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on Health Economics |
| By: | Hamermesh, Daniel S. (University of Texas at Austin); Myck, Michal (Centre for Economic Analysis, CenEA) |
| 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. |
| Keywords: | time use, disability |
| JEL: | J14 I10 D13 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18022 |
| By: | Hanming Fang; Ming Li; Jia Xiang |
| Abstract: | This paper investigates how physicians adjust their clinical decision-making following medical malpractice lawsuits and how these responses are driven by mental rather than financial costs, and do not align with rational expectations. We combine a comprehensive health insurance claim database from a Chinese city with the universe of malpractice lawsuits to study changes in physician behavior and patient outcomes. We find that physicians respond to lawsuits by practicing more conservatively, rejecting high-risk patients, reducing surgery rates, and increasing the use of diagnostic tests and traditional Chinese medicine. These changes are associated with worse patient outcomes, consistent with defensive medicine. The effects are not limited to the directly involved departments but spill over to other departments within the same hospital. In addition, the changes are short-lived, with physicians reverting to their pre-lawsuit treatment patterns in eight weeks. We provide evidence that such responses are likely driven by mental cost (including fear) and deviate from rational expectations. First, physicians in hospitals with more and less frequent lawsuits exhibit similar responses to a new lawsuit; moreover, they respond similarly to winning and losing cases. Second, physicians’ reactions to a patient’s death vary depending on the recency of a salient lawsuit. Lastly, physician responses are especially strong following criminal violence against physicians, which is emotionally and psychologically salient. |
| JEL: | I11 I12 P36 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34115 |
| By: | Bhalotra, Sonia (Department of Economics, University of Warwick, CAGE, IFS, CEPR, IEA, IZA); Daysal, N. Meltem (Department of Economics, University of Copenhagen, CEBI, CESifo, IZA); Trandafir, Mircea (Rockwool Foundation Research Unit and IZA) |
| Abstract: | Mental health disorders tend to emerge in childhood, with half starting by age 14. This makes early intervention important, but treatment rates are low, and antidepressant treatment for children remains controversial since an FDA warning in 2004 that highlighted adverse effects. Linking individuals across Danish administrative registers, we provide some of the first evidence of impacts of antidepressant treatment in childhood on objectively measured mental health indicators and economic outcomes over time, and the first attempt to investigate under- vs overtreatment. Leveraging conditional random assignment of patients to psychiatrists with different prescribing tendencies, we find that treatment during ages 8-15 improves test scores at age 16, particularly in Math, increases enrollment in post-compulsory education at age 18, and that it leads to higher employment and earnings and lower welfare dependence at ages 25–30. We demonstrate, on average, a reduction in suicide attempts, self-harm, and hospital visits following AD initiation. The gains to treatment are, in general, larger for low SES children, but they are less likely to be treated. Using a marginal treatment effects framework and Math scores as the focal outcome, we show positive returns to treatment among the untreated. Policy simulations confirm that expanding treatment among low SES children (and boys) generates substantial net benefits, consistent with under-treatment in these groups. Our findings underscore the potential of early mental health treatment to improve longer term economic outcomes and reducing inequality. |
| Keywords: | Antidepressants, mental health, education, test scores, human capital, Denmark, physician leniency, marginal treatment effects JEL Classification: I11, I12, I18, J13 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:cge:wacage:766 |
| By: | Bassoli, Elena (ETH Zurich); Eibich, Peter (PSL Université Paris Dauphine); Zai, Xianhua (Max Planck Institute for Demographic Research) |
| Abstract: | We examine the dynamic effects of the loss of a spouse on mental health. We use data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for 28 European countries over the period 2004-2022 and estimate event study regressions to examine how individuals’ mental health changes over the transition into widowhood. We find no evidence of changes in mental health before the death of a spouse due to anticipation or caregiving effects. Bereaved individuals experience up to 1.5 additional depressive symptoms and their risk of depression increases by around 20 percentage points, with similar effects for men and women. Individuals adapt relatively quickly and their risk of depression reverts to baseline levels within 3 years of the death. We provide suggestive evidence that this adaptation is in part due to increased rates of social participation. We also find some evidence that the impact on mental health is stronger for individuals living in Eastern Europe and in countries with strong family ties. In addition, individuals in countries with stronger family ties adapt less quickly. |
| Keywords: | depression, anticipation, adaptation, mental health, widowhood, SHARE, event study |
| JEL: | I14 J12 J14 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18027 |
| By: | Anders Humlum; Pernille Plato |
