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on Health Economics |
| By: | Cristina Bellés-Obrero (Universitat de Barcelona, IEB & IZA); Giulia La Mattina (University of South Florida & IZA); Han Ye (University of Mannheim, ZEW & IZA) |
| Abstract: | The prevalence and determinants of intimate partner violence (IPV) among older women are understudied. This paper documents that the incidence of IPV remains high at old ages and provides the first evidence of the impact of access to income on IPV for older women. We leverage a Mexican reform that lowered the eligibility age for a noncontributory pension and a difference-in-differences approach. Women’s eligibility for the pension increases their probability of being subjected to economic, psychological, and physical IPV. The estimated effects are found only among women in the short term and are more pronounced for women who experienced family violence in childhood and those from poorer households. Looking at potential mechanisms, we find suggestive evidence that men use violence as a tool to control women’s resources. Additionally, women reduce paid employment after becoming eligible for the pension, which may result in more time spent at home and greater exposure to violent partners. In contrast, we show that IPV does not increase when men become eligible for the non-contributory pension. |
| Keywords: | Non-contributory pension, Intimate partner violence, Retirement, Income |
| JEL: | H55 I38 J12 J26 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ieb:wpaper:doc2024-16 |
| By: | Sanna Bergvall (University of the Gothenburg); Nuria Rodriguez-Planas (Queens College – CUNY & IZA, University of Barcelona & IEB) |
| Abstract: | Most empirical studies indicate that becoming a mother is an augmenting factor for the perpetration of intimate partner violence (IPV). Using rich population-wide hospital records data from Sweden, we conduct a stacked DiD analysis comparing the paths of women two years before and after the birth of their first child with same-age women who are several quarters older when giving birth to their first child and find that, in contrast to the consensus view, violence sharply decreases with pregnancy and motherhood. This decline has both a short-term and longer-term component, with the temporary decline in IPV covering most of the pregnancy until the child is 6 months old, mimicking a temporary decrease in hospital visits for alcohol abuse by the children’s fathers. The more persistent decline is driven by women who leave the relationship after the birth of the child. Our evidence is not supportive of alternative mechanisms including suspicious hospitalizations, an overall reduction in hospital visits or selection in seeking medical care, mothers’ added value as the main nurturer, or mothers’ drop in relative earnings within the household. Our findings suggest the need to push for public health awareness campaigns underscoring the risk of victimization associated with substance abuse and to also provide women with more support to identify and leave a violent relationship. |
| Keywords: | Motherhood, stacked Difference-in-Differences model, event study, individual fixed effects, administrative longitudinal records data, population-wide estimates. |
| JEL: | J12 J13 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ieb:wpaper:doc2024-09 |
| By: | Cristina Bellés-Obrero (Universitat de Barcelona & IEB); Caoimhe T. Rice (University of York); Judit Vall Castelló (Universitat de Barcelona & IEB) |
| Abstract: | This paper investigates the causal link between healthcare access and intimate partner violence (IPV) victims’ help-seeking behavior. Access to healthcare serves as a critical avenue for screening or detecting IPV. Doctors are legally mandated to report suspected criminal injuries to the authorities and can guide victims towards IPV support services. We exploit the 2012 reform in Spain that removed access to the public healthcare system for undocumented immigrants. We use court reports and protection order requests from the Judicial Branch of the Spanish government to perform a difference-in-differences approach, comparing the helpseeking behavior of foreign and Spanish women before and after the reform. We find that restricting healthcare access led to an immediate 12% decrease in IPV reporting and protection order applications among foreign women, particularly in regions with strict enforcement. Importantly, we show suggestive evidence that the reform did not change the underlying incidence of IPV but the results are driven by a reduction in injury reports from medical centers. Our findings are important given the increase in migration flows globally as well as for corrent debates on granting/limiting access to healthcare for marginalized groups. |
| Keywords: | Healthcare Access, Intimate Partner Violence, Reporting, Undocumented Immigrants |
| JEL: | I10 I12 I14 I31 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ieb:wpaper:doc2024-06 |
| By: | Aguilar-Gómez, Sandra; Salazar-Díaz, Andrea |
