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on Health Economics |
| By: | David Bardey; Philippe De Donder; Marie-Louise Leroux |
| Abstract: | We study a situation where physicians differing in their degree of altruism exert a diagnostic effort before deciding whether to test patients to determine the most appropriate treatment. The diagnostic effort generates an imperfect private signal of the patient’s type, while the test is perfect. At the laissez-faire, physicians exert insufficient diagnostic effort and rely excessively on testing. We show that the first-best allocation (where the degree of altruism is observable) can be decentralized by a payment scheme composed of i) a pay-for-performance (P4P) part based on the number of correctly treated patients to ensure the provision of the optimal diagnostic effort, and of ii) a capitation part to ensure both the optimal testing decision and the participation of physicians. When physicians differ in their (non-observable) degree of altruism, the optimal contract is pooling rather than separating, an instance of non-responsiveness. Its uniform P4P component induces more altruistic physicians to exert a larger diagnostic effort while, to incentivize the second-best optimal testing decision, its capitation component must be contingent on the test cost. |
| Keywords: | diagnostic risk, personalized medicine, non-responsiveness, capitation payment, pay-for-performance, hidden action and hidden information. |
| JEL: | D82 D86 I18 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:rsi:creeic:2501 |
| By: | J. Travis Donahoe; Adam Soliman |
| Abstract: | In recent years, the majority of drug overdose deaths in the U.S. have involved illicitly-produced opioids (primarily heroin and fentanyl), overtaking prescription opioids as the main driver of the opioid epidemic. In this paper, we document a previously unexplored shift in heroin markets that played a critical role in driving this transition: the takeover of white powder heroin production by Mexican Drug Trafficking Organizations (DTOs) from Colombian DTOs beginning in 2012, which resulted in heroin that was adulterated with fentanyl and more variable in potency. Using a difference-in-differences approach that exploits the fact that white powder heroin markets were exposed to these heroin quality shocks while black tar heroin markets were not, we find that they increased heroin and fentanyl death rates by roughly 230% and 890%, respectively, from 2012 to 2019. Previously studied legal market interventions cannot explain these effects, and we shed light on key aspects of the evolving epidemic that were thus far unexplained. We conclude that shocks to heroin quality are a major determinant of the transition to the illicit opioid waves of the epidemic. |
| Keywords: | overdose epidemic, illicit opioids, segmented market , Crime |
| Date: | 2025–02–04 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepdps:dp2073 |
| By: | Simona Mandile |
| Abstract: | This paper investigates the impact of social media algorithms on mental health outcomes. I exploit a quasi-experimental setting combining data from the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) coupled with the introduction of the algorithmic feed on Instagram in 2016. I estimate a differences-in-differences model comparing individuals having an Instagram account with individuals who have an account on social media platforms other than Instagram. Using a longitudinal dataset, allows for comparison of the same individuals before and after the introduction of the algorithm. The results show that the introduction of the algorithm on Instagram had a negative impact on teenagers mental health. Furthermore, I show that this effect cannot be attributed to a decrease in stigma surrounding mental health issues or an increased likelihood of individuals reporting such conditions. Additionally, evidence on mechanisms suggests that the results are due to the algorithm on Instagram favoring negative social comparisons. |
| Keywords: | social media, recommendation algorithm, mental health |
| JEL: | I12 I31 L82 L86 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11648 |
| By: | Costa, Dora; Bygren, Lars Olov; Graf, Benedikt; Karlsson, Martin; Price, Joseph |
| 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: | JEL classification: I15, J11, N33 |
| Date: | 2025–01–22 |
| URL: | https://d.repec.org/n?u=RePEc:ajt:wcinch:82948 |
| By: | Fréget, Louis; Koch Gregersen, Maria |
| Abstract: | A large economics literature studies the marginal returns of birth interventions. Still, it is almost non-existent on a fairly common intervention: medically initiating labor to prevent the health risks of a pregnancy lasting too long. Because labor induction can also have side effects, the optimal timing of birth remains debated and can depend on the specific population of mothers under study. In this paper, we assess the effects of an early labor induction policy for a fast growing share of pregnancies: high-BMI women. We provide the first piece of causal evidence on the topic by exploiting Danish guidelines which recommend routine induction at 7 days after the expected due date instead of 10-13 days after for mothers with a pre-pregnancy BMI of at least 35. Early labor induction improves immediate maternal and neonatal health, reduces universal nurse visits during the first year of life of the child, as well as maternal postpartum depression risks. |
