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on Health Economics |
| By: | Meltem Daysal, N.; Elder, Todd E.; K. Hellerstein, Judith; A. Imberman, Scott; Orsini, Chiara |
| Abstract: | We assess theories that autism spectrum disorder (ASD) is heritable and transmitted through parental skills using data from Denmark. We construct parental skill measures by mapping Danish occupations to the Occupational Information Network (O*NET) survey of US occupations and principal factor analysis. We find that fathers’ skills are linked to ASD in children. A one standard deviation increase in a systems and ordering skills factor correlates with a modest but statistically significant 0.041 percentage point (2.4 percent) increase in ASD incidence. There is a negative and slightly larger relationship with communication skills. ASD also is similarly correlated with Deming’s (2017) routineness and social skills measures, and fathers again play larger roles. We also find evidence consistent with Baron-Cohen (2002) whereby extreme personality traits in parents affect ASD incidence; having two parents with high systems and ordering relative to communication skills leads to a 35 percent higher diagnosis rate than having parents with “balanced” skills. While all of these estimates are meaningful given the costs of ASD, they explain only a small fraction of variation in ASD diagnoses. Finally, although assortative mating on skills exists, we cannot detect a role for it in recent dramatic increases in ASD. |
| JEL: | I10 J10 |
| Date: | 2024–06–28 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:118278 |
| By: | Sebastián Fleitas; Caitlyn Fleming; Gautam Gowrisankaran; Anthony T. Lo Sasso |
| Abstract: | The Affordable Care Act (ACA) changed incentives for individual and employer-sponsored insurance. Using unique small group market (SGM) data with detailed claims and enrollment information, we analyze the welfare gains across households in the SGM from alternative formulations of ACA health insurance exchanges (HIXs). Accounting for observable heterogeneity increases estimated demand elasticities. Shutting down the SGM would reduce equilibrium adverse selection in HIX-type markets, increasing welfare for households moved to HIXs by $842 annually. The majority of households would obtain higher equilibrium welfare from HIXs, stemming from having more choices. Adding the 2014 ACA penalties only modestly decreases adverse selection. |
| JEL: | H30 I13 L11 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33938 |
| By: | Karen Clay; Grant Miller; Margarita Portnykh; Ethan J. Schmick |
| Abstract: | Early twentieth century efforts to overhaul the quality of medical education in the United States (principally between 1905 and 1915 – the “Flexner Report Era”) led to a steep decline in the number of medical schools and medical school graduates. In this paper, we examine the consequences of these medical school closures be- tween 1900 and 1930 for county-level physicians, nurses, and midwives per capita as well as for infant, non-infant, and total mortality. To do so, we construct a school closure intensity measure for all counties in the United States, combining variation in (i) distance from closures, (ii) the historical number of graduates from closing schools, and (iii) the timing of closures. Nearby medical school closures (within 300 miles) led to a 4% reduction in physicians per capita, even after physician market adjustment through physician migration and postponed retirement. Strikingly, we find that medical school closures led infant mortality rates to decline by 8% and non- infant mortality rates to decline by 4%, suggesting that reducing the supply of poorly trained physicians may have reduced mortality. |
| JEL: | I11 I18 N31 N32 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33937 |
| By: | Posso, Christian; Tamayo, Jorge; Guarin Galeano, Arlen Yahir; Saravia, Estefania |
| Abstract: | This paper estimates the effect on birth outcomes of a mother’s being treated by more-skilled versus less-skilled physicians, by exploiting a Colombian government program that randomly assigned newly graduated physicians to local health centers. It estimates the impact on 255, 089 children whose mothers received care in the local health centers using administrative data from the program, local health centers’ vital statistics records, and records from physicians’ mandatory graduation exams. The findings show that mothers treated at local health centers with more-skilled physicians were 9.14 percent less likely to give birth to an unhealthy baby, potentially because the more-skilled physicians better targeted care toward more-vulnerable mothers. |
| Date: | 2025–06–11 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11143 |
| By: | Mariana Carrera; Niels Skipper |
| Abstract: | Using data on prescriptions for cholesterol-lowering drugs (statins), we study differences in the treatments chosen by Danish physicians for themselves versus for their patients. We estimate that physicians discount patient health benefit relative to their own, valuing the additional potency of a stronger statin by significantly more if it is for their own use. We exploit variation in expected coinsurance to estimate that moral hazard accounts for a modest share, no more than 15%, of this additional valuation. Statin-using physicians also respond more quickly to a patent expiration, suggesting greater effort to stay informed on drug classes they personally use. |
| JEL: | D82 I13 I18 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33954 |
| By: | Pinka Chatterji; Chun-Yu Ho; Wenqing Li |
