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on Health Economics |
| By: | Angela Wyse; Bruce D. Meyer |
| Abstract: | We examine the causal effect of health insurance on mortality using the universe of low-income adults, a dataset of 37 million individuals identified by linking the 2010 Census to administrative tax data. Our methodology leverages state-level variation in the timing and adoption of Medicaid expansions under the Affordable Care Act (ACA) and earlier waivers and adheres to a preregistered analysis plan, a rarely used approach in observational studies in economics. We find that expansions increased Medicaid enrollment by 12 percentage points and reduced the mortality of the low-income adult population by 2.5 percent, suggesting a 21 percent reduction in the mortality hazard of new enrollees. Mortality reductions accrued not only to older age cohorts, but also to younger adults, who accounted for nearly half of life-years saved due to their longer remaining lifespans and large share of the low-income adult population. These expansions appear to be cost-effective, with direct budgetary costs of $5.4 million per life saved and $179, 000 per life-year saved falling well below valuations commonly found in the literature. Our findings suggest that lack of health insurance explains about five to twenty percent of the mortality disparity between high- and low-income Americans. We contribute to a growing body of evidence that health insurance improves health and demonstrate that Medicaid’s life-saving effects extend across a broader swath of the low-income population than previously understood. |
| JEL: | H0 I1 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33719 |
| By: | Andrew C. Johnston; Maggie R. Jones; Nolan G. Pope |
| Abstract: | Nearly a third of American children experience parental divorce before adulthood. To understand its consequences, we use linked tax and Census records for over 5 million children to examine how divorce affects family arrangements and children’s long-term outcomes. Following divorce, parents move apart, household income falls, parents work longer hours, families move more frequently, and households relocate to poorer neighborhoods with less economic opportunity. This bundle of changes in family circumstances suggests multiple channels through which divorce may affect children’s development and outcomes. In the years following divorce, we observe sharp increases in teen births and child mortality. To examine long-run effects on children, we compare siblings with different lengths of exposure to the same divorce. We find that parental divorce reduces children’s adult earnings and college residence while increasing incarceration, mortality, and teen births. Changes in household income, neighborhood quality, and parent proximity account for 25 to 60 percent of these divorce effects. |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:cen:wpaper:25-28 |
| By: | Wu , Wanrui (Peking University); Liu , Gordon (Peking University); Pan, Yuhang (Peking University) |
| Abstract: | Climate change poses significant challenges to healthcare systems. This research estimates temperature impacts on hospital workload, using inpatient records from more than 1, 000 emergency departments (EDs) in the People’s Republic of China between 2013 and 2022. We find inpatient admissions in EDs decrease by 12.3% on days with a mean temperature below −6°C, while increasing by 7.7% on days with a mean temperature exceeding 30°C, compared with a temperature reference of 12°C to 15°C. Heterogeneity analysis indicates that specific departments such as internal medicine, surgery, and pediatrics experience more substantial increases in workload during extreme heat. Temperature also reshapes the patient structure: male patients, child patients, and patients with injuries or respiratory diseases take up a larger proportion of total admissions on extremely hot days. Considering adaptation methods, we show that hospitals temporarily allocate more junior physicians to EDs when the temperature is hot. Hospitals in cities where people have higher incomes and better-heated homes are less sensitive to temperature changes. In terms of monetary burden, we estimate corresponding healthcare expenditures, which suggest that the impact of extreme temperatures is larger on the insured portion of expenditures than it is on out-of-pocket payments. This research highlights the relationship between temperature and workload burden faced by the major healthcare facilities, providing suggestions for the healthcare system to increase personnel and adjust resource allocation in response to climate change. |
| Keywords: | hospital workload; climate change; extreme temperature; healthcare expenditure; People’s Republic of China |
| JEL: | I10 I12 I18 Q50 Q51 Q54 |
| Date: | 2025–05–15 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:0780 |
| By: | Manasi Deshpande; Greg Kaplan; Tobias Leigh-Wood |
| Abstract: | Many developed countries have enacted reforms to reduce enrollment in disability benefits (DI). We evaluate the effects of a DI crackdown in Australia on the most comprehensive set of outcomes available to date, including earnings, government benefits, family income, and health care utilization. Using a 2014 reform to Australia’s Disability Support Pension, we find that, on average, DI removal has a net zero effect on household income but leads to an increase in prescriptions for strong mental health drugs. However, average effects mask heterogeneity by family structure. For removed recipients living with family, family members increase their earnings by enough to offset the lost DI income, with minimal increase in mental health prescriptions. In contrast, removed recipients living alone do not increase their own earnings or have family support, but their use of strong mental health drugs increases dramatically. We develop a welfare analysis that considers multiple margins of behavioral adjustment. We find that behavioral adjustments offset more than half of the private welfare loss for recipients living with family but very little for those living alone. Government savings exceed household willingness to pay for DI for those living with family, but not for those living alone. |
