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on Health Economics |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | Between the early 1990s and 2015 the relationship between mental despair and age was hump-shaped in the United States: it rose to middle-age, then declined later in life. That relationship has now changed: mental despair declines monotonically with age due to a rise in despair among the young. However, the relationship between age and mental despair differs by labor market status. The hump-shape in age still exists for those who are unable to work and the unemployed. The relation between mental despair and age is broadly flat, and has remained so, for homemakers, students and the retired. The change in the age-despair profile over time is due to increasing despair among young workers. Whilst the relationship between mental despair and age has always been downward sloping among workers, this relationship has become more pronounced due to a rise in mental despair among young workers. We find broad-based evidence for this finding in the Behavioral Risk Factor Surveillance System (BRFSS) of 1993-2023, the National Survey on Drug Use and Health (NSDUH), 2008-2023, and in surveys by Pew, the Conference Board and Johns Hopkins University. |
| JEL: | I31 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34071 |
| By: | Emily C. Lawler; Meghan M. Skira |
| Abstract: | We study the effects of state hospital regulations intended to increase breastfeeding by requiring certain care standards during the postpartum hospital stay. Policy adoption increased breastfeeding initiation by 3.3–4.1 percentage points (4.2–5.2 percent) and breastfeeding at 3 months postpartum by 6–9 percent. Further, following adoption, infant mortality declined by 0.2 deaths per 1, 000 live births (3.5 percent), and infant hospitalization charges fell. Declines in mortality and charges primarily occurred among medically vulnerable infants, consistent with evidence that breast milk supports immune development. Additional evidence suggests that improvements in infant sleep practices also played a role in reducing mortality. |
| JEL: | D13 I12 I18 J13 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34032 |
| By: | Samuel Dodini; Katrine V. Loken; Petter Lundborg; Alexander Willen |
| Abstract: | We examine the welfare consequences of reallocating high-skilled labor across national borders. A labor demand shock in Norway—driven by a surge in oil prices—substantially increased physician wages and sharply raised the incentive for Swedish doctors to commute across the border. Leveraging linked administrative data across the two countries and a difference-in-differences design, we show that this shift doubled commuting rates and significantly reduced Sweden’s domestic physician supply. The result was a persistent rise in mortality in Sweden, with no corresponding health gains in Norway. These effects were unevenly distributed, disproportionately harming certain places and populations. The underlying mechanism was a severe strain on Sweden’s healthcare system: shortages of high-skilled generalists led to more hospitalizations, premature discharges and higher readmission rates. Mortality effects were larger in low-density physician regions and concentrated in older individuals and acute conditions. |
| Keywords: | brain drain; worker mobility; mortality |
| JEL: | J2 J6 H1 |
| Date: | 2025–08–04 |
| URL: | https://d.repec.org/n?u=RePEc:fip:feddwp:101405 |
| By: | Akifumi Kusano (Graduate School of Economics, Waseda University; Waseda Institute of Social and Human Capital Studies (WISH), Tokyo, Japan); Haruko Noguchi (Faculty of School of Political Science and Economics, Tokyo, Japan; WISH, Tokyo, Japan); Yichen Shen (Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan; WISH, Tokyo, Japan) |
| Abstract: | The maternity ward closures are observing across many countries, yet little known about how the closures affect obstetrician behavior and delivery practices. The unique institutional setting in Japan, exclusion of natural delivery from public health insurance, creates a unique institutional setting for analyzing physician’s delivery practices. This study analyzes the effect of hospital-based maternity ward closures on cesarean section practice and health outcomes. Using the Survey of Medical Institutions and Vital Statistics and employing a staggered difference-in-differences, we show that clinics increased the rate of cesarean section regardless of risk-factors of cesarean delivery. Moreover, this result was driven by private clinics. We interpret this result as evidence of overuse of cesarean sections that was caused by physician’s profit-maximizing behavior. Our findings imply that the expansion of insurance coverage for delivery care can mitigate this unintended effect. |
| Keywords: | Cesarean delivery, Physician-induced demand, Maternity ward closure |
| JEL: | I13 I18 J1 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2520 |
| By: | Ruijun Hou (Department of Population Health Sciences, University of Leicester; School of Economics, University of Bristol); Samuel Baker (School of Economics, University of Bristol); Stephanie von Hinke (School of Economics, University of Bristol; Institute for Fiscal Studies; Institute for the Study of Labor); Hans H. Sievertsen (The Danish Center for Social Science Research, VIVE; School of Economics, University of Bristol; Institute for the Study of Labor); Emil S{\o}rensen (School of Economics, University of Bristol); Nicolai Vitt (School of Economics, University of Bristol) |
