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on Health Economics |
| By: | Joshua Angrist; Bruno Ferman; Carol Gao; Peter Hull; Otavio L. Tecchio; Robert W. Yeh |
| Abstract: | The ISCHEMIA Trial randomly assigned patients with ischemic heart disease to an invasive treatment strategy centered on revascularization with a control group assigned non-invasive medical therapy. As is common in such “strategy trials, ” many participants assigned to treatment remained untreated while many assigned to control crossed over into treatment. Intention-to-treat (ITT) analyses of strategy trials preserve randomization-based comparisons, but ITT effects are diluted by non-compliance. Conventional per-protocol analyses that condition on treatment received are likely biased by discarding random assignment. In trials where compliance choices are made shortly after assignment, instrumental variables (IV) methods solve both problems—recovering an undiluted average causal effect of treatment for treated subjects who comply with trial protocol. In ISCHEMIA, however, some controls were revascularized as long as five years after random assignment. This paper extends the IV framework for strategy trials, allowing for such dynamic non-random compliance behavior. IV estimates of long-run revascularization effects on quality of life are markedly larger than previously reported ITT and per-protocol estimates. We also show how to estimate complier characteristics in a dynamic-treatment setting. These estimates reveal increasing selection bias in naive time-varying per-protocol estimates of revascularization effects. Compliers have baseline health similar to that of the study population, while control-group crossovers are far sicker. |
| JEL: | C26 C32 I10 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33296 |
| By: | Henning Hermes (ifo Institute Munich); Marina Krauß (University of Augsburg); Philipp Lergetporer (Technical University of Munich); Frauke Peter (German Centre for Higher Education Research and Science Studies); Simon Wiederhold (University of Halle) |
| Abstract: | We provide experimental evidence that enabling access to universal early child care increases maternal labor supply and promotes gender equality among families with lower socioeconomic status (SES). Our intervention offers information and customized help with child care applications, leading to a boost in child care enrollment among lower-SES families. 18 months after the intervention, we find substantial increases in maternal full-time employment (+160%), maternal earnings (+22%), and household income (+10%). Intriguingly, the positive employment effects are not only driven by extended hours at child care centers, but also by an increase in care hours by fathers. Gender equality also benefits more broadly from better access to child care: The treatment improves a gender equality index that combines information on intra-household division of working hours, care hours, and earnings by 40% of a standard deviation, with significant increases in each dimension. For higher-SES families, we consistently observe negligible, insignificant treatment effects. |
| Keywords: | maternal employment |
| JEL: | J13 J18 J22 C93 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:hka:wpaper:2024-023 |
| By: | Timothy Layton; Eran Politzer |
| Abstract: | Setting payment rates for providers contracted over multiple periods is a persistent challenge in government procurement. We study the dynamics of fiscal costs following the outsourcing of Medicaid provision to private health insurers by states. We focus on beneficiaries with disabilities who account for a third of Medicaid's spending. Using a national administrative database, we identify county-level private plan enrollment mandates and exploit them as an instrument for individuals' transition to managed care plans. These transitions, while initially slightly reducing fiscal costs, lead to a continuous increase in Medicaid's costs over subsequent years. Counties subject to mandates experience a 9.8% higher cost four years post-mandate compared to those without mandates. "Actuarially sound" endogenous payment rates, that are based on past costs in the market, may serve as mechanism underlying the rising spending. |
| JEL: | H0 H70 I1 I13 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33302 |
| By: | De Groote, Olivier (Toulouse School of Economics); Rho, Minyoung |
| Abstract: | We use data from a platform that centralizes a day care matching process. We estimate parents' preferences and nursery priorities by analyzing parents' rank-ordered lists and nurseries' acceptance decisions. We account for strategic behavior by using a novel estimation approach inspired by the dynamic discrete choice framework. We use the estimates to evaluate centralized matching policies tailored to the day care setting. We compare mechanisms and assess the effects of subsidies, increased capacity, and affirmative action. We find that affirmative action policies are crucial for boosting the participation of disadvantaged children, though they increase segregation due to location-based preferences. |
| Keywords: | day care, affirmative action, segregation, centralized matching markets, CCP estimation |
| JEL: | C61 D82 I24 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17547 |
| By: | Krekel, Christian; Shreedhar, Ganga; Lee, Helen; Marshall, Claire; Boler, Alison; Smith, Allison; Dolan, Paul |
| Abstract: | We study the wellbeing returns from volunteering in England's National Health Service (NHS) Volunteer Responders, set up in response to Covid-19. Using linked survey and administrative data, we exploit the oversubscription of volunteers and the random allocation of tasks via an app to establish causality. Volunteers show stronger wellbeing and feelings of belongingness and connectedness to their local area. Welfare analyses suggest that the benefits of the programme substantially exceeded its costs. We are the first to study the welfare effects of a nationwide volunteering programme. Our findings show that pro-social behaviour improves personal wellbeing as well as social welfare. |
| Keywords: | volunteering; pro-social behaviour; causal wellbeing returns; quasi-experiment; welfare analysis |
| JEL: | I31 I38 D61 D64 |
| Date: | 2024–11–25 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126209 |
| By: | Brekke, Kurt R. (Dept. of Economics, Norwegian School of Economics and Business Administration); Dalen, Dag Morten (Dept. of Economics, BI Norwegian Business School); Straume, Odd Rune (Dept. of Economics, University of Bergen) |