| JEL: | I30 J14 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33745 |
| By: | Si, Yafei; Chen, Gang; Zhou, Zhongliang; Yip, Winnie; Chen, Xi |
| Abstract: | Despite growing evidence of gender disparities in healthcare utilization and health outcomes, there is a lack of understanding of what may drive such differences. We present novel evidence on the impact of physician-patient gender match on healthcare quality using the standardized patients (SPs) method in an experiment. The experiment collected interactions between standardized patients and physicians in a primary care setting in China during 2017-2018. We find that, compared with female physicians treating female SPs, female physicians treating male SPs resulted in a 23.4 percentage-point increase in correct diagnosis and a 19.0 percentage-point increase in correct drug prescriptions. Despite these substantial gains in healthcare quality, there was no significant increase in medical costs or time investment. The gains in healthcare quality were partly attributed to better physician-patient communications, but not the presence of more clinical information. More importantly, female physicians treating male SPs prescribed more unnecessary tests but fewer unnecessary drugs to balance their time commitment and costs. The results suggest the potential role of cultural gender norms and physician defensive behavior when female physicians treat male SPs. Our findings imply that improving patient centeredness may lead to significant gains in the quality of healthcare with modest costs, while reducing gender differences in care quality. |
| Keywords: | gender disparities, healthcare quality, standardized patient, experiment, China |
| JEL: | I11 I12 I14 J16 J22 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1607 |
| By: | Paul Makdissi (Department of Economics, University of Ottawa, Canada); Myra Yazbeck (Department of Economics, University of Ottawa, Canada) |
| Abstract: | This paper develops a framework for decomposing inequality of opportunity into racial stratification and social class components. We derive novel dominance conditions that enable robust rankings of joint distributions of income and birth circumstances, and develop additional dominance criteria for restricted classes of indices reflecting either pro-poor or meritocratic perspectives. Our framework includes an estimation approach and statistical tests for these stochastic dominance conditions, ensuring practical application with survey data. Using Health and Retirement Study data, we analyze inequality of opportunity in earnings among aging U.S. populations between 2010-2020. While social class-based inequality decreased for certain classes of indices, the racial stratification component increased, driving overall rising inequality of opportunity. |
| Keywords: | Inequality of opportunity, stochastic dominance, stratification. |
| JEL: | I31 I32 Z13 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ott:wpaper:2503e |
| By: | Andrea Bernini (University of Oxford); Sven A. Hartmann (Trier University & Institut für Arbeitsrecht und Arbeitsbeziehungen in der Europäischen Union (IAAEU)) |
| Abstract: | This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 10.7 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies. |
| Keywords: | Health, Smoking, Cultural Transmission, Television, Social Norms, German Reunification |
| JEL: | I12 I18 N34 Z13 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:iaa:dpaper:202502 |
| By: | Appelbaum, Elie; Leshno, Moshe; Prisman, Eitan; Prisman, Eliezer, Z. |
| Abstract: | The problem of crossing Kaplan-Meier curves has not been solved in the medical research literature to date. This paper integrates survival curve comparisons into decision theory, providing a theoretical framework and a solution to the problem of crossing Kaplan-Meier curves. The application of decision theory allows us to apply stochastic dominance concepts and risk preference attributes to compare treatments even when standard Kaplan-Meier curves cross. The paper shows that as additional risk preference attributes are adopted, Kaplan-Meier curves can be ranked under weaker restrictions, namely with higher orders of stochastic dominance. Consequently, even Kaplan-Meier curves that cross may be ranked. The method we present allows us to extract all possible information from survival functions; hence, superior treatments that cannot be identified using standard Kaplan-Meier curves may become identifiable. Our methodology is applied to two examples of published empirical medical studies. We show that treatments deemed non-comparable because their Kaplan-Meier curves intersect can be compared using our method. |
| Keywords: | Survival Curve Analysis; Decision Theory; Risk Preference Modelling; Stochastic Dominance; Medical Treatment Comparison; Healthcare Data Interpretation |
| JEL: | C18 C65 D81 I10 I12 I19 |
| Date: | 2025–03–20 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124419 |
| By: | Asker, Erdal (University of West Georgia); Rees, Daniel I. (Universidad Carlos III de Madrid); Agüero, Jorge (University of Connecticut) |
