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on Health Economics |
| By: | Bíró, Anikó; Hornok, Cecília; Krekó, Judit; Prinz, Daniel; Scharle, Ágota |
| Abstract: | Disability benefits provide social insurance against the risk of losing working capacity, as well as an important source of income for individuals with disabilities. They are also costly and tend to reduce labor supply. Although spending can be contained by careful targeting, correcting past flaws in eligibility rules or assessment procedures may entail welfare costs. This paper studies a major reform in Hungary that reassessed the health and working capacity of a large share of beneficiaries. Leveraging age and health cutoffs in the reassessment, the paper estimates employment responses to loss or reduction of benefits. The findings show that among those who left disability insurance due to the reform, 58 percent were employed in the primary labor market, 6 percent participated in public works, and 36 percent were out of work without benefits in the post-reform period. The consequences of leaving disability insurance differed sharply by pre-reform employment status. Among the beneficiaries who were employed in the pre-reform year, 81 percent worked, while only 33 percent of those without pre-reform employment did. The gains of the reform in activating beneficiaries were small and strongly driven by pre-reform employment status. This points to the importance of combining financial incentives with broader labor market programs that increase employability. |
| Date: | 2023–09–26 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10575 |
| By: | Sandra Aguilar-Gomez; Joshua S. Graff Zivin; Matthew J. Neidell |
| Abstract: | Extreme heat imperils health and results in more emergency department (ED) visits and hospitalizations. Since temperature affects many individuals within a region simultaneously, these health impacts could lead to surges in healthcare demand that generate hospital congestion. Climate change will only exacerbate these challenges. In this paper, we provide the first estimates of the health impacts from extreme heat that unpacks the direct effects from the indirect ones that arise due to hospital congestion. Using data from Mexico’s largest healthcare subsystem, we find that ED visits rise by 7.5% and hospitalizations by 4% given daily maximum temperatures above 34◦C. As a result, more (and sicker) ED patients are discharged home, and deaths within the hospital increase. While some of those hospital deaths can be directly attributed to extreme heat, our analysis suggests that approximately over half of these excess deaths can be viewed as spillover impacts due to hospital congestion. Additional analyses also reveal an increase in the share of deaths occurring outside hospitals, consistent with congestion-related health harms arising from the discharge of sicker patients from the ED. Our findings highlight an important new avenue of adaptation to climate change. If hospital congestion contributes to excess health damages from a changing climate, then expanding labor and capital investments and improving surge management tools can help reduce those damages. |
| JEL: | I15 I18 Q54 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33491 |
| By: | Ginja, Rita (University of Bergen); Riise, Julie (University of Bergen); Willage, Barton (University of Delaware); Willén, Alexander (Norwegian School of Economics) |
| Abstract: | We estimate doctor value-added (VA) combining population-wide patient-doctor register data with exogenous variation in the assignment of patients to GPs. We find substantial variation in the quality of GPs as measured by patients' post-assignment mortality. Certain doctor characteristics and practice styles predict VA, but most of the variation in GP quality is driven by differences in GPs' unobserved ability. VA variation across GPs primarily reflects differences in GPs' ability to engage in prevention and assign the right procedure to the patient. Finally, patients are unable to identify who the high-quality doctors are, and patient-generated ratings are uncorrelated with GP VA. |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17726 |
| By: | Oparina, Ekaterina; Krekel, Christian; Srisuma, Sorawoot |
| Abstract: | Mental health problems impose significant costs, yet healthcare systems of-ten overlook them. We provide the first causal evidence on the effectiveness of a nationwide-scaled mental health service in England for treating depression and anxiety using non-experimental data and methods. We exploit over-subscription and resulting exogenous variation in waiting times across areas and time for identification, based on a novel dataset of over one million patients. We find that treatment improves mental health and reduces impairment in work and social life. We provide suggestive evidence that it enhances employment. Impacts vary across patients and services. Nevertheless, the programme is highly cost-effective. |
| Keywords: | mental health; psychological therapies; quasi-natural experiment; policy evaluation; machine learning; cost-benefit analysis; wellbeing |
| JEL: | I18 D61 D00 |