| Keywords: | Early Health Interventions, Labor Induction, Child \& Maternal Health, Regression Discontinuity |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:cpm:docweb:2501 |
| By: | Carine Milcent (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | Electronic health records (EHRs) are intended to reduce healthcare costs and improve the quality of care. Nevertheless, usability issues common to EHRs have been identified. In this paper, we investigate these usability issues for social vulnerability codes. Using the acute care EHR and the rehabilitation care EHR databases, hospital stays of 800'000 patients are studied. This article highlights the differences in coding processes between public and private institutions observed when there are different incentives to code. Furthermore, it shows that the differences in coding are not random but depend on the coding strategy. This article emphasises that the reuse of data leads to biases in interpretation. Using the example of social vulnerability alerts policymakers to the need to consider these differences in coding processes when decisions are based on EHR information. Otherwise, this process of coding differences in social vulnerability may exacerbate social inequalities rather than reduce them. |
| Keywords: | Database, Hospitals, quality, efficiency, ownership, social vulnerability, inequity |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:hal:pseptp:hal-03960584 |
| By: | Carine Milcent (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Hanta Ramaroson (Bordeaux University Hospital); Fleur Maury (Lille University Hospital, Medical Information Department); Florence Binder-Foucard (HUS - Les Hôpitaux Universitaires de Strasbourg); Marie Moitry (UNISTRA - Université de Strasbourg); Anne-Marie Moulin (SPHERE UMR 7219 - Sciences, Philosophie, Histoire - CNRS - Centre National de la Recherche Scientifique - UPCité - Université Paris Cité) |
| Abstract: | To counter the spread of COVID-19, the French government imposed several stringent social and political measures across its entire population. We hereto assess the impact of these political decisions on healthcare access in 2020, focusing on patients who suffered from an ischemic stroke. We divide our analysis into four distinct periods: the pre-COVID-19 pandemic period, the lockdown period, the "in-between" or transitional period, and the shutdown period. Our methodology involves utilizing a retrospective dataset spanning 2019–2020, an exhaustive French national hospital discharge diagnosis database for stroke inpatients, integrated with income information from the reference year of 2019. The results reveal that the most affluent were more likely to forgo medical care, particularly in heavily affected areas. Moreover, the most disadvantaged exhibited even greater reluctance to seek care, especially in the most severely impacted regions. The data suggest a loss of opportunity for less severely affected patients to benefit from healthcares during this lockdown period, regardless of demographic, location, and socioeconomic determinants. Furthermore, our analysis reveals a notable discrepancy in healthcare-seeking behavior, with less affluent patients and seniors (over 75 years old) experiencing slower rates of return to healthcare access compared to pre-pandemic levels. This highlights a persistent gap in healthcare accessibility, particularly among socioeconomically disadvantaged groups, despite the easing of COVID-19 restrictions. |
| Keywords: | Deprivation, Geographical residence, Inequity, COVID-19 pandemic, Healthcare access, Public health, Stroke |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:hal:pseptp:hal-04690280 |
| By: | F. Angei |
| Abstract: | This paper studies the under-reporting of workplace injuries in Italy, leveraging administrative data on work accidents. Using a difference-in-differences approach, I compare injury reporting behavior across provincial economic sectors exposed to the news of a fatal workplace accident with those not exposed, providing a causal estimate of the effect of the news. The analysis reveals that, in the weeks following such news, the weekly number of non-severe injuries reported per 100, 000 workers increases. This suggests that, under typical conditions, a substantial number of non-severe accidents remain unreported. Two mechanisms drive this pattern - media coverage, which likely puts pressure on both firms and workers to better comply with reporting standards, and a strong presence of workers' unions. In fact, a decomposition of the ATT shows that the effect is stronger in provinces with higher union membership. |
| Keywords: | Workplace Injuries;Reporting Behaviour;Fatal Workplace Accidents;Media Coverage;unions;Difference-in-differences |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:cns:cnscwp:202503 |
| By: | Ruiz Buendía, Felipe (Universidad de los Andes) |