| Abstract: | We study the effect of having an older sister on the likelihood that girls in sub-Saharan Africa marry before reaching adulthood. Relying on the randomness of the firstborn sibling’s sex, we show that having an older sister (as opposed to an older brother) reduces the likelihood of marrying before the age of 18 by 1.5 percent. In addition, we find that older sisters reduce the likelihood that their younger sisters become sexually active as a teenager, reduce the likelihood that their younger sisters give birth as a teenager, and increase their younger sisters’ awareness of HIV/AIDS. The estimated effects on childhood marriage are largest in more conservative societies (as measured by the Social Institutions and Gender Index), suggesting that the protective role played by firstborn sisters can be especially important when access to accurate information about sex and reproductive rights is limited. |
| Keywords: | teenage sexual activity, older sisters, child marriage, reproductive health |
| JEL: | I12 J12 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17867 |
| By: | Volha Lazuka; Peter Sandholt Jensen |
| Abstract: | Can the effects of childhood vaccination extend across three generations? Using Swedish data spanning 250 years, we estimate the impact of smallpox vaccination on longevity, disability, and occupational achievements. Employing mother fixed-effects, difference-in-differences, and shift-share instrumental-variables designs, we find that vaccination improves health and economic outcomes for at least two subsequent generations. Causal mediation analysis reveals that these benefits arise from improved health behaviors and epigenetic factors. Even in milder disease environments as seen today, vaccination delivers lasting advantages, demonstrating its long-term benefits beyond epidemic contexts. These findings highlight the benefits of early-life health interventions lasting for subsequent generations. |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2504.21580 |
| By: | Sachintha Fernando; Katharina Kolb; Christoph Wunder |
| Abstract: | This paper employs a panel event study design to examine the causal effects of the 2013 flood disaster in East Germany on subjective well-being. We merge geo-spatial flood data with longitudinal data from the German Socio-Economic Panel (SOEP) to identify individuals in affected municipalities. Our results show that those affected by the flood report a significant life satisfaction drop of 0.17 points on an 11-point scale, which is equivalent to a 2.5% fall from pre-flood levels, in the year after the flood. The effect is more severe in peripheral areas than in central areas, and for low-income individuals than for high-income individuals. However, the effect dissipates by 2015. Additionally, we observe a notable initial decrease in health satisfaction, followed by recovery, while financial satisfaction was largely unaffected. |
| Keywords: | natural disasters, flood, quality of life, life satisfaction, health satisfaction, financial satisfaction |
| JEL: | I31 Q51 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp1224 |
| By: | Lin, Zhuoer; Qian, Yuting; Gill, Thomas M.; Hou, Xiaohui; Allore, Heather; Chen, Shanquan; Chen, Xi |
| 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: | global aging, dementia, disability, ADL, IADL, unmet need, elder care |
| JEL: | J14 J18 I11 I18 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1608 |
| By: | DiNardi, Michael |
| Abstract: | I examine how the substance use treatment sector responded to the abuse-deterrent reformulation of OxyContin, which contributed to a shift from prescription opioid misuse to heroin and synthetic opioids. First, I document a national increase in substance use treatment facilities after the reformulation and a shift toward outpatient-only care. Medication-assisted treatment with buprenorphine and naltrexone grew strongly throughout the first and second waves of the opioid crisis, while opioid treatment programs providing methadone increased relatively modestly after the reformulation. To isolate the role of exposure to OxyContin’s reformulation, I use variation in states’ pre-reformulation OxyContin misuse rates in a continuous difference-in-differences design. I find that pre-reformulation misuse rates are associated with larger increases in substance use treatment facilities after the reformulation, particularly outpatient-only facilities, with limited evidence misuse rates the availability of medication-assisted treatment services or inpatient care across states. Medicaid expansion under the Affordable Care Act was associated with more substance use treatment facilities and this effect was stronger in states with higher misuse rates, while the expansion of substance use treatment facilities was lower in states with certificate-of-need laws, highlighting the importance of insurance and regulatory barriers in treatment access. Back-of-the envelope estimates suggest the additional SUT facilities averted 2, 700-7, 800 overdose deaths between 2011 and 2019, corresponding to a value of $36-102 billion. |
| Keywords: | OxyContin, opioids, substance use, substance use treatment |
| JEL: | I11 I18 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124502 |
| By: | Federico Felizzi |
| Abstract: | We investigate the economic impact of controlling the pace of aging through biomarker monitoring and targeted interventions. Using the DunedinPACE epigenetic clock as a measure of biological aging rate, we model how different intervention scenarios affect frailty trajectories and their subsequent influence on healthcare costs, lifespan, and health quality. Our model demonstrates that controlling DunedinPACE from age 50 onwards can reduce frailty prevalence, resulting in cumulative healthcare savings of up to CHF 131, 608 per person over 40 years in our most optimistic scenario. From an individual perspective, the willingness to pay for such interventions reaches CHF 6.7 million when accounting for both extended lifespan and improved health quality. These findings suggest substantial economic value in technologies that can monitor and modify biological aging rates, providing evidence for both healthcare systems and consumer-focused business models in longevity medicine. |
