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on Health Economics |
| By: | Nicholas A. Carollo; Jason F. Hicks; Andrew Karch; Morris M. Kleiner |
| Abstract: | The analysis of occupational licensing has concentrated largely on its labor market and consumer welfare effects. By contrast, relatively little is known about how occupational licensing laws originated or the key factors in their evolution. In this paper, we study the determinants of U.S. licensing requirements from 1870 to 2020. We begin by developing a model where licensing arises as an endogenous political outcome and use this framework to study how market characteristics and political incentives influence regulators’ choices. Our empirical analysis draws on a novel database tracking the initial enactment of licensing legislation for hundreds of unique occupations, as well as changes to the specific qualifications required to obtain a subset of licenses over time. We first show that, consistent with the predictions of our model, licensing requirements are more common and were adopted earlier for occupations whose tasks plausibly pose some risk to consumers. Second, large, urbanized states are significantly more likely to produce new policies. Third, among occupations regulated before 1940, licensing requirements appeared earlier in states with more practitioners and where incumbent workers likely experienced greater labor market competition. After 1980, state-level factors are more strongly associated with the timing of policy adoption. Finally, political organization, as measured by the establishment of a state professional association, significantly increases the probability of regulation. Together, our findings suggest that both public and private interests have contributed to the diffusion of licensing requirements across states and occupations. |
| JEL: | J01 J29 J4 J44 J48 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33580 |
| By: | Keith Marzilli Ericson; Johannes G. Jaspersen; Justin R. Sydnor |
| Abstract: | Spending induced by health insurance is often called moral hazard and definitionally assumed to be inefficient. We adapt standard models and show that for those living "hand-to-mouth", the financing benefits of insurance cause a portion of moral hazard to be efficient. Although insurance's price distortions also create some inefficient spending, the net welfare impacts of moral hazard can be positive. We present an intuitive graphical framework and formal results to distinguish moral hazard’s efficient and inefficient components. Simulations show economically significant net benefits of moral hazard in many cases. Our framework also provides a new way of modeling the "income effect'" induced by insurance, and distinguishes it from the "liquidity effect". While both can lead to efficient moral hazard, moral-hazard benefits from the "liquidity effect" are often substantially larger. We use our framework to revisit prior estimates of Medicaid’s value from the Oregon Health Insurance Experiment. For individuals with minimal liquidity, Medicaid's value is more than twice prior estimates. |
| JEL: | D15 D80 H30 I13 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33648 |
| By: | Afrasiab Mirza (Department of Economics, University of Birmingham); Eric Stephens (Department of Economics, Carleton University) |
| Abstract: | This paper considers the general equilibrium implications of moral hazard in private health insurance markets. We show that the structure of standard contracts gives rise to a pecuniary externality whereby individuals ignore the impact of their insurance purchases on the future price of care. At the equilibrium, individuals over-insure against health expenditure risk, and over-spend on medical services while facing an excessive price of care. Reducing insurance coverage at the margin can mitigate the externality by exerting downward pressure on prices, thereby raising welfare. |
| JEL: | D52 I11 I13 I18 |
| Date: | 2024–12–22 |
| URL: | https://d.repec.org/n?u=RePEc:car:carecp:25-02 |
| By: | Sara Sofie Abrahamsson; Aline Bütikofer; Katrine V. Løken; Marianne E. Page |
| Abstract: | We document that the long-run economic benefits of a low-cost early-life health intervention transmit to later generations, but only for children of exposed mothers. We provide novel evidence that the program improved mothers' marriage outcomes but had limited effects on fathers' partnering decisions. Changes in assortative mating patterns may, therefore, be an important mechanism behind program-induced intergenerational spillovers. We also show that the intervention significantly increased economic mobility across three generations, suggesting that early health interventions may be important candidates for reducing the cycle of poverty. |
| JEL: | H5 I14 I3 J12 J18 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33612 |
| By: | Albertini, Mattia (University of Svizzera Italiana); Bakx, Pieter (Erasmus University Rotterdam); Mazzonna, Fabrizio (USI Università della Svizzera Italiana) |
| Abstract: | We investigate the health and labor market consequences of primary care variation in benzodiazepine prescriptions, a common type of low-value care. Linking Dutch general practitioners’ records to administrative data, we construct an exogenous measure of prescribing behavior that exploits institutional constraints limiting patient choice. Using the loss of a close relative as a common mental health shock and a dynamic difference-in-differences approach, we find that patients treated by high-prescribing GPs are more likely to receive out-of-guidelines benzodiazepine prescriptions, become long-term users, and are less likely to access specialized mental health care. These patients also experience worse labor market outcomes, including increased short-term reliance on unemployment benefits and substantial long-term declines in earnings, primarily driven by reduced wages. |