| Abstract: | Every year, 245 million women are victims of intimate partner violence (IPV). Climate change is hypothesized to exacerbate this figure through its disruptive impact on household livelihoods, among other channels. However, little causal evidence exists on this aspect of the climate-gender nexus, partly due to measurement challenges that have contributed to gaps in the literature. In this paper, we use three different IPV data sources to examine the effect of drought in Mexico and the role of agricultural vulnerability in intensifying these effects. We find robust evidence of increases in all measures of IPV in response to local precipitation deficits: as unanticipated exposure to days without rain in the previous month rises, more injuries linked to IPV are recorded in the public health system, police reports increase, and more 911 calls related to IPV are made. The effects are stronger in regions highly dependent on agriculture, particularly when the shock occurs during the growing season. In a country where most agricultural income and land are controlled by men, our results align with theoretical predictions from male-backlash IPV models and extractive violence models. We also find that the impact of drought on IPV is more pronounced in municipalities with low state capacity, though potential differences in reporting behavior between IPV measures complicate comparisons. Our findings underscore the need to design gender-sensitive disaster relief policies, strengthen trust in reporting mechanisms and helplines, and reduce the social acceptability of IPV. |
| Keywords: | drought;domestic violence;intimate partner violence;Agriculture |
| JEL: | I15 J16 D13 Q54 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:13943 |
| By: | Itzik Fadlon; Astrid Sophie Fugleholm; Torben Heien Nielsen |
| Abstract: | We use administrative records on the healthcare utilization and economic outcomes of the universe of Danish households to characterize survivors' mental health following their spouse's death. We provide visually clear evidence for the inevitable immediate, large, and lingering adverse impacts and focus on studying the role of potential mediators: economic conditions and the presence of children. We find no evidence of heterogeneity in family composition. As for economic outcomes, baseline levels of income and net wealth play only a modest role: there is no meaningful cross-household inequality gradient in mental health declines, so that spousal death is devastating for both the rich and the poor. Rather, a key source of heterogeneity in the decline in mental health is the household's degree of income insurance, that is, the within-household income variation. Specifically, the least-insured households experience an immediate decline in mental health that is 80 percent larger. Our findings suggest that the consumption smoothing welfare gains from income protection policies can have important spillovers to improved mental health in the context of severe household events. |
| JEL: | D1 H5 I1 I3 J1 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33359 |
| By: | Alberto Prati; Claudia Senik |
| Abstract: | We revisit the famous Easterlin paradox by considering that life evaluation scales refer to a changing context, hence they are regularly reinterpreted. We propose a simple model of rescaling based on both retrospective and current life evaluations, and apply it to unexploited archival data from the USA. When correcting for rescaling, we find that the well-being of Americans has substantially increased, on par with GDP, health, education, and liberal democracy, from the 1950s to the early 2000s. Using several datasets, we shed light on other happiness puzzles, including the apparent stability of life evaluations during COVID-19, why Ukrainians report similar levels of life satisfaction today as before the war, and the absence of parental happiness. |
| Keywords: | happiness, life satisfaction, subjective well-Being, Easterlin Paradox, Cantril Ladder, rescaling, Gallup, SOEP |
| Date: | 2025–01–20 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepdps:dp2068 |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | We report on the wellbeing of the young in 31 Ex-Soviet Republics located in Eastern Europe and Central Asia. We find no evidence of the decline in the mental health of the young relative to older people which characterizes Western Europe and English-speaking advanced economies. The mental health of the young in ex-Soviet republics is stable relative to older people across various surveys including the Gallup World Poll, the Eurobarometers, the World Values Surveys and the European Social Survey, as well as in surveys from the European Bank of Reconstruction and Development and UNICEF. However, there are two exceptions. A 2023 Flash Eurobarometer Mental Health survey conducted by the European Commission shows unhappiness declines in age in every EU member country including 11 in Eastern Europe. A similar finding emerges in our analysis of the web-based Global Minds surveys of 2020-2024 in 9 former Soviet republics. Youngster ages 18-24 in these surveys are especially unhappy. Furthermore, in keeping with research on children aged 15-16 in the PISA surveys in other countries, we find life satisfaction of these school children in ex-Soviet Republics declined over the period 2015-2022 and that, among this group, time spent on digital devices was associated with lower happiness. |
| JEL: | I31 J13 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33356 |
| By: | Laliotis, Ioannis; Mourelatos, Evangelos; Lohtander, Joona |