| Date: | 2024–02–29 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126829 |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | We examine the age profile of subjective wellbeing and illbeing in nine Asian countries (Bangladesh, Hong Kong, India, Indonesia, Japan, Pakistan, Philippines, Singapore, Sri Lanka) and seven Middle Eastern countries (Iraq, Israel, Jordan, Turkey, Saudi Arabia, the UAE and Yemen). We find the relationship between age and reported wellbeing differs according to the way the survey is conducted. In the Gallup World Poll, where the data are collected by interviewers face-to-face or by telephone (computer-aided telephone interviews, or CATI) the young are the happiest and the results are the same across the two survey modes. We find the same result in CATI surveys in the Global Flourishing Survey (GFS) of 2022-2024 in 7 Asian and Middle Eastern (AME) countries. However, when the GFS survey is conducted on the web (computer-aided web interview, or CAWI) wellbeing is u-shaped in age, and is highest among the oldest respondents. If we turn to negative affect measures (loneliness, anxiety, depression, worry) these rise with age using CATI but fall with age using CAWI. We look for survey mode switching in the age coefficient across 40 outcomes. In general, the switch is confined to subjective wellbeing and illbeing metrics. Switching does not occur when respondents are asked about their physical health, bodily pain, unemployment status, drinking and smoking, or personality-related questions. It appears that the mode effect is largely confined to how individuals rate their subjective wellbeing and illbeing. The results are suggestive of social desirability response bias which leads young people to under-report socially undesirable affective states to interviewers. |
| JEL: | I31 J13 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33475 |
| By: | Steffens, Camila; Pereda, Paula Carvalho |
| Abstract: | Smoking bans have been widely implemented, despite mixed evidence on their effectiveness in reducing firsthand smoking. This paper provides novel insights into the dynamic impacts of smoking bans in the context of a large developing country, Brazil, that had more than 18.6 million regular smokers in 2013. Our estimation strategy exploits the staggered implementation of comprehensive smoking bans in Brazilian state capitals using an event-study framework. We also leverage the variation in policy enforcement across cities. Our results indicate that bans reduced smoking prevalence by up to 15% among young adults, particularly when rigorously enforced. This effect is primarily driven by smoking cessation, while the impact on initiation is relatively modest. Our analysis suggests that the Brazilian policy prevented roughly USD 53 million in costs in the capitals where it was highly enforced. |
| Keywords: | Smoking bans, Addiction, Policy enforcement, Difference-in-differences, Development |
| JEL: | D04 D12 I12 I18 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:312177 |
| By: | Borgbjerg, Anne Katrine (Aarhus University); Agerbo, Esben (Aarhus University); Datta Gupta, Nabanita (Aarhus University); Halliday, Timothy J. (University of Hawaii at Manoa) |
| Abstract: | We analyze administrative and genetic data from over 200, 000 Danes to study the effects of genetic risk for Alzheimer's Disease (AD) on labor market outcomes. Higher AD genetic risk increases dementia diagnoses and GP visits for both genders. Among women aged 45–65, it reduces labor participation and raises disability pension uptake, especially near retirement. These effects weaken for women with high polygenic scores for education. For men, AD genetic risk shows no employment impact. These gender differences align with evidence that AD genetic markers are more predictive in women. |
| Keywords: | Alzheimer's Disease, labor supply, genoeconomics |
| JEL: | I14 J14 J22 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17714 |
| By: | Shubhashrita Basu; Jason Fletcher; Qiongshi Lu; Jiacheng Miao; Lauren L. Schmitz |
| Abstract: | We examine whether genome-wide summary measures of genetic risk known as polygenic indices (PGIs) provide new insights into the efficacy of the Lung Health Study (LHS)–a large, randomized controlled trial (RCT) that evaluated the effect of a smoking cessation intervention program on cessation maintenance and lung function. Results indicate that the intervention was less successful for participants with higher PGIs for smoking initiation and intensity. Given the increasing availability and affordability of genomic data, we argue that in the context of RCTs, PGIs can further our understanding of heterogeneous treatment effects and the mechanisms that may be driving them. |
| JEL: | I1 I10 I18 J10 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33473 |
| By: | Brüll, Eduard; Rostam-Afschar, Davud; Schlenker, Oliver |
| Abstract: | We study how the threat of entry affects service quantity and quality of general prac- titioners (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 com- petitors 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: | Entry regulation, general practitioners, healthcare provision, threat of entry, regression discontinuity design |
| JEL: | I11 I18 J22 L10 L22 R23 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:312185 |
| By: | Bedoya Arguelles, Guadalupe; Das, Jishnu; Dolinger, Amy |
| Abstract: | This paper presents results from the first randomization of a regulatory reform in the health sector. The reform established minimum quality standards for patient safety, an issue that has become increasingly salient following the Ebola and COVID-19 epidemics. In the experiment, all 1, 348 health facilities in three Kenyan counties were classified into 273 markets, and the markets were then randomly allocated to treatment and control groups. Government inspectors visited health facilities and, depending on the results of their inspection, recommended closure or a timeline for improvements. The intervention increased compliance with patient safety measures in both public and private facilities (more so in the latter) and reallocated patients from private to public facilities without increasing out-of-pocket payments or decreasing facility use. In treated markets, improvements were equally marked throughout the quality distribution, consistent with a simple model of vertical differentiation in oligopolies. This paper thus establishes the use of experimental techniques to study regulatory reforms and, in doing so, shows that minimum standards can improve quality across the board without adversely affecting utilization. |
| Date: | 2023–03–28 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10386 |
| By: | Michael R. Richards; Maggie Shi; Christopher M. Whaley |
