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on Health Economics |
| By: | Ashvin Gandhi; YoungJun Song; Prabhava Upadrashta |
| Abstract: | This paper studies how product market competition shapes the impact of private equity (PE) acquisitions on consumers. We examine nursing home buyouts and observe that PE-owned facilities exhibit greater competitive sensitivity: competing more aggressively when competitive incentives are strong and exploiting market power more aggressively when competitive incentives are weak. We find that PE-owned facilities are more sensitive to local market competition—even when comparing effects only across facilities purchased as part of the same acquisition—and are more responsive to a pro-competitive policy helping consumers compare facilities. This suggests that the competitive sensitivity of acquirers and the concentration of markets where acquisitions occur are important factors contributing to the effects of a merger, as well as that pro-competitive polices can reshape the effects of PE ownership on consumers. |
| JEL: | G3 G32 G34 G38 I1 I11 I18 L1 L11 L15 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34306 |
| By: | Liran Einav; Amy Finkelstein; Neale Mahoney; James C. Okun |
| Abstract: | We use detailed data on the evolution of health for about 0.8 million Black and 5.4 million white nursing home patients covered by Medicare between 2011 and 2019 to estimate race-specific value-added measures for more than 8, 000 nursing homes in the United States. We estimate that the average nursing home value-added experienced by Black patients is about 30% lower than that received by white patients. Most of this gap reflects differences in value-added experienced by similar Black and white patients within the same nursing home, rather than differences in value-added across the nursing homes they go to. |
| JEL: | H44 I1 I14 L0 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34324 |
| By: | Lavy, Victor; Rachkovski, Genia; Yoresh, Omry |
| Abstract: | Literature has shown that air pollution can have short- and long-term adverse effects on physiological and cognitive performance. In this study, we estimate the effect of increased pollution levels on the likelihood of accidents at construction sites, a significant factor related to productivity losses in the labor market. Using data from all construction sites and pollution monitoring stations in Israel, we find a strong and significant causal effect of nitrogen dioxide (NO2), one of the primary air pollutants, on construction site accidents. We find that a 10-ppb increase in NO2 levels increases the likelihood of an accident by as much as 25 %. Importantly, our findings suggest that these effects are non-linear. While moderate pollution levels, according to EPA standards, compared to clean air levels, increase the likelihood of accidents by 138 %, unhealthy levels increase it by 377 %. We present a mechanism where the effect of pollution is exacerbated under conditions of high cognitive strain or reduced awareness. Finally, we perform a cost-benefit analysis, supported by a nonparametric estimation calculating the implied number of accidents due to NO2 exposure, and examine a potential welfare-improving policy to subsidize the closure of construction sites on highly polluted days. |
| Keywords: | workplace accidents; labor productivity; air pollution; government policy |
| JEL: | R14 J01 |
| Date: | 2025–11–30 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:129773 |
| By: | Manisha Shah; Lydia Barski |
| Abstract: | Intimate partner violence (IPV) is a pervasive global issue, with approximately one in three women experiencing IPV over their lifetime. IPV prevalence is higher in low- and middle-income countries (LMICs), and costs of IPV are also considerably larger as a percentage of GDP in LMICs. We present the economic theory behind IPV and highlight some important determinants such as poverty and societal norms. We then synthesize the causal evidence on the impact of a range of policies and interventions, highlighting approaches which have been effective in reducing IPV. We identify key insights from the existing literature and outline areas where further theoretical and empirical research is needed. |
| JEL: | I18 J12 O12 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34337 |
| By: | Katherine Rittenhouse; David Simon; Lindsey Lacey |
| Abstract: | Over one third of children in the U.S. are investigated by the child protection system (CPS) by age 18, but the effects of this interaction on families and children are largely unknown. Investigations aim to protect children from harm and direct services to families in need. However, they also bring the implicit threat of child removal, which can generate both stress and institutional distrust among affected families. Using a regression discontinuity design, we study the impacts of this interaction on child health. Children who are just above the threshold for being “defaulted” into an investigation see a reduction in injuries and an increase in preventative care in the two months following the referral. Effects are consistent across child gender, race and age. Finally, investigations increase the likelihood that a parent is jailed, suggesting that investigations also detect criminal activity within the home. An exploration of mechanisms suggests that it is the investigation, rather than home removal or parental criminal justice system involvement, which improves child health. |