| Abstract: | This paper tests whether mergers between nursing home chains and independent facilities affect quality of care using facility-level data from 1999-2019. Staggered difference-in-differences estimates suggest that acquired facilities experience a 5% reduction in health deficiency citations 2 years post-merger. This improvement relies on the continuous supply of efficiency from chains; persists for four years; and is specific to mergers between chains and independent homes. Quality effects are driven by mergers involving smaller, higher-quality and non-private-equity-owned chains. A structural model suggests that the quality effect is generated by enhanced cost efficiency achieved by facilities serving larger numbers of residents after mergers. |
| JEL: | I11 L11 L15 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33967 |
| By: | Barış K. Yörük; Joseph J. Sabia; Tessie Krishna; Dhaval M. Dave |
| Abstract: | With the goal of lowering incentives for alcohol and substance abuse, U.S. states have historically permitted private health insurers to deny reimbursement of medical claims stemming from alcohol or opioid impairment. However, a potential unintended consequence of such “exclusion provisions” is that they may reduce providers’ incentives to screen patients for alcohol intoxication and substance abuse, leading to an increase in risky health behaviors that carry substantial externality costs. In response to these concerns, 16 states and the District of Columbia repealed their exclusion provisions and replaced them with explicit prohibitions on the denial of health insurance claims resulting from alcohol and other substance use impairment (PDHIAs). This study is the first to comprehensively explore the effects of PDHIAs on alcohol- and drug- related outcomes, with a particular focus on externalities associated with these risky health behaviors, allowing us to broadly assess their potential welfare effects. Leveraging a variety of national data sources (Uniform Crime Reports, Fatality Analysis Reporting System, Behavioral Risk Factor Surveillance System, Treatment Episode Data Set, and Medical Expenditure Panel Survey) in conjunction with a generalized difference-in-differences approach, we find little support for the hypothesis that PDHIAs generated ex ante moral hazard. To the contrary, there is some evidence that PDHIAs may have reduced some criminal arrests, drunk driving behaviors, and alcohol use. One explanation for these findings is that physicians may be more willing to refer treatment services for substance use-related health issues when patients and hospitals are not financially penalized by PDHIAs. Lastly, there is little evidence that PDHIAs had broader impacts on private insurance markets, either in affecting private health insurance coverage or average premiums. |
| JEL: | I10 I11 I12 I13 I18 K23 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33935 |
| By: | Carolina Arteaga; Natalia Vigezzi; Pilar García-Gómez |
| Abstract: | In this paper we provide new evidence on the health spillover effects of health shocks within couples. Using administrative data from the Netherlands and a matching event-study framework, we estimate the causal effect of experiencing a health shock within a couple on the health of the initially unaffected partner. Our findings reveal a significant deterioration in the partner’s health outlook, characterized by substantial increases in hospital visits, overnight stays, and mortality. The health decline is broad in scope, encompassing higher risk of infections, accidents, and digestive and cardiovascular conditions. This deterioration is accompanied by substantial increases in stress, anxiety and depression for both men and women, as well as sleep disorders for women. These effects are not driven by a heavy caregiving load, financial distress or worsening of health behaviors. On the contrary, the adverse outcomes persist despite suggestive positive changes, including increased exercise for both men and women, and reduced alcohol consumption among women. |
| JEL: | I12 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33994 |
| By: | Karinna Saxby (The Melbourne Institute: Applied Economic and Social Research, The University of Melbourne); Thomas Buchmueller (Ross School of Business, University of Michigan); Sonja C. de New (Centre for Health Economics, Monash Business School, Monash University, IZA, RWI); Dennis Petrie (Centre for Health Economics, Monash Business School, Monash University) |
| Abstract: | Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72% and 19% of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related ED presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions. |
| Keywords: | healthcare supply, healthcare demand, mental health, regional variation, suicide |
| JEL: | H51 I11 I13 I14 I18 J18 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:2025-11 |
| By: | Valentin Bolotnyy; Natalia Emanuel; Pim Welle |
| Abstract: | Involuntary hospitalization of people experiencing a mental health crisis is a widespread practice, 2.4 times as common as death from cancer and as common in the U.S. as incarceration in state and federal prisons. The intent of involuntary hospitalization is to prevent individuals from harming themselves or others through incapacitation, stabilization and medical treatment over a short period of time. Does involuntary hospitalization achieve its goals? We leverage quasi-random assignment of the evaluating physician and administrative data from Allegheny County, Pennsylvania, to estimate the causal effects of involuntary hospitalization on harm to self (proxied by death by suicide or overdose) and harm to others (proxied by violent crime charges). For individuals whose cases are judgment calls, where some physicians would hospitalize but others would not, we find that hospitalization nearly doubles both the probability of dying by suicide or overdose and also nearly doubles the probability of being charged with a violent crime in the three months after evaluation. We provide evidence of earnings and housing disruptions as potential mechanisms. Our results suggest that, on the margin, the system we study is not achieving the intended effects of the policy. |
