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on Health Economics |
| By: | Martha J. Bailey; Emilia Brito Rebolledo; Deniz Gorgulu; Kelsey Figone; Vanessa W. Lang; Alexa Prettyman; Vanessa Dalton |
| Abstract: | We use a randomized controlled trial to examine how the costs of contraception affect method choice, pregnancy, abortion, and childbirth among U.S. women. The study recruited women seeking care through Title X—a national family planning program subsidizing reproductive health services for low-income Americans—and randomized vouchers making the full spectrum of available contraception highly discounted or free. We find that subsidizing contraception has large and persistent effects on the choice of contraceptive method, resulting in significantly fewer pregnancies and abortions within two years. Subsidizing contraception negatively affected births, but the effect was not significant at two years. |
| JEL: | I14 I18 J13 J18 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34400 |
| By: | Liran Einav; Amy Finkelstein |
| Abstract: | What is the optimal path of Social Security benefits for an individual who has retired with a stock of wealth, faces stochastic mortality, and has no access to annuities and no preferences for bequests? It is a deferred annuity in which the government annuity pays out zero for some periods and a constant amount after that. The optimal length of the deferral period is increasing in the retiree's initial wealth and in their survival probability. |
| JEL: | H55 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34384 |
| By: | Jessica L. Arnup (Australian National University, POLIS: Centre for Social Policy Research); Nicole Black (Monash University, Monash Business School, Centre for Health Economics); David W. Johnston (Monash University, Monash Business School, Centre for Health Economics) |
| Abstract: | Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental health condition among children and adolescents, with diagnosis rates rising sharply over the past two decades. We examine the impact of adolescent ADHD on early adulthood outcomes using whole-of-population administrative data from Australia and two complementary identification strategies: sibling fixed effects and neighbour fixed effects. ADHD is identified through prescription records, capturing moderate-to-severe cases, and models account for a range of comorbid health conditions. Adolescents with ADHD are 12-16 percentage points less likely to be enrolled in tertiary education and 5-6 percentage points more likely to receive unemployment payments at age 20 compared to similar peers. These economic penalties are larger than those for other common conditions, including anxiety/mood and psychotic disorders. Relative reductions in tertiary enrolment are similar for males and females. Additional analyses show that comorbid mental health conditions do not meaningfully exacerbate the disadvantage associated with ADHD. Our findings highlight the substantial and enduring costs of ADHD for young people, even among those receiving treatment, and underscore the need for greater investment in school-based supports and transitional services. |
| Keywords: | ADHD, Education, Unemployment, Fixed Effects, Mental Health |
| JEL: | I2 I2 J6 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:2025-16 |
| By: | Cronin, Christopher J.; Harris, Matthew C.; Ziebarth, Nicolas R. |
| Abstract: | We study how public school teachers use paid sick leave. Most US sick leave schemes operate as individualized credit accounts: Paid leave is earned, and unused leave accumulates. We construct a unique dataset of daily leave balances and behavior among 982 teachers for 2010-2018. Sick leave use increases during flu season, and evidence indicates that the average teacher does not use sick leave for leisure though some subsets of teachers (e.g., the young and inexperienced) do. Usage increases with leave balance; the elasticity is around 0.4. Further, teachers with higher balances are less likely to work sick, particularly during flu season. |
| Keywords: | sick leave, teacher, presenteeism, moral hazard, labor supply |
| JEL: | I12 I13 I18 I28 J22 J28 J32 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:330324 |
| By: | Dan Anderberg (Royal Holloway, University of London); Line Hjorth Andersen (Rockwool Foundation, Research Unit); N.Meltem Daysal (Department of Economics, University of Copenhagen); Mette Ejrnaes (Department of Economics, University of Copenhagen) |
| Abstract: | We examine the impact of a 2002 Danish parental leave reform on intimate partner violence (IPV) using administrative data on assault-related hospital contacts. Using a regression discontinuity design, we show that extending fully paid leave increased mothers leave-taking and substantially reduced IPV, with effects concentrated among less-educated women. The reform also lengthened birth spacing, while separations remained unchanged and earnings effects were modest. The timing and heterogeneity of impacts point to fertility adjustments rather than exit options or financial relief as the key mechanism. Parental leave policy thus emerges as an underexplored lever for reducing IPV. |
| Keywords: | Intimate partner violence, parental leave |
