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on Health Economics |
| By: | Diallo, Yaya (McGill University); Lange, Fabian (McGill University); Renée, Laetitia (University of Montreal) |
| Abstract: | This paper examines the impact of paternity leave on the gender gap in labor market outcomes. Utilizing administrative data from Canadian tax records, we analyze the introduction of Quebec's 2006 paternity leave policy, which offers five weeks of paid leave exclusively to fathers. Using mothers and fathers of children born around the reform, we estimate how the policy impacted labor market outcomes up to 10 years following birth. The reform significantly increased fathers' uptake of parental leave and reduced their earnings immediately after the reform. However, in the medium to long-run, we find that the reform did not impact earnings, employment, or the probability of being employed in a high-wage industry for either parent. We for instance find a 95%-CI for the effect on average female earnings 3-10 years following the reform ranging from -2.2 to +1.7%. Estimates of effects on other outcomes and for males are similarly precise zeros. There is likewise no evidence that the reform changed social norms around care-taking and family responsibilities. |
| Keywords: | paternity leave, gender earnings gap |
| JEL: | J13 J16 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17624 |
| By: | Chuo, Anthony (San Diego University); Cotti, Chad D. (Michigan State University and Center for Demography of Health and Aging University of Wisconsin-Madison); Courtemanche, Charles J. (Gatton College of Business and Economics University of Kentucky); Maclean, Johanna Catherine (Schar School of Policy and Government George Mason University); Nesson, Erik T. (Wake Forest University, Economics Department); Sabia, Joseph J. (Department of Economics Center for Health Economics & Policy Studies San Diego State University) |
| 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. |
| Keywords: | ENDS taxes; youth e-cigarette use; LGBQ teens; sexual minorities |
| JEL: | I10 I12 I18 |
| Date: | 2025–01–27 |
| URL: | https://d.repec.org/n?u=RePEc:ris:wfuewp:0122 |
| By: | Jeremy Clark (University of Canterbury); Andrea Menclova (University of Canterbury) |
| Abstract: | Drug companies seeking regulator approval for a new drug must submit evidence regarding its efficacy and safety, based partly on the results of randomized clinical trials. The number of people who must be exposed to the new drug in these trials, and the duration of their exposure, are two dimensions that are agreed to by the regulator and company. Regulators face a trade-off: insisting on high sample size and long exposure makes it less likely that unforeseen problems will emerge after drug approval, but raises the cost to companies of getting a new drug approved. Excess rigour could result in fewer beneficial drugs being developed. Under current practice, sample size and duration requirements are moderate, but after drug approval clinicians report adverse reactions to regulators, who upon investigation may issue additional safety warnings. We study whether, conditioned on drug type, regulators sufficiently adjust the sample size and duration they require in new drug applications. Specifically, we manually record the sample size and average duration of exposure for all clinical trials underlying the 424 new drugs approved by the United States’ Food and Drug Administration (FDA) between 2008 and 2019, and the number of new FDA warnings issued after each drug is approved for a specific use. We then test whether sample size and average exposure duration pre-approval can significantly predict the number of new FDA warnings post-approval. We begin with simple predictive models using only sample size, duration, and time since approval, then add controls for approval process, then type of drug, and instrument for time and duration using the number of trials and average length of trials. We do not find that pre-approval sample size and average duration of exposure reduce the number of new post-approval warnings, suggesting the FDA is not compromising safety in its current practice. |
| Keywords: | Clinical trials, Sample size, Duration, New drug applications, Drug approvals, Safety warnings |
| JEL: | D04 D18 D22 I11 I18 |
| Date: | 2025–02–01 |
| URL: | https://d.repec.org/n?u=RePEc:cbt:econwp:25/02 |
| By: | Hamid Noghanibehambari; Jason Fletcher |
