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on Health Economics |
| By: | Kevin Callison; Michael E. Darden; Keith F. Teltser |
| Abstract: | We study disparities in liver transplant allocation when innovation alleviates the scarcity of organs. When direct-acting antivirals for Hepatitis C (HCV) reduced HCV+ liver demand, we show a disproportionate increase in White HCV- liver transplants (56.6%) relative to Black HCV- transplants (11.9%). The time to transplant decreased (31.1%), and the transplant rate increased (19.5pp), only for White HCV- patients. Our results are surprising because liver health is the primary determinant of transplant priority and marginal White patients were of better liver health. We show more similar gains when we focus on privately insured patients and/or areas with more Black patients. |
| JEL: | I10 I11 I14 O3 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33735 |
| By: | Claire Boone; Pablo A. Celhay; Paul Gertler; Tadeja Gracner |
| Abstract: | We study how preventive medical care use affects health behaviors and outcomes for patients with chronic diseases. Leveraging variation induced by a national appointment reminder program, rolled out across 315 public primary care clinics in Chile, we use an instrumental variables approach with patient-level administrative data from over 300, 000 patients with type 2 diabetes and hypertension. We find that increased preventive visits lead to more screening tests and large increases in medication adherence. Preventive care also leads to earlier detection and treatment of cardiovascular complications: we document an increase in cardiovascular hospitalizations but a reduction in in-hospital mortality. |
| JEL: | I12 I18 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33738 |
| By: | Dou, Jialu (University of Pittsburgh); Gihleb, Rania (University of Pittsburgh); Giuntella, Osea (University of Pittsburgh); Lonsky, Jakub (University of Edinburgh) |
| Abstract: | This study evaluates the impact of California’s SB 328, the first statewide mandate delaying school start times for middle and high schools, on adolescent sleep, mental health, and academic outcomes. Using YRBS, ATUS, SEDA, and SAT data, we apply difference-in-differences and matched DID methods. SB 328 led to significant improvements in sleep duration and academic performance. We find suggestive mental health benefits, though estimates are imprecise, and substantial heterogeneity in effects, with stronger gains among boys and Hispanic students across both sleep and academic outcomes. |
| Keywords: | Mental Health, Sleep, School Start Times, Academic Achievement |
| JEL: | I10 I20 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17930 |
| By: | Anne Brenoe (University of Zurich); Ursa Krenk (University of Zurich); Andreas Steinhauer (University of Edinburgh); Josef Zweimueller (University of Zurich) |
| Abstract: | How do firms adjust their labor demand when a female employee takes temporary leave after childbirth? Using Austrian administrative data, we compare firms with and without a birth event and exploit policy reforms that significantly altered leave durations. We find that (i) firms adjust hiring, employment, and wages around leave periods, but these effects fade quickly; (ii) adjustments differ sharply by gender, reflecting strong gender segregation within firms; (iii) longer leave entitlements extend actual leave absences but have only short-term effects; and (iv) there is no impact on firm closure up to five years after birth. |
| Keywords: | family leave, firms, labor supply, labor demand, gender, absence duration |
| JEL: | H2 H5 J2 J08 J13 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:2514 |
| By: | Panle Jia Barwick; Ashley T. Swanson; Tianli Xia |
| Abstract: | Making innovative drugs affordable and accessible is a pressing global challenge. Centralized negotiation is an increasingly popular policy solution, but it remains understudied despite wide variation in implementation. This paper studies China’s ongoing NRDL Reform, which combines centralized drug price negotiation with expanded insurance coverage. The reform reduced retail prices by 48% and out-of-pocket costs by 80%, and increased drug utilization by 350%. At the same time, the insurance design was regressive, and 25% of negotiations failed. Focusing on cancer drugs, we estimate a flexible demand and supply model that features heterogeneous households, bargaining with potential breakdowns, and a government objective function that depends on consumer surplus and insurance spending. We estimate that including innovative cancer drugs in the NRDL generated Y40 billion ($5.6 billion) in annual consumer surplus gains and increased survival by 900, 000 life-years among Chinese cancer patients each year. Among the counterfactual policies we examined, centralized market-access negotiation with an optimal coinsurance schedule raises social surplus by 19% relative to the observed policy and achieves 90% of the social surplus of an efficient benchmark. |
| JEL: | I0 L0 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33832 |
| By: | Bhalotra, Sonia; Clarke, Damian |