| JEL: | I1 I30 J13 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34334 |
| By: | Jane Greve; Mette T. Jensen; Esben Agerbo; John Cawley |
| Abstract: | This paper contributes to the literature on the impact of early-life health on education by estimating the effect of genetic predisposition to a higher body mass index (BMI) on educational attainment and related outcomes. The identification strategy exploits the randomness in which genes one inherits from one's parents by estimating sibling fixed effects models of the polygenic score for a higher BMI. These models are estimated using rich administrative data from Denmark for over 14, 000 full siblings. We find that a one-standard-deviation increase in the genetic predisposition to a higher BMI is associated with a 1.4 percentage point (4.4%) lower probability of earning a high school diploma, a 1.7 percentage point (12.3%) lower probability of a college degree, and a 1.7 percentage point (3.7%) higher probability of vocational training. An investigation into mechanisms suggests that youth with a greater genetic predisposition to a higher BMI are more likely to report being bullied, have greater school absences, and lower test scores. |
| JEL: | I1 I14 I2 I23 I24 J13 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34322 |
| By: | Danea Horn; Abby E. Alpert; Mark Duggan; Mireille Jacobson |
| Abstract: | Immunotherapy is a breakthrough innovation in cancer care but is also among the most expensive treatments, with costs exceeding $150, 000 per patient. We study the introduction of immune checkpoint inhibitors (ICIs), the most widely used class of immunotherapy drugs. In 2022, ICIs accounted for 44% of the $17.5 billion Medicare Part B cancer drug spending. We focus on metastatic melanoma, the first approved indication for ICIs. While overall cancer mortality rates declined since the 1990s, melanoma mortality rates increased through the early 2010s. Following the first ICI approvals in 2011 and 2014, melanoma mortality declined sharply. Using traditional Medicare claims, we estimate the impact of the introduction of ICIs on healthcare utilization, costs, and 1-year survival for patients with metastatic melanoma, relative to metastatic colorectal cancer (CRC), where ICIs were not approved until 2017. Variation in approval timing allows us to isolate the effect of ICIs from broader cancer care trends. We find that ICIs reduced 1-year mortality by 6.2%. Since about 1 in 5 metastatic melanoma patients received ICIs, this implies a 27.5% reduction among treated patients. The introduction of ICIs also reduced chemotherapy and radiation use, but increased Medicare spending by 59.3% or about 260% among ICI-treated patients. Accounting for life expectancy gains beyond one year, the benefits of ICIs for melanoma patients appear comparable, or potentially even greater, than the substantial added Medicare costs. Nonetheless, ICI use remains relatively low given large survival benefits and few alternative treatments, suggesting that costs and other barriers limit patient access. |
| JEL: | H51 I13 I18 O38 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34317 |
| By: | Ghouma, Rym; Lagarde, Mylène; Powell-Jackson, Timothy |
| Abstract: | In this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit experiment in Tunisia, sending standardised patients with the same symptoms to 130 public and private primary care doctors for consultation. Informed by in-depth qualitative work, we vary the attitude and appearance of the patients so that they appear to be “poor” or “middle-class”. We find no evidence that doctors manage patients differently, but they respond to the socioeconomic profile of patients by prescribing fewer expensive drugs and giving out more free drugs to poorer patients. We also show significant differences in communication between patients: doctors are more likely to provide more explanation to richer patients about the diagnosis, the drugs prescribed and the treatment plan. These differences are not explained by time constraints as doctors spent comparable time with both types of patients. To the extent that differences in communication with patients can lead to differences in patients’ health decisions, our results suggest that doctors could contribute indirectly to health inequalities. |
| Keywords: | health care provision; socioeconomic inequalities; standardised patients; audit experiment; Tunisia |
| JEL: | J1 |
| Date: | 2025–12–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:129460 |
| By: | Celine Bonnet; Fabrice Etile; Sebastien Lecocq |
