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on Health Economics |
| By: | Owen Fleming (Department of Economics, Wayne State University); Lilly Springer (Department of Economics, University of Kansas, Lawrence, KS 66045, USA) |
| Abstract: | Nurse practitioner (NP) scope of practice (SOP) reform has been shown to improve access to healthcare, leading to direct health benefits. However, given that NPs are likely to practice in underserved areas, liberalizing SOP may also have spillover benefits on safety net program participation, which would amplify the benefits of SOP expansion for underrepresented populations. In this paper, we study these potential spillovers by examining the effect of NP SOP expansions on enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Leveraging the staggered rollout of NP SOP expansions across states, we find that starting 4-5 years after SOP expansion, total WIC participation increases by 4% in treated states, which rises to 6.8% one decade after SOP expansion. This increase in total WIC enrollment is driven by increases in the enrollment of women and children. Mechanism analyses suggest that while access to healthcare is an important channel, the effect may also be driven by the fact that NPs are trained to deliver holistic, patient-centered care. Our results suggest that spillovers on safety net program participation are another pathway by which NP SOP expansions can improve the health and well-being of underserved populations. |
| Date: | 2025–01 |
| URL: | https://d.repec.org/n?u=RePEc:kan:wpaper:202506 |
| By: | Pooja Madhanraj; Slawa Rokicki |
| Abstract: | Reduction of poverty among children may have significant long-run benefits. The Earned Income Tax Credit (EITC) is the largest federal anti-poverty program in the United States and a large body of evidence demonstrates beneficial impacts on family income, employment, and wealth. Research has also found positive effects of EITC exposure on health and social outcomes. However, there is limited understanding of the extent to which exposure to the EITC in early life affects long-run health. We conducted a scoping review to examine the current state of the evidence on the relationship between EITC exposure and health and social outcomes, and mapped that evidence to the broader literature on long-run health impacts across the life course. We searched the literature through August 2024, and focused on methodologically-strong studies (quasi-experimental or randomized trials). Results are presented across the stages of the life course, including infancy, childhood, adolescence, and adulthood. We discuss key gaps found. |
| Keywords: | Earned Income Tax Credit, Scoping Review, Life Course |
| JEL: | I10 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:psm:wpaper:202401 |
| By: | Adler, Matthew; Ferranna, Maddalena; Hammitt, James K.; de Laubier, Eugénie; Treich, Nicolas |
| Abstract: | The fair innings principle states that fairness requires allocating life-saving treatments to younger rather than older patients when each would gain the same extension in longevity. It is motivated by the notion that older patients have already benefited from a longer life and so have less claim to scarce treatment resources than younger patients who have not yet lived their “fair innings.” The principle can be theoretically justified by a prioritarian social welfare function applied to lifetime wellbeing. We conducted an online survey to test whether there is support for the principle in the general population (in France). We find substantial but not universal support. When choosing to allocate a treatment that would provide the same life extension to an older or a younger patient, about one-half the respondents would allocate the treatment to the younger patient while about one-third are indifferent to which patient is treated and about one-fifth would allocate treatment to the older patient. Holding the life extension to the older patient fixed, decreasing the life extension to the younger patient decreases (increases) the fraction of respondents that would allocate treatment to the younger (older) patient. These results highlight the tension between principles of equal treatment and of giving priority to those who are worse off that confound healthcare policy. |
| Keywords: | Fair innings; life saving; prioritarianism; health; ethical preferences; questionnaire study; Covid-19 |
| JEL: | D61 D63 H4 I18 Q51 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:130472 |
| By: | Hackmann, Martin (University of California, Los Angeles); Heining, Jörg (Institute for Employment Research (IAB), Nuremberg, Germany); Klimke, Roman (Harvard University); Polyakova, Maria (Stanford University); Seibert, Holger (Institute for Employment Research (IAB), Nuremberg, Germany) |