| Abstract: | We explore how religiosity influences perceptions and the adoption of protective health behaviours, as reflected in COVID-19 infection and vaccination rates. In the first part of our analysis, we use Finnish data from four nationally representative surveys, we find that individuals with higher self-reported religiosity and those from more conservative religious groups tend to hold less favourable attitudes towards science, technology and medicine, compared to non-religious individuals. In the second part, we observe that municipalities with higher shares of conservative religious groups experienced greater COVID-19 spread and lower vaccination rates, with these trends persisting throughout the pandemic. Our findings underscore the importance of accounting for religiosity when crafting public health policies, as it may contribute to the existence of non-compliance hotspots. |
| Keywords: | Covid-19; Finland; religion; religiosity; coronavirus |
| JEL: | H10 I10 Z10 |
| Date: | 2025–02–28 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126615 |
| By: | Marcella Alsan; Crystal Yang |
| Abstract: | The U.S. has one of the highest incarceration rates in the world, with over seven million admissions to jails each year. Incarcerated individuals are the only group in the U.S. that have a constitutional right to receiving "reasonably adequate" health care. Yet, there is little oversight and funding for health care in jails, where illness and mortality are rampant. In this study, we randomize the offer of health care accreditation to 44 jails across the U.S. Surveys of staff indicate that accreditation improves coordination between health and custody staff. We also find that accreditation improves quality standards and reduces mortality among the incarcerated, which is three times higher among control facilities than official estimates suggest. These health gains are realized alongside suggestive reductions in six-month recidivism, such that accreditation is highly cost effective. |
| JEL: | I1 I14 I18 I3 K10 K14 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33357 |
| By: | Cristina Bellés-Obrero (Universitat de Barcelona & IEB); Sergi Jiménez-Martín (Universitat Pompeu Fabra); Han Ye (University of Mannheim) |
| Abstract: | This paper studies the mortality effect of delaying retirement by investigating the impacts of the 1967 Spanish pension reform, which affected the general population and exogenously changed the early retirement age, depending on the date individuals started contributing to the pension system. Using the Spanish administrative data, we find that delaying retirement by one year increases the hazard of dying between the ages of 60 and 69 by 38 percent. We show that the reform leads to higher mortality in all subgroups, and the effects are statistically stronger for those employed in sectors with the highest workplace accidents and for those with low selfvalue jobs. Moreover, we show that allowing flexible retirement mitigates the adverse effects of delaying retirement. |
| Keywords: | Delaying Retirement, Mortality, Heterogeneity, Work Conditions |
| JEL: | I10 I12 J14 J26 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ieb:wpaper:doc2024-07 |
| By: | Eskander, Shaikh M.S.U.; Barbier, Edward B. |
| Abstract: | We use childhood exposure to disasters as a natural experiment inducing variations in adulthood outcomes. Following the fetal origin hypothesis, we hypothesize that children from households with greater famine exposure will have poorer health outcomes. Employing a unique dataset from Bangladesh, we test this hypothesis for the 1974-75 famine that was largely caused by increased differences between the price of coarse rice and agricultural wages, together with the lack of entitlement to foodgrains for daily wage earners. People from northern regions of Bangladesh were unequally affected by this famine that spanned several months in 1974 and 1975. We find that children surviving the 1974-75 famine have lower health outcomes during their adulthood. Due to the long-lasting effects of such adverse events and their apparent human capital and growth implications, it is important to enact and enforce public policies aimed at ameliorating the immediate harms of such events through helping the poor. |
| Keywords: | Bangladesh; fetal origin hypothesis; health; long-term effects; the 1974-75 Bangladesh famine |
| JEL: | Q54 O15 I31 |
| Date: | 2024–12–20 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126622 |
| By: | Brekke, Kurt R. (Dept. of Economics, Norwegian School of Economics and Business Administration); Straume, Odd Rune (Dept. of Economics, University of Minho); Siciliani, Luigi (Dept. of Economics and Related Studies, University of York) |
| Abstract: | This paper analyses the impact of public dental care coverage-universal versus targeted-on access, pricing, and public spending in a model with two competing dental practices and heterogeneous patient income groups. We evaluate two types of reimbursement schemes: fixed subsidies and cost sharing. Our findings show that public coverage improves access for low-income patients but increases producer prices due to reduced price elasticity of de-mand. Targeted coverage provides greater access at lower public cost compared to universal coverage, especially under cost-sharing schemes. With fixed subsidies, both schemes achieve similar access, but targeted coverage remains more cost-efficient. The policy that maximises utilitarian welfare is targeted coverage with a fixed subsidy, balancing improved access for low-income patients against higher prices for high-income patients. This trade-off highlights challenges in implementing targeted policies but provides insights for designing efficient and equitable public dental care systems. |