| Abstract: | Reforming alcohol price regulations in wine-producing countries is challenging, as current price regulations reflect the alignment of cultural preferences with economic interests rather than public health concerns. We evaluate and compare the impact of counterfactual alcohol pricing policies on consumer behaviors, firms, and markets in France. We develop a micro-founded partial equilibrium model that accounts for consumer preferences over purchase volumes across alcohol categories and over product quality within categories, and for firms' strategic price-setting. After calibration on household scanner data, we compare the impacts of replacing current taxes by ethanol-based volumetric taxes with a minimum unit price (MUP) policy of 0.50 Euro per standard drink. The results show that the MUP in addition to the current tax outperforms a tax reform in reducing ethanol purchases (-15% vs. -10% for progressive taxation), especially among heavy drinking households (-17%). The MUP increases the profits of small and medium wine firms (+39%) while decreasing the profits of large manufacturers and retailers (-39%) and maintaining tax revenues stable. The results support the MUP as a targeted strategy to reduce harmful consumption while benefiting small and medium wine producers. This study provides ex-ante evidence that is crucial for alcohol pricing policies in wine-producing countries. |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2509.14116 |
| By: | Pablo Garcia Sanchez; Olivier Pierrard |
| Abstract: | Both health and wealth are distributed heterogeneously across the population. These two dimensions are empirically linked by a robust positive correlation between income and life expectancy. Yet the mechanisms underlying this link and the implications for economic policy remain incompletely understood. This paper develops a life-cycle model with heterogeneous agents to explore the bidirectional relationship between income and health: higher income enables greater health investment, while better health enhances productivity and therefore earnings. We calibrate the model to U.S. data, capturing key empirical aspects of the distribution of income, health and age-at-death. We show that the income-tohealth channel is more important early in life, while the health-to-income channel dominates at older ages. We then use this framework to evaluate policies aimed at redistribution or health. We find that income redistribution, while reducing inequality, weakens individuals’ incentives to invest in health, lowering both average life expectancy and aggregate income. In contrast, health subsidies enhance health, raising both longevity and economic output, without reducing income inequality. |
| Keywords: | Health, Income, heterogeneity, life-cycle model, policies. |
| JEL: | C60 D15 H24 H51 I12 I14 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:bcl:bclwop:bclwp200 |
| By: | Marshall Burke; Andrew J. Wilson; Tumenkhusel Avirmed; Jonas Wallstein; Mariana C. M. Martins; Patrick Behrer; Christopher W. Callahan; Marissa Childs; June Choi; Karina French; Carlos F. Gould; Sam Heft-Neal; Renzhi Jing; Minghao Qiu; Lisa Rennels; Emma Krasovich Southworth |
| Abstract: | A large literature documents how ambient temperature affects human mortality. Using decades of detailed data from 30 countries, we revisit and synthesize key findings from this literature. We confirm that ambient temperature is among the largest external threats to human health, and is responsible for a remarkable 5-12% of total deaths across countries in our sample, or hundreds of thousands of deaths per year in both the U.S. and EU. In all contexts we consider, cold kills more than heat, though the temperature of minimum risk rises with age, making younger individuals more vulnerable to heat and older individuals more vulnerable to cold. We find evidence for adaptation to the local climate, with hotter places experiencing somewhat lower risk at higher temperatures, but still more overall mortality from heat due to more frequent exposure. Within countries, higher income is not associated with uniformly lower vulnerability to ambient temperature, and the overall burden of mortality from ambient temperature is not falling over time. Finally, we systematically summarize the limited set of studies that rigorously evaluate interventions that can reduce the impact of heat and cold on health. We find that many proposed and implemented policy interventions lack empirical support and do not target temperature exposures that generate the highest health burden, and that some of the most beneficial interventions for reducing the health impacts of cold or heat have little explicit to do with climate. |
| JEL: | Q50 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34313 |
| By: | Lidia Farr; Libertad González Luna; Claudia Hupkau; Jenifer Ruiz-Valenzuela |
| Abstract: | We study the effect of paternity leave on early child development. We collect survey data on 5, 000 children under age six in Spain, and exploit several extensions of paternity leave that took place between 2017 and 2021. We follow a differences-indiscontinuities research design, based on the date of birth of each child and using cohorts born in non-reform years as controls. We show that the extensions led to significant increases in the length of leave taken by fathers, without affecting that of mothers, thus increasing parental time at home in the first year after birth. Eligibility for four additional weeks of paternity leave led to a significant 12 percentage-point increase in the fraction of children with developmental delays. We provide evidence for two potential mechanisms. First, children exposed to longer paternity leave spend less time alone with their mother, and more time with their father, during their first year of life. Second, treated children use less formal childcare. Our results suggest that paternity leave replaces higher-quality modes of early care. We conclude that the effects of parental leave policies on children depend crucially on the quality of parental versus counterfactual modes of childcare. |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:upf:upfgen:1892 |