| Abstract: | This paper shows that effective reskilling can have profound mental health benefits for workers and their partners. Using institutional variation in access to higher education after work accidents in Denmark, we find that reskilling prevents one case of depression for every three injured workers. Strikingly, the spillover effects on partners are just as large. These mental health gains are accompanied by higher partner employment and increased separation rates, suggesting that reskilling frees partners from costly relationship commitments. Together, the mental health and partner benefits add 83% to the direct labor earnings gains from reskilling. |
| JEL: | I18 I26 I31 J12 J24 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34095 |
| By: | Alberto Batinti; Joan Costa-Font; Vasuprada Shandar; Joan Costa-i-Font |
| Abstract: | We study the effect of royalty status - historically rooted legal privilege enjoyed by hereditary monarchs - on human longevity, a proxy of individuals’ health capital. We disentangle royalty status that encompassed serving as heads of state, and hence subject to status-related stress, from other family members alongside their contemporary countrymen. We exploit a dataset containing relevant demographic data and specifically the lifespan (age at death) of European Royals and their families spanning the past three centuries (1669 to 2022) from the sixteen European countries, including information for 845 high-status nobility and relative monarchs which is compared to otherwise similar countrymen by adjusting for relevant confounders. We document robust evidence of a statistically significant gap in life expectancy between monarchs and other members of the royal family, as well as between monarchs and the general population of an average of 5.2 to 7.1 years longer than their contemporaneous countrymen. |
| Keywords: | royal family, monarchy, life expectancy, health inequality, social determinants of health, healthy lifestyles, universal health insurance, age at death |
| JEL: | I18 N13 P00 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12047 |
| By: | Agnoletto, Margherita (University of Turin); Della Giusta, Marina (University of Turin); Mendolia, Silvia (University of Turin) |
| Abstract: | We examine the impact of intensive social media use on puberty timing, particularly earlier menarche in girls. Using data from the Millennium Cohort Study (MCS), a nationally representative longitudinal dataset tracking around 19, 000 children in the UK, we analyse how digital engagement influences adolescent development. Our results show that intensive social media use significantly accelerates menarche in girls but has no clear effect on male puberty markers. The likely mechanism behind this effect is the negative impact of social media on mental health, particularly stress and anxiety, which have been linked to earlier menarche. Our findings highlight social media use itself as a potential risky behaviour, reinforcing concerns about its effects on adolescent well-being. |
| Keywords: | menarche, stress, social media, risky behaviours |
| JEL: | I12 I31 J13 J16 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18013 |
| By: | Senan Hogan-Hennessy |
| Abstract: | Natural experiments are a cornerstone of applied economics, providing settings for estimating causal effects with a compelling argument for treatment randomisation, but give little indication of the mechanisms behind causal effects. Causal Mediation (CM) provides a framework to analyse mechanisms by identifying the average direct and indirect effects (CM effects), yet conventional CM methods require the relevant mediator is as-good-as-randomly assigned. When people choose the mediator based on costs and benefits (whether to visit a doctor, to attend university, etc.), this assumption fails and conventional CM analyses are at risk of bias. I propose a control function strategy that uses instrumental variation in mediator take-up costs, delivering unbiased direct and indirect effects when selection is driven by unobserved gains. The method identifies CM effects via the marginal effect of the mediator, with parametric or semi-parametric estimation that is simple to implement in two stages. Applying these methods to the Oregon Health Insurance Experiment reveals a substantial portion of the Medicaid lottery's effect on self-reported health and happiness flows through increased healthcare usage -- an effect that a conventional CM analysis would mistake. This approach gives applied researchers an alternative method to estimate CM effects when an initial treatment is quasi-randomly assigned, but the mediator is not, as is common in natural experiments. |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2508.05449 |
| By: | Jonas Esser; Mateus Maia; Judith Bosmans; Johanna van Dongen |
| Abstract: | Healthcare decision-making often requires selecting among treatment options under budget constraints, particularly when one option is more effective but also more costly. Cost-effectiveness analysis (CEA) provides a framework for evaluating whether the health benefits of a treatment justify its additional costs. A key component of CEA is the estimation of treatment effects on both health outcomes and costs, which becomes challenging when using observational data, due to potential confounding. While advanced causal inference methods exist for use in such circumstances, their adoption in CEAs remains limited, with many studies relying on overly simplistic methods such as linear regression or propensity score matching. We believe that this is mainly due to health economists being generally unfamiliar with superior methodology. In this paper, we address this gap by introducing cost-effectiveness researchers to modern nonparametric regression models, with a particular focus on Bayesian Additive Regression Trees (BART). We provide practical guidance on how to implement BART in CEAs, including code examples, and discuss its advantages in producing more robust and credible estimates from observational data. |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2507.03511 |
| By: | Getrude Njokwe (University of Pretoria, Pretoria, South Africa); Yoko Kijima (National Graduate Institute for Policy Studies, Tokyo, Japan) |