| Keywords: | labor market, mental health, prescribing style, primary care, benzodiazepine, bereavement |
| JEL: | I11 I18 J24 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17771 |
| By: | Gabriella Aboulafia; Jonathan Gruber; Benjamin D. Sommers |
| Abstract: | The Affordable Care Act (ACA) significantly expanded health insurance in the United States, but its impact has varied across time and states. We assess the law’s heterogeneous impacts over the three presidential administrations since its enactment, as well as across states with different levels of implementation of the law. We focus on Medicaid expansion and Marketplace subsidies, including the enhanced subsidies under the American Rescue Plan of 2021 (ARP). We use national household survey data and a triple-difference design – leveraging variation by time, state, and income – to identify the coverage impacts of the key components of the law. We find that 55% of ACA-related coverage gains between 2013 and 2023 came from Marketplace subsidies – about 37% from the original ACA subsidies and 19% from the ARP enhancements – while 45% were due to Medicaid, including from the "welcome mat" effect. Coverage gains differed substantially across presidential administrations, with Marketplace subsidies proving roughly 30% more effective under Presidents Obama and Biden than under President Trump. The same subsidy amount was more than twice as effective in states with their own Marketplaces than in states relying on the federal Marketplace. Our findings highlight that while the ACA’s explicit economic features drive coverage gains, their effectiveness can be substantially enhanced or hindered through federal and state implementation. |
| JEL: | I13 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33615 |
| By: | Jetson Leder-Luis; Anup Malani |
| Abstract: | Healthcare fraud imposes a sizable cost on U.S. public healthcare budgets and distorts health care provision. We examine the economics of health care fraud and enforcement using theory and data and connect to a growing literature on the topic. We first offer a new economic definition of health care fraud that captures and connects the wide range of activities prosecuted as fraud. We define fraud as any divergence between the care an insurer says a patient qualifies for, the care a provider provides, and the care a provider bills for. Our definition clarifies the economic consequences of different categories of fraud and provides a framework for understanding the slate of existing studies. Next, we examine the incentives for committing and for prosecuting fraud. We show how fraud is driven by a combination of inadequate (expected) penalties for fraud and imperfect reimbursement rates. Public anti-fraud litigation is driven by the relative monetary, political or career returns to prosecuting fraud and by prosecutorial budgets. Finally, we examine the prevalence of health care fraud prosecutions across types of fraud and types of care, and across the US, by machine learning on text data from Department of Justice press releases. |
| JEL: | I13 K40 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33592 |
| By: | Victor Duarte; Julia Fonseca; Divij Kohli; Julian Reif |
| Abstract: | One in seven Americans carry medical debt, with $88 billion reported on consumer credit reports. In April 2023, the three major credit bureaus stopped reporting medical debts below $500. We study the effects of this information deletion on consumer credit scores, credit limits and utilization, repayment behavior, and payday borrowing. Using a machine learning model, we show that small medical debts are not meaningfully predictive of defaults, suggesting their deletion should have minimal effect on lending decisions. We test this prediction using two complementary research designs. First, a regression discontinuity analysis comparing individuals above and below the $500 threshold finds no direct benefits from the information deletion, ruling out small changes in credit access. Second, to assess indirect effects, we classify consumers based on whether their predicted default probability increases or decreases when debts are deleted. A difference-in-differences analysis comparing these groups before and after the 2023 policy change reveals no evidence of negative spillover effects. Finally, we show that larger medical debts (≥ $500) are also not meaningfully predictive of default, suggesting that eliminating medical debts entirely from credit reports, as planned under a January 2025 decision by the Consumer Financial Protection Bureau, is unlikely to affect credit outcomes. |
| JEL: | G5 I1 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33644 |
| By: | Joshua Angrist; Amanda E. Kowalski; Ljubica Ristovska; Marcia L. Stefanick |
| Abstract: | Landmark results from the Women's Health Initiative trial showed that random assignment to menopausal hormone therapy (MHT) elevated risks of breast cancer and other adverse events. Recent analyses argue that MHT risks are small. These analyses report intention-to-treat (ITT) effects, ignoring the fact that many women assigned intervention were non-adherent, while many women assigned control initiated treatment. Instrumental variable (IV) methods and adherence data allow us to estimate effects of MHT on compliers who took MHT if and only if assigned. IV estimates show risks and benefits that are substantially larger than the ITT estimates used to inform MHT guidelines. |