| Abstract: | Information technology (IT) can enhance firms’ long-run performance but is also a risky investment, with high fixed costs and uncertain returns. Whether market events influence this tradeoff has received limited attention. We leverage the healthcare context to empirically examine hospitals’ IT investments following economic downturns and public insurance expansions––i.e., large industry shocks in opposite directions. We find novel and symmetrical responses. Recessions restrain investments while expansion policy indirectly stimulates them. Importantly, the IT margin is more elastic than other spending responses to market fluctuations. Supplementary analyses suggest that hospitals’ finances and perceptions of uncertainty drive these capital investment adjustments. |
| JEL: | H42 I1 I11 I13 I18 L21 L23 L24 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33487 |
| By: | Eduardo Montero; Dean Yang; Triana Yentzen |
| Abstract: | How do economic costs affect religious choices, and how do religious institutions adapt to economic realities? We study the Seventh-Day Adventist (SDA) church in Sub-Saharan Africa, which prohibits production of tobacco, coffee, and tea, creating salient opportunity costs for potential members in areas suitable for these crops. We construct a measure of SDA membership opportunity cost that varies over time and space based on local crop suitability and export prices. Using church administrative data and member surveys, we find that increased opportunity costs lead to lower membership growth and lower satisfaction with the church among existing members. The church responds by establishing new educational and health institutions and reducing emphasis on "healthy living" religious tenets. These findings reveal how religious organizations can show striking flexibility in balancing tradition and adaptation when faced with economic pressures. Our study provides new insights into the microeconomics of cultural change, as mediated by religious institutions. |
| JEL: | D71 L31 O12 Z12 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33482 |
| By: | Oparina, Ekaterina; Clark, Andrew E.; Layard, Richard |
| Abstract: | We use Gallup World Poll data from over 150 countries from 2009-2019 at both the individual and country levels to revisit the relationship between income and subjective wellbeing. Our inspiration is the paradox first proposed by Easterlin (1974), according to which higher incomes are associated with greater happiness in cross-sections yet increases in a country's GDP per head do not increase its average wellbeing. In our analysis subjective wellbeing (or happiness) is measured by the Cantril ladder on a 0-10 scale. Across individuals, other things equal, one unit of log income raises subjective wellbeing by 0.4 points. In other words, doubling income raises wellbeing by 0.3 points out of 10. Across countries, a crude regression of log income on per capita income gives a higher coefficient of 0.6. But, once social variables like health and social support are introduced, the picture changes. In rich countries, income no longer has a significant effect, either in country cross-sections or in time series: higher income only matters due to its correlation with the social variables. For low-income countries the result is also clear cut - income raises happiness in both cross-section and time series, whether the social variables are controlled for or not. For middle income countries the result is mixed. |
| Keywords: | subjective wellbeing; income; GDP; Easterlin paradox; public goods |
| JEL: | F15 R10 R12 |
| Date: | 2024–11–06 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126798 |
| By: | Sun, Yimeng; Zhao, Eric |
| Abstract: | In this paper, we explored the application of mathematical modeling and operations research techniques in optimizing healthcare delivery in rural settings. We introduced a queuing model to understand the dynamics of patient arrival rates, service rates, system utilization, and waiting times, providing crucial insights into potential areas for healthcare improvement. The paper further investigates the utilization of operations research methods such as linear programming, integer programming, and simulation-based optimization to balance service quality, patient waiting times, and operational costs. Although these techniques present their own implementation challenges, they offer a means for more effective decision-making. While rural healthcare presents unique constraints and challenges, the integration of mathematical modeling and operations research holds the promise of improving healthcare delivery and patient outcomes. Further research in this field could offer significant advancements in the sustainability and effectiveness of rural healthcare services. |
| Date: | 2023–09–19 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:nvhmf_v1 |
| By: | Farré, Lídia; González, Libertad; Hupkau, Claudia; Ruiz-Valenzuela, Jenifer |
| Abstract: | We study the effect of paternity leave on early child development. We collect survey data on 5, 000 children under age six in Spain and exploit several extensions of paternity leave that took place between 2017 and 2021. We follow a differences-in-discontinuities research design, based on the date of birth of each child and using cohorts born in non-reform years as controls. We show that the extensions led to significant increases in the length of leave taken by fathers, without affecting that of mothers, thus increasing parental time at home in the first year after birth. Eligibility for four additional weeks of paternity leave led to a significant 12 percentage-point increase in the fraction of children with developmental delays. We provide evidence for two potential mechanisms. First, children exposed to longer paternity leave spend less time alone with their mother, and more time with their father, during their first year of life. Second, treated children use less formal childcare. Our results suggest that paternity leave replaces higher-quality modes of early care. We conclude that the effects of parental leave policies on children depend crucially on the quality of parental versus counterfactual modes of childcare. |