| Keywords: | Dental care; Public coverage; Reimbursement schemes |
| JEL: | H51 I11 I18 L13 |
| Date: | 2025–01–27 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:nhheco:2025_002 |
| By: | Costa, Dora L. (UCLA); Bygren, Lars Olov (Karolinska Institutet); Graf, Benedikt (NBER); Karlsson, Martin (University of Duisburg-Essen); Price, Joseph (Brigham Young University) |
| Abstract: | Explanations for the West's escape from premature mortality have focused on chronic malnutrition or income and on public health or state capacity. We argue that by ignoring the multigenerational effects of variance in ancestors' harvests, we are underestimating the contribution of modern economic growth to the escape from early death at older ages. Using a newly constructed multigenerational dataset for Sweden, we show that grandsons' longevity was strongly linked to spatial shocks in paternal grandfathers' yearly harvest variability when agricultural productivity was low and market integration was limited. We reason that an epigenetic mechanism is the most plausible explanation for our findings. We posit that the removal of trade barriers, improvements in transportation, and agricultural innovation reduced harvest variability. We contend that for older Swedish men (but not women) born 1830-1909 this reduction was as important as decreasing contemporaneous infectious disease rates and more important than eliminating exposure to poor harvests in-utero. |
| Keywords: | intergenerational transmission, longevity, ecomomic growth, harvest variability |
| JEL: | I15 J11 N33 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17620 |
| By: | Erika Kirgios; Susan Athey; Angela L. Duckworth; Dean Karlan; Michael Luca; Katherine L. Milkman; Molly Offer-Westort |
| Abstract: | Effective information sharing is critical for the success of organizations and governments. Because information that is easy to access is more likely to be adopted, leaders often minimize friction in information delivery. However, one type of friction may increase engagement: piquing curiosity by posing relevant questions prior to sharing information. To test this, we shared identical information about COVID-19 in either question-and-answer format or via direct statements across two preregistered field experiments in Ghana and Michigan (total N=49, 395). Q&A-style communication increased information seeking about directly related topics (e.g., how to wear a mask properly) by 1.0 percentage-point (216%) in Ghana and by 1.1 percentage-points (19%) in Michigan (p’s |
| JEL: | D83 D91 I12 M3 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33294 |
| By: | Qiqi Li; Wei Wang; Yiying Zhang |
| Abstract: | In economic analysis, rational decision-makers often take actions to reduce their risk exposure. These actions include purchasing market insurance and implementing prevention measures to modify the shape of the loss distribution. Under the assumption that the insureds' actions are fully observed by the insurer, this paper investigates the interaction between self-protection and insurance demand when insurance premiums are determined by convex premium principles within the framework of distortion risk measures. Specifically, the insured selects an optimal proportional insurance share and prevention effort to minimize the risk measure of their end-of-period exposure. We explicitly characterize the optimal combination of prevention effort and insurance demand in a self-protection model when the insured adopts tail value-at-risk and strictly convex distortion risk measures, respectively. Additionally, we conduct comparative static analyses to illustrate our main findings under various premium structures, risk aversion levels, and loss distributions. Our results indicate that market insurance and self-protection are complementary, supporting classical insights from the literature regarding corner insurance policies (i.e., null and full insurance) in the absence of ex ante moral hazard. Finally, we consider the effects of moral hazard on the interaction between self-protection and insurance demand. Our findings show that ex ante moral hazard shifts the complementary effect into substitution effect. |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2411.19436 |
| By: | Colleen Heflin (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Hannah Patnaik (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Leonard M. Lopoo (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Siobhan O'Keefe |