| JEL: | C26 H0 I1 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33635 |
| By: | Maclean, J. Catherine (Temple University); Pabilonia, Sabrina Wulff (U.S. Bureau of Labor Statistics) |
| Abstract: | Unlike most developed countries, the U.S. lacks a federal paid sick leave policy. As a result, many workers must choose between losing earnings and attending to childcare responsibilities. To date, 17 states and the District of Columbia have adopted or announced paid sick leave mandates that provide up to seven days of paid leave per year that can be used for family responsibilities and healthcare. In this study, we estimate the effects of state paid sick leave mandates on parents’ time spent providing childcare using time diaries from the 2004–2023 American Time Use Survey. Findings from difference-in-differences estimators suggest that post-mandate, parental time spent providing childcare increases by 5.8%. Effects are stronger among women with younger children. Overall, our findings suggest that paid sick leave mandates allow parents to better balance work and family responsibilities. |
| Keywords: | childcare, mandated benefits, paid sick leave, time use |
| JEL: | I18 J28 J32 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17786 |
| By: | Noghanibehambari, Hamid (University of Texas at Austin); Slusky, David (University of Kansas); Vu, Hoa (Northwestern University) |
| Abstract: | We examine the multigenerational impacts of legalized abortion in the United States by analyzing how early-life exposure to this policy shift affects birth outcomes in the next generation. Using event study and two-way fixed effects models, we link maternal early-life exposure to legal abortion with improved birth outcomes in the subsequent generation, including higher birth weights and reduced rates of low birth weight. Our analysis of the mechanisms shows that these improvements in birth outcomes are not driven by changes in maternal racial or age composition within the treated generation. Instead, enhanced educational attainment and increased prenatal care utilization among the treated generation appear to play a critical role. Our results highlight the far-reaching implications of reproductive health policies, especially relevant in the post-Dobbs era, where access may once again become constrained for many. |
| Keywords: | intergenerational effects, infant health, Roe v. Wade, Abortion, Dobbs v. Jackson Women’s Health Organization |
| JEL: | H75 I12 I18 J13 J16 J18 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17760 |
| By: | Caitlin K. Myers; Daniel L. Dench; Mayra Pineda-Torres |
| Abstract: | We use difference-in-differences research designs to estimate the effects of abortion bans on births at the county level, leveraging data on changes in driving distance and appointment availability at the nearest facility where abortion remains legal. We find that bans alone increase births, but their total impact depends on geographic barriers to access. Even in counties where distance and appointment availability remain unchanged, a total ban leads to a 1.0% increase in births, suggesting a chilling effect—potentially due to legal uncertainty, misinformation, or logistical hurdles—that is independent of measurable barriers. However, the effects grow substantially with travel burdens. In counties where the nearest abortion facility was 50 miles away pre-Dobbs, a total ban increases births by 2.8% when distance rises to 300 miles. Limited appointment availability in destination cities further amplifies these effects, resulting in an additional 0.4 percentage point increase in births. The largest increases occur among Black and Hispanic women, those without a college degree, and unmarried women. We do not observe evidence that the effects have diminished with time despite expanded logistical, financial, and telehealth abortion support, underscoring the persistent role that geographic barriers play in abortion access. |
| JEL: | I11 I12 I18 J13 K23 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33548 |
| By: | James M. Flynn; Bethany I. Lemont; Barton Willage |
| Abstract: | Hepatitis C is a major public health concern due to its high rates of infection and mortality. Recent breakthroughs in pharmaceuticals not only have the potential to cure hepatitis C but could also cause large positive health externalities through reduced transmission. The high cost of these drugs under traditional reimbursement schemes create large obstacles to care, but a recent first-of-its-kind two-part tariff system in Louisiana aims to circumvent these obstacles using a modified subscription model with an exclusive pharmaceutical provider. Under this model, the medication is provided at no marginal cost to the state to cover the state's Medicaid and incarcerated population. This creates an incentive for Louisiana to aggressively test and treat as many patients as possible in order to maximize the benefits of this agreement. Using a number of different data sources, we implement synthetic control and event-study specifications, and find that detection and treatment of hepatitis C increased dramatically, with meaningful reductions in hepatitis C-related mortality and liver transplants after this agreement. Finally, after calculating the Marginal Value of Public Funds of this agreement, we find that the program more than pays for itself. |
| JEL: | H42 I11 I18 L11 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33617 |
| By: | Shui, Ailun (University of Groningen); van den Berg, Gerard J. (University of Groningen); Mierau, Jochen O. (University of Groningen); Viluma, Laura (University of Groningen) |