| Abstract: | Looking at the earnings profiles of men and women after their first child is born, a num- ber of studies establish that women suffer a larger penalty in earnings than men—a child penalty. Leveraging randomness in the sex of the first birth, we show that the child penalty in the UK is larger when the first born child is a girl. We label this the daughter penalty. Exploiting rich longitudinal survey data, we examine behavioural responses to the birth of a daughter vs. a son to illuminate the underpinnings of the daughter penalty. We find that the birth of a daughter triggers more household specialisation than the birth of a son, with mothers taking on a larger share of household chores and childcare. Mothers suffer a daughter penalty in mental health, while fathers report more satisfaction with their rela- tionship. Our findings imply that girls and boys in the UK are, on average, growing up in different home environments, with girls growing up in households that, by multiple mark- ers, are more gender-regressive. This is potentially a mechanism for the inter-generational transmission of gendered norms. |
| Date: | 2025–05–28 |
| URL: | https://d.repec.org/n?u=RePEc:ese:iserwp:2025-03 |
| By: | Jan Goebel; Christian Krekel; Katrin Rehdanz |
| Abstract: | Most people consider parks important for their quality of life, yet systematic causal evidence is missing. We exploit exogenous variations in their use values to estimate causal effects. Using a representative household panel with precise geographical coordinates of households linked to satellite images of green spaces with a nationwide coverage, we employ a spatial difference-in-differences design, comparing within-individual changes between residents living close to a green space and those living further away. We exploit Covid-19 as exogenous shock. We find that green spaces raised overall life satisfaction while reducing symptoms of anxiety (feelings of nervousness and worry) and depression. There is also suggestive evidence for reduced loneliness. Given the number of people in their surroundings, a compensating-surplus calculation suggests that parks added substantial benefits during the period studied. |
| Keywords: | Parks, Green Spaces, Mental Health, Quasi-Natural Experiment, Compensating Surplus, Wellbeing |
| Date: | 2025–06–02 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepdps:dp2106 |
| By: | Monica Deza; Johanna Catherine Maclean; Alberto Ortega |
| Abstract: | Child maltreatment is a major public health concern in the United States. Maltreatment is associated with a range of poor health, developmental, and economic outcomes for child victims. In this study, we examine the impact of recent state paid sick leave mandates on child maltreatment reports over the period 2011-2022. Paid sick leave mandates confer financially protected time that can be used for health and family responsibilities as well as for actions such as court hearings that can reduce exposure to domestic violence. These benefits may also reduce maltreatment reports. Using difference-in-differences and event-study methods, we find that child maltreatment reports decline by 11% following the adoption of a state paid sick leave mandate. An analysis of mechanisms suggests that increases in parental and child health, family economic standing, childcare provision, and healthcare are important channels linking paid sick leave mandates to child maltreatment reports. |
| JEL: | J2 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33758 |
| By: | Robert Paul Hartley (Columbia University); Carlos Lamarche (University of Kentucky); James P. Ziliak (University of Kentucky) |
| Abstract: | We investigate how length of time on welfare during childhood affects economic outcomes in early adulthood. Using intergenerationally linked mother-child pairs from the Panel Study of Income Dynamics, we adopt a nonlinear difference-in-differences framework using the 1990s welfare reform to estimate average and quantile treatment effects on intensity of welfare use and earnings in adulthood. The causal estimates indicate that additional childhood welfare exposure leads to more adulthood years on the broader safety net for both daughters and sons, yet this positive relationship only applies below moderate levels of adult welfare participation and reverses at greater levels of dependence. Increasing childhood welfare exposure implies lower earnings in adulthood for daughters, however we find no evidence that it depresses adult sons’ earnings. Both daughters and sons exhibit some wage penalty from childhood welfare exposure, yet only daughters are penalized through hours worked in the labor market. |
| JEL: | I38 J62 H53 |
| Date: | 2028–06 |
| URL: | https://d.repec.org/n?u=RePEc:dls:wpaper:0350 |
| By: | Alessandro Fedele (Free University of Bozen-Bolzano, Italy); Mirco Tonin (Free University of Bozen-Bolzano, Italy); Daniel Wiesen (University of Cologne, Germany) |
| Abstract: | The health sector requires skilled, altruistic, and motivated individuals to perform complex tasks for which ex-post incentives may prove ineffective. Understanding the determinants of self-selection into health professions is therefore critical. We investigate this issue relying on data from surveys and incentivized dictator games. We compare applicants to medical and healthcare schools in Italy and Austria with non-applicants from the same regions and age cohorts. Drawing on a wide range of individual characteristics, we employ machine learning techniques for variable selection. Our findings show that higher cognitive ability, greater altruism, and the personality trait of conscientiousness are positively associated with the likelihood of applying to medical or nursing school, while neuroticism is negatively associated. Additionally, individuals with a strong identification with societal goals and those with parents working as doctors are more likely to pursue medical education. These results provide evidence of capable, altruistic, and motivated individuals self-selecting into the health sector, a necessary condition for building a high-quality healthcare workforce. |
