|
on Health Economics |
| By: | Marika Cabral; Marcus Dillender |
| Abstract: | This paper analyzes the importance of doctor discretion in medical evaluations. Leveraging comprehensive administrative data and random assignment of doctors to evaluations in workers’ compensation insurance, we identify the scope for doctor discretion in medical evaluations of injured workers and the impacts of this discretion on later claimant outcomes. Our analysis indicates there is wide variation across doctors in medical evaluations, these decisions are consequential for later claimant outcomes, and doctor effects vary systematically by observed doctor characteristics. In addition, we analyze the relationship between doctor effects in medical evaluations and market allocation when claimants can select their own doctors. Our findings suggest both claimants and insurers influence the allocation of doctors in line with their respective incentives, indicating market forces shape the distribution of program benefits. Finally, we conclude with supplemental counterfactual analysis and discussion of the policy implications of these findings. |
| JEL: | H0 I11 J0 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33988 |
| By: | Bolt, U.; French, E.; Warrier, V.; Yang, Q.; Zhang, W. |
| Abstract: | This paper investigates how genetic endowments influence lifetime earnings using a dynamic life cycle model and longitudinal data from a cohort tracked from birth to retirement. We examine genetic impacts on skill formation as well as choices of parental investments, educational attainment, and occupation. A one standard deviation increase in the polygenic score for educational attainment raises lifetime earnings by 18.9%. Although part of this effect is due to genetic endowments impacting skill formation, the majority is due to genetic endowments impacting choices. Extending our analysis to include polygenic scores for additional traits reveals other channels through which they operate. Furthermore, our estimates show that genetic endowments and investments are substitutes in the production of earnings during early childhood but are complements later in life, highlighting the crucial importance of early-life interventions to effectively mitigate genetic inequalities. |
| Keywords: | Polygenic Scores, Educational Attainment, Life Time Earning, Cognitive Skills |
| JEL: | I24 J24 C38 |
| Date: | 2025–07–03 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2547 |
| By: | Deschenes, Olivier; Jarvis, Stephen; Jha, Akshaya; Radford, Alan D |
| Abstract: | There is a large literature documenting the adverse impacts of air pollution on human health. In contrast, there is a paucity of research studying the effects of air pollution on animal health. We fill this gap, utilizing five years of data on over seven million visits to veterinary practices across the United Kingdom. Leveraging within-city variation in daily monitor-measured air pollution levels, we find that increases in fine particulate matter (i.e., PM2.5) lead to significant increases in the number of vet visits for both cats and dogs. In aggregate, these estimates indicate that reducing ambient PM2.5 levels to a maximum of 5µg/m3 as recommended by the World Health Organization would result in eighty thousand fewer vet visits each year (a 0.4% reduction). |
| Keywords: | pets; air pollution; animal health |
| JEL: | I00 Q51 Q53 Q57 |
| Date: | 2024–10–17 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:128526 |
| By: | Fernando M. Aragon, Mahyar Rezazadeh (Simon Fraser University) |
| Abstract: | This paper examines how adaptation shapes the impact of extreme heat on labor productivity. We use global data on competitive runners, combined with highresolution weather information, to estimate how race-day heat affects running speed. Consistent with adaptation, we find that runners from hotter countries are significantly less affected by extreme temperatures. The performance gap is most pronounced in endurance events and narrows in high-stakes races, suggesting that both physiological factors and incentives may play a role. Our findings contribute to the literature on climate adaptation by providing evidence that prior exposure reduces sensitivity to heat. |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:sfu:sfudps:dp25-02 |
| By: | Paola Bertoli; Veronica Grembi |