| By: | Selidji Caroline Tossou |
| Abstract: | This paper evaluates the causal effect of the access to Benin's free cesarean section policy on females and their children. I use a large sample of Demographic and Health Surveys (DHS) for West African countries and analyze how the exemption of the cesarean section user fees for females in Benin directly impacts maternal and infant mortality, family size decisions, and labor market participation. I use a Difference in Differences approach and find that having access to the free cesarean section policy significantly reduces the number of stillbirths and infant mortality by 0.0855 (a 18.79 percentage change). Second, for the surviving children, I find that access to the free cesarean section increases the likelihood of maternal mortality by 0.00465 (a 5.21 percentage change). The policy is effective at reducing infant mortality and saving the newborn. However, it harms the mother's health which translates to lower fertility after the first birth and decreased maternal labor supply post-birth. |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2510.03658 |
| By: | Dan Anderberg; Line Hjorth Andersen; N. Meltem Daysal; Mette Ejrnæs |
| Abstract: | We study the effects of a parental leave reform in Denmark in 2002 on intimate partner violence (IPV) contacts. The reform extended leave-taking among mothers but not fathers and led to a marked reduction in IPV incidence, specifically among mothers with below-median years of education. Analysis of further outcomes suggests that increased birth spacing is a key mechanism linking extended parental leave to reduced IPV risk. |
| Keywords: | intimate partner violence, parental leave |
| JEL: | J12 I38 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12189 |
| By: | Alba, Charles |
| Abstract: | The Make America Healthy Again (MAHA) movement highlights the complexity of public perceptions surrounding policies rooted in populist health initiatives in the United States. While supporters embrace the movement’s messaging around healthier lifestyles and nutritional choices, critics point to its political undertones and the widespread misinformation associated with it. To better understand the dynamics of public perceptions of the MAHA movement, our study leverages sentiment classification and topic modeling to analyze discourse about the movement on X. Our analysis reveals an interesting trend: although the movement initially generated overwhelmingly positive sentiment, overall positivity declined following the nomination and subsequent confirmation of Robert F. Kennedy Jr. as President Trump’s Secretary of Health and Human Services to the point where negative sentiment began to outweigh positive sentiments. Further integration of such trends with topic modeling analysis suggests that while the public initially supported the ideals of healthier lifestyles promoted by the MAHA movement, enthusiasm diminished and eventually turned negative once the movement became entangled with political dimensions and controversial policies. |
| Date: | 2025–10–02 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:2gsxq_v1 |
| By: | Brendon Andrews (University of Alberta) |
| Abstract: | The homeopathic practice of diluting medications by factors of 100 raised to the power of 12, 30, or even higher is unscientific. Why might a healthcare provider choose to follow such a doctrine? This short article uses an economic model of provider behavior including altruism for patients to argue that both cost-reduction and well-meaning concern can explain the practice’s adoption in the early nineteenth century. Altruistic behavior consistent with high dilutions is predicted when undiluted treatment benefits are negative, even when homeopaths are overconfident and believe otherwise, and can reduce patient harm. Homeopathic practice choice is most attractive in this context to altruistic, steadily overconfident low-quality healthcare providers. Related modern treatment settings can be constructed which imply policy-relevant research directions. |
| Keywords: | Alternative Medicine; Altruism; Healthcare; Homeopathy; Provider Behavior |
| JEL: | I11 J44 N31 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:ris:albaec:021640 |
| By: | Elijah Kahn-Woods (Consultant); Anthony McDonnell (Center for Global Development) |
| Abstract: | Antimicrobial resistance (AMR) represents one of the most pressing global health challenges, yet translating scientific evidence into effective policy has proven slow, uneven, and fragmented across contexts. To inform the design of a proposed Independent Panel for Evidence for Action (IPEA) against AMR, this paper reviews lessons from past and ongoing efforts to bridge the evidence-policy gap in AMR and related fields. Using desk research and 15 key informant interviews with AMR experts across disciplines and geographies, we applied the Knowledge-to-Action framework to examine challenges and opportunities in evidence translation. Our analysis highlights persistent gaps in knowledge creation, uneven investment in evidence synthesis, and limited downstream uptake mechanisms, particularly in low- and middle-income