| Keywords: | Self-selection, Health professions, Altruism, Cognitive ability, Personality traits, Machine learning (Lasso, high-dimensional metrics). |
| JEL: | I1 J24 J4 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:bzn:wpaper:bemps115 |
| By: | Michael E. Darden; Reginald B. Hebert; Michael F. Pesko; Samuel Sturm |
| Abstract: | We study the effects of cigarette excise taxes on smokers’ household budgets. In a randomized survey experiment, smokers respond to tax increases by adjusting cigarette shopping behaviors, substituting towards other tobacco products, and reducing both discretionary and human capital-related expenditures. Using Consumer Expenditure Survey data and a quasi-experimental design, we find cigarette taxes reduce smoking prevalence but increase cigarette expenditures among continuing smokers. Additionally, a $1 increase in cigarette taxes causes a 2.12% decline in human capital-related expenditures among below median income smokers. Our work uncovers important unintended consequences of cigarette taxes, particularly for low-income individuals. |
| JEL: | I10 I12 I14 I18 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33746 |
| By: | Subelack, Jonas |
| Abstract: | Objective: This study aims to investigate whether specific treatments or combinations of treatments are significantly associated with the profitability of Swiss acute-care hospitals under the current diagnosis-related group (S-DRG) reimbursement system, while accounting for differences between public and private institutions. Methods: A comprehensive panel dataset of 142 Swiss acute-care hospitals, spanning from 2015 to 2022, was utilized, combining detailed financial and clinical case-level data. Profitability was assessed through hospital-level net financial results excluding deficit-covering payments. All cases were assigned uniquely to a medically homogeneous service group or area, as determined by Swiss hospital capacity planning. Fixed-effects panel regression models analyzed the associations between service areas and profitability, while an Apriori association rule mining algorithm identified service group combinations associated with profitability. Results: From 2015 to 2022, overall hospital profitability margins declined continuously, with public hospitals consistently reporting lower profitability than private hospitals (net profitability margin: 0.75% vs. 1.61%), despite receiving substantial subsidies (CHF 67.1 million vs. CHF 4.1 million). The primary panel regression revealed that three service areas are significantly associated with hospital profitability: Ear, nose and throat (16, 778 CHF; p |
| Keywords: | Hospital financing, hospital profitability, hospital reimbursement, DRG, Switzerland |
| JEL: | H51 I11 I15 I18 L51 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:hsgmed:202502 |
| By: | Böckerman, Petri (University of Jyväskylä); Haapanen, Mika (University of Jyväskylä); Jepsen, Christopher (University College Dublin) |
| Abstract: | Using high-quality Finnish register data and a regression discontinuity approach, we study the health effects of reaching the legal drinking ages of 18 and 20. Our results show that at age 18, when beer, wine, and car driving become legal, mortality and hospitalizations increase discontinuously, especially among men, and they are driven by alcohol and traffic-related causes. At age 20, when spirits become legal, alcohol-related deaths and accidents increase for men, and suicide risk rises for women. We also find meaningful adverse spillover effects on younger siblings. When an older sibling turns 18, their younger brothers face increases in alcohol-related mortality, traffic-related hospitalizations, and suicide attempts, while younger sisters experience more alcohol-related hospitalizations. Spillovers at age 20 are weaker but persist for younger brothers. |
| Keywords: | sibling effects, hospitalizations, mortality, legal age, drinking age, regression discontinuity |
| JEL: | I12 K32 H50 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17924 |
| By: | Elodie Carpentier; Alexander Cuntz; Alessio Muscarnera; Julio Raffo |
| Abstract: | Scientific progress relies on access to prior knowledge, yet costly access to academic literature can hinder researchers, particularly in marginalized positions of academia and developing economies. This paper examines the impact of free or lower-cost access to scientific literature on gender representation in research. Leveraging the staggered adoption of the Hinari program, which provides digital access to health science research, we analyze its effects on women’s participation in research production and academic publishing across more than 600 institutions in 80 countries. Using a triple difference approach, we find that improved digital access to knowledge increases the share of women scientists in publishing faculty and enhances their research output. The program's effects are most pronounced in countries with lower gender balance in educational attainment, where it appears to help overcome attainment gaps and activate women's potential in academic labor markets. Our study contributes to the literature on digitization, access to knowledge and gender disparities in academia, while also helping to inform science and innovation policy and human capital development. |
| Keywords: | Open science, Development, Health Science, Gender studies, Triple difference, Impact evaluation |
| JEL: | J16 L17 O31 O33 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:wip:wpaper:88 |