| Abstract: | This study investigates lifetime socioeconomic health disparities through longitudinal biomarkers from the Dutch Lifelines cohort study and biobank. We construct an allostatic load index from 12 biomarkers and analyze the dynamics of health and its association with socioeconomic status (SES) over the life cycle. Our findings reveal that health risks linked to lower SES emerge early and precede chronic disease onset. Further analysis investigates the drivers of allostatic load and emphasizes health behaviors. The results highlight the need for early interventions targeting SES-related health disparities and provide new insights into the physiological pathways linking SES to long-term health outcomes. |
| Keywords: | life cycle, chronic diseases, allostatic load, Keywords: biomarkers, lifestyle |
| JEL: | D31 I12 I14 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17796 |
| By: | Alonso-Armesto, Luis (University of Oxford); Cáceres-Delpiano, Julio (Universidad Carlos III de Madrid); Lekfuangfu, Warn N. (Universidad Carlos III de Madrid) |
| Abstract: | This study examines the impact of increasing the Minimum Legal Drinking Age (from 16 to 18 years old) on the academic performance, substance use, and peer behaviours of teenagers. Using a difference-in-discontinuities design, we exploit regional MLDA reforms in Spain and PISA data to identify significant improvements in mathematics and science performance, particularly among male teenagers and those from lower socioeconomic backgrounds. A complementary analysis using data from the Survey on Drug Use in Secondary Education in Spain indicates that these academic gains coincide with reductions in alcohol consumption, intoxication, smoking, and marijuana use, suggesting a link between substance use and educational outcomes. Moreover, the reform led to less drinking and less use of illicit drugs within peer networks, highlighting the amplifying role of peer effects in policy impact. |
| Keywords: | difference-in-discontinuities, alcohol, risky behaviour, education, minimum legal drinking age, PISA, ESTUDES, Spain, teenagers |
| JEL: | I18 I12 I21 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17772 |
| By: | Castro-Pires, Henrique (University of Miami); Fischer, Kai (Düsseldorf Institute for Competition Economics (DICE)); Mello, Marco (University of Aberdeen); Moscelli, Giuseppe (University of Surrey) |
| Abstract: | Restrictive immigration policies may force firms to abruptly change their workforce composition. But how does this impact the performance of these organizations? We study the effects of the 2016 Brexit referendum, which led to a drop in the share of EU nationality nurses in English hospitals. Using high-quality administrative patient-level data and a continuous difference-in-differences design which exploits the different pre-referendum hospital exposure to the shock, we estimate the causal effect of the workforce composition changes on hospital quality of care. We find that, in the post-referendum period, emergency patients admitted to NHS hospitals with a mean pre-referendum share of EU nurses faced an increase in mortality risk, equivalent to about 1, 485 additional deaths per year. These findings are consistent with a theory model that predicts a decrease in the quality of newly hired hospital workers to avert labour shortages. We provide empirical evidence in support of this mechanism by showing that the foreign joiner nurses hired in the post-referendum period were assigned to lower salary grades than those hired prior to the referendum, indicating lower levels of skills and job experience. |
| Keywords: | patient care, migration, worker mobility, labour supply, hospital quality, Brexit |
| JEL: | J45 J61 J68 I11 C26 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17797 |
| By: | Cellini, Stefano (University of Surrey); Mello, Marco (University of Aberdeen); Moscelli, Giuseppe (University of Surrey) |
| Abstract: | We build a unique dataset by linking high-quality administrative data sources and model the mobility choices of tenured English National Health Service (NHS) hospital doctors across hospital organizations according to a random utility choice framework based on hospital quality, pay-for-performance incentives, local residential amenities and travel-to-work commuting distances. We account for the endogeneity of hospital quality through a control function approach. Doctors are willing to move 5.3 extra kilometers in order join a new hospital organization with a one-standard-deviation lower mortality rate, whereas they are willing to trade a standard deviation of the average monetary bonus received for their clinical excellence with the cost of moving 5 extra kilometers from their home. Primary school quality and low crime residential areas are only marginally salient in the choice of new employer. Counterfactual simulation estimates reveal that simultaneous improvements in hospital mortality and performance-related pay awards by one fourth of a standard deviation can lead to decreases in regional hospital doctor vacancy rates by 2% to 11%. |
| Keywords: | organization quality, hospital, physicians, mobility, skilled workers, incentive pay, vacancies |
| JEL: | C25 I11 J24 J45 J62 J63 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17798 |
| By: | Modestino, Alicia Sasser (Northeastern University); Young, Garry (National Institute of Economic and Social Research (NIESR)); Hasan, Md Mahmudul (University of Florida); Shi, Jiesheng (Northeastern University); Alam, Md Noor E (Northeastern University) |