| Abstract: | In many countries, public healthcare systems are facing the unprecedented challenge of attracting new physicians and retaining existing physicians. Given that the role of noneconomic factors in responding to such a challenge is as important as the role played by economic factors, we use outbreaks of healthcare scandals from 2000 to 2020 in approximately 100 Italian provinces to address the impact of perceived corruption on the density of public hospital physicians. The outbreak of a scandal is associated with a 3.6% decrease in the presence of public hospital physicians. The effect is explained mainly by so-called supply-side drivers, such as ethical concerns (i.e., a scandal related to a malpractice case), a lack of motivation in the workplace, concerns about the high salience of the scandal (e.g., more media coverage), and more outside options. Demand-side drivers, such as a lower level of trust on the patient side, which affects the patient distribution and, indirectly, the physician distribution, do not seem to play a crucial role within the institutional setting analyzed. Our results are robust to different staggered DID estimators, the inclusion of trends to capture potential time-varying attitudes toward corrupt behaviors, and the inclusion of variables that are expected to affect both the density of public hospital physicians and the occurrence of scandals. Healthcare scandals do not seem to affect the density of other types of civil servants, such as teachers or firefighters. |
| Keywords: | Healthcare, Corruption, Staggered Diff-in-Diff, Physicians' Supply |
| JEL: | D7 I19 J24 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:baf:cbafwp:cbafwp25243 |
| By: | Jack Keane; Dennis Guignet |
| Abstract: | About 15% of the United States population (43 million people) rely on private wells for their primary source of potable water, and yet (in contrast to public water systems), no routine contaminant monitoring and water treatment is required. Water testing can be expensive, and the need for routine testing may often be unknown to residents, thus allowing potentially harmful water contaminants to go undetected. As such, estimates of the potential effects on households are needed to inform policies and programs to maintain safe potable groundwater wells. We attempt to help fill this gap by estimating hedonic property value models of homes in the Orlando, Florida Metropolitan Statistical Area. We link home transactions to home-specific private well tests conducted by the Florida Department of Health. We find that homes with groundwater well contamination experience a roughly 7% decline in value, and that this decrement persists for many years. Key Words: contamination; drinking water; groundwater; hedonic; housing; private well |
| JEL: | D6 Q51 Q53 R2 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:apl:wpaper:25-05 |
| By: | Alessandra Cascarico (Bocconi University, Dondena and CESifo.); Edoardo Di Porto (CSEF, INPS, Università di Napoli Federico II, UCFS, Uppsala University); Joanna Kopinska (University of Rome La Sapienza); Salvatore Lattanzio (Bank of Italy and Dondena) |
| Abstract: | Relying on a reform that increased parental leave generosity, we estimate workplace peer effects in the use of leave, with a focus on fathers. Coworker fathers are more likely to take parental leave when exposed to a higher share of peer fathers, who are exogenously affected by the reform. This effect is stronger in larger establishments, those with higher levels of social capital and higher use of parental leave before the reform. We also document that own-gender peer effects are larger than cross-gender influences, and show the absence of career costs for fathers exposed to the reform, which provides an explanation for our findings. Peer effects extend to coworker fathers’ partners, who experience an increase in earnings and labor supply. Peer effects are observed also for mothers, but the response of their partners is less pronounced. |
| Keywords: | Parental leave, Peer effects, Career costs, Female labor market participation. |
| JEL: | G33 K22 L25 O52 |
| Date: | 2025–04–15 |
| URL: | https://d.repec.org/n?u=RePEc:sef:csefwp:748 |
| By: | Kulvik, Martti; Kuusi, Tero; Laurikka, Annu; Valkonen, Tarmo |
| Abstract: | Abstract Sickness absence is a complex and costly problem that affects all parties in the workplace. The aim of our research has been to explore, develop, test and critically evaluate different approaches to gain a deeper understanding of the economic significance of sickness absence on the one hand, and to identify possible causal links on the other. The study is based on a dataset provided by Keva (data on around 215, 000 employees for the period 2019–2021), which includes information on public sector employers, occupations, gender, wages and sickness absence. We applied several measures, such as frequency of absenteeism, total number of days of absence and length of absenteeism, while keeping the objective and focus of the analyses on costs. Short sickness absences account for the majority of all sickness absences, both in terms of quantity and cost, but they can also predict longer absences and thus act as health indicators. In this respect, it is noteworthy that there is a positive association between organisational effects on short sickness absence and longer or recurrent sickness absence requiring early intervention. One short period of sickness absence related to organisational factors predicts 1.4 periods of sickness absence requiring early intervention. In the future, combining survey data with quantitative analysis could be useful for assessing the usefulness of different interventions. |