| Keywords: | paternity leave; child development; family policies; intergenerational skill transmission; regression discontinuity; differences-in-differences |
| JEL: | J12 J13 J16 J18 |
| Date: | 2024–07–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126799 |
| By: | Wilkinson, Thomas David; Wang, Mengxiao; Friedman, Jed; Prestidge, Marelize |
| Abstract: | Numerous digital health interventions have been piloted in response to the health care challenges low- and middle-income countries face. Because the opportunity cost of investing in digital health interventions can be large, countries must make choices about which interventions to scale up. To make good investment decisions about digital health interventions, there is a need to define and establish their value, and to use economic evaluation to make informed decisions, however DHIs present methodological challenges for economic evaluation. To address these challenges, this paper first creates a ‘gap map’ of digital health intervention evidence which reveals a dearth of economic evaluation evidence about digital health interventions; this lack can limit decisions on policy, programming, and appropriate scale-up of digital health interventions. To advance work in this field, this paper then develops an economic evaluation framework that can be used when determining the economic value of digital health interventions. Such a standardized approach, alongside guidance to assist the conduct and use of economic evidence, can improve decision making and investments in DHI under constrained health budgets. The resulting digital health intervention economic evaluation framework consists of 5 steps: (1) determine the context, (2) determine the intervention type, (3) establish the level of complexity, (4) set the analytic principles, and (5) represent the value proposition. Users of the framework should attempt to adhere to its steps and principles, but where this is not feasible or appropriate, they should provide justification for the methodological choice. The framework should facilitate methodological transparency, thereby improving the overall usefulness of economic evaluations of digital health interventions. |
| Date: | 2023–04–12 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10407 |
| By: | Baseler, Travis Andreas; Hennig, Jakob Johannes |
| Abstract: | Natural disasters displace millions of people a year, but little is known about their long-run impacts when institutional capacity to respond to the disaster is low. This paper estimates the long-run impacts of six major landslides in Uganda, where most affected households received little aid. The analysis combines administrative and survey data from nearly the full population of affected and nearby households with e xact landslide paths and a geological model of landslide risk to identify impacts relative to nearby households facing similar risk. Landslides substantially increase long-term displacement and migration, and affected households have significantly worse economic and mental health outcomes years afterward. Displacement worsens long-run outcomes, especially when not administered by the government. These findings contrast with many other studies of natural disaster, and suggest that the positive impacts of displacement require a favorable financial and institutional environment unlikely to be found in many countries. |
| Date: | 2023–08–02 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10535 |
| By: | Andrea Di Giovan Paolo; Jose Higueras |
| Abstract: | This paper examines the equilibrium effects of insurance contracts on healthcare markets using a mechanism design framework. A population of risk-averse agents with preferences as in Yaari (1987) face the risk of developing an illness of unknown severity, which can be treated in a competitive hospital services market at the prevailing market price. After privately observing their health risk, but before learning their sickness level, agents have the option to purchase insurance from a monopolistic provider. Insurance contracts specify premiums, out-of-pocket costs (OPCs), and hospital service coverage, thus determining demand and price in the downstream hospital market through a market-clearing condition. Our first main result shows that optimal insurance contracts take a simple form: agents can choose between full hospital coverage with a high OPC or restricted coverage with a low OPC. This highlights a novel form of under-insurance (rationing or restricted access to healthcare services) emerging purely due to the insurer's attempt to control his price impact. Our second key result illustrates the nuanced effect of price impact on the amount of insurance provided. Higher healthcare prices increase insurer payouts but also worsen agents' outside options, making them more willing to pay for insurance ex ante. The net effect of these forces determines whether insurance provision exceeds or falls short of a price-taking benchmark. |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2503.01780 |
| By: | Morshed, Monzur |
| Abstract: | Bangladesh’s worst dengue fever epidemic was 2019 and the fever has plagued the nation since 2000. The purpose of this study was to learn more about the socioeconomic context of dengue in Bangladesh, as well as the general public's knowledge, attitude, and behavior (KAP) toward the disease. In this short study, it has been observed that Masters pass participants had 13% lower practices compared to the Bachelor pass participants and employed participants had 3.69 times more practices compared to the unemployed participants. According to knowledge and attitude status, the chance of practicing the items towards dengue fever was more for knowledgeable persons [aOR: 3.00 (95% CI: 0.52, 17.37); p-value=0.221] and persons who had good attitude [aOR: 1.28 (95% CI: 0.30, 5.46); p-value=0.742]. But all associations were statistically insignificant due to the small size of the sample population. |