| JEL: | J12 I38 |
| Date: | 2025–10–24 |
| URL: | https://d.repec.org/n?u=RePEc:kud:kucebi:2512 |
| By: | Diogo G.C. Britto; Caio de Holanda; Alexandre Fonseca; Breno Sampaio |
| Abstract: | We investigate the effects of maternity and paternity leave on families and firms. Drawing on rich administrative data linking generations in Brazil and leveraging a policy reform that expanded parental leave, we evaluate the impacts on parents, their spouses, and children, as well as the broader consequences for firms. Our analysis spans labour market outcomes, fertility, health, and education, offering new evidence on the multifaceted effects of parental leave in a developing country context. We find that mothers eligible for extended leave experience a 6.33 p.p. |
| Keywords: | Gender inequality, Child wellbeing, Firms |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:unu:wpaper:wp-2025-71 |
| By: | Samuel MacIsaac; René Morissette |
| Abstract: | Until recently, lack of data on paid sick leave (PSL) hindered analyses of whether employee PSL coverage had improved or worsened in Canada over the last few decades, an important limitation highlighted by the COVID-19 pandemic. This study fills this information gap. Using the 1995 Survey of Work Arrangements and the Labour Force Survey from 2020 to 2022, this study documents the evolution of employee PSL coverage in Canada from 1995 to 2022. The study shows that self-reported PSL coverage increased moderately from 1995 to 2022. In many cases, coverage appears to have risen faster in jobs that traditionally exhibit relatively low coverage than in other jobs. Nevertheless, large differences in self-reported coverage remained in 2022 across several dimensions such as education, industry, firm size and deciles of the wage distribution. The study also shows that for many front-line workers—such as those employed in grocery stores, gasoline stations, child day-care services, and nursing and residential care facilities—PSL coverage still appears to be far from universal. |
| Keywords: | sick leave, job quality, non-wage benefits |
| JEL: | J23 M21 |
| Date: | 2023–10–25 |
| URL: | https://d.repec.org/n?u=RePEc:stc:stcp8e:202301000001e |
| By: | Cristina Bellés-Obrero; Sergi Jiménez-Martín; Han Ye |
| Abstract: | This paper studies the mortality effects of delaying retirement by leveraging the 1967 Spanish pension reform, which exogenously increased the earliest voluntary claiming age from 60 to 65 based on individuals’ date of first contribution. Using Spanish administrative data, we find that removing access to early retirement delays age at last employment by 4 months and increases the probability of death between ages 60 and 69 by 11 percent. The mortality effects are concentrated among workers in physically demanding, high-psychosocial-burden, and low- skilled occupations, while men and women are affected similarly. Access to flexible retirement mitigates the adverse effects of delaying retirement. |
| Keywords: | heterogeneity , mortality , early retirement , delaying retirement , work conditions |
| JEL: | I10 I12 J14 J26 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:upf:upfgen:1924 |
| By: | Jonathan H. Cantor; Jill Horwitz; Christopher M. Whaley; Anthony Yu |
| Abstract: | Certificate of Need (CON) laws regulate entry and capital investments in healthcare with the goal of containing costs while preserving access and quality. This paper examines the relationship between these laws and overall mortality as well as leading causes of mortality: cancer and cardiovascular disease. Using county-level death records, we conducted an event-study analysis comparing mortality rates in states that repealed their CON laws to states that did not between 1979 and 2004. The repeal of CON laws was associated with short-run reductions in cancer mortality, primarily from reductions in lung cancer mortality. Cardiovascular mortality and all-cause mortality rates were unchanged. |
| JEL: | I0 I1 I11 I18 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34403 |
| By: | Cristina Bellés-Obrero; Manuel Flores; Pilar García-Gómez; Sergi Jiménez-Martín; Judit Vall-Castelló |
| Abstract: | Spain, with one of the highest life expectancies globally and a rapidly ageing population, faces growing challenges in sustaining its pension, healthcare, and long-term care systems. This study examines trends in health inequalities among retired Spaniards from 2004 to 2022, using eight waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). We analyse five health outcomes—limitations in daily and instrumental activities, number of chronic conditions, a composite health deficiency index, mental health (EURO-D scale), and cognitive performance—and use linear regression to assess income-related gradients, adjusted for age and sex. We also compute a catch-up time measure—the number of years a poorer individual would need to reach the same level of health as a richer individual—and concentration indices of bad health. We then examine how these inequalities change over time, allowing us to explore the potential influence of pension reforms within the context of Spain’s Beveridge-style healthcare system and tax-funded long-term care provision. Our results show no clear evidence that health inequality has increased from 2004 to 2022. These findings contribute to understanding how income disparities interact with social protection systems in ageing societies and inform the design of equitable health, long-term care, andpension policies |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:fda:fdaeee:eee2025-26 |