| Keywords: | Costs of sickness absence, Municipal employers, Keva, Public sector, Organisational effects |
| JEL: | J22 J30 J45 |
| Date: | 2025–06–23 |
| URL: | https://d.repec.org/n?u=RePEc:rif:report:165 |
| By: | Fréget, Louis |
| Abstract: | The aging of the general physician workforce in developed countries is expected to lead to increased practice closures. Hence, concerns arise regarding the health effects of such closures, particularly for patients facing them during critical life stages such as pregnancy. However, no study exists to date on the health effects of general physicians’ (GP) practice closures during pregnancy. I assess the effects of such closures during pregnancy on birth outcomes in Denmark. I compare the birth outcomes of mothers experiencing practice closures within nine months post-conception to those facing closures nine months pre-conception. I find a small to medium-sized adverse effect of discontinuity in care on birth outcomes. Closures increase the share of births of fetuses who are small for their gestational age. The negative effect on birth weight is especially pronounced when the closure happens in the last trimester of pregnancy. Consistently, mothers affected by GP practice closures during pregnancy experience small disruptions in healthcare provision at the extensive and at the intensive margin. |
| Keywords: | Health Policies, Practice closures, Antenatal care |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:cpm:docweb:2407 |
| By: | Lionel Wilner; Philippe Choné |
| Abstract: | To empirically assess how physicians respond to financial incentives, we leverage a quasi-natural experiment in France where most GPs' fees are regulated. In 2017, a wide-scale regulatory change caused the price of a visit to increase from €23 to €25. Relying on granular claims data covering the universe of patients, doctors, and visits, we show that physician activity grew by nearly 9% after the price increase, yielding a unitary price elasticity of healthcare provision. The number of distinct patients examined increased substantially, while the provision of medical services per patient hardly changed, resulting in a slight increase in physicians' number of days worked. Drug prescription per patient is also shown to decrease, suggesting that the policy was cost-effective and enhanced access to healthcare, with limited adverse effects. Early-career physicians responded strongly to these financial incentives, while later-career physicians hardly changed their labor supply behavior. |
| Keywords: | physician labor supply, financial incentives, claims data, access to healthcare, medical spending |
| JEL: | I11 I18 J44 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11947 |
| By: | Dércio de Assis (School of Economics, University of Nottingham); Arpita Ghosh (Department of Economics, University of Exeter); Sonia Oreffice (Department of Economics, University of Exeter); Climent Quintana-Domeque (Department of Economics, University of Exeter) |
| Abstract: | Non-fatal strangulation (NFS) is a common and dangerous form of intimate partner violence (IPV) and a predictor of homicide, yet it was historically neglected by the criminal justice system. Since the year 2000, most U.S. states have enacted laws enlisting NFS as a standalone criminal offense. We compile a novel dataset on state NFS statutes and link it to the FBI Supplementary Homicide Reports from 1990 to 2019 to estimate the causal effects of these laws on intimate partner homicide rates. Using a difference-in-differences strategy, and an estimator that accounts for staggered adoption and treatment heterogeneity, we find that NFS laws led to significant reductions in intimate partner homicides (IPH). We estimate that these laws reduce female-victim IPH by 14% and male-victim IPH by 36%, among victims 18-34. No significant effects are observed for victims 50 and above or for homicides committed by strangers. Event-study estimates support the parallel trends assumption. Our findings suggest that NFS laws can effectively disrupt the escalation of IPV and reduce lethal outcomes. |
| Keywords: | intimate partner violence, non-fatal strangulation, homicide, difference-in-differences, criminal justice policy |
| JEL: | C21 I18 J1 J16 K14 K42 |
| Date: | 2025–06–27 |
| URL: | https://d.repec.org/n?u=RePEc:exe:wpaper:2501 |
| By: | Daniel Avdic (Centre for Health Economics Research and Evaluation, University of Technology Sydney); Bo Lagerqvist (UCR and SCAAR Study Group, Uppsala University); Nils Gutacker (Centre for Health Economics, University of York); Giovanni van Empel (Department of Health Economics, Wellbeing, and Society, The Australian National University); Johan Vikström (IFAU, Uppsala University) |