| Keywords: | involuntary commitment; psychiatric detention; mental health treatment |
| JEL: | I18 I12 K14 |
| Date: | 2025–07–01 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fednsr:101310 |
| By: | Stephen P. Utkus; Olivia S. Mitchell |
| Abstract: | Extensions in human longevity are prompting a growing interest in maximizing healthspan, or the number of years of life unencumbered by the chronic diseases of old age. This chapter reviews recent research on healthy life extension, including several measures and determinants of longer healthspans. We also provide an overview of recent efforts by medical and business enterprises to enhance longevity and healthspan, followed by a discussion of policy and workplace options to foster healthier lives. Such efforts hold the promise of improving quality of life, expanding labor supply, and lowering the cost of health care costs associated with population aging. |
| JEL: | I12 I24 J11 J14 J16 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33992 |
| By: | Janice Compton; Robert A. Pollak; Seth G. Sanders |
| Abstract: | Using data from the National Health Interview Survey (NHIS), we construct two measures of the longevity of older wives and husbands. For definiteness, we focus on couples in which the wife was 60 and the husband 62 in 1988. Our first measure utilizes a 4 x 4 "longevity matrix" in which the bins correspond to the decades in which the spouses died. For example, an entry in the (3, 2) bin indicates that the wife died in the 3rd decade (between ages 80 and 89) and the husband in the second decade (between ages 72 and 81). Our second measures use the Gompertz distribution to estimate the censored observations from the NHIS. We use the Gompertz estimates of age-specific mortalities to construct joint and survivor life expectancies for the couples in our working sample. We compare the longevity estimates based on actual couples from the NHIS with estimates based on synthetic couples constructed from the 1988 CDC life tables. Research based on randomly formed synthetic couples constructed from CDC life table data shows that the randomness of mortality and the overlap between spouses' age-specific mortality distributions imply dramatically long life spans for surviving spouses. The 4 x 4 longevity matrices show that longevity effects are magnified at the level of the couple by assortative marriage. |
| JEL: | J10 J12 J14 J19 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33931 |
| By: | Booth, Charlotte; Goodman, Alissa; Fitzsimons, Emla |
| Abstract: | Despite policy efforts, early childhood inequalities have remained relatively stable in England over recent decades. In this study, we aimed to understand the determinants of early childhood inequality and how these have changed in their composition and impact on early child development, using two nationally representative cohorts of pre-school children collected in 2004 (N = 8, 990) and 2014 (N = 3, 877). Child development was assessed in both cohorts at age three, using the British Ability Scales – Naming Vocabulary test, and developmental inequality was depicted by concentration indices across quintiles of the English Index of Multiple Deprivation. A between-sample test of the concentration index revealed there was no real change to developmental inequality over time. However, decomposition of the concentration index revealed there were some changes to the determinants of inequality. Most notably, higher rates of maternal education were associated with reduced inequality, while living in the most deprived areas was associated with increased inequality, helping to explain the overall net zero change over time. Other factors, such as attending early childhood education and care by age three, made little contribution to developmental inequality, despite much higher attendance in 2014. This study highlights the complexity of factors contributing to early childhood inequality and includes a discussion on where policy efforts may be useful going forward. |
| Date: | 2025–06–16 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:zt4fp_v1 |
| By: | Sandra Bohmann; Susann Fiedler; Maximilian Kasy; Jürgen Schupp; Frederik Schwerter |
| Abstract: | Mental health and wellbeing are unequally distributed in high-income countries, disadvantaging low-income individuals. Unconditional, regular, and guaranteed cash transfers may help address this inequality by promoting financial security and agency. We conducted a preregistered RCT in Germany, where treated participants received monthly payments of EUR 1, 200 for three years. Cash transfers improve mental health and wellbeing. These effects are substantively large and robust. Cash transfers also improve perceived autonomy, savings, prosocial giving, time with friends, and sleep. Our findings suggest that cash transfers improve mental health and wellbeing if they empower agency and meaningful life changes. |
| Keywords: | cash transfers, mental health, life satisfaction, purpose in life, agency, autonomy, life changes |