| Abstract: | Pharmaceutical expenditures are rising rapidly, driven in part by the innovation of highly effective but very expensive drug therapies that treat multiple diseases. While these drugs offer substantial health benefits, payers face a critical trade-off between cost containment and access to new medicines. A key policy question is whether producers should be restricted to uniform pricing or allowed to use indication-based pricing, where prices vary across patient groups. We analyse how this choice affects drug producers' incentives to invest in new indications, their pricing strategies, and the resulting surplus for health plans. In a monopoly setting, indication-based pricing yields higher profits and thus strengthens incentives to invest in new indications, while the payer prefers uniform pricing unless the fixed investment costs cannot be recouped. The novelty of our study lies in showing that monopoly-based insights may not hold under competition. Specifically, we identify a softening-of-competition effect, where a uniform pricing restriction serves as a credible commitment to raise prices in the competitive market. In this case, the health plan generally favours indication-based pricing to reduce costs. However, an exception arises, where both parties prefer uniform pricing, if the uniform price generates significant health gains through demand expansion in the original monopoly market. Our findings suggest that neither pricing scheme is universally optimal, underscoring the need for case-by-case assessments across drug classes. |
| Keywords: | Pharmaceuticals; Innovation incentives; Payer pricing schemes |
| JEL: | I18 L13 L65 O31 |
| Date: | 2025–01–08 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:nhheco:2025_001 |
| By: | Owen Fleming (Department of Economics, Wayne State University); Lilly Springer (Department of Economics, University of Kansas) |
| Abstract: | Nurse practitioner (NP) scope of practice (SOP) reform has been shown to improve access to healthcare, leading to direct health benefits. However, given that NPs are likely to practice in underserved areas, liberalizing SOP may also have spillover benefits on safety net program participation, which would amplify the benefits of SOP expansion for underrepresented populations. In this paper, we study these potential spillovers by examining the effect of NP SOP expansions on enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Leveraging the staggered rollout of NP SOP expansions across states, we find that 3 years after NP SOP expansion, total WIC participation increased by 5.3%, driven by a 6.2% increase in the enrollment of women and a 5.6% increase in the enrollment of children. Mechanism analyses suggest that while access to healthcare is an important channel, the effect may also be driven by the fact that NPs are trained to deliver holistic, patient-centered care. Our results imply that spillovers on safety net program participation are another pathway by which NP SOP expansions can improve the health and well-being of underserved populations. |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:kan:wpaper:202501 |
| By: | Bagues, Manuel (University of Warwick); Villa, Carmen (University of Warwick) |
| Abstract: | Over the past decades, many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 years. This study provides novel evidence of the impact of this policy on educational outcomes by exploiting the staggered timing of MLDA changes across Spanish regions. Raising the MLDA decreased alcohol consumption among adolescents aged 14–17 by 8 to 18% and improved their exam performance by 4% of a standard deviation. This effect appears driven by alcohol's direct impact on cognitive ability, as we find no significant changes in potential mediators like use of other substances or time spent on leisure activities, including socialising, sports, gaming, or internet use. We also observe a decrease in tranquilliser and sleeping pill use, suggesting improved mental health. Our findings indicate that reducing teenage alcohol consumption represents a significant opportunity to improve educational outcomes in Europe, where youth drinking rates remain notably high. |
| Keywords: | alcohol, adolescence, minimum legal drinking age, PISA |
| JEL: | I18 I12 I21 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17507 |
| By: | Anna Aizer; Emilia Brito Rebolledo |
| Abstract: | Children with a disability are 3.5 times more likely to be maltreated. Federal Early Intervention (EI) serves 426, 000 children 0-3 with a disability, 3.7% of the entire population under three. EI’s objective is to support families in caring for their children’s special needs. Compared to children evaluated but ineligible for EI, children receiving EI in the first year of life are 3.3 percentage points less likely to be maltreated later in life, a decline of 45%, with smaller effects for those receiving services later. Targeting at-risk children, intervening early, and engaging with families in a cooperative manner effectively reduces future maltreatment. |
| JEL: | I18 I28 J12 J13 J14 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33341 |
| By: | Li, Yanan (Beijing Normal University); Menon, Nidhiya (Brandeis University); Sunder, Naveen (Bentley University) |
| Abstract: | Attending kindergarten (KG) has been shown to have persistent benefits, but the peer effects of KG remain largely unexplored. We fill this gap in the literature by using nationally representative panel data on a cohort of middle-school students (grade 7) in China. We demonstrate that when peers have had limited time to interact with one another (three to six months), there are no discernable effects of peer KG status. However, in the medium-term (14+ months), having a peer group with KG experience improves academic (math, English, and Chinese exam scores) and non-cognitive outcomes including mental health and social adjustment. These impacts are more pronounced among children from underprivileged families, and are explained by reallocation of student time and effort, a better classroom environment, improved friends' attitudes and behaviors, and pedagogically effective teacher-student interactions. The presence of these positive cross-peer spillovers indicates that the overall benefits of KG attendance are likely to be even higher than previously understood. |
| Keywords: | Kindergarten attendance, positive spillovers, cognitive and non-cognitive measures, mental health, middle-school, China |
| JEL: | I21 I24 I26 J13 J24 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17531 |
| By: | Yörük, Baris (University at Albany, SUNY); Sabia, Joseph J. (San Diego State University); Dave, Dhaval M. (Bentley University) |
| Abstract: | Alcohol exclusion provisions, embedded in the Uniform Accident and Sickness Policy Provision Law (UPPL), allow health insurance providers to punish alcohol consumption by permitting them to deny claims for injuries stemming from alcohol impairment or the use of non-prescribed narcotics. Although the UPPLs were originally proposed to discourage excessive drinking and substance use, there is no clear evidence to either support or refute that these laws achieved their intended purpose. Furthermore, few studies document that these laws may have unintended consequences, as they create a disincentive for physicians to test the blood alcohol concentration (BAC) levels of injured patients due to concerns about potential insurance reimbursement denials. We provide a comprehensive analysis of the UPPLs by investigating their impact on alcohol consumption at the intensive and extensive margin, drunk driving behavior, alcohol-related traffic fatalities, alcohol-related crime, and health insurance coverage rates and premiums. |