| Abstract: | We study the long-term health and human capital impacts of local economic conditions experienced during the first 1, 000 days of life. We combine historical data on monthly unemployment rates in urban England and Wales 1952-1967 with data from the UK Biobank on later-life outcomes. Leveraging variation in unemployment driven by national industry-specific shocks weighted by industry's importance in each area, we find no evidence that small, common fluctuations in local economic conditions during the early life period affect health or human capital in older age. |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2507.08159 |
| By: | Liran Einav; Amy Finkelstein; Petra Persson |
| Abstract: | We characterize the causal impact of having a child with Down syndrome relative to having one without Down syndrome using event studies around birth and population-wide Swedish administrative data from 1990 to 2019. The incremental effect of having a child with Down syndrome is to increase the likelihood of parental co-habitation and subsequent child-bearing. These effects exist both in an environment with essentially no prenatal testing – where the birth of a child with Down syndrome is random conditional on maternal age – as well as once prenatal screening and testing is more common. In both contexts, total income also increases due to the presence of a generous allowance for families with a child with a disability, but the impact on labor earnings differs. In the “no-testing” environment, having a child with Down syndrome leads to a greater decrease in maternal earnings post-birth relative to having a child without Down syndrome, but this effect reverses sign once testing is available. Our results speak to the impact on families of a child with Down syndrome in a setting where families are largely insured against any additional financial costs. |
| JEL: | I1 J13 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34064 |
| By: | Silvia De Poli |
| Abstract: | This paper assesses how extending paternity leave duration in Spain affects labour market outcomes and relationship stability. By combining administrative data from different sources, this study provides both descriptive and causal evidence of the effectiveness of the reform. First, we show that having a child substantially increases the gender employment gap between fathers and mothers by about 20 percentage points. Yet, between 2016 and 2021, when the duration of paternity leave gradually increased from two to sixteen weeks, this gap decreased by five percentage points. Second, using a regression discontinuity design, we analyse the causal effect of the 2018 reform, which introduced an additional week of leave for fathers that, for the first time, could be taken independently of the mother’s leave. Although we do not find robust evidence of an effect on the labour market, we show that the reform increased the stability of the relationship among couples where the mother was employed before childbirth. From a policy perspective, our findings suggest that extending paternity leave could have important implications in balancing family responsibilities and mitigating relationship conflicts. |
| Keywords: | paternity leave, employment, relation stability, regression discontinuity design |
| JEL: | C31 J12 J31 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:fbk:wpaper:2025-03 |
| By: | Cristhian D. Prieto; Arthur Grimes; Ilan Noy |
| Abstract: | Disasters adversely affect mental well-being. However, little is known about their causal effects on diagnosed psychological disorders or the mediating role of earnings. This study uses a Synthetic Difference-in-Differences approach (SDID) to examine Cyclone Gabrielle’s impact on workers’ mental health and earnings in New Zealand. By leveraging administrative data on prescribed medications and income tax records, we find that workers residing in heavily damaged areas were more likely to be prescribed medication for treating psychological disorders than those living in similar unaffected areas. Contrary to common belief, income effects played a limited role in mediating the impact of disaster damage on mental health. Instead, physical and emotional trauma due to direct exposure emerged as key mechanisms influencing mental health outcomes. These findings underscore the critical role of non-economic factors in shaping psychological well-being following disasters triggered by natural hazards. |
| Keywords: | cyclone, disaster, mental health, stress, anxiety, medication |
| JEL: | I10 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12009 |
| By: | Minghong Yuan; Wen Wen; Indranil Bardhan |
| Abstract: | What is the impact of private equity (PE) investment on healthcare value? Does PE investment hurt or improve healthcare value, and if so, can its effect be mitigated through the use of health information technologies (IT)? Given the significant investments by PE firms in the healthcare sector in recent years, these are important research questions. Stakeholders, including policy makers, care providers, and patients, need to understand their likely impact and whether PE ownership is aligned with their interests. Using a staggered difference-in-differences approach and data from US hospitals from 2008-2020, we observe that the overall value of healthcare delivered by hospitals declines after PE investment. However, our empirical evidence reveals that IT-enabled, health information sharing plays an important moderating role. Hospitals with stronger information-sharing capabilities exhibit greater cost efficiencies and improvements in care quality, leading to higher healthcare value after PE investment. Furthermore, we find that the type of health information sharing matters. Specifically, we observe that improvements in care quality are primarily driven by information sharing between hospitals and ambulatory care providers, instead of simply hospital-to-hospital sharing of patient health data. Our research also identifies the underlying mechanisms through which health information sharing improves care value by reducing hospital-acquired infections and readmission rates, thereby improving care quality, and enhancing labor productivity by reducing operating costs. Our results highlight the critical role of policies and common data standards needed to promote IT-enabled information sharing between healthcare providers, which, in turn, can align incentives of PE firms with the goals of value-based care. |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2507.14717 |