| Abstract: | Food insecurity is more common among military families than the general population, and the transition from active service to civilian life is a time of heightened risk. The Supplemental Nutritional Assistance Program (SNAP) is designed to support food security among low-income families. Many eligible military and veteran families do not enroll in SNAP due to a lack of information, stigma, and administrative barriers. This brief highlights findings from a survey experiment conducted in 2022 and 2023 to assess how small changes to SNAP informational flyers, such as simplifying information provided about SNAP, highlighting that other veterans use SNAP, and emphasizing how much monetary support veterans may be foregoing, to improve SNAP uptake among military families transitioning to civilian life. Results of the study show that making these small changes to informational flyers increased veterans’ awareness and comprehension of SNAP, while also reducing the cognitive load placed on veterans and their families. |
| Keywords: | Food insecurity, SNAP, veterans |
| Date: | 2023–11 |
| URL: | https://d.repec.org/n?u=RePEc:max:cprpbr:7 |
| By: | Vähäsarja, Luka Elliott Joonatan; Lipsanen, Jari; Kouvonen, Anne; Lahelma, Eero; Lappalainen, Raimo; Virtanen, Marianna; Lallukka, Tea |
| Abstract: | We conducted the first validation of the Depression Anxiety Stress Scales (DASS-21) in Finnish. DASS-21 is a short public-domain questionnaire, which presents a way to quickly and effectively screen for mental ill-health. We recruited two large samples, one aged 24–45 (N = 3, 101 [2, 488 women]), the other aged 60–82 (N = 5, 462 [4, 473 women]), all employees of the City of Helsinki at inclusion (2017 and 2000–2002). DASS-21 measured depression, anxiety, stress, and general distress reliably among Finnish-speaking adults. It appeared invariant with age and gender as evinced by invariance analyses, latent mean comparisons, and an examination of psychometric properties for the subscales and individual items. The subscales negatively correlated with the Emotional Well-being subscale of the RAND-36, as expected. A comparison of five structural models using confirmatory factor analyses (CFA) and a robust estimation method (WLSMV) showed good fit for a one-factor solution. We discuss the use and interpretation of the DASS-21 as both a measure of specific affective symptoms and unidimensional General Distress. We provide future researchers and clinicians with norms and estimates of measurement error among Finnish-speaking adults. |
| Date: | 2025–01–16 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:d7vu2 |
| By: | Amarante, Verónica; Galván, Estefanía; Yapor, Mijail |
| Abstract: | This paper provides novel insights into labor market dynamics during the COVID-19 pandemic and the subsequent recovery period in Uruguay. Using social security administrative records, we focus on the gender-differentiated patterns of labor market transitions following the pandemic outbreak, compared to a previous period. Furthermore, we evaluate the role of unemployment insurance (UI) as an instrument for employment protection during the pandemic-induced recession. The analysis reveals that womenparticularly those with children and earning low wagesexperienced greater employment and wage losses compared to men at the pandemics onset, though they showed signs of recovery in later periods. Moreover, women were more likely to transition from UI to formal employment during the pandemic, diverging from previous trends, largely due to the suspension modality (similar to a temporary lay-off) of the Uruguayan UI program. Through a regression discontinuity (RD) approach, the study identifies positive local effects of the beneficiaries of the UI suspension program on the probability of being employed and earning higher wages for both men and women, eight and twelve months after entering the program. These findings carry significant policy implications, underlying the importance of maintaining and potentially expanding UI programs with temporary suspension schemes, and the necessity of adapting social protection systems to respond quickly to crises. Our results underscore the potential of temporary layoff unemployment insurance schemes in developing countries as effective tools to address unexpected crises or shocks like COVID-19, preserving employment relationships and facilitating faster economic recovery. |
| Keywords: | COVID-19;gender;labor market;Unemployment insurance |
| JEL: | J16 J08 J21 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:13944 |
| By: | Xue Zhang (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Mildred Warner (Cornell University); Gen Meredith (Cornell University) |
| Abstract: | State and local governments enacted various public health emergency policies during the COVID-19 pandemic that resulted in lower infection and death rates than would have occurred without these policies. However, some states limited emergency public health authority of state executives, state governors, and state and local officials during the pandemic. This brief summarizes the results of a study that used data from the Center for Public Health Law Research and Oxford COVID-19 Government Response Tracker to explore which states passed laws that limited emergency public health authority during the COVID-19 pandemic and the effects of those limitations on COVID-19 death rates. The study finds that states with unified Republican control were more likely to limit emergency authority during the COVID-19 pandemic and that limiting emergency public health authority was associated with higher COVID-19 death rates. |
| Keywords: | Public health policy, COVID-19, legislative professionalism |
| Date: | 2023–08 |
| URL: | https://d.repec.org/n?u=RePEc:max:cprpbr:6 |