| Abstract: | Patients in rural areas have higher rates of opioid use and overdose than those in urban areas that are linked to the greater prevalence and amounts of opioids prescribed. We merge individual claims data with county-level supply and demand factors to examine this relationship between geographical density and opioid prescribing. We find patients in rural areas are 10 percentage points more likely to receive an opioid prescription with about half of this differential attributable to the underlying health of the local population. A Blinder-Oaxaca decomposition reveals that roughly 80 percent of the remaining gap is explained by a combination of supply and demand factors. Allowing for the interaction of demand (e.g., working in a physically demanding occupation) and supply (e.g., healthcare delivery system) variables eliminates the gap. Our findings suggest several way states can reduce the gap in opioid prescribing between rural and urban areas, with possible downstream impacts on overdose and mortality. |
| Keywords: | opioid, prescribing, density, health disparity, geography |
| JEL: | I14 I15 I18 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17738 |
| By: | Erel, Isil (Ohio State U and ECGI); Ge, Shan (New York U); Ma, Pengfei (Singapore Management U) |
| Abstract: | We examine how healthcare providers' financial health affects their opioid prescription decisions, using changes in house prices in providers' residential neighborhoods as shocks to their wealth. We find that providers increase opioid prescriptions when experiencing adverse financial conditions: a one-standard-deviation decrease in house price growth leads to a 3% increase in opioid prescriptions. Results are robust to including provider office-year fixed effect and using the subsample of providers who live far away from their offices, which largely rules out a patient-demand explanation. Providers living in zip codes with price changes in the bottom half during 2007-2009 increased their opioid prescriptions by approximately 16% more in 2010-2012 than others. The effect is stronger among providers with greater home equity, those in competitive markets, and those serving vulnerable populations. Our findings reveal a previously undocumented channel through which providers' financial incentives affect opioid prescriptions. |
| JEL: | G51 I11 I13 I14 I18 L15 R30 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:ecl:ohidic:2024-27 |
| By: | Abrahamsson, Sara (Norwegian Institute of Public Health (NIPH)); Barschkett, Mara (University of Bonn); Flatø, Martin (Norwegian Institute of Public Health (NIPH)) |
| Abstract: | Menopause marks a crucial juncture in women's lives and careers. We provide novel evidence on the effects of menopause onset on labor and health outcomes. Combining Norwegian register with survey data from the HUNT study on self-reported menopause age, we apply a stacked difference-in-differences design. Our findings show declines in earnings, increased sick leave, and more diagnoses related to menopause. Additionally, women without symptoms, and those with mild symptoms who seek care, do not experience earnings losses. Moreover, timely healthcare-seeking and treatment onset can mitigate earnings losses. This suggests that policies promoting menopause awareness could alleviate individual and societal burdens. |
| Keywords: | administrative health data, women's health, menopause, labor market outcomes, HUNT |
| JEL: | I10 I12 J16 J24 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17789 |
| By: | Costa-Font, Joan (London School of Economics); Nici?ska, Anna (University of Warsaw); Rosello-Roig, Melcior (University of Rome) |
| Abstract: | Past trauma resulting from personal life shocks, especially during periods of particular volatility, such as regime transition (or regime change), can give rise to significant long-lasting effects on people's health and well-being. We study this question by drawing on longitudinal and retrospective data to examine the effect of past exposure to major individual-level shocks (specifically hunger, persecution, dispossession, and exceptional stress) on current measures of an individual's health and mental well-being. We study the effect of the timing of the personal shocks, alongside the additional effect of 'institutional uncertainty' of regime change in post-communist European countries. Our findings are as follows: First, we document evidence of the detrimental effects of shocks on a series of relevant health and well-being outcomes. Second, we show evidence of more pronounced detrimental consequences of such personal shocks experienced by individuals living in formerly communist countries (which accrue to about 8% and 10% in the case of hunger and persecution, respectively) than in non-communist countries. The effects are robust and take place in addition to the direct effects of regime change and shocks. |
| Keywords: | transition shocks, Soviet communism, later life health, health care system |
| JEL: | I18 H75 H79 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17780 |
| By: | Bressler, R. Daniel (Columbia University); Papp, Anna (Columbia University); Sarmiento, Luis (Bank of Mexico); Shrader, Jeffrey G. (Columbia University); Wilson, Andrew J. (Stanford University) |