| By: | Philipp Dierker (Max Planck Institute for Demographic Research, Rostock, Germany); Mine Kühn (Max Planck Institute for Demographic Research, Rostock, Germany); Sanna Kailaheimo-Lönnqvist; Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | Objective: This study examines whether life events of ex-partners with a shared child affect each other’s mental health. Background: While prior research has documented interdependencies within intact families, such as between parents and children or within couples, we extend the linked lives concept to separated parents. We argue that parents’ lives remain interdependent even after separation, unlike separations between partners without children. Accordingly, life events experienced by the ex-partner (re-partnering, separation, childbirth, cancer diagnosis, death, and parental death) could affect an individual’s mental health. Method: Using Finnish register data and panel data methods (fixed effects, fixed effects with individual slopes, and dynamic difference-in-difference models), we analyze families in which parents separated while their firstborn was a minor. Mental health is operationalized by psychotropic medication purchasing. Results: Positive life events of the ex-partner, such as re-partnering and childbirth, reduce the probability of the other ex-partner purchasing psychotropic medication. Conversely, negative life events, including the ex-partner’s cancer diagnosis and death, increase this probability, with stronger effects observed for women. More distant life events, such as the ex-partner’s separation or their parent’s death, show no consistent associations. Conclusion: These findings support the presence of enduring links among separated parents. However, the effects of life events diminish with generational distance and after new partnerships are formed. Current partners’ life events have a stronger impact than those of ex-partners throughout. |
| Keywords: | Finland, end of union, family dynamics, life span, mental health, parents |
| JEL: | J1 Z0 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:dem:wpaper:wp-2025-014 |
| By: | Abdoulaye Ndiaye; Zhixiu Yu |
| Abstract: | Raising the retirement age is a common policy response when social security schemes face fiscal pressures. We develop and estimate a dynamic life cycle model to study optimal retirement and tax policy when individuals face health shocks and income risk and make endogenous retirement decisions. The model incorporates key features of Social Security, Medicare, income taxation, and savings incentives and distinguishes three channels through which health affects retirement: nonconvexities in labor supply due to health-dependent fixed costs of working, earnings reductions, and mortality risk. We estimate our model to match US microdata and show that labor supply nonconvexities play a dominant role in driving early retirement, making rigid increases in the retirement age welfare reducing. In contrast, more flexible policies, such as increasing the dependence of Social Security benefits on the claiming age, can improve welfare and pay for themselves with a fiscal surplus. We map a range of policy reforms to their marginal values of public funds (MVPFs), showing that certain incentives to delay claiming offer MVPFs of infinity while broad-based retirement age increases have negative willingness-to-pay. These findings offer novel retirement policy prescriptions and challenge the prevailing emphasis on raising the retirement age. |
| Keywords: | flexible retirement, optimal taxation, social security reform, life cycle model, health shocks, retirement decisions, marginal value of public funds (MVPF), labor supply nonconvexities, mortality risk, medicare |
| JEL: | H21 H55 J26 D15 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11904 |
| By: | Charles Yuji Horioka; Emin Gahramanov; Xueli Tang |
| Abstract: | The purpose of this paper is to conduct a theoretical and empirical analysis of how the behavior of parents and children is affected by the presence or absence of long-term care insurance (LTCI). In our empirical analysis, we use micro data from the Japan Household Panel Survey on Consumer Preferences and Satisfaction (JHPS-CPS), formerly known as the Preference Parameter Study, conducted by Osaka University. Japan is an interesting case to analyze because a public LTCI system was introduced there in 2000. Our analysis shows that, in the case of Japan, if parents are eligible for public LTCI benefits, their children will be less likely to be their primary caregiver and that this, in turn, will reduce their children’s perceived likelihood of receiving a bequest from them. This result implies that bequests are selfishly or strategically motivated (i.e., that parents leave bequests to their children in order to elicit care from them) and that the introduction of a public LTCI system will reduce the likelihood of children providing care to their parents and through this channel reduce their perceived likelihood of receiving a bequest from them. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:dpr:wpaper:1250r |
| By: | David G. Blanchflower; Bruce Sacerdote |
| Abstract: | We study the determinants of poor mental health among students at an elite private institution. Survey measures of well-being have declined significantly over the last decade for both high school students and those of college age. This is an international phenomenon that appears to have started in the US around 2013 and that was not caused by but was exacerbated by COVID and the associated lockdowns. We focus on elite and non-elite institutions and examine Dartmouth as a special case. Dartmouth ranks well compared to other institutions. However, around a quarter of Dartmouth students (26%) report they suffer from moderate to severe depression and 22% that they suffer from moderate, to severe, anxiety and 10% say they contemplated suicide. Student’s wellbeing appears to be impacted negatively by stress over finances. We find broad patterns in the data, that ill-being is higher among females, those who engage in little exercise, have low GPAs, are not athletes nor in academic clubs nor religious organizations, reside in fraternity housing or are on financial aid. |