| Abstract: | In the presence of segregation and discrimination during the late 19th and early 20th century, many African American men changed their racial identity and “passed” for white. Previous studies have suggested that this activity was associated with increases in income and socioeconomic status despite the costs associated with cutting ties with their black communities. This study adds to this literature by evaluating the long-run effects of passing on old-age longevity. We construct longitudinal data of black families in historical censuses (1880-1940) linked to their male children’s Social Security Administration death records (1975-2005). We use family fixed effects to demonstrate that individuals passing as white live approximately 9.4 months longer, on average, than their non-passing siblings. Additional analyses suggest substantial improvements in education and occupational standing scores as well as differential parental investments as potential pathways. |
| JEL: | I1 I14 J1 J15 N0 N32 N33 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33394 |
| By: | Elmira, Elza Samantha; Suryahadi, Asep |
| Abstract: | Many low- and middle-income countries (LMICs) are experiencing a nutrition transition from traditional diets to high-energy, processed foods, increasing non-communicable disease risks. Digitalization of food systems plays a significant role in shaping this transition. This paper investigates the impact of super app expansions (including food delivery, ridesharing, and other daily life assistance) on nutritional outcomes and the underlying mechanisms. Staggered district-level adoption of Indonesia's two largest digital platforms, Gojek and Grab from 2015 to 2018, is used. This information is combined with the health dataset from Indonesia’s Basic Health Survey (Riskesdas) and food consumption data from the National Socioeconomic Survey (Susenas). To address the endogeneity issue associated with the correlation between super app entry decisions and nutritional outcomes, we use doubly robust difference-in-differences, which incorporates baseline covariates ensuring a conditional parallel trend. The results show that super apps contribute to an increase in BMI scores, particularly among individuals who are already overweight and obese. This effect is especially driven by the online food delivery feature and is more pronounced in cities than regencies and among individuals with employment, above median income, and education beyond primary school. These increases could be attributed to unhealthy food consumption (i.e., salty and prepared foods). Our findings suggest that super apps may exacerbate malnutrition. On the other hand, we find underweight reduction in the cities and an overall increase in fruit and meat consumption, indicating super apps’ potential to improve malnutrition. These findings highlight the role of super apps in the nutrition transition in LMICs. |
| Keywords: | Community/Rural/Urban Development, Food Consumption/Nutrition/Food Safety |
| Date: | 2025–01–13 |
| URL: | https://d.repec.org/n?u=RePEc:ags:ubzefd:349215 |
| By: | Flynn, James (Miami University); Gruber, Anja (University of Colorado, Boulder) |
| Abstract: | This paper uses restricted-access data from the Behavioral Risk Factor Surveillance System Survey to assess whether the sugar-sweetened beverage (SSB) tax levied in Seattle in 2018 led to declines in body mass index (BMI) and the rate of obesity. We implement an event-study design which compares these outcomes in the treated region to those of untaxed areas. We find no evidence of divergence in trends prior to the tax, followed by large declines in both outcomes after the tax was implemented. We estimate that the tax led to a reduction of .61 BMI points and reduced the obesity rate by 4.5 percentage points. Declines were largest for individuals with lower incomes, those without a college degree, and younger people, which are all groups who tend to consume more SSBs at baseline. We address concerns that our results are driven by the COVID-19 pandemic and provide suggestive evidence that SSB taxes improved these outcomes in other SSB-taxed jurisdictions as well. Our study adds to the growing evidence that SSB taxes can improve public health, rather than only affecting prices, purchasing, or consumption of taxed beverages. |
| Keywords: | soda tax, health behavior, taxation, obesity |
| JEL: | H2 H3 I12 I18 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17617 |
| By: | Aparicio Fenoll, Ainoa (University of Turin); Fernandez-Baldor Laporta, Pablo (University of Geneva); Vall Castello, Judit (University of Barcelona) |
| Abstract: | Dual labor markets are characterized by a group of workers with permanent jobs and a stable income source and another group with short-term contracts who suffer from income uncertainty and employment volatility. These differences in job security translate into several spheres of these workers' lives, with potential implications for families' well-being. This paper analyzes the causal effect of parental job security on children's health. To address endogeneity, we exploit a reform that incentivized secure labor contracts for young (under 30) and female workers in Spain by reducing payroll taxes paid by employers. Using data from several waves of the Spanish National Health Survey and combining Instrumental Variables and Differences-in-Differences methods, we find that having a secure labor contract increases the probability that children are in good or very good health by 20%. We also document some mechanisms, such as reductions in children's accidents, increases in the frequency of physical activity, and a more protein-intense diet. |