| Abstract: | We investigate how occupation influences the relationship between temperature and mortality in Mexico. Using multiple decades of nationwide death records---which include information on occupation---linked to local weather data, we find that heat-related mortality risk varies sharply by occupation. Young adults in climate-exposed jobs, especially in agriculture, experience significantly higher death rates from warm and hot temperatures. A 15 to 24 year-old agricultural worker is over 10 times more likely to die from heat exposure than a peer in professional or managerial employment, underscoring the role of occupation in climate vulnerability. These findings show that the burden of extreme heat disproportionately falls on the working poor. Our results suggest that implementing occupational safety measures and targeted heat adaptation policies (such as mandatory rest breaks and early warnings for outdoor workers) are essential to protect vulnerable workers. Furthermore, ongoing economic shifts away from highly exposed sectors may reduce increases in heat-related mortality due to climate change. |
| Keywords: | health, occupation, climate, temperature, mortality |
| JEL: | I10 J81 Q54 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17759 |
| By: | López Artero, Javier Adrián (Universidad de Alicante); Sanz-de-Galdeano, Anna (Universidad de Alicante); Vuri, Daniela (University of Rome Tor Vergata) |
| Abstract: | We analyze the impact of unexpected health shocks—defined as the sudden diagnosis of cancer, stroke, or heart attack—on the probability of couple dissolution using longitudinal representative data on older individuals (50+). We leverage the longitudinal nature of the HRS and utilize a quasi-experimental research approach that creates counterfactual scenarios for affected households by comparing them to households set to experience the same event in subsequent years. We find that experiencing a health shock significantly increases the probability of couple dissolution by approximately 19% of the mean divorce prevalence. This effect intensifies gradually over time rather than appearing immediately after the adverse health event. Additionally, we examine several mechanisms through which health shocks may influence divorce, focusing on three potential channels: mental health, cognitive decline, and financial strain. Our findings suggest that all three mechanisms likely play a role in mediating the relationship between health shocks and the increased probability of divorce. |
| Keywords: | divorce, health shocks, aging |
| JEL: | I14 I24 J15 Z13 J13 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17849 |
| By: | Danzer, Alexander M. (Catholic University of Eichstätt-Ingolstadt); Zeidler, Helen (Technical University of Munich) |
| Abstract: | This paper examines the link between dynamically inconsistent time preferences and individual food waste behavior. Food waste is conceptualized as unintentional outcome of choices along the food consumption chain. Capitalizing on a nationally representative longitudinal survey from Germany, we construct targeted metrics of food consumption and waste behaviors. We find that more present-biased individuals waste more food. Our study investigates the behavioral mechanism that involves postponing domestic consumption of healthy food despite good consumption intentions, resulting in food spoilage. Studying inconsistencies between grocery shopping and food preparation is pivotal for understanding the significant, persistent amounts of food waste within households. |
| Keywords: | food waste, food consumption, dynamic inconsistency, healthy eating |
| JEL: | D12 D15 Q53 Q18 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17802 |
| By: | Firouzi Naeim, Peyman (University of Technology, Sydney); Johnston, David W. (Monash University); Naghsh Nejad, Maryam (University of Technology, Sydney) |
| Abstract: | Parental caregiving responsibilities can disrupt paid work, contributing to persistent gender inequalities in employment and earnings. Using Australian employer-employee linked data and a dynamic difference-in-differences approach, this study examines how workplace environments shape the impacts of caregiving shocks, focusing on working parents of children diagnosed with cancer. Mothers experience large and persistent earnings losses, while fathers’ outcomes remain stable. Supportive firms and occupations, defined by high female representation in senior roles and lower work hour intensity, significantly reduce mothers’ earnings penalties. These findings highlight the important role of workplace conditions in reducing gendered economic costs of caregiving. |
| Keywords: | workplace, gender gap, child health, caregiving, earnings |
| JEL: | J13 J16 J22 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17850 |
| By: | Marina Chiara Garassino; Kunle Odunsi; Marciano Siniscalchi; Pietro Veronesi |
| Abstract: | Technological advances and genomic sequencing opened the road to personalized medicine: specialized therapies targeted to patients displaying specific molecular alterations. For instance, targeted therapies are now available for 50% of lung cancer patients—with some alterations affecting less than 1% of patients—greatly increasing life expectancy. In an investment model of drug development, we show that current institutions mandating experimentation and approval of individual therapies eventually disincentivize investments in personalized medicine as researchers identify increasingly rare alterations. Recent AI-based technologies, such as AlphaFold3, make personalized medicine viable when regulatory approval regards the process for drug discovery rather than individual therapies. |
| JEL: | I11 I18 O32 O38 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33539 |
| By: | Weijia (Daisy) Dai; Ginger Zhe Jin; Ben Zou |