| Keywords: | alcohol exclusion provisions, Uniform Accident and Sickness Policy Provision Law, alcohol consumption, alcohol consumption related outcomes |
| JEL: | I10 I18 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17546 |
| By: | Wang, Zeyang |
| Abstract: | The Volume-Based Procurement (VBP) undertaken by governments significantly influences the healthcare landscape across numerous nations. Initiated in 2018 and broadened in 2019, the National Volume-Based Procurement in China has experienced eight phases of execution throughout key regions. This research utilizes a Difference-in-Differences (DID) framework to assess the effects of centralized procurement on pharmaceutical results. The results indicate that: (1) in the 2018 pilot phase, there was a significant reduction in drug expenditures, an increase in quantities, and a marked decline in prices; and (2) when analyzing the impact of all seven subsequent rounds, both expenditures and prices continued to show significant decreases, although quantities also saw a considerable decline. |
| Keywords: | Volume-Based Procurement (VBP); Pharmaceutical Prices; Difference-in-Differences (DID) |
| JEL: | C8 H40 I18 |
| Date: | 2024–12–13 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:123015 |
| By: | Leigh, Andrew (Parliament of Australia); Robson, Stephen (Australian National University) |
| Abstract: | Using multiple sources, we document a substantial worsening in the mental wellbeing of Australians aged 15-24, as measured by surveys, self-harm hospitalisations and suicide deaths. The shift began around 2007-2010 and is worse for young women than for young men. While several factors could be to blame, we present six pieces of evidence suggesting that smartphones and social media may have played a causal role in damaging the mental health of young Australians. |
| Keywords: | mental health, technology, smartphones, social media |
| JEL: | D91 I12 L82 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17525 |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | Growing evidence from around the world suggests the mental health of children and young adults is declining. We examine trends in mental health in Africa where there has been little prior work. We examine data from a number of surveys including Afrobarometers, the Gallup World Poll, the World Values Surveys, UNICEF’s Multiple Cluster Indicator Surveys and Global Minds. We find little support for the proposition that the age structure of wellbeing in Africa has changed over the last decade, although the Global Minds surveys, conducted over the internet, do find mental health improves with age. One potential reason for this is the limited amount of internet access in Africa, especially for women. In countries like Burkina Faso and Guinea the majority of the population say they have never accessed the internet. In a new survey in rural Tanzania, where there is little or no internet access, mental health improves with age. The absence of the internet might help explain why the mental health of young Africans have been declining less than elsewhere other than for the internet savvy. However, there are dangers on the horizon as the sales of smartphones explode in Africa. |
| JEL: | I31 J13 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33280 |
| By: | Marcotte, Dave E. (American University); Rakus, Alexandra (American University) |
| Abstract: | We examine whether increases in Medicaid coverage among teens reduced suicide risk. Youth are at elevated risk for depression but receive the least care. We exploit state-level variation in Medicaid coverage controlling for crowd-out to identify effects on risk for suicide. We build an age-group/state/year panel measuring suicide rates from CDC data and age-specific rates of insurance coverage from the American Community Survey. We estimate that among those between the ages of 15 and 19, suicide rates fell by 0.023 log points, or 1 percent of the mean with each 1 percent increase in the population of teens covered by Medicaid. This decline was larger for teens than any other group. We assess whether our TWFE estimated effect of a continuous treatment approximates an average causal response by comparing treatment effects at different margins. We form 47 treatment-control groupings of states changing key features of Medicaid enrollment policies in different years along with always/never treated states. Our treatment effects at these various margins are within confidence bounds for our average effects. We provide the first evidence on the role of public health insurance coverage on teen suicide in the U.S. |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17474 |
| By: | Cabeza Martínez, Begoña; D'Hombres, Beatrice; Kovacic, Matija |
| Abstract: | The rapid rise of social media has transformed communication and raised concerns about its societal impact, particularly on mental health and well-being. Using data from a novel EU-wide survey, this study investigates the association between social media usage, loneliness, and emotional distress among young people across 27 European member states. We find that intensive use of social networking sites correlates positively with loneliness and emotional distress, whereas excess use of messaging tools plays a very limited role. These findings are robust to alternative measures of loneliness and emotional distress and to a variety of model specifications. Young adults who either grew up with smartphones during their teenage years or their twenties are particularly vulnerable to excessive use of social network sites. Further analysis suggests that the harmful effects of excessive social networking site consumption may arise from its predominantly passive nature, while instant messaging tools, which primarily involve active engagement, do not exhibit this detrimental impact. |
| Keywords: | Loneliness, mental well-being, social media use, Europe |
| JEL: | L82 D91 I12 I31 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1551 |
| By: | Böckerman, Petri (University of Jyväskylä); Haapanen, Mika (University of Jyväskylä); Kuhakoski, Jani (LABORE Labour Institute for Economic Research); Kuuppelomäki, Tiina (Labour Institute for Economic Research); Villanen, Juuso (LABORE Labour Institute for Economic Research) |