| Date: | 2023–02–14 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:78wt2_v1 |
| By: | Moore, Duncan A.Q.; Yaqub, Ohid; Sampat, Bhaven N. |
| Abstract: | The Medical Subject Headings (MeSH) thesaurus is a controlled vocabulary developed by the U.S. National Library of Medicine (NLM) for classifying journal articles. It is increasingly used by researchers studying medical innovation to classify text into disease areas and other categories. Although this process was once manual, human indexers are now assisted by algorithms that automate some of the indexing process. NLM has made one of their algorithms, the Medical Text Indexer (MTI), available to researchers. MTI can be used to easily assign MeSH descriptors to arbitrary text, including from document types other than publications. However, the reliability of extending MTI to other document types has not been studied directly. To assess this, we collected text from grants, patents, and drug indications, and compared MTI’s classification to expert manual classification of the same documents. We examined MTI’s recall (how often correct terms were identified) and found that MTI identified 78% of expert-classified MeSH descriptors for grants, 78% for patents, and 86% for drug indications. This high recall could be driven merely by excess suggestions (at an extreme, all diseases being assigned to a piece of text); therefore, we also examined precision (how often identified terms were correct) and found that most MTI outputs were also identified by expert manual classification: precision was 53% for grant text, 73% for patent text, and 64% for drug indications. Additionally, we found that recall and precision could be improved by (i) utilizing ranking scores provided by MTI, (ii) excluding long documents, and (iii) aggregating to higher MeSH categories. For simply detecting the presence of any disease, MTI showed > 94% recall and > 87% precision. Our overall assessment is that MTI is a potentially useful tool for researchers wishing to classify texts from a variety of sources into disease areas. |
| Date: | 2023–02–25 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:b75fr_v1 |
| By: | Motta, Matt (Boston University School of Public Health); Liu, Yuning; Yarnell, Amanda |
| Abstract: | A substantial body of social scientific research considers the negative mental health consequences of social media use on TikTok. Fewer, however, have considered the potentially positive impact that mental health content creators (“influencers”) on TikTok can have to improve health outcomes; including the degree to which the platform exposes users to evidence-based mental health communication. We aim to remedy this shortcoming by influencing TikTok creator content-producing behavior via a large, within-subject field experiment (N = 105 creators with a reach of over 16 million TikTok followers; N = 3, 465 unique videos). Our randomly-assigned field intervention exposed influencers on the platform to either (a) asynchronous digital (.pdf) toolkits, or (b) both toolkits and synchronous virtual training sessions that aimed to promote effective evidence-based mental health communication (relative to a control condition, exposed to neither intervention). We find that creators treated with our asynchronous toolkits – and, in some cases, those also attending synchronous training sessions – were significantly more likely to (i) feature evidence-based mental health content in their videos and (ii) generate video content related to mental health issues. Moderation analyses further reveal that these effects are not limited to only those creators with followings under 2 million users. Importantly, we also document large system-level effects of exposure to our interventions; such that TikTok videos featuring evidence-based content received over half a million additional views in the post-intervention period in the study’s treatment groups, while mental health content (in general) received over two million additional views. We conclude by discussing how simple and cost-effective interventions like ours can be deployed at scale to influence mental health content production on TikTok. |
| Date: | 2023–10–10 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:amzdb_v1 |
| By: | Rojas Mendez, Ana Maria; Munoz Boudet, Ana Maria; Moscoe, Ellen Elizabeth; Jamison, Julian C; Herl, Carlos Rumiallo |
| Abstract: | Addressing the growing burden of noncommunicable diseases to achieve healthy longevity for an aging population has become central to global health policy goals. New policy tools are needed for effectively and efficiently tackling health and lifestyle behaviors and habits linked to the development of noncommunicable disease risk factors. Behavioral science offers insights into psychological barriers, mental models, biases, and other factors that influence decision making and habit formation. Applying these insights can support current policy efforts toward healthy longevity. This paper develops a framework to clarify the relationships between noncommunicable disease formation, detection, and management and behavioral determinants at the individual, community, and health system levels. Following the framework, the paper documents frequently identified behavioral barriers at the three key stages of patients’ noncommunicable disease trajectories. It identifies policy lessons from the behavioral science literature to address such barriers and, together with other policies, reduce the incidence of noncommunicable diseases and improve treatment effectiveness. |
| Date: | 2023–03–07 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10347 |
| By: | Pierre Azoulay; Wesley H. Greenblatt |