| By: | Seungwhan Chun; Marco Duarte; Cici McNamara; Jason M. Lindo |
| Abstract: | Are state-imposed behavioral remedies effective substitutes for federal antitrust enforcement? We evaluate state regulation of hospital mergers under Certificates of Public Advantage (COPAs). Using hospital data from 1996-2022, we compare COPA-regulated mergers to unregulated mergers with similar anticompetitive potential. In highly concentrated markets, COPA mergers result in 11.1 p.p. lower price growth but 0.5 p.p. greater increases in 30-day mortality rates. We find a negative correlation between price and mortality effects for COPA mergers, consistent with theoretical predictions that binding price caps exacerbate quality deterioration. Our findings suggest that COPA contracts are poor substitutes for traditional antitrust enforcement. |
| JEL: | G38 I11 K21 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34373 |
| By: | Paolo Berta (University of Milano-Bicocca); Carla Guerriero (University of Naples Federico II and CSEF); Sara Moccia (University of Naples Federico II.); Sara Muzzi (University of Milan-Bicocca); Lorien Sabatino (Politecnico of Torino (DIGEP)) |
| Abstract: | This paper investigates the causal impact of broadband diffusion on the consumption of diagnostic medical services in Lombardy, Italy, between 2013 and 2019. Using a difference-in-differences estimator for continuous treatments, we estimate the impact of increased internet availability on patient behavior in the healthcare system. Our findings suggest that greater broadband coverage leads to a significant rise in the number of diagnostic prescriptions, including magnetic resonance imaging scans, tomographs, and sonograms. We interpret this pattern as consistent with a behavioral mechanism: individuals with enhanced internet access are more likely to search for health information online, which may trigger anxiety or precautionary responses, ultimately increasing demand for medical testing. Boxplot analyses reveal a strong gradient across broadband coverage quartiles, reinforcing the association between digital access and healthcare utilization. These results raise important considerations for health policy, particularly regarding digital health literacy and the design of interventions to manage demand in digitally connected health systems. |
| Keywords: | Broadband; Continuous treatment, Diff-in-Diff, Overprescription. |
| JEL: | I18 I12 |
| Date: | 2025–10–15 |
| URL: | https://d.repec.org/n?u=RePEc:sef:csefwp:763 |
| By: | Jonathan Davis; Nathan Deutscher; Bhashkar Mazumder |
| Abstract: | Studies of intergenerational mobility have begun to expand outside of the traditional outcomes such as income, education and occupation, into using alternative measures of wellbeing. In this chapter we survey the evidence on studies of these alternative measures with a focus on health, consumption and life satisfaction. We also incorporate lessons from the income mobility literature that may be relevant for how we think about these alternative measures both conceptually and empirically. We highlight a few approaches that researchers can consider to incorporate alternative measures and we conclude that a widening of our conception of intergenerational mobility to incorporate measures of wellbeing may identify shortfalls in some of our current approaches. |
| JEL: | E2 I14 I3 J62 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34407 |
| By: | Felipe Lozano Rojas; John Cawley; David E. Frisvold |
| Abstract: | Taxes on sweetened beverages have been widely adopted in response to increases in diet-related chronic disease. An episode of particular interest occurred in Cook County, Illinois, where a beverage tax was announced, implemented, and then repealed. This paper is the first to estimate the effects of this tax using household-level data on purchases. We estimate difference-in-differences models that compare the change in beverage purchases over time in Cook County to that in comparison areas. The results indicate that consumer purchases did not detectably respond to the announcement of the tax. Implementation of the tax reduced purchases by 22.5% for all taxed beverages, 16.5% for high-calorie taxed beverages and a 33% for low-calorie (e.g. diet) taxed beverages. This implies a price elasticity of demand of -0.66 for all taxed beverages, -0.48 for high-calorie taxed beverages and -0.97 for low-calorie taxed beverages. The impact of the tax did not vary by household income, and there is no detectable impact of the tax on purchases of possible substitutes (bottled water, fruit juice, milk). After repeal of the tax, purchases of taxed beverages returned to their baseline quantities; there was no evidence of habit formation. |
| JEL: | H2 I12 I18 Q18 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34412 |