| Abstract: | Restrictive abortion laws in many African nations are associated with risks such as unsafe procedures and teenage motherhood. This study examines how abortion legalization influences sexual and reproductive health and women’s empowerment in South Africa, using a difference-in-differences design. Analyzing variations in birth cohorts and access to health care facilities with abortion services across provinces, the study finds no direct causal impact of the abortion policy on teenage motherhood, fertility rates, early sexual debut, high school completion, or college attendance, though negative associations with teenage motherhood and fertility rates and positive associations with early sexual debut, high school completion, and college attendance, were observed. The study suggests that limited access to health care facilities with abortion services and cultural taboos contribute to underreporting of behaviors. Given these findings, we recommend prioritizing access to contraception and creating supportive environments for adolescent girls living in vulnerable situations, including improved access to health care facilities that offer abortion services. |
| Keywords: | abortion legalization, fertility, schooling, adolescent, difference-in-difference; South Africa. |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:ngi:dpaper:25-09 |
| By: | Hiziroglu Aygun, Aysun |
| Abstract: | We examine the short-term effects of Türkiye’s Family Support Program (FSP), a large-scale unconditional cash transfer (UCT) introduced in 2022 amid 85.5% annual inflation. The program complements food and shelter support and offers approximately one-third of the monthly minimum wage to low-income families. Using a regression discontinuity design based on the program's per capita income eligibility threshold, we analyze the program's short-term effects on child labor, time use, health, and emotional well-being within six months of implementation. We find significant reductions in children's participation in family businesses and agricultural work. Investigating the heterogeneous effects, we find that the program reduces non-market outside work for boys and time spent on domestic work for girls. Emotional well-being improved, especially among boys. These findings suggest that UCTs can improve child welfare during macroeconomic crises when combined with in-kind transfers. |
| Keywords: | cash transfers, in-kind support, child labor, regression discontinuity design, program evaluation, Türkiye |
| JEL: | I21 I28 I38 J21 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:esprep:324156 |
| By: | Ismaël Rafaï (GREDEG - Groupe de Recherche en Droit, Economie et Gestion - UNS - Université Nice Sophia Antipolis (1965 - 2019) - CNRS - Centre National de la Recherche Scientifique - UniCA - Université Côte d'Azur); Bérengère Davin-Casalena (ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]); Dimitri Dubois (CEE-M - Centre d'Economie de l'Environnement - Montpellier - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - Institut Agro Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - UM - Université de Montpellier); Thierry Blayac (CEE-M - Centre d'Economie de l'Environnement - Montpellier - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - Institut Agro Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - UM - Université de Montpellier); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | Recent advances in artificial intelligence (AI) have made it possible to detect neurodegenerative diseases (NDDs) earlier, potentially improving patient outcomes. However, AI-based detection tools remain underutilized. We studied individual valuation for early diagnosis tests for NDDs. We conducted a discrete choice experiment with a representative sample of the French adult population (N = 1017). Participants were asked to choose between early diagnosis tests that differed in terms of: (1) type of test (saliva vs. AI-based tests analysing electronic health records); (2) identity of the person communicating the test results; (3) sensitivity; (4) specificity; and (5) price. We calculated the weights in the decision for each attribute and examined how socio-demographic characteristics influenced them. Respondents revealed a reduced utility value when AI-based testing was involved (valuated at an average of €36.08, CI [€22.13; €50.89]) and when results were communicated by a private company (€95.15, CI [€82.01; €109.82]). We interpret these figures as the shadow price that the public attaches to medical data privacy. Beyond monetization, our representative sample of the French population appears reluctant to adopt AI-powered screening, particularly when performed on large sets of personal data. However, they would be more supportive when medical expertise is associated with the tests. |
| Date: | 2025–07–23 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05189620 |
| By: | Brodeur, Abel (University of Ottawa); Cook, Nikolai (Wilfrid Laurier University); Heyes, Anthony (University of Birmingham); Wright, Taylor (Brock University) |
| Abstract: | How efficiently do scientific results make their way into the wider world? Applying multiple methods to the universe of hypothesis tests reported in three leading health journals between 2016 and 2022 we evidence the important role of statistical significance as a driver of popular attention to research results. For example, a research finding with significance that places it marginally inside the arbitrary 5% threshold attracts 60 to 110% more real world attention than one with significance marginally outside that threshold. We explore underlying mechanisms and argue that the results have important implications for the (in)efficiency of science translation. |
| Keywords: | p-hacking, social media, news media, popular science, knowledge mobilization, statistical significance, hypothesis testing, publication bias, research credibility |