| JEL: | C93 I31 D10 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11989 |
| By: | Berlanda, Andrea (University of Padua); Lodigiani, Elisabetta (University of Padova); Rocco, Lorenzo (University of Padova) |
| Abstract: | In this paper, we use the Survey of Health, Ageing, and Retirement in Europe (SHARE), complemented with register data on the share of the foreign population in the European regions, to examine the effects of migration on the level of informal care provided by children to their senior parents. Our main results show that migration decreases informal care among daughters with a university degree, while it increases the provision of informal care among daughters with low-to-medium levels of education. Viceversa, migration has practically no effect on sons' care provision who remain little involved in care activities. These results depend on the combination of two supply effects. First, migration increases the supply of domestic and personal services, making formal care more affordable and available. Second, as immigrants compete with low-to-medium-educated native workers, while improve the labor market opportunities of the better educated, the supply of informal care can increase among the less educated daughters and decrease among the more educated. |
| Keywords: | immigration, home production, caregiving, Europe |
| JEL: | F22 J14 J22 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17984 |
| By: | Schmitt, Maike |
| Abstract: | This paper analyses the relation between air quality and individual life satisfaction in Germany. Life satisfaction data from the German socio-economic panel is connected with daily county pollution in terms of carbon monoxide, nitrogen dioxide and ozone from 1998 to 2008. The assumed microeconometric happiness function is estimated considering individual fixed effects. Ozone has a significant negative impact on life satisfaction. The effect of carbon monoxide as well as nitrogen dioxide is not significant. Moreover, I found that people with environmental worries are more affected by ozone pollution. This was not the case for people with a bad health status. Using the marginal rate of substitution between income and air pollution, it is calculated that an increase of one µg/m³ in average county ozone has to be compensated by an increase of € 11.33 in monthly net household income to hold an average individual's life satisfaction constant. |
| Date: | 2025–06–16 |
| URL: | https://d.repec.org/n?u=RePEc:dar:wpaper:155306 |
| By: | Dercio de Assis |
| Abstract: | This paper analyzes data from urban Brazil using supervised machine-learning techniques to shed greater light on the role that childhood poverty plays in lifelong health and longevity. By examining a unique dataset collected over a 10-year period from thousands of very small, sub-neighborhood-level geographic areas, I document that child poverty measures have higher predictive power than household income, and other major socioeconomic variables, in forecasting child and adult health outcomes and lifespans. In addition, using a rich dictionary of hundreds of variables and different data-driven specification selections, the machine-learning models reveal that experiencing more severe deprivation in childhood is associated with a decrease of 4 percentage points in the probability of survival to ages 40 and 60. These predictions offer further economic insights on the importance of early life circumstances for human development. |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:not:notnic:2025-12 |
| By: | Lidia Farre; Libertad Gonzalez; Claudia Hupkau; Jenifer Ruiz-Valenzuela |
| Abstract: | Between 2017 and 2021, Spain progressively extended paternity leave from 2 to 16 weeks, equalizing it with maternity leave and introducing mandatory weeks. A 2018 reform also allowed fathers to split their leave. Using administrative data on all leave permits since 2016, we analyze trends in paternity leave take-up. Following the introduction of mandatory leave, the share of fathers taking leave increased by around 20 percentage points, and most now use nearly the full entitlement. The share opting to split leave has steadily grown, surpassing 50% by 2023. However, this behavior shows marked heterogeneity: while overall uptake is uniform across groups, leave-splitting is far more common among higher-income fathers and more prevalent in certain sectors. Spain's experience illustrates how policy design can significantly increase paternity leave usage, though workplace flexibility and income-related constraints shape how fathers use that time. |
| Keywords: | paternity leave, reform, take-up, mandatory parental leave |
| Date: | 2025–07–02 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepdps:dp2111 |
| By: | Goldbach, Stefan; Nitsch, Volker |
| Abstract: | This paper examines the effect of national government response measures to Covid-19 on German international capital flows. Analyzing highly disaggregated monthly data from the German balance of payments statistics over the period from January 2019 through January 2021, we find that bilateral financial interactions are negatively affected by stricter containment and closure policies as well as health system policies of a partner country, while German capital flows benefit from a partner’s economic support policies. Moreover, to the extent that public interventions to fight the pandemic affect financial interactions, the adjustment mainly takes place along the intensive margin. |
| Date: | 2025–06–24 |
| URL: | https://d.repec.org/n?u=RePEc:dar:wpaper:155480 |