| Abstract: | Scientific projects that carry a high degree of risk may be more likely to lead to breakthroughs yet also face challenges in winning the support necessary to be carried out. We analyze the determinants of renewal for more than 100, 000 R01 grants from the National Institutes of Health between 1980 and 2015. We use four distinct proxies to measure risk taking: extreme tail outcomes, disruptiveness, pivoting from an investigator’s prior work, and standing out from the crowd in one’s field. After carefully controlling for investigator, grant, and institution characteristics, we measure the association between risk taking and grant renewal. Across each of these measures, we find that risky grants are renewed at markedly lower rates than less risky ones. We also provide evidence that the magnitude of the risk penalty is magnified for more novel areas of research and novice investigators, consistent with the academic community’s perception that current scientific institutions do not motivate exploratory research adequately. |
| JEL: | H51 O32 O38 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33495 |
| By: | Hémono, Rebecca; Balampama, Marianna; De Walque, Damien B. C. M.; Mccoy, Sandra Irene; Dow, William H. |
| Abstract: | Financial incentives are a promising approach for HIV prevention. Some studies have shown that financial incentive interventions aimed to promote positive health and social behaviors have mixed or harmful effects on gender-based violence, and little is known about their effects among higher risk groups such as female sex workers. To address this gap, this study investigated the relationship between a lottery-based incentive and gender-based violence among female sex workers in Dar es Salaam, Tanzania. Data were analyzed from the RESPECT II trial, which enrolled 2, 206 female sex workers in Dar es Salaam, Tanzania, to evaluate the effect of a lottery-based incentive on HIV and sexually transmitted infections. Participants were randomized in a one-to-one ratio to: (1) the basic test group (control), which provided baseline testing and counseling for HIV and sexually transmitted infections and bi-weekly text messages on safe sex practices; or (2) the lottery group, which included the basic test group intervention plus entry into a weekly random lottery for an award of 100, 000 Tanzanian shillings conditional on negative tests for sexually transmitted infections (syphilis and trichomonas vaginalis). An intent-to-treat analysis was conducted to estimate differences in physical and sexual gender-based violence (overall), and intimate partner violence and non-partner violence between treatment arms at endline, with estimates expressed as unadjusted prevalence differences with 95 percent confidence intervals. Adjusted estimates controlled for baseline reports of violence. Multiple imputation and inverse-probability of treatment weighting were used to account for missing data. Causal, population-level impacts were estimated using g-computation. Gender-based violence, intimate partner violence, and non-partner violence declined in both treatment arms over the study period among the sample of 1, 117 female sex workers retained at endline. The lottery group had a lower prevalence of gender-based violence overall, intimate partner violence, and non-partner violence compared to control at endline; however, the differences were not statistically significant. The results indicate that the lottery intervention had no effect on violence outcomes among endline participants in the RESPECT II trial. These results suggest that this economic approach does not pose additional risks of violence in the context of sex work; however, they must be interpreted with caution due to high attrition in the study sample. Additional research is warranted to examine how this incentive mechanism impacts violence for female sex workers. |
| Date: | 2023–09–26 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10573 |
| By: | Arguello-Mondragón, Elian; Acosta-Rivas, Sofia; Canencia, Miguel Atencia; Nunez-Rodriguez, Eduardo; Moya-Moya, Luz Marina; Palencia-Sánchez, Francisco (Pontificia Universidad Javeriana) |
| Abstract: | Introduction. Colombia faces a shortage of doctors that, added to multiple reports of inequitable and centralized distribution of this health personnel, has grave consequences for public health. For this reason, characterizing the medical population in Colombia is so essential. Aim. To describe the medical population and its geographical distribution in Colombia, categorizing it between general practitioners and specialists. Methodology. a descriptive cross-sectional study. We used the ReTHUS and DANE databases to carry out a descriptive analysis of medical personnel in Colombia by department, subdividing between specialist doctors and general practitioners, as well as the six primary specialties. Results. Medical personnel are concentrated in the country's main population centers, particularly the Andean region. In all departments, there are more general practitioners than specialists. Discussion. Our results are similar and are near the projections raised in previous studies. On the other hand, it is no coincidence that the departments where we find the lowest density of medical personnel have other shortcomings regarding resources and neglect of population needs. Multiple associations could be raised for these findings. It is pertinent to delve into the role of the general practitioner and their different fields of action since they represent most of the personnel available in the country. Conclusions. There is no reliable registry of medical personnel in Colombia. There is a centralization in the distribution of the registration of doctors in the country, both for the total number of doctors, general practitioners, and specialist physicians. Knowing the supply of doctors contributes to subsequent decision-making in public health policy. |
| Date: | 2023–04–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:vtpze_v1 |
| By: | Balampama, Marianna; De Walque, Damien B. C. M.; Dow, William H.; Hémono, Rebecca |