| Abstract: | We study how multi-technology hospitals respond to market entry of single-technology competitors using a rescindment of regulations for heart attack treatments that prompted a rapid expansion of catheterization laboratories (cath labs) in Sweden. We isolate supply-side effects by exploiting that patients can-not choose their hospital and compare outcomes of cardiac patients residing in areas affected and unaffected by provider market entry, respectively. We show that patients with indications for cardiac surgery were more likely to receive catheter-based treatment after a cath lab opened in their hospital, and document increases in adverse health outcomes for inframarginal patients. Incumbent hospitals responded to this demand reallocation by augmenting their own demand for surgery, but to a lesser extent and without patient health consequences. |
| Keywords: | hospitals, market entry, technological substitution, supplier-induced demand, heart attacks |
| JEL: | D23 I11 I18 L22 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:2025-10 |
| By: | Barry Chiswick; Hope Corman; Dhaval M. Dave; Nancy Reichman |
| Abstract: | This study analyzes, for the first time, the effect of increases in the minimum wage on the labor market outcomes of working age adults with cognitive disabilities, a vulnerable and low-skilled sector of the actual and potential labor pool. Using data from the American Community Survey (2008-2023), we estimated effects of the minimum wage on employment, labor force participation, weeks worked, and hours worked among working age individuals with cognitive disabilities using a generalized difference-in-differences research design. We found that a higher effective minimum wage leads to reduced employment and labor force participation among individuals with cognitive disabilities but has no significant effect on labor supply at the intensive margin for this group. Adverse impacts were particularly pronounced for those with lower educational attainment. In contrast, we found no significant labor market effects of an increase in the minimum wage for individuals with physical disabilities or in the non-disabled population. |
| JEL: | J14 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33990 |
| By: | Rachel Kranton; Duncan Thomas |
| Abstract: | Why do workers exert effort at their tasks and what are the implications for their well-being when greater effort is necessary? This paper, which studies university employees during the Covid-19 pandemic, provides empirical evidence that identity – in terms of both the importance of work to employees’ sense of self and the extent to which their employer shares their values – is related to both effort and productivity. Those employees who feel work is important to them and feel the university does not share their values report exerting more effort but accomplishing less, relative to a pre-pandemic benchmark. Furthermore, all these factors are associated with employee’s reported mental health. Stress and anxiety are particularly elevated for employees for whom work is important and who feel the employer does not share their values, with similar patterns for depression symptoms and worse overall mental health relative to pre-pandemic. These relationships hold across job roles (faculty vs. staff) and the number of co-resident children. The research suggests a new direction in the study of incentives and organizations: links between non-pecuniary motivations and work-related mental health. |
| JEL: | D2 D9 I1 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33812 |
| By: | Perin, Fernanda |
| Abstract: | The rising costs of innovative medicines present a major challenge for public healthcare systems, particularly in countries striving for universal health coverage. Health Technology Assessment (HTA) is critical in guiding reimbursement decisions and negotiating medicine prices, particularly in monopoly markets where pharmaceutical companies hold exclusive rights due to patent protection. This study examines how eight healthcare systems – England, Australia, Canada, Germany, Colombia, Mexico, India, and Brazil – utilise HTA in price negotiations for new medicines. By analysing the integration of HTA into pricing mechanisms, decision-making criteria, and economic evaluation methods, this research highlights significant disparities in terms of socioeconomic context, healthcare system management, and HTA maturity. These insights offer valuable policy recommendations for optimising HTA’s role in controlling medicine prices and ensuring sustainable healthcare financing. |
| Date: | 2025–07–02 |
| URL: | https://d.repec.org/n?u=RePEc:akf:cafewp:36 |
| By: | Emmanuel, Zachariah; Emmanuel, Maria; Aipoh, Godwin; Dickson, Vonke; Collins, Emma |