| Date: | 2025–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2503.20357 |
| By: | Michaela Kecskésová (Department of Economics, Masaryk University, Lipová 41a, 60200 Brno, Czech Republic); Štěpán Mikula (Department of Economics, Masaryk University, Lipová 41a, 60200 Brno, Czech Republic) |
| Abstract: | This paper investigates the effects of air pollution on public mood using sentiment analysis of geolocated social media data. Analyzing approximately 7 million twitter posts from the United States in July 2015, we examine how fluctuations in air quality caused by Canadian wildfires influence sentiment. We find robust evidence that higher exposure to particulate matter leads to decreased positive sentiment and increased negative sentiment. Given the importance of mood as a factor in labor productivity, our results suggest that the short-term psychological effects of air pollution, alongside its well-documented physical health impacts, should be considered in policy discussions, as negative shifts in public mood due to poor air quality could have far-reaching economic consequences. |
| Keywords: | air pollution; particulate matter; mood; sentiment analysis; Twitter; wildfires |
| JEL: | Q5 D9 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:mub:wpaper:2025-05 |
| By: | David M. Cutler; Ellen Meara; Susan Stewart |
| Abstract: | The growth of longevity in the U.S. and other countries has increased interest in raising the age of eligibility for public retirement benefits. The consequences of this policy depend on the health of the older adult population overall and by socioeconomic group. In this paper, we estimate how multiple dimensions of non-fatal health in older adults evolve over time and across cohorts – physical functioning, mental health, pain, and cognition. Our sample is individuals in the Health and Retirement Study who are aged 51 to 54 at baseline and are followed for up to two decades. We find that limitations in most domains have increased for younger cohorts, especially pain and cognitive impairment. People are more impaired in their 50s, where such impairment used to occur in one’s 60s. However, this appears to be a speeding up of impairment more than a long-term increase. Among people in their late 60s, health for later cohorts is similar to health for earlier cohorts. To evaluate the implications of these trends, we simulate the work capacity of adults just before reaching age 65 based on the health status of people at this age and the relationship between health and the labor force outcomes of younger people. Overall health among those age 62 to 64 remains high, despite impairment striking at younger ages. However, among people without high school degrees, less than half are predicted to have the capacity to work full time by age 62 to 64, and over a quarter are predicted to be receiving SSDI. |
| JEL: | I1 J01 J20 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33733 |
| By: | Francesco Chiocchio; Jeremy Greenwood; Nezih Guner; Karen A. Kopecky |
| Abstract: | At the onset of COVID-19, U.S. labor-force participation dropped by about 3 percentage points and remained below pre-pandemic levels three years later. Recovery varied across states, with slower rebounds in those more affected by the pre-pandemic opioid crisis, as measured by age-adjusted opioid overdose death rates. An event study shows that a one-standard-deviation increase in pre-COVID opioid death rates corresponds to a 0.9 percentage point decline in post-COVID labor participation. The result is not driven by differences in overall health between states. The effect of prior opioid exposure had a more significant impact on individuals without a college degree. The slow recovery in states with more opioid exposure was characterized by an increase in individuals who are not in the labor force due to disability. |
| Keywords: | labor-force participation; health; opioids; COVID-19 |
| JEL: | I12 I14 J11 J12 J21 |
| Date: | 2025–05–14 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fedcwq:99976 |
| By: | Blamey Amelia (Motu Economic and Public Policy Research); Ilan Noy (Victoria University of Wellington) |
| Abstract: | We investigate the effect of interpersonal and institutional trust on COVID-19 vaccination hesitancy. Although the development of COVID-19 vaccinations helped to reduce the spread and severity of the disease, ongoing vaccine hesitancy has presented a challenge. We ask whether interpersonal and institutional trust predict COVID-19 vaccination delay and refusal. We use an unprecedently rich and representative dataset of over 22, 000 New Zealand respondents, sourced from the 2014, 2016, and 2018 General Social Survey. Respondents reported their trust in seven domains: Parliament, police, health, education, courts, media, and the general public. Their survey responses are linked to respondents’ later records of vaccinations and their socio-demographic characteristics. We assess the correlation between their earlier interpersonal and institutional trust and vaccination delay and refusal while controlling for relevant covariates. We find that all measured trust domains exhibit a significant and negative correlation with vaccine hesitancy. As trust increases, vaccination hesitancy decreases and so does the time it takes people to vaccinate. The correlation is strongest for trust in police and interpersonal trust, and weakest for trust in media. By understanding how trust informs vaccination decision-making, we can better prepare for and respond to future pandemics and public health vaccination campaigns more generally. |
| Keywords: | COVID-19, vaccination, trust, general social survey, GSS |
| JEL: | I12 I18 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:mtu:wpaper:25_03 |