| Abstract: | Female sex workers are a key population who experience a disproportionately high burden of HIV and sexually transmitted infections. A growing body of evidence suggests that financial incentives can reduce risky sexual behavior and the incidence of HIV and sexually transmitted infections; however, few studies have examined a lottery-based incentive mechanism or been conducted with female sex workers. This paper examines the effect of a lottery intervention on the combined incidence of HIV and herpes simplex virus 2 among female sex workers in Tanzania. The RESPECT II trial was an unmasked, two-arm, parallel group randomized controlled trial conducted in Dar es Salaam, Tanzania among 2, 206 enrollees from 2018 to 2021. Participants were randomized in a one-to-one ratio to the basic test control group or to the lottery intervention group. The basic test group received testing and counseling for HIV and biweekly text messages with information on safe sex practices. The lottery group received the basic test group intervention plus entry into a weekly lottery with a 100, 000 Tanzanian shilling (US$50) reward offered to 10 randomly selected participants, conditional on negative test results for syphilis and trichomonas. The primary outcome was combined HIV and herpes simplex virus 2 incidence after 36 months. The results showed no statistically significant effect on this primary outcome. Thus the study finds no evidence that the lottery-based incentives reduced the incidence of HIV and sexually transmitted infections among the female sex worker population. However, the results may have been affected by disruption from the COVID-19 pandemic, and unexpectedly high study attrition levels made it impossible to statistically rule out possible moderate-sized effects. |
| Date: | 2023–09–25 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10571 |
| By: | Motta, Matt (Boston University School of Public Health); Motta, Gabriella; Stecula, Dominik (University of Pennsylvania) |
| Abstract: | Canine vaccine hesitancy (CVH) can be thought about as dog owners’ skepticism about the safety and efficacy of administering routine vaccinations to their pets. CVH is potentially problematic not only because it may inspire vaccine refusal – which may in turn facilitate infectious disease spread in both canine and human populations – but because it may contribute to veterinary care provider burnout. While anecdotal reports suggest that CVH may be widespread, few have made an effort to assess its prevalence, socio-political correlates, or animal/human health consequences. In a nationally representative survey of the US adult population (N = 2, 200), we introduce a novel survey-based instrument for measuring CVH. We document pervasive CVH in dog owner subpopulations, with 53% expressing concerns about the safety (37%), efficacy (22%), and/or necessity (30%) of canine vaccination. We further provide evidence of vaccine “spillover” effects; such that dog owners who hold negative attitudes about human vaccines – views which tend to be over-represented on the ideological right – are significantly more likely to express CVH. Troublingly, we find that CVH is associated with rabies non-vaccination, as well as opposition to evidence-based vaccine policies. We conclude by discussing the human and animal health consequences of CVH, and outline a research agenda for future opinion-based research on this important topic. |
| Date: | 2023–07–07 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:qmbkv_v1 |
| By: | Hanke Heun-Johnson; Darius Lakdawalla; Julian Reif; Bryan Tysinger |
| Abstract: | The COVID-19 pandemic has resulted in significant excess mortality among the US population, impacting the future outlays of the US Social Security Administration (SSA) Old Age, Survivors, and Disability Insurance (OASDI) program. This study aimed to estimate the net effects of pandemic-induced excess deaths on OASDI liabilities, utilizing dynamic microsimulation models, and examined how these effects vary across different socioeconomic and racial-ethnic groups. Data on excess deaths were obtained from the CDC and processed to account for seasonal variations and demographic disparities. The simulation incorporated demographic and health status variables to project OASDI retirement and disability benefits, and survivors’ benefits for spouses and children, for respondents with highest COVID mortality risk. The pandemic resulted in approximately 1.7 million excess deaths among individuals aged 25 and older between 2020 and 2023. These premature deaths reduced future retirement payments, which increased the Social Security fund by $294 billion. However, this gain was offset by reductions in future payroll tax flows ($58 billion) and increased payments to surviving spouses and children ($32 billion), resulting in a net impact of $205 billion. Non-Hispanic Black and Hispanic decedents left behind more underage children per capita, yet payments to their surviving family members were lower compared to non-Hispanic White decedents, across all educational levels. Excess mortality during the COVID-19 pandemic has complex implications for the OASDI program. While there is an estimated net positive financial impact due to reduced future retirement benefits, this effect is mitigated by decreased payroll tax contributions and increased survivors’ benefits. The differential impact by race and ethnicity highlights existing inequalities and underscores the importance of considering demographic disparities in future projections of Social Security liabilities. These findings provide critical insights for informing SSA trust fund projections and policy decisions. |
| JEL: | I10 I18 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33465 |
| By: | Chen, Xiaoguang; Huang, Hanwei; Ju, Jiandong; Sun, Ruoyan; Zhang, Jialiang |
| Abstract: | We study infectious diseases in a spatial epidemiology model with forward-looking individuals who weigh disease environments against economic opportunities when moving across regions. This endogenous mobility allows regions to share risk and health resources, resulting in positive epidemiological externalities for regions with high R0s. We develop the Normalized Hat Algebra to analyze disease and mobility dynamics. Applying our model to US data, we find that cross-state mobility controls that hinder risk and resource sharing increase COVID-19 deaths and decrease social welfare. Conversely, by enabling "self-containment" and "self-healing, " endogenous mobility reduces COVID-19 infections by 27.6% and deaths by 22.1%. |