| Abstract: | This paper examines the effects of tobacco restrictions policy on respiratory health. We leverage the heterogeneous timing across states in the adoption of the policy from a sample of 8, 175 individuals between the ages of 18 and 21. Using the 2011 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), we estimate the impact of the Tobacco 21 MLSA policy on the prevalence of chronic obstructive pulmonary disease (COPD), a progressive lung condition marked by airflow obstruction due to prolonged exposure to irritants like cigarette smoke and air pollution. We find that the T21 MLSA policy lowered the risk of COPD by 11.4 percentage points, or approximately 6.7%, among young adults between the ages of 18 and 21. In addition, we find that the policy had a greater effect on male, black, and Hispanic populations. We also find the policy to be more effective among 20-year-old unemployed young adults with some college education. These findings suggest that the T21 MLSA policy has effectively reduced respiratory health problems among teenagers and young adults, supporting its public health benefits to society. Therefore, states that are yet to adopt the T21 MLSA policy should consider its potential to decrease the risk of COPD and, ultimately, tobacco-related mortality as a valuable component of their health policy. |
| Keywords: | Tobacco 21 MLSA policy, respiratory health, copd, |
| JEL: | I1 I12 I18 |
| Date: | 2025–03–26 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124994 |
| By: | Abdoulaye Ndiaye (New York University); Zhixiu Yu (Louisiana State University) |
| 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: | dynamic models, Medicare, income taxation, savings, Labor Supply, marginal value of public funds, MVPF, willingness to pay |
| JEL: | J26 H55 H21 I10 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:hka:wpaper:2025-005 |
| By: | Fausto Cavalli; Ahmad Naimzada; Daniela Visetti |
| Abstract: | We study a model encompassing economic, epidemiological and environmental domains, which feature reciprocal interactions. The economy is described by an overlapping generations model in which productivity and agents’ preferences are affected by the epidemiological situation. The evolution of an epidemic is represented through a susceptible-infected-susceptible model, in which the disease spread depends on the pollution level and can be reduced through the government expenditure. The pollution level increases during the production process and can be reduced by allocating resources to its abatement. Resources are collected through the capital taxation and the regulator must decide how to share them between healthcare and environmental protection. For the resulting model, we show the possible existence of a unique steady state, either characterized by the presence of epidemics or disease-free. We study its comparative statics depending on the policy parameter regulating the share of resources that is devoted to improve the epidemiological situation with respect to the environmental one. We investigate the emergence of dynamics non convergent toward the equilibrium, with possible complex and quasi-periodic trajectories. |
| Keywords: | OLG model, Epidemiological and environmental domains, Dynamical analysis, Bifurcations. |
| JEL: | C61 O11 Q56 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:mib:wpaper:555 |
| By: | Charles J. Courtemanche; Joseph Garuccio |
| Abstract: | The 340B Drug Pricing Program was instituted to bolster the non-profit health care safety net without relying on taxpayer money. It allows participating health care facilities, called covered entities, to purchase drugs filled at in-house or contracted external pharmacies at discounts from manufacturers. Covered entities, most of which are hospitals, argue that discounts from the program are critical to their ability to provide charity care and unprofitable lines of service. At the same time, with 340B purchases now comprising over 13% of prescription drug sales, drug manufacturers argue that the program has grown beyond its original intent and led to important revenue losses. These manufacturers have responded to the rapid growth in the network of contract pharmacies by enacting restrictions on distribution that in turn led to a flurry of lawsuits and legislative activity. Given the 340B program’s size, importance, and role in ongoing policy debates, it is perhaps surprising that it has received very little attention in economics journals. Our paper reviews the scholarly literature on the 340B program, which lies almost completely in public health and medical journals, with an eye for the gaps in this literature that economics research can help fill. In particular, economists’ causal inference econometric toolkit and theoretical understanding of the role of government intervention can help improve our understanding of 340B’s impacts and lead to more informed policy decisions. |
| JEL: | I11 I18 L25 L51 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33788 |