| Abstract: | Nutritional disparities across socioeconomic groups contribute to health inequality in the U.S. This paper studies the role of heterogeneous consumer preferences in food choices and explores pricing policies that can promote healthier eating among disadvantaged consumers. Using detailed transaction-level data from a large fast-food restaurant chain, we show that consumers in disadvantaged neighborhoods tend to choose less healthy, higher-calorie items. We estimate a mixed logit discrete choice model to identify consumer preference heterogeneity across demographic groups. Lower-SES consumers display higher price sensitivity across items with varying nutritional quality and show flexibility in substituting between healthy and less healthy options. Counterfactual simulations show that modest, targeted price adjustments in disadvantaged neighborhoods can be an effective tool to reduce nutritional disparities across neighborhoods, with little impact on restaurant revenue or profits. |
| JEL: | D12 I12 I14 L83 R20 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33706 |
| By: | Eric V. Edmonds; Priya Mukherjee; Nikhilesh Prakash; Nishith Prakash; Shwetlena Sabarwal |
| Abstract: | We examine the impact of a randomized therapy intervention on Nepali adolescents at risk of school dropout. Our study is the largest of its kind (N = 1, 707) and is novel in that participation does not require a preexisting diagnosis. Ninety percent of those offered therapy participated, with younger adolescents demonstrating higher compliance. Among those who complied, therapy significantly reduced psychological distress, improved emotional regulation, and enhanced life perspective, even in individuals without baseline mental health issues. However, these improvements in well-being did not lead to increased school attendance or better cognitive performance, suggesting that additional interventions may be necessary to enhance educational engagement in low-resource settings. |
| JEL: | I12 I15 I25 I31 O12 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33677 |
| By: | Lutz Sager |
| Abstract: | In 2013, China introduced the ambitious Air Pollution Prevention and Control Action Plan (APPCAP) targeting ambient fine particle (PM2.5) pollution. Using panel data covering 239 countries and territories worldwide, from 2000 to 2019, I provide quasi-experimental estimates of nationwide reductions in PM2.5 exposure achieved since 2013. I find that the APPCAP lowered PM2.5 exposure of the average Chinese resident in 2019 by over 20%, reducing PM2.5-related deaths by between 220 and 280 thousand depending on estimation strategy. Monetizing the mortality reductions with recent values of statistical life suggests total benefits of up to 1 trillion Renminbi or 1% of Gross Domestic Output. |
| Keywords: | air pollution, health, mortality, regulation. |
| JEL: | I18 Q52 Q53 Q58 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11826 |
| By: | Lin, Zhuoer (University of Illinois at Chicago); Qian, Yuting (Yale University); Gill, Thomas M. (Yale University); Hou, Xiaohui (World Bank); Allore, Heather (Yale University); Chen, Shanquan (University of Cambridge); Chen, Xi (Yale University) |
| Abstract: | Assistance with daily activities is crucial for persons living with dementia and disabilities, yet many face significant challenges in accessing adequate care and support. Using harmonized longitudinal survey data (2012-2018) from the United States, England, 18 European countries and Israel, and China, we found that at least one-fifth of persons with dementia and disabilities received no personal assistance for basic or instrumental activities of daily living (ADL/IADL), regardless of regional development level. Care gaps were widespread across both ADL and IADL limitations, as well as for informal and formal care. Disparities were evident, with less-educated individuals more likely to lack formal care, while those living alone often lacked informal support, resulting in the absence of any care. Alarmingly, care availability showed no improvement over time. Our findings underscore the urgent need for policies to address inequities and ensure critical access to care services for this vulnerable population worldwide. |
| Keywords: | IADL, ADL, disability, dementia, global aging, unmet need, elder care |
| JEL: | J14 J18 I11 I18 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17777 |
| By: | Kjelsrud, Anders (University of Oslo); Kotsadam, Andreas (Ragnar Frisch Centre for Economic Research); Rogeberg, Ole (Ragnar Frisch Centre for Economic Research); Brodeur, Abel (University of Ottawa) |
| Abstract: | Siddique et al. (2024a) report massive effects of a mobile phone-based health awareness campaign in a randomized field experiment conducted in rural Bangladesh and India during the COVID-19 pandemic. Both awareness and compliance with preventive COVID-19 measures were higher when the information was received by voice call rather than text, and even higher for those receiving both. Reproducing the analyses we identify many severe issues, including that the study did not in fact randomize treatment assignment. We further find implausible response patterns in the data, undisclosed sampling criteria that negate the study motivation, and an (unreported) re-treatment where some of the respondents were also included in a separate study that provided additional COVID-19 information immediately before the last data collection. |
| Keywords: | health awareness, replication, COVID-19 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17783 |
| By: | Seoyeon Chang (School of Political Science and Economics, Waseda University); Sonoko Ishikawa (School of Political Science and Economics, Waseda University); Naoki Miyamoto (School of Political Science and Economics, Waseda University); Ryo Takahashi (Bren School of Environmental Science & Management, University of California, Santa Barbara) |