| Abstract: | This paper examines the understudied effect of relative age on mental health in adulthood. Our empirical analysis utilizes nationwide Finnish register-based data on mental health, encompassing a spectrum of conditions from severe to less severe mental health problems. To identity causal effects, we employ a regression discontinuity design centered around the January 1 cutoff. We find that being born at the start of the year leads to better mental health outcomes. Notably, these effects, primarily influenced by relative school starting age, are driven by women in their late twenties. |
| Keywords: | relative age, mental health, education, school starting age, children |
| JEL: | I10 I14 I31 J13 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17501 |
| By: | Brüll, Eduard (ZEW); Rostam-Afschar, Davud (University of Mannheim); Schlenker, Oliver (University of Konstanz) |
| Abstract: | We study how the threat of entry affects service quantity and quality of general practitioners (GPs). We leverage Germany's needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. We compile novel data covering all German primary care regions and up to 30, 000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. We find no effects on working hours or quality measures at the regional level including hospitalizations and mortality. |
| Keywords: | threat of entry, healthcare provision, general practitioners, entry regulation, regression discontinuity design |
| JEL: | I11 I18 J44 J22 L10 L22 R23 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17504 |
| By: | Cantero Lara Sofía |
| Abstract: | In this work I examine the impact of the school calendar on suicides in adolescents (10-19 years) in a developing country -Argentina-. To do this, I use a regression discontinuity design based on suicide administrative data that allows me to exploit the temporal and geographical variability in the start date of the school calendar. The results confirm the existence of a negative impact of the school calendar on adolescent suicide in Argentina. In the days after the beginning of the school year, the number of deaths by suicide is reduced by 35% in relation to the previous days. The mechanism analysis, which exploits the shock of the COVID-19 pandemic, shows that the presence of parents in the household operates as a protective factor that reduces the number of suicides. These results are robust against age placebos (i.e., there are no differences in the number of suicides between older cohorts who presumably have already finished their school years) and temporal placebos (i.e., there are no differences when considering dates other than the actual school start date). These findings have important implications for educational policy. |
| JEL: | I2 I1 |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:aep:anales:4714 |
| By: | Andrén, Daniela (Örebro University School of Business) |
| Abstract: | Advancing the economic understanding of suicide’s externalities, this study uses the well-being valuation method (WVM) to quantify the exposure to suicide, specifically through knowing someone near, family, or friend (NFF) who attempted or died by suicide. First, using data from a survey of Swedish adults, we separately estimate several life satisfaction equations. For each equation, we use the same comparison group of individuals who reported never having been exposed to others’ suicide, and compare them against different groups, each exposed to NFF-related suicide attempts or deaths. We find that income has a statistically significant positive impact on life satisfaction across all equations, and except for the experience of death alone, all other exposures to suicide have a statistically significant negative impact on life satisfaction. Next, we use these estimates to calculate the monetary compensation required to offset the decline in life satisfaction for individuals exposed to a NFF’s suicide attempt or death. The required annual monetary compensation to offset this decline ranges from 6, 400 to 9, 910 euros, which suggests an economic value for mitigating the negative effects of suicide exposure equivalent to around a median monthly household income. However, our findings should be considered with caution when used to inform healthcare policies and prevention strategies aimed at reducing the spillover effects of exposure to suicide. |
| Keywords: | suicide exposure; suicide attempt; life satisfaction; suicide spillover; well-being valuation method; life satisfaction approach; Sweden |
| JEL: | C21 I12 I18 I31 |
| Date: | 2025–01–09 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:oruesi:2025_002 |
| By: | Wolfgang Frimmel; Felix Glaser; Gerald J. Pruckner |
| Abstract: | Using high-quality administrative data from Upper Austria, we analyze the eect of hospi- tal crowding on patients' short- and medium-term healthcare utilization and labor market outcomes. Focusing on acute inpatient diagnoses, we exploit idiosyncratic variation in daily diagnosis-related hospital occupancy rates to estimate the causal eect of hospital crowding. We nd that higher crowding levels reduce hospital care intensity, as reected in fewer medical services provided, lower hospital expenditures, and earlier discharges. Despite these changes, quality of care indicators, including readmissions and mortality, remain unaected. However, no signicant eects are observed either on inpatient and outpatient healthcare utilization in the short- and medium-term or on patients' labor market outcomes following initial hospitalization. These results suggest that crowding- induced dierences in hospital care do not lead to changes in patients' health or economic situations over the medium term. |
| Keywords: | Hospital Crowding, Health Care Utilization, Labor Market |
| JEL: | I10 I12 I14 I31 J20 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:jku:econwp:2025-01 |
| By: | Guimbeau, Amanda (University of Sherbrooke); Ji, Xinde James (University of Florida); Menon, Nidhiya (Brandeis University) |
| Abstract: | This study investigates the impact of climate change on intimate partner violence in Bangladesh and shows that policy can mitigate much if not all of the harmful consequences of climate shocks on women. Utilizing a novel dataset linking geo-referenced meteorological remote-sensed data with information on women's agency from the Bangladesh Demographic and Health Surveys, we find that dry shocks increase tolerance for intimate partner violence among women in poor and agriculture-dependent communities, amplifying existing social and environmental vulnerabilities. Climate resilience projects funded by the Bangladesh Climate Change Trust (BCCT), a domestic climate fund, mitigate the negative impacts of dry shocks, highlighting the important role of such initiatives in generate positive spillover effects in ameliorating the negative social impacts of changing climate. We show that impacts are mitigated as these projects enhance resilience in agriculture by reducing the effects of droughts on acreage and yield in rainfed areas. Our findings underline the role of targeted policy interventions in fostering climate adaptation and wellbeing. |