| Keywords: | sird model; spatial economy; endogenous mobility; basic reproduction number; normalized hat algebra; containment policies; Covid-19; coronavirus |
| JEL: | C61 D91 I12 I18 J61 R13 |
| Date: | 2024–02–12 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126830 |
| By: | Markhof, Yannick Valentin; Wollburg, Philip Randolph; Zezza, Alberto |
| Abstract: | Routine immunization coverage estimated in surveys often substantially differs from figures reported in administrative records, presenting a dilemma for researchers and policy makers. Using high-frequency phone surveys and administrative records from government sources in 36 low- and middle-income countries, this paper shows that such misalignment has also been common in the case of COVID-19. Across the sample, survey estimates exceed administrative figures by 47 percent on average, at times suggesting markedly different policy conclusions depending on the data source consulted. This pattern is particularly stark and consistent in Sub-Saharan Africa. To investigate the sources of this discrepancy, the paper presents results from six methodological experiments that vary survey design choices and documents their effect on estimated COVID-19 vaccine coverage. The results show that design choices matter, in particular the selection of respondents to be interviewed. However, phone survey estimates prove remarkably robust to several commonly claimed biases. After accounting for observed errors of representation and measurement in the survey data, there remains a nonnegligible, unexplained residual gap with administrative records. The paper provides indicative evidence of flaws and weaknesses in administrative data recording and reporting that affect reported vaccination rates and could contribute to this gap. The findings matter for past research on COVID-19 vaccination, future immunization efforts, and the design of robust data production systems on health topics. |
| Date: | 2023–05–10 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10443 |
| By: | Seitz, William Hutchins; Yamada, Eiji; Shimizutani, Satoshi |
| Abstract: | This paper studies the effect of proposing a monetary incentive for vaccination intentions, with a survey-based randomized controlled experiment conducted separately in three countries, Tajikistan, Uzbekistan, and Kazakhstan. Respondents from nationally representative surveys were randomly assigned to a control group (for which no incentive was proposed) or to one of several treatment groups with varying levels of hypothetical compensation. Offering incentives markedly reduced overall vaccination intentions —all three counties. Country-level results ranged from no meaningful effect on vaccination intentions (Tajikistan) to a decline of up to 22 percent (Uzbekistan and Kazakhstan). In follow-up questions, most respondents said they disapprove of offering financial incentives for vaccination, and especially in contexts with strong negative effects in the experiment. The results contrast with the well-established efficacy of monetary incentives to influence vaccination behavior in other settings, but they are consistent with findings from the behavioral literature in which incentive payments signal inferiority or disutility. The findings suggest that policy makers and practitioners should use caution when considering extrinsic incentives for vaccination and other health interventions where effects have not been tested. |
| Date: | 2023–03–09 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10349 |
| By: | Katz, Lindsay; Chong, Michael; Alexander, Monica |
| Abstract: | Patterns and trends in short-term mobility are important to understand, but data required to measure such movements are often not available from traditional sources. We collected daily data from Facebook’s Advertising Platform to measure short-term mobility across all states and provinces in the United States and Canada. We show that rates of short-term travel vary substantially over geographic area, but also by age and sex, with the highest rates of travel generally for males. Strong seasonal patterns are apparent in travel to many areas, with different regions experiencing either increased travel or decreased travel over winter, depending on climate. Further, some areas appear to show marked changes in mobility patterns since the onset of the pandemic. We used the traveler rates constructed from Facebook to adjust Covid-19 mortality rates over the period July 2020 to July 2021, and showed that accounting for travelers leads to on average a 3 per cent difference in implied mortality rates, with substantial variation across demographic groups and regions. |
| Date: | 2023–06–16 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:bev4p_v1 |
| By: | Heidmann, Laure; Neirac, Lucie; Andreu, Sandra; Conceiçao, Pierre; Eteve, Yann; Fabre, Marianne; Vourc'h, Ronan |
| Abstract: | In March 2020, schools in France closed for two months due to the COVID-19 pandemic. Using data from the national assessments, we measure the impact of this unprecedented crisis on the learning of 800, 000 students who were in first grade during the school closures. We show that students' learning progress dropped after the lockdown by 10% standard deviation from a normal year in mathematics, and even more dramatically in French with a decrease of 15% standard deviation. The crisis exacerbated pre-existing inequalities since students from disadvantaged schools were the most affected. We also find that the effects are particularly strong in domains where the school plays a fundamental role in reducing social inequalities in early learning, namely reading and writing. |
| Date: | 2023–04–06 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:qn9a8_v1 |