| Keywords: | job security, children's health |
| JEL: | I14 I12 J41 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17625 |
| By: | Tim Laurence (Perma Analytics Ltd); Olimpia Lamberti (London School of Hygiene and Tropical Medicine); Robert Smith (Dark Peak Analytics); Tom Drake (Center for Global Development); Anthony McDonnell (Center for Global Development) |
| Abstract: | This study estimates the global direct inpatient healthcare expenditure attributable to antimicrobial resistance (AMR) and projects future expenditures under different scenarios. Using the Institute for Health Metrics and Evaluation’s estimates of AMR burden, and a novel epidemiological literature review, new estimates of AMR inpatients admission volumes are produced. Following a literature review of 232 cost studies and statistical modelling, the analysis provides a comprehensive estimate of AMR’s financial burden in the healthcare sector for 204 countries. Globally, the study estimates there are 25.4 million hospital admissions with AMR infections annually, representing 3.5 percent of global admissions, with total excess inpatient healthcare expenditure due to AMR estimated at $66.4 billion annually. The study also finds that low- and middle-income countries bear a disproportionate share of these costs relative to their healthcare budgets, with low-income countries spending 2.0 percent and lower-middle-income countries spending 1.5 percent of total healthcare expenditure on AMR-related costs. Future projections indicate that AMR-related healthcare expenditure is likely to increase, potentially reaching $159.4 billion by 2050. |
| Date: | 2025–01–29 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:wpaper:712 |
| By: | Amanda M. Countryman (Colorado State University); Anthony McDonnell (Center for Global Development) |
| Abstract: | Antimicrobial resistance (AMR) is a complex global challenge that negatively affects human health and has widespread economic consequences. This research investigates the economy-wide effects of AMR in humans by considering five AMR-scenarios to understand the potential global and country-level impacts of resistance. This work simulates the combined impacts of AMR-induced changes in population, healthcare costs, labour, hospitality, and tourism in a computable general equilibrium modeling framework. Findings show absolute changes in global GDP in 2050 ranging from $269 billion with better treatment of bacterial infections, to nearly $990 billion when a combined, four-part intervention approach is employed. Alternatively, results show that global GDP may decline by $1.67 trillion by 2050 with accelerated resistance. There are relatively larger potential gains for lower income countries if combined intervention strategies are pursued, which is driven by positive effects on labour, followed by tourism and hospitality. Conversely, upper-middle- and high-income countries stand to lose relatively more in terms of GDP and welfare if resistance accelerates over time as demand for hospitality and tourism declines in tandem with negative effects on labour. AMR imposes tremendous societal burdens across countries and this work highlights the potential gains that may be achieved if intervention strategies are pursued contrasted with the negative impacts that could occur with a rise in resistance. |
| Date: | 2025–01–29 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:wpaper:713 |
| By: | Yang, Tianli (Renmin University of China); Zhao, Zhong (Renmin University of China) |
| Abstract: | The Chinese government announced the pilot of public long-term care insurance (LTCI) policy in 2016. While most studies focus on LTCI's effects on labor supply and retirement behavior, its effect on retirement intentions, which offer certain advantages over actual behavior, remains unclear. This study applies the difference-in-differences design to estimate the effect of LTCI on urban workers' retirement intentions based on the Chinese Longitudinal Healthy Longevity Survey. The results indicate that LTCI significantly increases the probability of intentions to delay retirement and intended retirement age, especially for the LTCI providing both service and cash benefits. Moreover, the effects are larger and more significant among subgroups, including women, self-employed workers and workers' family members with LTCI eligibility, as these sub-samples are more likely to be caregivers and caregivers' effect is larger. Mechanism analysis reveals that LTCI reduces time support within the family and improves mental health, both of which contribute to delayed retirement intentions. The negative effect of mitigating precautionary saving motives caused by LTCI also exists but subtler. Overall, these empirical evidences support that LTCI helps shape workers' retirement intentions. |