| JEL: | I20 I3 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33742 |
| By: | Daniel J. Benjamin; Kristen B. Cooper; Ori Heffetz; Miles S. Kimball; Tushar Kundu |
| Abstract: | We elicited over a million stated preference choices over 126 dimensions or “aspects” of well-being from a sample of 3, 358 respondents on Amazon’s Mechanical Turk (MTurk). Our surveys also collected self-reported well-being (SWB) questions about respondents’ current levels of the aspects of well-being. From the stated preference data, we estimate relative log marginal utilities per point on our 0-100 response scale for each aspect. We validate these estimates by comparing them to alternative methods for estimating preferences. Our findings provide empirical evidence that both complements and challenges philosophical perspectives on human desires and values. Our results support Aristotelian notions of eudaimonia through family relationships and Maslow’s emphasis on basic security needs, yet also suggest that contemporary theories of well-being may overemphasize abstract concepts such as happiness and life satisfaction, while undervaluing concrete aspects such as family well-being, financial security, and health, that respondents place the highest marginal utilities on. We document substantial heterogeneity in preferences across respondents within (but not between) demographic groups, with current SWB levels explaining a significant portion of the variation. |
| JEL: | D12 D90 I31 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33846 |
| By: | Veronique Gille (IRD, UMR LEDa, PSL, Universite Paris-Dauphine, France); Flore Gubert (IRD, UMR LEDa, PSL, Universite Paris-Dauphine, France); Camille Saint-Macary (IRD, UMR LEDa, PSL, Universite Paris-Dauphine, France); Stéphanie Dos Santos (LPED (IRD/AMU), Centre Saint-Charles, Marseille, France); Franck Houffoue (Institute of Statistics and Applied Economics, Abidjan, Ivory Coast); Hugues Kouadio (Institute of Statistics and Applied Economics, Abidjan, Ivory Coast); Epiphane Marahoua (Institute of Statistics and Applied Economics, Abidjan, Ivory Coast); Petanki Soro (UFR of Earth Sciences and Mineral Resources, University Felix Houphouet Boigny, Abidjan, Ivory Coast); Alexander van Geen (Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA) |
| Abstract: | Lead (Pb) exposure is a major global health concern, particularly for young children, yet awareness of the risks is low. Pb-based paint remains a significant source of exposure in many low- and middle-income countries, despite existing regulations. We investigate whether personalized information on lead in paint can increase awareness and encourage preventive behaviors. As part of a pilot study in Abidjan, Ivory Coast, painted surfaces in 200 pregnant women’s homes were tested using a low-cost Pb detection kit, followed by confirmatory testing with an X-ray fluorescence (XRF) device. Women whose homes tested positive for Pb were 34 percentage points more likely to acknowledge their exposure risk. This increased awareness led to self-reported behavioral changes among mothers of young children, including a higher likelihood of preventing children from ingesting paint chips and washing their hands more frequently. However, we find no impact on home-cleaning or renovation behaviors. Our findings highlight the potential of personalized information to drive behavioral change in environmental health. |
| JEL: | I12 I15 I31 Q53 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:dia:wpaper:dt202504 |
| By: | Berman, Yonatan; Hovland, Tora |
| Abstract: | This paper studies the impact of austerity measures implemented by the UK government after 2010 on life expectancy and mortality. We combine administrative data sources to create a panel dataset spanning from 2002 to 2019. Using a difference-indifferences strategy, we estimate the effect of cuts to welfare benefits and changes in health expenditure on life expectancy and mortality rates. Our findings indicate that these austerity measures reduced life expectancy by 2.5 to 5 months by 2019. Women were nearly twice as affected as men. The primary driver of this trend is cuts to welfare benefits, although healthcare spending changes have a larger effect per pound spent. The results suggest that austerity policies caused a three-year setback in life expectancy progress between 2010 and 2019. This is equivalent to about 190, 000 excess deaths, or 3 percent of all deaths. Taking into account the years of life lost, we conclude that the costs of austerity significantly exceeded the benefits derived from reduced public expenditure. (Stone Center on Socio-Economic Inequality Working Paper) |
| Date: | 2025–05–20 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:7d4ac_v1 |
| By: | Enrico Mattia Salonia (Toulouse School of Economics) |
