailty, or biological age, of White men and women 13 and 20 years older, respectively, while Hispanic men and women exhibit frailty akin to White men and women 5 and 6 years older. The health deficits composing frailty reveal that most health deficits are more likely for Black and Hispanic people than for White people, with the notable exception of those requiring a diagnosis. Imputing medical diagnoses to Black and Hispanic people uncovers even larger health gaps, especially for Black men. Health inequality also emerges as a powerful determinant of economic inequality. If Black individuals at age 55 had the health of their White peers, the life expectancy gap between these two groups would halve, and the gap in disability duration would decrease by 40-70%. Other outcomes are similarly affected by health at age 55, indicating that targeted health interventions for minority groups before middle age could substantially reduce economic disparities in the quantity and quality of life. |
| Keywords: | Gender; Health inequality; economic disparities; Ethnicity; Race |
| JEL: | I14 H31 D12 |
| Date: | 2024–10–01 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fedmoi:98906 |
| By: | Alexander Ahammer; Gerald J. Pruckner; Flora Stiftinger |
| Abstract: | We estimate the long-run labor market and health effects of breast cancer among Austrian women. Compared to a random sample of same-aged non-affected women, those diagnosed with breast cancer face a 22.8 percent increase in health expenses, 6.2 percent lower employment, and a wage penalty of 15 percent five years after diagnosis. Although affected women sort into higher quality jobs post-diagnosis, this is offset by a reduction in working hours. We argue that the hours reduction is more likely driven by an increase in the time preference rate, meaning that patients increasingly value the present over the future, rather than by an incapacitation effect or employer discrimination. |
| Keywords: | Breast cancer, labor supply, health shocks, time discounting |
| JEL: | I10 J22 I12 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:jku:econwp:2024-09 |
| By: | Dunia Kabunga, Philippe; Geenen, Sara; Bashizi, Anuarite |
| Abstract: | Artisanal and small-scale mining (ASM) in the Eastern Democratic Republic of Congo presents various occupational health and safety risks, as documented by research from the Catholic University of Bukavu's Centre of Expertise in Mining Governance. The study emphasizes the need for tailored OHS approaches for different worker types and operations, with management strategies involving existing practices and collaboration among state agencies, cooperatives, workers, and stakeholders. |
| Keywords: | Artisanal and small-scale mining, DRC, DR Congo, Democratic Republic of Congo |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:iob:apbrfs:2024006 |
| By: | Libertad González; Luis Guirola; Laura Hospido |
| Abstract: | We provide evidence of fathers’ time-use during paternity leave by studying the timing of paternity leave spells around a large sports event with strong male following: the 2022 Soccer World Cup. We use administrative data from Spain, a country with generous paternity leave policies and a strong following of soccer competitions. Our data cover the universe of paternity (and maternity) leave spells, and we exploit the exact dates of the 2022 World Cup in a difference-in-differences framework. We show that, during the exact dates of the Qatar World Cup (November 20-December 18, 2022), there was a daily excess of more than 1, 000 men on paternity leave (1.3%), relative to the surrounding dates, and using the year before and after as controls (for seasonality). We also show in triple-differences specifications that this excess is not present in maternity leave spells, or in paternity leave spells among self-employed workers (with much more flexible schedules). We interpret these results as direct evidence that (at least a fraction of) fathers use paternity leave for purposes unrelated to childcare. |
| Keywords: | gender inequality, paternity leave, childcare |
| JEL: | J13 J16 J22 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1463 |
| By: | Pepin, Gabrielle (Upjohn Institute for Employment Research) |
| Abstract: | The Child and Dependent Care Credit (CDCC), a tax credit based on income and child care expenses, reduces child care costs for working families. The Economic Growth and Tax Relief Reconciliation Act expanded the CDCC in 2003, generating differential increases in generosity across states and family sizes. Using data from the March Current Population Survey, the author finds that a $100 increase in CDCC generosity increases paid child care participation by 0.6 percentage points among single mothers and 2.2 percentage points among married mothers with children younger than 13 years old. The author also finds that CDCC benefits increase labor supply among married mothers, who may experience long-run earnings gains. |
| Keywords: | child care subsidies, paid child care participation, female labor supply |
| JEL: | J13 H24 J22 H71 |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17238 |
| By: | Zhang, Xin (Beijing Normal University); Wang, Yixuan (Ohio State University); Hu, Xingyi (Ohio State University); Chen, Xi (Yale University) |
| Abstract: | This paper examines the impact of fetal exposure to air pollution on low-stakes test performance across a broad age range, with a focus on gender-specific parental responses to this negative shock. Using data from a nationally representative survey in China, we find that fetal PM2.5 exposure significantly reduce cognitive ability in women, particularly those with brothers. Gender-biased human capital investment by families tends to amplify the harmful effects for girls, while diminishing these effects for boys. Specifically, when exposed to the same level of fetal PM2.5, females receive less homework assistance from their families and attain lower levels of education. |