countries and non-human health sectors. Case studies of the Evidence-Informed Policy Network and Regional AMR Data Analysis for Advocacy, Response and Policy collaboration and the US Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria demonstrate the importance of local capacity building, multisectoral collaboration, sustained governance, and clear policy outputs. We recommend that the IPEA prioritize equitable One Health engagement, modular and context-specific policy guidance, stronger linkages between upstream evidence generation and downstream implementation, and coordination with existing initiatives to avoid duplication. By embedding these lessons, the IPEA can accelerate the uptake of AMR evidence into actionable policies, strengthen global governance, and help preserve the effectiveness of antimicrobials for future generations. |
| Date: | 2025–10–06 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:wpaper:731 |
| By: | Ran Gu; Enhui Ding; Shigui Ma |
| Abstract: | Vaccines play a crucial role in the prevention and control of infectious diseases. However, the vaccine supply chain faces numerous challenges that hinder its efficiency. To address these challenges and enhance public health outcomes, many governments provide subsidies to support the vaccine supply chain. This study analyzes a government-subsidized, three-tier vaccine supply chain within a continuous-time differential game framework. The model incorporates dynamic system equations that account for both vaccine quality and manufacturer goodwill. The research explores the effectiveness and characteristics of different government subsidy strategies, considering factors such as price sensitivity, and provides actionable managerial insights. Key findings from the analysis and numerical simulations include the following: First, from a long-term perspective, proportional subsidies for technological investments emerge as a more strategic approach, in contrast to the short-term focus of volume-based subsidies. Second, when the public is highly sensitive to vaccine prices and individual vaccination benefits closely align with government objectives, a volume-based subsidy policy becomes preferable. Finally, the integration of blockchain technology positively impacts the vaccine supply chain, particularly by improving vaccine quality and enhancing the profitability of manufacturers in the later stages of production. |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2510.03661 |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | We examine evidence on the well-being and ill-being of the young for 22 countries in the Global Flourishing Study (GFS) 2022-2024 with the commonly used 12-component “flourishing” index and a new 4-component “not flourishing” index. Although flourishing is U-shaped in age in the pooled data it rises in age in 13 countries and declines in 7. By contrast, not-flourishing declines in age overall, and in each of its four components, and it declines in age in 15 of the 22 countries. We explore sensitivity of results to survey mode in countries using both computer-assisted telephone interviews (CATI) and computer-assisted web-based interviews (CAWI). When CATI is used, the young are happier than other age groups, but the opposite is the case when data are collected via CAWI. We validate the findings with analyses from two other data sets. First, we construct flourishing and not flourishing indices using different variables for the four European countries in the GFS - Germany, Spain, Sweden and UK - from the interviewer based European Social Survey (ESS) of 2023-2024. As with the GFS, the not-flourishing data shows ill-being declines in age while the flourishing data is more mixed. Second, we examine the internet-based Global Minds (GM) surveys, 2020-2025, on the same group of countries, and find well-being rises in age for all in both flourishing and not-flourishing variables. We argue that trends in youth suicide, self-harm and mental health hospitalizations are consistent with the age patterns in the not-flourishing index and with the internet-based survey evidence from both the flourishing and not-flourishing indexes. |
| JEL: | I30 J13 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34321 |
| By: | König, Tobias; Schmacker, Renke |
| Abstract: | Using surveys and experiments, we provide evidence on how people think about and justify sugar-sweetened-beverage (SSB) taxes, a widely discussed behavioral policy intervention. We show that motives to correct internalities and behavioral biases impact policy preferences almost as much as standard externality reasoning. However, antipaternalistic attitudes explain why many people oppose SSB taxes although they acknowledge the relevance of behavioral biases. We demonstrate that instructional explanations about how behavioral SSB taxes work significantly increase support for such taxes. By contrast, simple information feedback regarding the statistical prevalence of internalities and externalities has no effect. Our findings suggest that the nature of information provision-particularly explaining a policy's goals and mechanisms-is crucial for enhancing its acceptability. |
| Keywords: | Paternalism, sin tax, internality, externality, soda tax, self-control |
| JEL: | H23 I18 D12 D78 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:wzbmbh:328006 |