| Keywords: | climate change, women's agency, intimate partner violence, adaptation, mitigation, resilience, agriculture, Bangladesh |
| JEL: | Q54 J16 O13 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17529 |
| By: | Guimbeau, Amanda (University of Sherbrooke); Menon, Nidhiya (Brandeis University) |
| Abstract: | We leverage the expansion of the National Social Assistance Program (NSAP) in India in 2006 to estimate the impact of access to public pensions on three measures of depression for the elderly in below poverty line households, using a regression discontinuity design based on age-eligibility cutoffs. We focus on India given that it is the largest lower-middle-income country in terms of population, has limited welfare safety nets, and relatively large proportions of disadvantaged people with mental health vulnerabilities. We find that becoming eligible for public pensions reduces the likelihood that the elderly poor are depressed. In particular, the intent-to-treat estimate is a 10.1 percentage point decline in the broadest measure of depression. Our gender-specific analyses reveal heterogeneous impacts across demographic groups. More specifically, widowed populations, the majority of whom are elderly poor women, gain the most. Our investigation into the underlying mechanisms reveals that pension eligibility improves mental health through decreased labor market participation, increased healthcare utilization, improved lifestyle choices, enhanced life satisfaction and greater control over resources. Our results offer insights for shaping effective social assistance policies aimed at raising the welfare of the most at-risk populations in resource-constrained contexts. |
| Keywords: | pension eligibility, depression, mental health, elderly populations, gender, poor, widowed, India |
| JEL: | H55 I12 I18 I38 J14 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17530 |
| By: | Hamid Noghanibehambari; Jason Fletcher |
| Abstract: | This study examines the long-term effects of the Rockefeller Sanitary Commission’s (RSC) hookworm eradication campaign, initiated in the American South in the 1910s, on old-age longevity. Utilizing Social Security Administration death records linked to the 1940 full-count census, we employ a difference-in-differences approach to examine the effects of early-life exposure to the eradication campaign on later-life outcomes. We find that individuals exposed to the RSC campaign during in-utero and early-life experience an increase of 1.3 months in longevity. The effects are substantially larger among nonwhites, children of illiterate mothers, and those born in urban areas. Moreover, we provide evidence of dynamic complementarity in the effects of hookworm eradication on longevity, with larger effects observed in counties exposed to the Rosenwald school construction movement and in states with more stringent child labor laws. Using the 1940 census and World War II enlistment data, we provide suggestive evidence of improvements in educational attainment, income, and cognitive ability as possible pathways. Our findings contribute to the literature on the lasting effects of early-life public health interventions and underscore the importance of such programs in addressing present-day global health challenges. |
| JEL: | I1 I14 J10 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33249 |
| By: | Maximilian Mähr; Alida Sangrigoli; Giuseppe Sorrenti; Gilberto Turati |
| Abstract: | This paper examines how media coverage of corruption scandals influences the behavior of public healthcare workers, specifically ICU medical staff involved in organ procurement. Using Italy’s National Health Service as a case study, we investigate the behavioral responses of medical staff to two corruption scandals—one involving a hospital manager and the other a surgeon. By employing a difference-in-differences strategy across regions with varied exposure to media coverage, we isolate the impact of corruption-related news on reported organ donors. Our findings indicate that media coverage of the surgeon scandal, but not the manager scandal, significantly reduces reported donors, likely due to heightened sensitivity among staff to corruption within their professional ranks. Additional text analysis reveals no substantial semantic differences in reporting between the two scandals, suggesting that the observed effects stem from the shared professional mission among ICU staff rather than from media bias. The results underscore the indirect costs of corruption on public sector performance, with potential negative welfare implications for organ donation rates. |
| Keywords: | corruption, worker motivation, organ procurement |
| JEL: | D64 D73 H41 I18 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11511 |
| By: | Nguyen, Ha Trong; Mitrou, Francis |
| Abstract: | Amidst growing concerns over heightened natural disaster risks, this study pioneers an inquiry into the causal impacts of cyclones on the demand for private health insurance (PHI) in Australia. We amalgamate a nationally representative longitudinal dataset with historical cyclone records, employing an individual fixed effects model to assess the impacts of various exogenously determined cyclone exposure measures. Our findings reveal that only the most severe category 5 cyclones significantly increase the likelihood of individuals acquiring PHI in both the concurrent and subsequent years. Furthermore, the effect diminishes as the distance from the cyclone's eye increases. The largest estimated cumulated impact amounts to over 5 percentage points, representing approximately 11% of the sample mean and aligns with documented effects of certain PHI policies aimed at enhancing coverage. Furthermore, our findings withstand a series of sensitivity assessments, including a placebo test and three randomization examinations. Moreover, the cyclone impacts are more pronounced for younger demographics, individuals of higher socioeconomic status, and inhabitants of coastal or historically cyclone-affected areas. Additionally, after ruling out income, transfers, health status, and premiums as mechanisms, our study furnishes suggestive evidence that cyclone-induced home damage and heightened psychological stress are plausible pathways through which cyclones increase PHI uptake. |
| Keywords: | Natural Disasters; Health Insurance; Risk Preferences; Australia |
| JEL: | D81 G22 I13 Q54 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:123055 |
| By: | Daniel Kessler; William Wygal |