| Abstract: | Why are investors overconfident and trade excessively? Why do patients at health risk avoid testing? Why are voters polarised? Possibly because their beliefs directly influence their well-being, i.e., they have belief-dependent preferences. However, existing theories of belief-dependent preferences struggle to generate testable predictions or to identify simultaneously beliefs and preferences. This paper addresses these issues by providing an axiomatic characterization of a class of preferences and belief-updating rules that deviate from Bayesian updating. Preferences, beliefs, and updating rules are identified from choices over contingent menus, each entailing a menu of acts available at a later time contingent on an uncertain state of the world. The results provide a theory-based approach to experimental designs to test information avoidance, distortion, and other behaviours consistent with beliefdependent preferences. |
| Keywords: | Belief-dependent preferences, Non-Bayesian updating, Information avoidance, Belief distortion, Contingent menus |
| JEL: | D03 D81 D83 D91 |
| Date: | 2025–05–27 |
| URL: | https://d.repec.org/n?u=RePEc:rtv:ceisrp:599 |
| By: | Ulrike Famira-Mühlberger (WIFO); Thomas Horvath; Thomas Leoni (University of Applied Sciences Wiener Neustadt); Martin Spielauer (WIFO); Viktoria Szenkurök (WIFO); Philipp Warum (WIFO) |
| Abstract: | Europe's demographic shift is putting increasing pressure on long-term care (LTC) systems and raising concerns about the sustainability of LTC financing. This paper analyses Austria's LTC system, particularly its universal long-term care allowance (LTCA), and uses a dynamic microsimulation model to project LTCA expenditure under four scenarios up to the year 2080. Using pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we estimate care needs and prevalence rates across all seven care allowance levels. This enables us to project both public spending and individual lifetime costs, disaggregated by sex and education. Although total LTCA expenditure is projected to rise due to population ageing, scenario comparisons show that compositional shifts – such as higher educational attainment, which is linked to lower care needs, and gains in healthy life expectancy accompanying mortality im- provements – can significantly mitigate cost growth. The projected total expenditure increases range from 29 percent in a scenario where increasing life expectancy – as assumed in official population projections – is neglected, to 185 percent in a scenario accounting for rising life expectancy but no future health gains. The findings also highlight the impact of longevity and education on the distribution of individual lifetime costs. Beyond its policy implications for LTC planning, the study demonstrates the advantages of dynamic microsimulation in capturing individual-level heterogeneity, offering a significant improvement on traditional macrosimulation approaches. |
| Date: | 2025–05–26 |
| URL: | https://d.repec.org/n?u=RePEc:wfo:wpaper:y:2025:i:705 |
| By: | Dimico, Arcangelo |
| Abstract: | I evaluate the impact of abortion policies in sub-Saharan Africa to understand the potential consequences of a reduced international support for women's rights following the overturn of Roe v. Wade. I find that decriminalizing abortion reduces fertility through two complementary channels. For households at the top of the wealth distribution, the effect manifests as a reduction in excess fertility, which is more pronounced among lower-educated women due to their lower likelihood of using contraception. For households at the bottom of the wealth distribution, the impact runs through a decline in the number of children with a low survival probability. This latter effect is more pronounced among highly educated women, who are more likely to control their own health-related decisions and view abortion as a viable option. I also find that while women's education levels rise after decriminalization, this does not lead to better labor market opportunities. Children born afterwards tend to achieve higher levels of education. |
| Keywords: | Abortion, fertility, child mortality, human capital |
| JEL: | O15 J13 J16 K38 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1609 |
| By: | Minghao Qiu; Christopher W. Callahan; Iván Higuera-Mendieta; Lisa Rennels; Bryan Parthum; Noah S. Diffenbaugh; Marshall Burke |
| Abstract: | Human-induced climate change has increased wildfire risks, associated air pollution, and health damages in North America. Despite its large potential for damage, climate-induced wildfire smoke is rarely incorporated in estimates of the societal costs of climate change. We develop an integrated framework to estimate PM₂.₅ from climate-induced wildfire smoke and the associated mortality damage in the U.S. Our framework combines econometric estimates of smoke-mortality relationships, machine learning estimates of climate-smoke relationships, and econometric estimates of negative feedbacks between current and future wildfire activity. We estimate that 3°C of future warming will lead to 46, 200 annual deaths associated with smoke pollution in the US, doubling estimated mortality from smoke during 2011-2020. For an additional tonne of CO₂ emitted in 2025, we estimate a partial social cost of carbon of $15.1 (95%CI: $2.5-$49.3) due to climate-induced wildfire smoke mortality in the U.S, which doubles current estimates of the U.S. domestic social cost of carbon. We estimate that smoke-related mortality benefits due to projected emissions reductions from the 2022 Inflation Reduction Act are alone equal to 25% of estimated abatement costs associated with the Act. |
| JEL: | Q51 Q52 Q54 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33829 |