| Abstract: | "We leverage decades of administrative data and quasi-experimental variation in the introduction of universal long-term care (LTC) insurance in Germany in 1995 to examine whether health insurance expansions can stimulate local economies. We find that the LTC insurance rollout led not only to sizeable growth of the target LTC sector, but also to an aggregate fall in unemployment and an increase in the labor force participation. Quantitatively, a 10 percentage point increase in the share of insured LTC patients led to 4 more nursing home workers per 1, 000 individuals age 65 and older (12 percent increase). Wages did not rise in the LTC sector or other sectors of the economy. The quality of newly hired nursing home workers declined, but this had no negative effect on old-age life expectancy. Overall, the insurance expansion brought lower-skilled workers into new jobs rather than reallocating workers away from other productive sectors. Our marginal value of public funds (MVPF) analysis suggests that the reform paid for itself when taking the positive fiscal externalities in the labor market into account. To understand which market primitives underpin our findings and to inform the external validity of our results, we develop and estimate a general model of labor markets with product-market subsidies in the presence of wedges, such as income taxes. Our model simulations show that the aggregate welfare effects of insurance expansions are theoretically ambiguous and depend centrally on the magnitude of frictions in input markets." (Author's abstract, IAB-Doku) ((en)) |
| Keywords: | Bundesrepublik Deutschland ; IAB-Open-Access-Publikation ; Auswirkungen ; Beschäftigungseffekte ; Einkommenseffekte ; Erwerbsbeteiligung ; Arbeitslosigkeitsentwicklung ; Integrierte Erwerbsbiografien ; Altenpflege ; Altenpflegehelfer ; Altenpfleger ; Niedrigqualifizierte ; öffentliche Einnahmen ; Pflegeversicherung ; Sozialabgaben ; Steueraufkommen ; 1975-2008 |
| JEL: | D58 H00 H51 I00 I31 I38 J14 J23 J64 J08 I13 |
| Date: | 2025–03–07 |
| URL: | https://d.repec.org/n?u=RePEc:iab:iabdpa:202503 |
| By: | Giuseppe Canzonieri; Luigi Giamboni |
| Abstract: | This paper measures the efficiency of public spending in the education and health sectors using Stochastic Frontier Analysis (SFA) and Data Envelopment Analysis (DEA). It covers all EU Member States from 2000 to 2022. The model uses panel data and accounts for country-specific factors such as school systems, economic structure, socio-economic background, and health risks, treated as fixed effects. A common frontier approach, assuming equal access to production technologies across countries, is estimated with both methods. DEA also evaluates variable returns to scale and considers multi-output and multi-input analysis. The analysis shows that most countries operate near their efficiency frontiers for quantitative outcomes (tertiary education attainment rates and life expectancy at 65) while significant gaps seem to exist for qualitative targets (PISA scores and years of healthy life expectancy at 65). DEA analysis suggests the presence of decreasing returns to scale between public spending and outcomes in both domains. Malmquist index calculation points to technological shifts of the frontier to have a role in explaining inefficiency over time. |
| JEL: | H40 H51 H52 I11 I21 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:euf:dispap:217 |
| By: | Omari, Firas; , Abu Bakar Abdul Hamid; Ya’akub, Noor Inayah |
| Abstract: | The spread of diseases underscores the significance of understanding the patient complaint behaviour in order to deliver a quick responsiveness in a very empathetic, reliable, and courteous manner that helps patient recovering from illness as soon as possible. Our study mainly examines patient complaint behaviour, including the propensity to complain, engage in negative word of mouth, switch healthcare providers, and seek third-party assistance, within private and public hospitals in Damascus, Syria. Convenience sampling method was used to select 446 patients from four hospitals (two private and two public) in the Syrian capital Damascus. Structural equation modelling (SEM) implemented to empirically test the proposed hypotheses and to examine the significance relationship between the constructs. our findings indicate that complaint behaviour among Syrian patients in public hospitals differs significantly from that observed in private hospitals. Besides, in the private healthcare sector, our empirical findings provide substantial evidence of a significant association between price consciousness and the propensity to voice complaints (β= 0.36, P<0.00). However, in the public healthcare sector, the relationship between price consciousness and the propensity to complain is not statistically significant (β= 0.33, P >0.05). The findings of this study will provide valuable insights for policymakers and hospital administrators in mitigating the effects of complaints, minimizing their adverse impact on the quality of care, and improving patients' capacity to express their discontent. To the authors' knowledge, this study represents a distinctive and unique contribution as it explores and compares patient complaint behaviour in public and private hospitals, specifically within the context of developing countries. It provides a valuable contribution by addressing an area that has not been extensively explored. |
| Date: | 2023–06–24 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:5xfuz_v1 |
| By: | Pietro Colelli, Francesco; Pavanello, Filippo; Sarmiento, Luis |