| Abstract: | We investigate whether two characteristics of non-profit hospital boards – the number of board members and whether the CEO is a board member – are associated with CEO pay and several measures of hospital performance, including price, operating margin, quality, and service to low-income patients. Although the consequences of CEO board membership for for-profit firms have been studied extensively, the consequences for non-profits in general, and non-profit hospitals in particular, have received little attention. Because most hospitals are non-profit and non-profit hospital prices have increased rapidly over the past 20 years, this gap is important. We find a strong positive association between CEO board membership and non-profit hospital prices, operating margins, and CEO pay, with a weaker positive (negative) association between CEO board membership and quality (service to low-income patients). We conclude that CEO board membership contributes to the fundamental agency problem between non-profit hospitals’ management and the hospitals’ intended beneficiaries, consistent with the concerns expressed by Fama and Jensen (1983). |
| JEL: | G39 I11 L31 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33278 |
| By: | Prunty, Jonathan; Zhang, Jinbao; Toma, Madalina; Miller, Robin; Forder, Julien |
| Abstract: | Strengths-based models of care are increasingly popular with policymakers, but evidence of their effectiveness is currently limited. This study examines the impact that a strengths-based care programme – Community Led Support (CLS) – has had on new and existing clients in England. Specifically, we used a difference-in-difference approach to estimate the treatment effect of CLS on care provision, reviews, and expenditure, using the Short and Long Term (SALT) dataset published by NHS Digital (2016 to 2021). Within local authorities that implemented CLS, we found evidence of changing care pathways for new clients, including a ten percentage-point reduction in funded care provision – though evidence for increased signposting to alternative services in this dataset was mixed. For existing clients, we found evidence of general improvements in the quality of practice, as indicated by higher ratios of planned to unplanned care reviews. These improvements were also realised without concomitant increases in expenditure rates. We believe these results can contribute toward an evidence base for CLS, and for strengths-based practice more generally. |
| Date: | 2024–12–03 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:5jmbk |
| By: | Arozamena Leandro; Ruffo Hernán; Sanguinetti Pablo; Weinschelbaum Federico |
| Abstract: | We present a model that provides insights into the optimal structure of sin taxes, considering the varying health risks of different product variants and the presence of internalities and externalities. Then, we compare its predictions with the tax policies on tobacco, alcoholic beverages, and sugar-sweetened drinks in Latin America and the Caribbean. Our framework confirms the intuition that taxes should be levied based on the health risks these products impose on individuals. Nevertheless, we show evidence from Latin America demonstrating that sin taxes on these products are often not established in proportion to the harm they produce. Our model also suggests that consumption response to taxes is weaker when there is a higher subjective misperception of the health risk, necessitating further tax increases. A key policy issue that relates to the theoretical framework is the potential trade-off between health and revenue objectives that the government may face. Authorities may be worried that increasing these taxes for health purposes may reduce tax revenue if the demand falls to a greater extent than the taxes increase. Our model shows that the revenue argument for taxing sin products may imply higher taxes for all variants (though relatively lower for less harmful versions). |
| JEL: | H2 D6 |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:aep:anales:4708 |
| By: | Christopher Worsham; Charles Bray; Anupam Jena |
| Abstract: | The practice of medicine relies on accurate diagnosis. However, the diagnosis of many medical conditions involves assessments that invite varying degrees of subjectivity. External and arbitrary factors can influence physicians’ diagnostic assessments in conditions ranging from heart attacks to neurodevelopmental conditions like attention deficit hyperactivity disorder (ADHD). Quantifying this subjectivity is challenging, however, particularly for neurodevelopmental and psychiatric conditions where subjective assessments of behavior are common and important. Halloween, a holiday characterized by excitement among children, could present a natural experiment to study subjectivity in diagnosis, if any ensuing behavioral changes influence diagnosis rates of ADHD. Using data on over 100 million physician office visits, we compared ADHD diagnosis rates, by day, among children seen by physicians in the 10 weekdays surrounding seven Halloween holidays. The rate of new ADHD diagnosis was 62.7 per 10, 000 child-visits on Halloween, compared with 55.1 during surrounding weekdays, a 14% increase. There were no increases in diagnoses of several neuropsychiatric disorders with diagnostic criteria that are less focused on hyperactive behavior. Our findings highlight subjectivity in ADHD diagnosis and support the need to consider external factors that may influence diagnosis. |
| JEL: | I1 I10 I12 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33232 |
| By: | Joanne Haddad; Lamis Kattan |
| Abstract: | By the end of the nineteenth century, labor legislation for women had become a prominent issue in the United States, with most states enacting at least one female-specific work regulation. We examine the impact of three previously unexplored legislation: seating, health and safety, and night-work regulations. Given that not all states adopted these laws, and the staggered nature of adoption, we rely on a difference-in-differences strategy design to estimate the effects on female gainful employment. Our findings indicate that laws regulating health and safety conditions and restricting women’s night work increased the likelihood of female employment by about 4% to 8%, accounting for about 10% to 20% from the total increase during our period of analysis. Examining heterogeneous effects reveals that younger and married women without children witnessed the largest increase in the likelihood of employment. We also document that native, higher-class and literate women were also incentivized to join the workforce. Women’s labor supply in the decades under consideration has been estimated to be quite inelastic with respect to own wage. Nevertheless, we find sizable labor force participation responses to the female-specific labor regulation we study. This indicates that the legislation must have shifted women’s labor supply curves, either because it made jobs more pleasant, or because it improved perceptions about how respectable it is for a woman to work in the labor market. Both channels would reduce disutility from work, and increase labor supply at any given wage level. Our findings hold important implications for policymakers and advocates seeking to promote gender equality in the labor market. |
| Keywords: | labor supply, labor law, gender law, gender norms |