| 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: | A large body of literature demonstrates that exposure to major adverse events such as natural disasters affects physical and mental health. Less is known about health consequences of long- term exposure to smaller, recurring shocks such as mining-induced earthquakes. Leveraging data from the Dutch Lifelines Cohort Study and Biobank and the Royal Netherlands Meteorological Institute, we examine mental health effects of frequent earthquakes generated by the extraction of natural gas, which was a major source of economic revenue for the Netherlands. Long-term exposure is captured by the accumulated peak ground acceleration. We employ individual-level fixed effects models to deal with selective exposure. We find that exposure increases depression and anxiety symptoms. Our results are robust to selective migration and to varying the exposure indicator. The results support a reassessment of the societal costs of the mining of natural gas. |
| Keywords: | anxiety, depression, mental health, induced earthquakes, mining, stress, gas-extraction |
| JEL: | I10 I18 Q33 Q53 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17925 |
| By: | Joan Costa-i-Font; Anna Nicinska; Melcior Rossello Roig |
| Abstract: | We compare inequality and social mobility trends in European countries exposed to Soviet Communist (SC) regimes with those not exposed, using similar welfare mea-sures. We draw upon a rich retrospective dataset that collects relevant welfare measures across regimes, including information on living space and self-reported health, and relevant inequality and mobility indices for ordinal and categorical data. Our results suggest evidence of comparable welfare inequality trends in countries exposed to SC and those unexposed. Although individuals exposed to SC enjoyed higher levels of social mobility, differences in inequality across countries exposed to different regimes were negligible. A plausible explanation lies in the countervailing role of the welfare state in countries not exposed to SC and the inefficiency of the bureaucratic allocation of private goods aimed at reducing inequality in countries exposed to SC. |
| Keywords: | Inequality, welfare, living space, self-reported health, health inequality, education; social mobility, Soviet Communism, bureaucracies, European Communist Regimes |
| JEL: | I14 H53 I13 I38 N34 P20 P29 P36 P46 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11916 |
| By: | Huang, Kaixing; Hou, Hao |
| Abstract: | This study evaluates the economic impact of the New Rural Cooperative Medical Scheme in China, the world's largest rural public health program, covering over 800 million rural residents. Using longitudinal survey data from villages that gained access to the program in different years, we find that the program improved the probability of being in good health by 4.4% to 8.2% across age groups. For the average participating household, per capita income increased by 20.3% over a decade, driven primarily by greater off-farm labor participation and higher wages, alongside significant agricultural income growth. The aggregate income gains were six times the government's program investments. These effects can be replicated by a structural model that characterizes the health investments and labor allocation of utility-maximizing rural residents. Counterfactual analyses based on the structural model suggest that China could further increase the program's benefits by raising the reimbursement rate up to 0.8 (but not beyond). Additionally, eliminating the current cross-province reimbursement constraints would further boost income gains by 18.7%. |
| Keywords: | rural public health insurance, income, health, migration |
| JEL: | I13 I38 R23 |
| Date: | 2025–05–08 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124703 |
| By: | Rossouw, Stephanié; Greyling, Talita |
| Abstract: | The study of well-being has evolved significantly over the past three decades, reflecting both theoretical advancements and real-world applications across diverse populations, domains, and times. One of the most pressing issues in contemporary well-being research is the intersection between experienced well-being measures and societal compliance, especially in times of uncertainty. Effective crisis response depends not only on well-designed policies but also on how populations emotionally interpret uncertainty and respond behaviourally. This paper introduces a framework in which experienced well-being indicators are repositioned as behavioural inputs that shape compliance with public health interventions. Drawing on interdisciplinary theories, we argue that emotional readiness plays a critical role in driving prosocial behaviour during times of crisis. Using a cross-national dataset and applying XGBoost and SHAP, we examine how dynamic, within-country features, both structural and subjective, predict compliance with COVID-19 vaccination policy. Results show that general trust and happiness are among the strongest predictors of compliance, often rivalling or exceeding traditional factors like GDP per capita or healthcare spending. Our findings show experienced well-being indicators not only predict compliance within countries but also have cross-national relevance, providing a foundation for more psychologically informed policy design. We propose that policymakers integrate these emotional indicators into crisis response systems to improve behavioural effectiveness and public cooperation. |
| Keywords: | Compliance, global crisis, experienced well-being, emotions, XGBoost, SHAP |
| JEL: | C55 H12 I12 I18 Z13 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1612 |
| By: | Matus-López, Mauricio |