| Keywords: | long-term care insurance, retirement intentions, difference-in-differences, China |
| JEL: | H55 I28 J14 J26 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17642 |
| By: | Vishalie Shah; Julia Hatamyar; Taufik Hidayat; Noemi Kreif |
| Abstract: | This paper uses instrumental causal forests, a novel machine learning method, to explore the treatment effect heterogeneity of Indonesia's conditional cash transfer scheme on maternal health care utilisation. Using randomised programme assignment as an instrument for enrollment in the scheme, we estimate conditional local average treatment effects for four key outcomes: good assisted delivery, delivery in a health care facility, pre-natal visits, and post-natal visits. We find significant treatment effect heterogeneity by supply-side characteristics, even though supply-side readiness was taken into account during programme development. Mothers in areas with more doctors, nurses, and delivery assistants were more likely to benefit from the programme, in terms of increased rates of good assisted delivery outcome. We also find large differences in benefits according to indicators of household poverty and survey wave, reflecting the possible impact of changes in programme design in its later years. The impact on post-natal visits in 2013 displayed the largest heterogeneity among all outcomes, with some women less likely to attend post-natal check ups after receiving the cash transfer in the long term. |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2501.12803 |
| By: | Erkmen G. Aslim; Rafiuddin Najam; Erdal Tekin |
| Abstract: | This study examines the long-term effects of prenatal exposure to war violence on cognitive and developmental outcomes, focusing on children in Afghanistan, a country deeply affected by prolonged violent conflict. Using data from the 2022 Afghanistan Multiple Indicator Cluster Surveys and geo-referenced information on violent incidents, we estimate the effects of prenatal exposure to civilian casualties on educational attainment, math performance, and functional and disciplinary outcomes. Our findings reveal significant gender disparities, with girls exposed in utero demonstrating substantially worse cognitive and developmental outcomes compared to boys, including lower school attendance, reduced math performance, and increased functional difficulties. These adverse effects appear to be driven by disruptions in foundational cognitive skills during critical developmental periods. Post-birth exposure, while negatively affecting both genders, has less pronounced and consistent effects. These results highlight the intergenerational consequences of war conflict, emphasizing the need for interventions that address the unique vulnerabilities of children in conflict-affected regions. |
| JEL: | D74 I15 I25 O15 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33398 |
| By: | Elghafiky Bimardhika; Firman Witoelar |
| Abstract: | We study the causal effects of a labor law that governs child workers on labor market outcomes and the well-being of individuals. We exploit the timing of the national legislation to identify the causal effects of child labor reform using the Regression Discontinuity Design. We find that individuals who entered adulthood after the reform are less likely to have participated in the labor market during childhood. The reform also lowers the likelihood of poor health and improves the probability of working in paid jobs when children have reached adulthood. Our heterogeneity analysis highlights the importance of complementing regulation with enforcement and support programs to minimize unintended consequences that plagued many similar reforms. |
| JEL: | C21 J08 J80 I15 I25 J21 O15 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:pas:papers:2025-04 |
| By: | Hajdu, Tamás |
| Abstract: | This paper examines the effect of temperature on emergency department (ED) visits using administrative data covering 50% of the Hungarian population and 3.52 million ED visits from 2009 to 2017. The results show that ED visit rates increase when average temperatures exceed 10°C, primarily driven by mild cases that do not result in hospitalization. Higher humidity amplifies the heat effect, which is also stronger following consecutive hot days. The findings further indicate that the impacts of climate change - both present and future - are substantial. Between 2009 and 2017, 0.66% of the ED visits were attributed to temperature changes relative to the period 1950-1989. Furthermore, by the 2050s, compared to the first 15 years of the 21st century, the annual ED visit rate is projected to rise by 1.24%-1.70%, depending on the climate scenario. A heterogeneity analysis reveals that the effects of high temperatures and the future impacts of climate change are disproportionately greater in lower-income districts, areas with lower general practitioner density, and among younger adults. |