| Abstract: | Nearly one million people contract a sexually transmitted infection (STI) each day worldwide, and almost half of all pregnancies are unintended, underscoring a persistent global challenge for sexual and reproductive health. Despite research efforts, the understanding of the interplay between social structures and sexual behaviors is still insufficient. This paper investigates the relationship between perceived restrictiveness of intergenerational social norms surrounding sexual conduct and risky sexual behavior among young adults in university settings in Colombia. Drawing on the framework of social norms, I develop a novel index measuring the perception of social norms restrictiveness and conduct a list experiment to infer risky sexual behaviors, while also measuring their frequency. The results reveal a paradox: while more restrictive social norms reduce risky sexual behavior when they are actively enforced, individuals exposed to these norms during adolescence exhibit significantly higher levels of sexual risk-taking—such as multiple having sexual partners (in a context of low self-care) and substance-influenced sexual encounters—once these norms are no longer in place. These findings challenge the conventional view that restrictive social norms are always protective, evidencing their potential to generate unintended negative consequences. This research contributes to the understanding of the complex relationship between social norms, sexual behavior, and public health; advances knowledge on the social determinants of sexual health in Colombia; and sheds light on how intergenerational changes in norms may interact with the efficacy of sexual health interventions. Finally, these insights underscore the need for balanced policies that integrate comprehensive sexual education with adaptable and sustained norm-setting approaches to promote healthy sexual behaviors across the life course. |
| Keywords: | Social norms; sexual behavior; restrictiveness; intergenerational |
| JEL: | C90 I12 I18 J13 J18 |
| Date: | 2025–02–06 |
| URL: | https://d.repec.org/n?u=RePEc:col:000089:021315 |
| By: | Aditi Dimri (Chercheur indépendant); Véronique Gille (IRD - Institut de Recherche pour le Développement); Philipp Ketz (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | This paper demonstrates that sex-selective abortion induces a correlation between birth interval length and the sex of the next-born child. Using a statistical model, we show that shorter birth intervals for next-born girls indicate repeated sex-selective abortions between consecutive births. Analyzing data from India, we find evidence of repeated sex-selective abortions at birth order 2 when the first child is a girl, and strong evidence at birth order 3 when the first two children are girls. To quantify the extent of repeated abortions, we propose a maximum likelihood estimator that provides the number of women who abort and their likelihood of performing repeated abortions. Our estimation results reveal significant heterogeneity across birth orders, sibling compositions, and socio-demographic and geographic groups. Notably, literate and urban women who first had a girl rarely abort a second time, whereas women in northern India who first had two girls show a 13% likelihood of repeated sex-selective abortion. In this group, the estimated number of aborted female fetuses-the standard measure of sex-selective abortion-is 50% higher than the number of women who abort. |
| Keywords: | Sex ratio, Sex-selective abortion, Missing girls, Measurement, India |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:hal:pseptp:hal-04671748 |
| By: | Chiara Puccioni; Daniela Vuri |
| Abstract: | This study evaluates the impact of an Italian government initiative launched in 2007, which allocated €1 billion to regional governments to enhance early childhood care services for children aged 0-2, targeting both public and private childcare options. Exploiting variations in the timing of implementation across regions, we assess the program’s effectiveness in increasing the public provision of early childcare services and maternal labor market participation. Results show a significant increase in both public childcare slots and labor market participation among mothers. However, the initiative had limited effects on less-educated women, likely due to the service’s relatively high costs, which may hinder broader accessibility. |
| Keywords: | early childcare services, mothers’ labor supply, staggered difference-in-difference, dynamic estimates |
| JEL: | C21 C22 H52 H75 J13 J22 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11656 |