| By: | Koski, Heli |
| Abstract: | Abstract This paper examines the effects of data privacy regulation on R&D investment in the pharmaceutical and biotechnology sectors. In these industries, access to personal health data is essential for innovation, particularly in clinical research. Leveraging a firm-level panel of the world’s top R&D investors from 2013 to 2023, we exploit the staggered implementation of major data protection regimes to estimate their causal impact. Using a dynamic event-study design, we find that stricter privacy regulation leads to a significant decline in R&D spending. By year four after implementation, treated firms reduced R&D investment by approximately 39 percent. The effects are heterogeneous: firms without foreign affiliates and small and medium-sized enterprises experience larger declines. Our findings suggest that privacy regulation may constrain the foundations of data-driven innovation and shape the geographic distribution of R&D activity. |
| Keywords: | Privacy regulation, R&D investment, Innovation, Pharmaceuticals, Biotechnology, Firm-level panel, GDPR, Compliance costs |
| JEL: | D22 K23 L65 O32 O38 |
| Date: | 2025–08–11 |
| URL: | https://d.repec.org/n?u=RePEc:rif:wpaper:130 |
| By: | Janßen, Rebecca; Reif, Simon; Schubert, Sabrina |
| Abstract: | Digital therapeutics are increasingly used to complement traditional health care. In a pioneering move, Germany became the first country to introduce a structured regulatory framework - known as the DiGA scheme - that enables developers of digital therapeutics to be reimbursed in the statutory health insurance system. Our study evaluates the impact of this novel regulation on the development and market entry of patient-centered digital health applications. Using a panel dataset of app availability by language and month from the Apple App Store, covering the period from January 2018 to September 2021, we compare trends in health app availability in German to those in other languages. Applying event study designs and a set of synthetic control methods, we find that the DiGA regulation likely stimulated the development of German-language digital therapeutics in the app market. While the number of apps increased, our results suggest that neither the diversity of health conditions targeted nor the number of high-quality apps expanded significantly. To the contrary, the increase was almost exclusively driven by apps that sell patient data for advertisement. This suggests that the initial enthusiasm surrounding the new reimbursement pathway did not translate into a broad increase in high quality apps with strong data privacy protections. Further research is needed to assess the longer-term effects on innovation and quality, especially as other countries begin to adopt regulatory frameworks inspired by the German model. |
| Keywords: | Digital Health, DiGA, Reimbursement, Digital Therapeutics |
| JEL: | I11 I18 L52 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:321863 |
| By: | Misra, Shashank; Kulshreshtha, Shobhit |
| Abstract: | India consistently ranks among the countries with the highest levels of ambient air pollution worldwide. At the same time, it faces significant challenges in neonatal health, with newborns having low average birth weights and a high incidence of being born within the low birth weight (LBW) and very low birth weight (VLBW) category. Using data from the Indian National Family Health Survey (NFHS), we examine the impact of in-utero exposure to particulate matter on a number of birth weight indicators. We exploit variation in wind direction during the in-utero period to capture quasi-random variation in particulate matter exposure for each child. We find that reducing in-utero PM2.5 exposure by one standard deviation would lead to 1.3% increase in average birth weight, a 2.7 percentage point decrease in the incidence of LBW births and a 0.6 percentage point decrease in the incidence of VLBW births respectively. Drawing on estimates from prior studies, we find that the observed improvements in both average birth weight and reductions in LBW incidence from meeting WHO air quality standards could yield substantial long-run economic benefits, potentially amounting to billions of dollars annually in addition to broader gains in child health, cognition, and educational outcomes. |
| Keywords: | birth weight, air pollution, in-utero exposure, India |
| JEL: | J13 I12 Q53 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1635 |
| By: | Daniel S. Hamermesh; Michał Myck |