| Keywords: | temperature, climate change, morbidity, emergency department visits, heterogeneous impacts |
| JEL: | I10 I14 I18 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1560 |
| By: | Bayari, Celal |
| Abstract: | Japan’s national hospital system, which consists of a combination of private, national, prefectural and metropolitan hospitals, is the largest employers of the of the doctors. The article provides details on the women doctors’ discontinuous workforce participation in the Japanese hospital system, the dominance of part-time work patterns, and the nature of inflexibility in the work structures that disallow the maintenance of separate work and life spheres. This paper further discusses the effects of the COVID 19 pandemic on Japanese healthcare provision structures in hospitals and the extensive inhibitions that the pandemic placed on the careers of women doctors. The article details the nature of the chronic doctor shortage in Japan, and professional burnout incidences among the women doctors, and how the COVID 19 pandemic intensified these two factors. The analysis herein raises the policy issues at government and workplace level. The article argues that the establishment of free and universal childcare facilities, and family caregiving mechanisms via government fiscal restructuring would assist in the dissolution of gendered work patterns. |
| Keywords: | Burnout, gender gap, Japan, women doctors, workforce participation |
| JEL: | D13 D31 D6 D63 H5 H51 H52 H53 H55 I11 I13 I15 I18 J3 J31 J4 J41 J44 J45 J53 J58 J7 J71 K1 K12 P16 P43 P46 R1 R12 R13 Z13 |
| Date: | 2025–01–21 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:123405 |
| By: | Ismaël Rafaï (Aix Marseille Univ, CNRS, AMSE); Bérengère Davin-Casalena (Observatoire Régional de la Santé); Dimitri Dubois (CEE-M); Bruno Ventelou (Aix Marseille Univ, CNRS, AMSE) |
| Abstract: | Background. Earlier detection of neurodegenerative diseases may help patients plan for their future, achieve a better quality of life, access clinical trials and possible future disease modifying treatments. Due to recent advances in artificial intelligence (AI), a significant help can come from the computational approaches targeting diagnosis and monitoring. Yet, detection tools are still underused. We aim to investigate the factors influencing individual valuation of AI-based prediction tools. Methods. We study individual valuation for early diagnosis tests for neurodegenerative diseases when Artificial Intelligence Diagnosis is an option. We conducted a Discrete Choice Experiment on a representative sample of the French adult public (N=1017), where we presented participants with a hypothetical risk of developing in the future a neurodegenerative disease. We ask them to repeatedly choose between two possible early diagnosis tests that differ in terms of (1) type of test (biological tests vs AI tests analyzing electronic health records); (2) identity of whom communicates tests’ results; (3) sensitivity; (4) specificity; and (5) price. We study the weight in the decision for each attribute and how socio-demographic characteristics influence them. Results. Our results are twofold: respondents indeed reveal a reduced utility value when AI testing is at stake (that is evaluated to 36.08 euros in average, IC = [22.13; 50.89]) and when results are communicated by a private company (95.15 €, IC = [82.01; 109.82]). Conclusion. We interpret these figures as the shadow price that the public attaches to medical data privacy. The general public is still reluctant to adopt AI screening on their health data, particularly when these screening tests are carried out on large sets of personal data. |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:aim:wpaimx:2432 |
| By: | Alexandra Avdeenko; Jakob Gärtner; Marc Gillaizeau; Ghida Karbala; Laura Montenbruck; Giulia Montresor; Atika Pasha; Galina Zudenkova |
| Abstract: | We conduct a randomized controlled trial in rural Pakistan, comparing the effects of a remote awareness campaign with and without Imam-led loudspeaker endorsements on strategies to contain disease spread. Our results show that labor supply and social interactions decrease significantly only when religious leaders support the campaign, particularly among men. These results cannot be explained by differences in the mode or frequency of treatment across groups. Our findings—compatible with predictions from a model that analyzes the individual trade-off between prevention benefits and losses from forgone income—highlight the critical role of religious figures in shaping public responses to health crises. |
| Keywords: | Labor, Health, Religion |
| JEL: | I12 I18 D80 D81 O10 Z12 |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2025_621 |