| By: | Carine Milcent (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | This research paper examines changes in patient care management in acute care hospitals between 2001 and 2011. During this time, there were two opposing factors at play: the competition effect of the reform and the policymaker's decision to reduce public hospitals across France. By studying the trends, it is evident that there has been a significant overall shift in patient care management during this period. This change could be attributed to the global competition effect and the concentration of in-patients in specific public facilities. Through the difference-in-difference method, the study analyzed time variations in the intensity of local competition. It was found that local competition had a negligible impact on patient care management. Additionally, the study revealed that there was a significant positive competition effect on high-technical procedures for the private sector, which is in line with the market segment where private sector hospitals have a leadership position and the pro-competitive reform intensified this position. The study also uncovered a negative competition effect on the length of stay for public hospitals. Prior to the implementation of the DRG-based payment reform, public sector hospitals were paid a global budget. However, after the reform was implemented, they had to shorten the length of stay to increase the number of stays. For-profit hospitals have always been paid based on the number of stays. The results are robust and consistent when alternative measures of local competition are used. |
| Keywords: | Competition, Hospital ownership, Policy evaluation, Length of stay, High-tech procedure, Difference-in-difference, Measure of market structure, Heart attack |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:hal:pseptp:halshs-04568345 |
| By: | Carmen Camacho (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Chrysovalantis Vasilakis (Bangor Business School - forTANK, IZA - Forschungsinstitut zur Zukunft der Arbeit - Institute of Labor Economics) |
| Abstract: | We construct a Susceptible–Infected–Vaccinated Economic two‐sector growth model to explore the dynamics of inequality in an economy with distinct groups of workers exposed to a transmissible disease. Our analysis reveals a spectrum of outcomes in the long term, ranging from a disease‐free economic environment to a scenario where only the most susceptible group suffers from the disease. Long‐term outcomes are influenced by the reproduction rates both of the overall economy and those of the two groups of workers. If one group remains infected over time, the other will surely follow, leading to a perpetual disease burden for both. Additionally, because long‐term equilibria may not be unique, there is a possibility of long‐term uncertainty, posing additional challenges for policymakers. Notably, our calibrated model suggests that if the vaccination rate exceeds 24%, the relationship between disease exposure and inequality in capital assets becomes nonmonotonic. |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:hal:pseptp:halshs-04805658 |
| By: | Jacob Pratt (University of Tennessee Chattanooga, USA); Serkan Varol (University of Tennessee Chattanooga, USA); Serkan Catma (University of Tennessee Chattanooga, USA) |
| Abstract: | The COVID-19 pandemic has necessitated the use of multidisciplinary approach to assess public health interventions. Data science has been widely utilized to promote interdisciplinary collaboration especially during the post-COVID era. This study uses a comprehensive dataset, including mask usage and epidemiological metrics from U.S. counties, to explore the correlation between public compliance with mask-wearing guidelines and COVID-19 mortality rates. After employing machine learning approaches such as linear regression, decision tree regression, and random forest regression, our analysis identified the random forest model as the most accurate model in predicting mortality rates due to its efficacy with the lowest error metrics. The models' performances were rigorously evaluated through error metric comparisons, highlighting the random forest model's robustness in handling complex interactions between variables. These findings provide actionable insights for public health strategists and policy makers, suggesting that enhanced mask compliance could significantly mitigate mortality rates during the ongoing pandemic and future health crises. |
| Keywords: | machine learning applications, predictive modeling for public health, COVID-19 analysis, pandemic, model comparison |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:smo:raiswp:0455 |
| By: | Martorano, Bruno (Maastricht Graduate School of Governance, RS: GSBE MGSoG); Perra, Elena; Tiberti, Marco |
| Abstract: | In this paper, we study the evolution of spatial inequality during the recent COVID-19 pandemic in Africa and assess if there is any association between the outbreak of the health crisis, the strictness of policy restrictions and the changes observed in spatial inequality. Using remotely sensed night time lights data, we find that spatial inequality decreased after the COVID-19 outbreak. Yet, there are huge differences within and between countries. Spatial inequality decreased in Southern and Northern African countries while it increased in Central African countries. Spatial inequality mainly decreased in countries implementing more stringent measures but also in those areas that were richer before the outbreak of the COVID-19 pandemic. |
| JEL: | C22 D63 I18 O55 |
| Date: | 2023–09–25 |
| URL: | https://d.repec.org/n?u=RePEc:unm:unumer:2023032 |