| Abstract: | We consider how a physical disability alters patterns of time use. A disability may raise the time cost of all activities; of some—making them differentially less worth doing; or it may make switching activities more costly. The first yields no predictions about time use, but the latter two possibilities both predict that fewer activities will be undertaken, with more time spent on each. These explanations describe our findings based on non-working ATUS 2008-22 respondents ages 70+, 32 percent of whom self-assess a disability. Data from the Polish Time Use Survey, where disability is medically certified, show similar results; and they demonstrate the same loss of variety over multiple days. Remarkably similar basic results are found using homogenized British, Canadian, French, Spanish, and Italian time-diaries. Overall, a mobility/physical disability leads an otherwise identical person to engage in over 10 percent fewer activities on a typical day. The lost variety represents extra costs equivalent in data from six countries to over twice the average annual income among older individuals in the country. |
| JEL: | I12 J14 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34068 |
| By: | Huebener, Mathias (Bundesinstitut für Bevölkerungsforschung (BiB)); Odermatt, Reto (University of Basel) |
| Abstract: | We assess the gendered effects of having children on well-being, careers, and the division of domestic work. As exogenous variation in parenthood, we exploit the quasi-random success of in-vitro fertilisation (IVF) treatments. Children increase mothers’ well-being only in the short term, while fathers experience longer-lasting gains. However, only mothers show a persistent decline in labor supply and a rise in domestic work. Their satisfaction with the division of work declines, and they are more likely to perceive it as unfair, implying that the new equilibrium in the division of work deviates from mothers’ preferences. |
| Keywords: | IVF treatment, gender inequality, well-being, parenthood, child penalty |
| JEL: | I31 J13 J16 J22 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18039 |
| By: | Abate, Gashaw T.; Bernard, Tanguy; Deutschmann, Joshua; Fall, Fatou |
| Abstract: | Individuals often make decisions considering both private returns and welfare impacts on others. Food safety decisions by smallholder agricultural producers exemplify this choice, particularly in low-income countries where farmers often consume some of the food crops they produce and sell or donate the rest. We conduct a lab-in-the-field experiment with peanuts producers in Senegal to study the decision to invest in food safety information, exogenously varying the degree of private returns (monetary or health-wise) and welfare impacts on others. Producers are willing to pay real money for food safety information even absent the potential for private returns, but willingness to pay increases with the potential for private returns. A randomized information treatment significantly increases willingness to pay in all scenarios. Our results shed light on the complex interplay between altruism and economic decisions in the presence of externalities, and point to the potential of timely and targeted information to address food safety issues. |
| Keywords: | food safety; health; groundnuts; aflatoxins; smallholders; returns; Senegal; Africa; Sub-Saharan Africa; Western Africa |
| Date: | 2025–07–07 |
| URL: | https://d.repec.org/n?u=RePEc:fpr:ifprid:175569 |
| By: | Kulshreshtha, Shobhit; Bhattacharya, Leena; Ayyagari, Padmaja |
| Abstract: | Previous research, focusing primarily on high income countries, has linked later sunsets to sleep deficits and worse health outcomes. These results might not generalize to low- and middle- income countries, which have different socioeconomic, cultural, and environmental conditions. Using data from the 2015-16 and 2019-21 waves of India's Demographic and Health Surveys (DHS) and exploiting within-district variation in annual average sunset times, we estimate the causal impact of later sunsets on the long-term health outcomes of individuals. We find that later sunsets leads to a lower prevalence of anemia, diabetes, and thyroid disorders and an improvement in the overall health index. To explore mechanisms, we analyze variation in time allocation due to a later sunset time using the 2019 Time Use Survey. We find that individuals experiencing later sunsets sleep better and exercise more, but do not change their sedentary leisure activities. Additionally, they consume healthier food and increase labor supply. These lifestyle changes may explain the health improvements associated with delayed sunsets in India. |
| Keywords: | health, sunset time, time use, lifestyle, fixed effects |
| JEL: | J22 I12 I14 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1648 |
| By: | Fabian Stephany; Alejandra Mira; Matthew Bone |
| Abstract: | This study investigates the non-monetary rewards associated with artificial intelligence (AI) skills in the U.S. labour market. Using a dataset of approximately ten million online job vacancies from 2018 to 2024, we identify AI roles-positions requiring at least one AI-related skill-and examine the extent to which these roles offer non-monetary benefits such as tuition assistance, paid leave, health and well-being perks, parental leave, workplace culture enhancements, and remote work options. While previous research has documented substantial wage premiums for AI-related roles due to growing demand and limited talent supply, our study asks whether this demand also translates into enhanced non-monetary compensation. We find that AI roles are significantly more likely to offer such perks, even after controlling for education requirements, industry, and occupation type. It is twice as likely for an AI role to offer parental leave and almost three times more likely to provide remote working options. Moreover, the highest-paying AI roles tend to bundle these benefits, suggesting a compound premium where salary increases coincide with expanded non-monetary rewards. AI roles offering parental leave or health benefits show salaries that are, on average, 12% to 20% higher than AI roles without this benefit. This pattern is particularly pronounced in years and occupations experiencing the highest AI-related demand, pointing to a demand-driven dynamic. Our findings underscore the strong pull of AI talent in the labor market and challenge narratives of technological displacement, highlighting instead how employers compete for scarce talent through both financial and non-financial incentives. |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2507.20410 |