| JEL: | J08 J16 J21 J24 J78 K31 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11546 |
| By: | Andreas Kyriacaou (Departament d’Economia, Universitat de Girona (Spain)); Ronald Miranda-Lescano (Departamento de Métodos Cuantitativos and Departamento de Economía, Universidad de la República (Uruguay), and EMANES fellow); Leonel Muinelo-Gallo (Departamento de Economía and Instituto de Economía, Universidad de la República (Uruguay)); Oriol Roca-Sagales (Departament d’Economia Aplicada, Universitat Autònoma de Barcelona (Spain)) |
| Abstract: | This article constructs new indicators of subnational disparities in life expectancy for up to 101 low- and middle-income countries (LMICs) from 2000 to 2021, offering critical insights into health inequalities within countries. The findings reveal that subnational disparities in life expectancy are markedly higher in Sub-Saharan Africa compared to other LMIC world regions throughout the period. Moreover, while subnational disparities in life expectancy have decreased in most regions, Sub-Saharan Africa stands out as an exception, with persistently high disparities alongside rising average life expectancy. A country-level analysis indicates that subnational disparities in life expectancy declined in 61 countries, increased in 30, and remained unchanged in 10. A gender-specific analysis highlights that, while women generally live longer than men across all countries studied, subnational life expectancy disparities are greater for women. Sub-Saharan Africa exhibits the largest disparities in female life expectancy and the widest gap in disparities between men and women. |
| Keywords: | subnational disparities, life expectancy, inequality measurement, inequality determinants |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:uab:wprdea:wpdea2501 |
| By: | Valenti, Giulia; Vona, Francesco |
| Abstract: | This paper examines the impact of temperature shocks, measured by cold and heat waves, on labour market outcomes across 14 European countries. Using retrospective individual-level data from the Survey on Health, Ageing, and Retirement in Europe (SHARE) and daily climate data from the E-OBS dataset, we analyze the effect on wages and occupational transition. By leveraging plausibly exogenous weather shocks, we find that heat waves significantly reduce individual income, with losses accumulating over time. Moreover, our analysis documents that older individuals, those with severe health conditions, and workers in heat-exposed occupations experience particularly large income reductions. Losses are also more pronounced in Mediterranean and Eastern European countries, as well as in regions with less regulated wage-setting mechanisms. Additionally, our findings suggest that heat waves increase the likelihood of changing jobs and in particular to transition from heat-exposed to non-heat-exposed occupations. These results underscore the need for targeted policy interventions to mitigate economic losses and protect vulnerable workers in the face of increasing climate variability. |
| Keywords: | Climate Change, Labor and Human Capital |
| Date: | 2024–12–30 |
| URL: | https://d.repec.org/n?u=RePEc:ags:feemwp:348848 |
| By: | Joan Costa-Font; Cristina Vilaplana-Prieto; Joan Costa-i-Font |
| Abstract: | The hidden value of adult informal care (IC) refers to the unaccounted value of informal care in overall costs of long-term care (LTC) estimates. This paper estimates the net wellbeing value of adult IC in Europe, drawing on a wellbeing-based methodology. We use an instrumental variable strategy and a longitudinal and cross-country dataset to estimate the causal effect of the extensive and intensive margin of caregiving on subjective wellbeing. Finally, we estimate the so-called compensating surplus (CS), namely the income equivalent transfer to compensate for the net disutility of caregiving. We find that IC reduces average subjective wellbeing by about 1% compared to the mean (6% among co-residential caregivers). Relative to a country’s Gross Domestic Product (GDP), the value of informal care ranges between 4.2% in France and 0.85% in Germany, which is inversely correlated with the country’s share of formal LTC spending and leads to reconsidering LTC regimes. The average CS per hour of IC ranges between 9.55 €/hour, ranging between 22 €/hour in Switzerland and 5 €/hour in Spain. Finally, we also find that long-term CS is smaller than short-term CS. |
| Keywords: | informal care, wellbeing methods, the value of time, caregiving, daughters, life satisfaction |
| JEL: | I18 J17 J18 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11535 |
| By: | Anthony Chuo; Chad D. Cotti; Charles J. Courtemanche; Johanna Catherine Maclean; Erik T. Nesson; Joseph J. Sabia |
| Abstract: | Electronic nicotine delivery systems (ENDS) use among lesbian, gay, bisexual, and questioning (LGBQ) teenagers is over 30 percent higher than among their heterosexual counterparts. Yet little is known about how recent efforts to curb nicotine vaping through ENDS taxes impact sexual minorities. This study explores this question using data from the 2015-2021 State Youth Behavior Surveys. We find that a one-dollar (in 2021$) per mL of e-liquid increase in ENDS taxes reduces the likelihood of any prior-month ENDS use among heterosexual teens by about four percentage points and the likelihood of habitual vaping (as measured by frequent and everyday use) by about two percentage points. In sharp contrast, we find no evidence that ENDS taxes reduce any of the vaping measures for queer youths. The coefficient estimates are consistently less strongly negative for LGBQ than heterosexual youths, and the differences in effects on frequent and everyday vaping are statistically significant. Therefore, taxes widen disparities in vaping between queer and straight teens. The estimated effect of ENDS taxes on LGBQ teens who do not report being depressed, suicidal, or bullied is similar to the effect among heterosexuals, suggesting that LGBQ youths’ tax insensitivity may be explained by their dependence on e-cigarettes to cope with unique stress-related psychological challenges. |
| JEL: | I0 I12 I14 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33326 |
| By: | Geoffrey Gee; Jacob Goldin; Joseph Gray-Hancuch; Ithai Lurie; Vedant Vohra |
| Abstract: | Tax benefits tied to children form a central component of the social safety net in the United States. To participate in these programs, taxpayers must claim a child on their tax return. We study the claiming of children on tax returns by drawing on health insurance information returns to establish the presence of children in the United States. We estimate that the vast majority of insured children (approximately 95 percent) and a significant majority (between 88 and 97 percent) of all U.S. children are claimed on tax returns. Unclaimed children are disproportionately concentrated in lower income households and are more likely to live in Black and Hispanic neighborhoods. |