| Abstract: | This article presents a scoping review of the scholarly literature on the historical, institutional, and economic evolution of the health systems of Chile, Uruguay, and Costa Rica. These three countries were selected due to their differing institutional trajectories—market-oriented (Chile), universal public (Costa Rica), and hybrid-transitioning (Uruguay)—as well as their shared current status of near-universal coverage and high human development. The review aimed to systematically map peer-reviewed publications to identify key institutions, landmark reforms, long-term quantitative indicators, and critical assessments of system performance. A structured search was conducted in Web of Science, Scopus, and SciELO using terms related to health systems, institutional development, financing, and the three countries. After removing duplicates and applying thematic and geographic filters, 42 articles were selected for full-text analysis. Findings show a disproportionate focus on Chile, reflecting its globally unique model of function separation and private insurance. Costa Rica's system is consistently framed around the centrality of the CCSS and its primary care reforms, though discussion of the private sector remains limited. In Uruguay, the 2007 reform establishing the Integrated National Health System (SNIS) receives positive coverage, while earlier periods remain underexplored. Across cases, available quantitative data is fragmented and short-term, limiting comparative and longitudinal analysis. Despite coverage gaps, the review confirms key trends identified in broader literature and underscores the need to incorporate non-indexed sources—such as national reports and historical monographs—to fully grasp the institutional evolution of Latin American health systems |
| Keywords: | health care; health systems; history; institutions; Chile; Uruguay, Costa Rica, Latin America |
| JEL: | I11 I14 I15 I18 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124790 |
| By: | Christian Ochsner; Lukas Schmid |
| Abstract: | We study the effects of the largest adverse health shock in modern medicine - the 1918 influenza pandemic - on subsequent shifts in health-related attitudes and behavior and future-oriented policies. Our analysis builds upon self-digitized, individual-level death-register excerpts, vaccination records, and popular vote counts. We find that greater exposure to influenza leads to a decline in societal support for public health measures at the aggregate level, mainly triggered by deceased peers. However, individual-level data reveal increased vaccination rates in families who experienced influenza-related deaths. These differences did not exist before the pandemic. Our findings link to a U-shaped relationship between suffering from the pandemic and support for effective health policies. Places with predominantly indirectly-affected families drive the aggregate backlash. This challenges the idea that past health shocks improve life expectancy through societal learning. |
| Keywords: | health behavior, health attitudes, 1918 influenza pandemic, mistrust |
| JEL: | I12 I18 H51 D72 N34 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11903 |
| By: | Matthew A. Guzman; Scott A. Imberman; Neil R. Filosa; Tara Kilbride; Nat Malkus |
| Abstract: | Schools have long played a frontline role in efforts to contain infectious diseases and prevent spread to the wider community. These include vaccination requirements, school closures during periods of high illness, and the implementation of non-pharmaceutical interventions (NPI) during outbreaks. In this paper we investigate the impact of mask mandates in schools on COVID spread. We use event study and difference-in-differences models that exploit the removal of mask mandates in districts serving 50% of public school students in the U.S. surrounding the revocation of CDC guidance recommending school masking in February and early March of 2022. We estimate that going from 0% to 100% mandated masking in a county reduces COVID deaths by 0.57 per 100k people. We further estimate that the removal of mandates during this time contributed to 21800 COVID deaths through the rest of 2022, 9% of the U.S. total that year. Due to the fact that COVID deaths among students and, to a lesser extent, school staff were rare in the U.S. given school age profiles, we argue that the bulk of these deaths were from spillovers to residents in the wider community. |
| JEL: | I18 I21 I28 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33849 |
| By: | McWay, Ryan |
| Abstract: | Ravindran and Shah (2023) assesses the effect of COVID-19 lockdowns on violence against women (VAM) in India. Using a dynamic fixed effects methodology exploiting spatio-temporal variation in the timing and intensity of 'stay-at-home' mandates in Indian districts, the authors find that government-mandated lockdowns increased complaints of domestic violence in districts with the strictest lockdown rules. I successfully computationally reproduce their results. Further, I test the replicability of the results by re-analyzing the results using a Poisson estimator as opposed to the ordinary least squares (OLS) estimator used by the original authors. I find that lower bound censoring of the outcome measure resulted in attenuation of the marginal effect of government-mandated lockdowns. The effect of mobility restrictions on VAW are understated in the original study. This provides support for the internal validity of Ravindran and Shah (2023)'s results by suggesting that may present lower bound estimates of an under-reported consequence of mobility restrictions during the COVID-19 pandemic. |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:i4rdps:230 |