| Keywords: | air pollution, cognitive ability, fetal exposure, gender bias, parental investment |
| JEL: | Q53 I24 D13 J16 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17288 |
| By: | Dang, Hai-Anh H.; Trinh, Trong-Anh; Verme, Paolo |
| Abstract: | Hardly any evidence exists on the effects of mental distress on refugee labor outcomes. We offer the first study on this topic in the context of Australia, one of the host countries with the largest number of refugees per capita in the world. Analyzing the Building a New Life in Australia longitudinal survey, we exploit the variations in traumatic experiences of refugees interacted with post-resettlement time periods to causally identify the impacts of refugee mental health. We find that worse mental health, as measured by a one-standard-deviation increase in the Kessler mental health score, reduces the probability of employment by 11.9% and labor income by 22.8%. These effects appear more pronounced for refugees that newly arrive or are without social networks, but they may be ameliorated with government support. These findings have significant implications for the development of health and labor policies, particularly regarding the integration of refugees within host countries. |
| Keywords: | refugees; mental health; labor outcomes; instrumental variable; BNLA longitudinal survey; Australia |
| JEL: | J61 O15 J15 J21 |
| Date: | 2023–12–01 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:120053 |
| By: | Elena Bassoli (ETH Zürich; Ca’ Foscari University of Venice); Agar Brugiavini (Department of Economics, Ca’ Foscari University of Venice; Institute for Fiscal Studies); Ludovico Carrino (University of Trieste; King’s College London) |
| Abstract: | This paper provides new evidence on the cost of long-term care for individuals and society by looking at the onset of dementia in a population of older individuals aged 50 and above. By exploiting the Survey of Ageing and Retirement in Europe (SHARE) and the English Longitudinal Survey of Ageing (ELSA), we causally assess how a dementia shock affects commodities purchases and other domains of individual's life, in the short-run. We find that individuals reduce food consumption and increase rent and housing-related expenditures. We show that the demand for care is also affected, with an increase in both hospital, formal and informal care. Results are robust to alternative definitions of the shock and sensitivity analyses. Additionally, we discover spill-over effects on the spouse's well-being when the partner becomes sick. Finally, we compute the financial burden on individuals following a dementia diagnosis in terms of formal and informal care costs. |
| Keywords: | health economics, long-term care, SHARE, ELSA, welfare costs |
| JEL: | I12 I14 J14 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ven:wpaper:2024:13 |
| By: | Jonathan Batty (University of Leeds); Marlous Hall (University of Leeds) |
| Abstract: | Routinely collected healthcare data (including electronic healthcare records and administrative data) are increasingly available at the whole-population scale, and may span decades of data collection. These data may be analysed as part of clinical, pharmacoepidemiologic and health services research, producing insights that improve future clinical care. However, the analysis of healthcare data on this scale presents a number of unique challenges. These include the storage of diagnosis, medication and procedure codes using a number of discordant systems (including ICD-9 and 10, SNOMED-CT, Read codes, etc.) and the inherently relational nature of the data (each patient has multiple clinical contacts, during which multiple codes may be recorded). Pre-processing and analysing these data using optimised methods has a number of benefits, including minimisation of computational requirements, analytic time, carbon footprint and cost. We will focus on one of the main issues faced by the healthcare data analyst: how to most efficiently collapse multiple, disparate diagnosis codes (stored as strings across a number of variables) into a discrete disease entity, using a pre-defined code list. A number of approaches (including the use of Boolean logic, the inlist function, string functions and regular expressions) will be sequentially benchmarked in a large, real-world healthcare dataset (n = 192 million hospitalisation episodes during a 12-year period; approximately 1 terabyte of data). The time and space complexity of each approach (in addition to its carbon footprint), will be reported. The most efficient strategy has been implemented into our newly-developed Stata command: codefinder, which will be discussed. |
| Date: | 2024–09–16 |
| URL: | https://d.repec.org/n?u=RePEc:boc:lsug24:21 |
| By: | Rachel Glennerster; Catherine Che; Sarrin M. Chethik; Claire T. McMahon; Christopher M. Snyder |
| Abstract: | This paper evaluates the social value of investing in vaccine research, development, and manufacturing capacity for pandemic preparedness and response. Rapid vaccination during pandemics can significantly reduce mortality, economic losses, and societal disruptions. However, vaccine manufacturers often lack sufficient incentives for speed and capacity expansion. Strategic policies by governments and international organizations could enhance these incentives and improve equitable vaccine distribution. |
| JEL: | I15 I18 L65 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:32984 |