| By: | Babbar, Karan; Dhamija, Gaurav; Ojha, Manini; Yadav, Kartik |
| Abstract: | This paper investigates the causal effect of age at marriage on women's mental health in Nepal, focusing specifically on anxiety. Using nationally representative data from the latest round of the Nepal Demographic and Health Survey (NDHS), we address endogeneity in marriage timing by in- strumenting age at marriage with age at menarche, motivated by sociological evidence that menarche strongly in uences parental decisions about the timing of girls' marriages. Our findings show that a one-year delay in age at marriage reduces anxiety levels by 0.08 standard deviation. We find ad- ditional evidence that delayed marriage is associated with significant reductions in marital stress, suggesting that it is a key pathway through which delayed marriage lowers anxiety. These findings contribute to growing evidence on the mental health implications of early marriage and highlight the importance of policies that delay marriage age. |
| Keywords: | age at marriage, age at menarche, marital stress, anxiety, mental health, Nepal |
| JEL: | J12 I12 C26 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1642 |
| By: | Gallo, Giovanni; Ubaldi, Michele |
| Abstract: | This paper investigates the effect of partner unemployment on individual physical health. Using data from two nationally representative Italian surveys of households and employing partial identification to address endogenous selection into unemployment, we show that the impact of partner unemployment on individual physical health is related to the role of the unemployed within the household. We document a null effect when the spouse is unemployed, whereas we find a negative health effect when the household head is unemployed. The negative effect of household head unemployment may be explained by a larger budget constraint and a consequent change in the dietary habits involving all household members. In particular, we highlight a decline in the quality of food consumption in the household when the household head is unemployed. |
| Keywords: | Unemployment, dietary habits, consumption, food quality, body mass index |
| JEL: | D12 I10 J12 J60 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1638 |
| By: | Ricardo B. Ang III (Department of Economics, Tulane University); Giseong Kim (Department of Economics, Georgia State University); Soojin Kim (Department of Economics, Georgia State University); Michael F. Pesko (Department of Economics, University of Missouri) |
| Abstract: | We examine the impact of automation on workers' health risks in the United States. We first document that automation leads to a divergence in the severity of occupational health risks: while automation reduces nonfatal occupational injury incidence, it increases fatal injury incidence. Secondly, the disparity of health risks across age groups has widened due to automation. The overall hospitalizations have declined in commuting zones with higher automation exposure. Yet, the benefits are concentrated among young workers, while middle-aged workers experience increased hospitalizations, particularly due to despair-related conditions. Combining the occupational injury estimates, a back-of-the-envelope calculation suggests that workplace automation provides significant, health-driven economic benefits. |
| Keywords: | Automation, Workplace injury, Health Risks, Fatalities, Mental health |
| JEL: | I1 O3 J1 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:umc:wpaper:2508 |
| By: | Ayllón, Sara (Universitat de Girona); Lado, Samuel (Universitat de Girona) |
| Abstract: | This paper is the first to meta-analyse the literature on the causal effects of school-meal programmes on children's behavioural, health and educational outcomes in developed countries, while addressing potential publication bias and heterogeneity between studies. We create a sample of 2, 821 estimates from 42 studies and gather 59 aspects reflecting the context in which each estimate was obtained, including type of data, programme characteristics, student population, estimation method and publication quality, among others. We employ both linear and non-linear techniques to correct for publication bias, and we use Bayesian model averaging to study heterogeneous effects and address model uncertainty. The results are consistent with small publication bias - with the exception of studies devoted to analysing test scores, which appear more selective when reporting results. Once publication bias is accounted for, we find that school-meal programmes in high-income economies have minimal impact on students' behaviour, health and education. Our heterogeneity analysis documents the fact that means-tested programmes and breakfast initiatives yield the greatest benefits for children's outcomes. |
| Keywords: | meta-analysis, education, health, behaviour, children, school-meal programmes, Bayesian model averaging, model uncertainty |
| JEL: | H42 H53 I38 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18042 |