| Abstract: | We estimate the impact of temperatures on emergency department visits using daily data from the universe of public hospitals in Mexico from 2008 to 2022. We find that cold temperatures decrease visits by up to 8.9 percent on the same day, and warm temperatures increase visits by as much as 3.6 percent. Using distributed lag models, we then show that cold temperatures can reduce visits for the next 30 days by up to 16.3 percent. For warm temperatures, contemporaneous and cumulative effects are similar (limited harvesting). These findings suggest that, unlike mortality, temperatures affect the demand for emergency services linearly. Leveraging the granularity of our dataset, we also document significant heterogeneities (e.g., higher sensitivity for children and teenagers) and relevant mechanisms, such as ecosystem dynamics and behavioral changes. Finally, we project that temperature-driven annual emergency department visits will increase by 0.24 percent by midcentury, resulting in an estimated increase of 92 million USD in annual medical expenditures in Mexico.Keywords: Temperature, Morbidity, Mexico, Climate ChangeJEL: I12, O13, Q54 |
| Date: | 2025–03–25 |
| URL: | https://d.repec.org/n?u=RePEc:rff:dpaper:dp-25-11 |
| By: | Philipp Sternal |
| Abstract: | A growing number of studies suggest that individuals are cynical about others’ behavior. But these findings often rely on self-reported rather than actual behavior as benchmark. A well-documented limitation of self-reports is their tendency to overstate good behavior. I introduce a simple, portable test to assess the extent to which inattention to others’ potential misreporting drives apparently cynical beliefs about stated behavior. Drawing people’s attention to the possibility of misreporting in self-reports increases beliefs about others’ stated desirable climate and health behaviors by an average of 0.33 standard deviations, substantially reducing apparent cynicism. |
| Keywords: | Misperception, social desirability, attention |
| JEL: | C90 D83 D91 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:zur:econwp:465 |
| By: | Cremer, Helmuth; Gahvari, Firouz |
| Abstract: | This study contributes to the long-term care policy literature by exploring how, in an uncertain environment, redistributive tax policies and long-term care program design interact with informal care incentives, shaping long-term caregiving outcomes. The analysis is done within an overlapping-generations model in the steady state under full and asymetric information. Altruistic children provide informal care to their elderly parents if dependent. Not all children are altruistic. Children’s level of altruism is shaped by the time and attention they received in childhood. Key findings, under asymetric information, include: (i) Allocations are distorted for redistributive purposes, except for savings, (ii) marginal income tax rates are positive, aligning with standard nonlinear income taxation models, and (iii) a consequence of government’s redistributive policies is to encourage time spent with children thus incresing family caregiving. These three findings apply to both “opting out” and “topping up” schemes. (iv) Savings must be subsidized in an opting out system due to fiscal externalities; (v) if public assistance carries a stigma, it may have to be distorted upward; the opting-out policy welfare dominates the topping-up policy. Finally, if long term care provision carries no stigma, opting out is more cost-effective than topping up in both first- and second-best. |
| Keywords: | Long term care; uncertain altruism; opting out; topping up; public insurance |
| JEL: | H2 H5 |
| Date: | 2025–03–13 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:130430 |
| By: | Etienne Dagorn; Elena Claudia Meroni; Léonard Moulin |
| Abstract: | This paper provides descriptive evidence on how the COVID-19 pandemic influenced secondary school students’ application patterns to higher education in France, offering insights into the reallocation of preferences across academic fields and degree types. Using detailed administrative data, we document significant shifts in application shares during 2021, with increased interest in competitive tracks and concurrent declines in applications to bachelor’s and vocational programs. These findings suggest that students responded to the pandemic by favoring structured and selective pathways with clear labor market prospects, while moving away from generalist degrees. Students’ share of applications to STEM degrees increased, while applications to health and business programs remained stable. At the same time, analyzing the probability of applying to at least one program in a given field or degree reveals a decline in application diversification, as students concentrated their choices in fewer fields, reflecting a more risk-averse and selective approach in response to the pandemic. Our analysis highlights substantial heterogeneity in these effects across demographic groups. |
| Keywords: | Higher education, students, university application, choice, study programs, academic fields, Parcoursup, Covid-19 pandemic, France, ENSEIGNEMENT SUPERIEUR / HIGHER EDUCATION, FRANCE / FRANCE, CHOIX / CHOICE |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:idg:wpaper:ulmz2jub4xmgdo9y0l0a |