| Abstract: | This study examines whether gender bias in health communication reduces the effectiveness of information provision and explores the mechanism behind it. Specifically, it investigates whether the bias is driven by statistical discrimination—misperceptions about women’s competence—or by tastebased discrimination. We conducted a randomized controlled trial in Cambodia, where participants watched a video featuring either a male or female health instructor explaining the benefits of iron supplements for anemia prevention. To test the mechanism, half of those assigned to the female instructor condition received a corrective message addressing misperceptions about women’s abilities. The results show that willingness to pay for the supplement was significantly lower when the information was delivered by a female instructor, but this gap disappeared when the corrective message was provided. Similar patterns were observed in a list experiment measuring implicit bias. These findings suggest that gender bias reduces the effectiveness of health communication and is primarily driven by misperceptions about women’s competence rather than by taste-based discrimination. |
| Keywords: | anemia, gender bias, discrimination, misperception, list experiment |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2501 |
| By: | Jeffrey Clemens; Anwita Mahajan |
| Abstract: | The COVID-19 pandemic led to unprecedented levels of federal transfers to state and local governments. Did this funding impact population health? To answer this question, we leverage the fact that U.S. states that enjoy excess representation in Congress received substantially more fiscal assistance than did relatively underrepresented states. We find that the aid driven by excess representation had substantial impacts on population health. For each $1, 000 increase in federal fiscal aid per state resident, we estimate that states experienced 38 fewer deaths from all causes per 100, 000 residents from 2020 through 2022, of which 2/3 came from reductions in COVID-19 mortality. We estimate that the last $331 billion in federal pandemic aid, which corresponds with our in-sample variation, generated $591 billion in value through life years saved. Additional aid also reduced rates of COVID-19 related hospitalizations and emergency room visits, though not in the total number of positive cases detected. Plausible mechanisms for these improved outcomes include higher rates of COVID-19 vaccination, which plausibly account for nearly half of the mortality reductions we observe, and higher rates of COVID-19 testing. Medicaid enrollments and hospital capacity do not appear to play substantial mediating roles. Our robustness analyses provide evidence that the effects we estimate cannot be explained by pre-existing mortality trends, by the pandemic's differential impacts on relatively dense vs. rural areas, or by the pandemic's differential impacts on populations with more elderly individuals or with higher prevalence of chronic conditions. The mortality impacts we estimate were substantially greater for non-Hispanic Black Americans than for non-Hispanic White Americans, such that federal funds are associated with a reduction in population-wide health disparities over the course of the pandemic. |
| JEL: | H12 H72 I18 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33699 |
| By: | Lekfuangfu, Warn N. (Universidad Carlos III de Madrid); Olivera, Javier (National Bank of Belgium); Van Kerm, Philippe (University of Luxembourg) |
| Abstract: | Drawing on two data sources from across Europe, we show that both bequest motives of parents and children’s gender composition shape unequal divisions of bequests. First, the Survey on Health, Ageing and Retirement in Europe reveals that observed bequests are divided unequally when children differ in sex, caregiving, or income, with bequest motives strongest among mixed-sex children. Second, in a vignette experiment featuring alternative bequest motive scenarios and randomised gender compositions for two fictitious children, hypothetical bequests are most unequally divided under the exchange motive while children’s gender composition matters more under the altruistic motive. Fictitious parents favour daughters regardless of deservingness, granting the highest bequest share to a deserving daughter with a brother. In return, these patterns reinforce traditional gender norms. |
| Keywords: | altruism, deservingness, vignette experiment, gender, intergenerational transfers, bequest, exchange, Europe, HFCS, SHARE |
| JEL: | H24 D31 D63 E62 H53 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17833 |
| By: | Brodeur, Abel (University of Ottawa); Fiala, Lenka (University of Bergen); Fitzgerald, Jack (Vrije Universiteit Amsterdam); Kujansuu, Essi (University of Innsbruck); Valenta, David (University of Ottawa); Rogeberg, Ole (Ragnar Frisch Centre for Economic Research); Bensch, Gunther (RWI) |
| Abstract: | Vlassopoulos et al. (2024) find that after providing two hours of telephone counseling over three months, a sample of Bangladeshi women saw significant reductions in stress and depression after ten months. We find three anomalies. First, estimates are almost entirely driven by reverse-scored survey items, which are handled inconsistently both in the code and in the field. Second, participants in this experiment are reused from multiple prior experiments conducted by the paper’s authors, and estimates are extremely sensitive to the experiment from which participants originate. Finally, inconsistencies and irregularities in raw survey files raise doubts about the data. |
| Keywords: | reproduction, replication, mental health, COVID-19 |
| JEL: | B41 C12 I12 I18 J16 O12 |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17782 |