| JEL: | B41 C12 I10 L82 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18034 |
| By: | Matthew A. Tarduno; Reed Walker |
| Abstract: | This paper explores whether misperceptions about air pollution contribute to environmental inequality in the United States. We use a two-part survey experiment to elicit respondents' beliefs about local air quality and pollution's effects on life expectancy. We document how misperception differs across demographic groups and then how this misperception affects willingness to pay (WTP) for cleaner air. Since misperception or beliefs may be correlated with other unobservable determinants of WTP, we randomly show selected participants customized information about their actual air pollution. This allows us to trace out how experimentally induced changes in beliefs affect WTP for air quality. Our results suggest significant misperceptions about air pollution in the US. Respondents, on average, overestimate both their air pollution exposure and its impact on life expectancy. Beliefs about relative air pollution are not systematically biased but are noisy. Despite some differences in misperceptions between Black and White respondents, counterfactual exercises do not suggest that rectifying these misperceptions would meaningfully close the observed gap in WTP and/or pollution exposure. |
| JEL: | H4 Q5 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34116 |
| By: | Elmallakh, Nelly Youssef Louis William; Gatti, Roberta V.; Islam, Asif Mohammed; Mousa, Mennatallah Emam Mohamed Sayed |
| Abstract: | This paper examines the long-term impacts of early-life drought exposure on the human capital and socioeconomic outcomes of women born in the Arab Republic of Egypt, Jordan, and Morocco across more than five decades. Using a pooled cross-section of 13 rounds of the Demographic and Health Surveys, the paper demonstrates that early childhood drought exposure significantly hinders female education, leading to lower educational attainment, increased illiteracy, and reduced likelihood of secondary school completion. These adverse effects are concentrated among women from rural households, suggesting that drought impacts operate through disruptions to agricultural livelihoods. Furthermore, the paper finds that early-life drought exposure is associated with reduced adult height, an increased likelihood of early marriage, and continued engagement in agricultural labor. This study provides novel evidence on the enduring human costs of climate variability in the Middle East and North Africa region, highlighting the urgent need for targeted policy interventions to mitigate the socioeconomic vulnerabilities of rural women in the face of climate change. |
| Date: | 2025–08–19 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11190 |
| By: | Bogler, Lisa; Cullinan, John; Jockers, Dominik; Pechar, Stefanie |
| Abstract: | Moscona and Seck (2024a) examine how redistribution of economic benefits differs between age-based and kin-based societies in sub-Saharan Africa. Using the experimental evaluation of a cash transfer program in Kenya, they find that an increase in income of members of an individual's age cohort increased consumption expenditure in age-set societies but not in kin-based societies. Next, exploiting the staggered introduction of a pension program in Uganda, they find that the program had positive effects on child health in kin-based societies, though not in age-set societies. In this replication report, we successfully computationally reproduce all results of the paper, with only a few minor deviations. We then conduct three robustness checks on the pension program results in Uganda, by varying the definition of the exposure variable, excluding outliers, and re-weighting observations. The original results are robust to our sensitivity analyses. The point estimates are very close to the original results and statistical significance is unchanged. Finally, we highlight some issues relating to the lack of sample descriptive statistics on key explanatory variables in the original paper. |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:i4rdps:259 |
| By: | Denis Fernandes Alves (Federal University of Pernambuco, Caruaru, Pernambuco, Brazil); André Luis Squarize Chagas (Departmento of Economics, University of S˜ao Paulo, S˜ao Paulo, S˜ao Paulo, Brazil) |
| Abstract: | This paper investigates how spatial inequalities in urban infrastructure shape the risk of COVID-19 infection. We develop a stylized urban sorting model with regulated housing markets to formally link residential density, healthcare accessibility, and residence in low-income areas under special planning regulations to heterogeneous contagion risks. The model yields testable propositions, which we evaluate using georeferenced individual-level data from Recife, Brazil. To address endogeneity, we estimate an instrumental variable Probit model, using novel instruments based on 19th-century railway lines, early-2000s building density, and the share of designated low-income areas within each census tract. Results show that greater distance to health services, higher residential density, and residence in low-income neighborhoods each increase infection risk. The effects of distance and density are strongest among individuals aged 20–30, while the low-income area effect is more pronounced among those under 20; combined vulnerabilities amplify risks for older adults. Additional analyses reveal that risk varies systematically across land-use contexts. Our findings demonstrate that urban form and the spatial distribution of public services play a causal role in epidemic exposure, offering lessons for public health strategies in rapidly urbanizing and unequal cities worldwide. |
| Keywords: | Urban sorting; COVID-19 contagion; Spatial Inequality; Healthcare access; Built environment. |
| JEL: | R10 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ris:nereus:021488 |