| JEL: | H20 H24 H53 I13 I32 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33277 |
| By: | Vogel, Justus; Cordier, Johannes; Filipovic, Miodrag |
| Abstract: | Intensive care units (ICUs) operate with fixed capacities and face uncertainty such as demand variability, leading to demand-driven, early discharges to free up beds. These discharges can increase readmission rates, negatively impacting patient outcomes and aggravating ICU bottleneck congestion. This study investigates how ICU discharge timing affects readmission risk, with the goal of developing policies that minimize ICU readmissions, managing demand variability and bed capacity. To define a binary treatment, we randomly assign hypothetical discharge days to patients, comparing these with actual discharge days to form intervention and control groups. We apply two causal machine learning techniques (generalized random forest, modified causal forest). Assuming unconfoundedness, we leverage observed patient data as sufficient covariates. For scenarios where unconfoundedness might fail, we discuss an IV approach with different instruments. We further develop decision policies based on individualized average treatment effects (IATEs) to minimize individual patients' readmission risk. We find that for 72% of our sample (roughly 12, 000 cases), admission at point in time 𝑡 as compared to 𝑡+1 increases their readmission risk. Vice versa, 28% of cases profit from an earlier discharge in terms of readmission risk. To develop decision policies, we rank patients according to their IATE, and compare IATE rankings for instances, when demand exceeds the available capacity. Finally, we outline how we will assess the potential reduction in readmissions and saved bed capacities under optimal policies in a simulation, offering actionable insights for ICU management. We aim to provide a novel approach and blueprint for similar operations research and management science applications in data-rich environments. |
| Keywords: | Causal Machine Learning, Intensive Care Unit Management, Hospital Operations, Policy Learning |
| JEL: | I10 C44 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:hsgmed:202501 |
| By: | Luis Sarmiento; Martino Gilli; Filippo Pavanello; Soheil Shayegh |
| Abstract: | This paper examines the role of positive income shocks in helping workers adapt to extreme temperatures. We use daily temperature variations alongside the exogenous implementation of a wage and fiscal policy in Mexican municipalities along the US border to show that increased disposable income significantly reduces temperature-related mortality in treated areas. Exploring the mechanisms, we find that income gains increase households’ adaptive capacity, particularly through higher electricity expenditures and the purchase of electric heaters. Our findings provide causal estimates of how income influences the marginal effect of temperature on mortality and contribute to the debate on the effectiveness of climate-related redistribution policies. |
| Keywords: | temperature, mortality, distributional effects, public policies, minimum wage |
| JEL: | Q51 Q58 J81 J88 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11542 |
| By: | Buyi Wang; Meredith Slopen; Irwin Garfinkel; Elizabeth Ananat; Sophie M. Collyer; Robert Paul Hartley; Anastasia Koutavas; Christopher Wimer |
| Abstract: | National paid family leave programs have been repeatedly proposed in the United States in recent years. To inform policy discussions, we provide a benefit-cost analysis of introducing such a program. We systematically identify high-quality, quasi-experimental studies on the impact of paid leave on infants and parents. Using the most conservative estimates or the mean estimates from this literature, we estimate that every $1, 000 investment in paid parental leave would generate, respectively, $7, 275 or $29, 406 in present discounted net social benefits. We use these estimates to conduct a microsimulation of benefits and costs of two policy proposals with different eligibility and wage replacement rates. The first, a 4-week program, would have an initial fiscal cost of under $2 billion and net social benefits of $13 (conservative) or $55 billion (mean). The corresponding figures for the 12-week program are about 3.7 times larger, suggesting that either version would likely generate high returns. |
| JEL: | I18 J18 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33279 |
| By: | Lise Szekér; Maria Gaudiino; Anja Van den Broeck; Karolien Lenaerts; Sem Vandekerckhove; Steven Vanmarcke; Oscar Vargas Llave; Viginta Ivaskaité-Tamosiuné; Sara Riso |
| Abstract: | Psychosocial risks represent a major challenge to the health and well-being of workers in the EU. While the COVID-19 pandemic intensified some of these risks, it also increased awareness of them among policymakers. Using data from the European Working Conditions Telephone Survey 2021 and building on a theoretical model that differentiates between job stressors and job resources, this report examines key psychosocial risks in the workplace and their impact on health. It also assesses job characteristics that could help to protect workers’ health and well-being in post-pandemic workplaces. While the prevalence of psychosocial risks varies across the Member States, work–life interference and work intensity are the most widespread risks in the EU, and the prevalence of the latter increased during the pandemic. Job stressors such as adverse social behaviour and job insecurity continue to be experienced by a significant proportion of workers in the EU. Although resources are available to combat some risks, these may not be sufficient, and preventive policies need to be implemented to prevent risks from arising in the first place. |
| Keywords: | HIVA-Civil Society - Social Dial, HIVA-Work and Organisation, EWCS, psychosocial risks, workers well-being |
| Date: | 2023–11–23 |
| URL: | https://d.repec.org/n?u=RePEc:ete:woswps:729726 |
| By: | Silvia Angerer; Helena Antonie Baier; Daniela Glätzle-Rützler; Philipp Lergetporer; Thomas Rittmannsberger |
| Abstract: | This study investigates the relationship between economic preferences and COVID-19 vaccination readiness using two representative samples of the German population (N > 5, 000). We elicited altruism, patience, risk-taking and trust using validated survey questions. We find robust, positive relationships between vaccination readiness and both patience and trust. The positive association between altruism and vaccination readiness vanishes when controlling for the other preference dimensions. No consistent effect emerges for risk-taking. Our results underscore the importance of accounting for the interrelated nature of economic preferences when analyzing their impact on field behavior. |
| Keywords: | economic preferences, vaccination, Covid-19 |
| JEL: | C93 D90 I12 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11566 |