| By: | Pol Campos-Mercade; Armando N. Meier; Florian H. Schneider; Roberto A. Weber |
| Abstract: | We study attitudes toward offering monetary payments for vaccination. We develop the Policy Lab, an experimental paradigm to characterize policy preferences in which participants decide whether to implement actual interventions to influence others’ real-world behavior. In two studies with representative samples of the Swedish population (N=2, 010) and one with Swedish policymakers (N=2, 008), participants decide whether to provide others (N=1, 529) with monetary incentives for vaccination. A majority of participants oppose using monetary incentives. Despite the widespread perception that such incentives are an effective policy instrument, which is supported in our data, opposition to their use is driven by perceptions that they are coercive and unethical. Policymakers exhibit, if anything, greater opposition to the use of monetary incentives. We also document that opposition to incentives extends beyond vaccination to other health domains. Our study provides evidence that the public opposes policies that they correctly perceive as effective, potentially creating barriers to their adoption. We further introduce a novel method to elicit policy preferences, widely applicable whenever researchers conduct randomized trials. |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:zur:econwp:478 |
| By: | Jason Fletcher; Hamid Noghanibehambari |
| Abstract: | Several competing theories in a number of disciplines point to a possible influence of fertility history on health and mortality. However, the direction of effects is theoretically a-priori unknown and the empirical evidence is also inconclusive. This paper examines the effects of fertility during midlife on later-life longevity using Social Security Administration death records linked with the full-count 1940 census. We tackle endogeneity and selection concerns in the longevity-fertility association by implementing an instrumental variable based on the sex composition of first two children. Our findings indicate that having an extra child is linked to a decrease in women’s longevity by approximately 5 months. Men, on the other hand, experience smaller and insignificant reductions in longevity of about 3.3 months. This divergence in effects suggests that biological factors may play a small role in the relationship between fertility and later-life longevity. |
| JEL: | I1 J13 N0 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34378 |
| By: | Aimable Nsabimana; Fadzayi Chingwere |
| Abstract: | We study the spillover effects of a large-scale public health insurance programme on early learning outcomes in Rwanda. The policy, the community based health insurance programme, which expands affordable healthcare services especially among rural and low-income families, was introduced in different district hospitals at different times. |
| Keywords: | Health insurance, Learning, Healthcare, Public healthcare, Rwanda |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:unu:wpaper:wp-2025-73 |
| By: | Pablo Garcia-Sanchez (Banque centrale du Luxembourg, Departement Economie et Recherche); Olivier Pierrard (Banque centrale du Luxembourg, Departement Economie et Recherche) |
| Abstract: | Income and life expectancy are strongly correlated, yet the mechanisms underlying this relationship remain debated. This paper develops a structural model in which both variables are endogenous and jointly determined. Calibrated to U.S. data, the model replicates the income-longevity gradient and the distribution of age at death. It highlights the importance of both the health-to-income and income-to-health channels in accounting for these empirical patterns. Our model also offers a more cautious assessment of income redistribution policies than empirical studies, showing that redistribution can weaken incentives for preventive care and increase mortality risk. By contrast, lowering the price of preventive care through subsidies promotes better health and longer lives. |
| Keywords: | Health, Income, Inequality, Redistribution, Subsidy |
| JEL: | C60 D15 H24 H51 I12 I14 |
| Date: | 2025–10–22 |
| URL: | https://d.repec.org/n?u=RePEc:ctl:louvir:2025016 |
| By: | Hui-Kuan Chung; Nick Doren; Lasse Mononen; Mia Lu; Marcus Grueschow; Helen Hayward Könnecke; Alexander Jetter; Boris B. Quednow; Nick Netzer; Philippe N. Tobler |
| Abstract: | Models of limited attention have the potential to become a new unifying paradigm that could replace the rational choice approach. In this paper, we test the limited attention hypothesis by enhancing attention using pharmacological substances. A total of 160 subjects participated in our randomized, placebocontrolled, and double-blind experimental study. We find that enhancing attention through boosting the noradrenergic system with reboxetine improves the quality of choice as captured by multiple different measures of rationality. Eye-tracking suggests that boosting noradrenaline promotes more rational choice by efficiently directing attention to more valuable options. Other attention-enhancing drugs (methylphenidate, which boosts the dopaminergic system, and nicotine, which boosts the cholinergic system) improve rationality to a lesser extent. Aside from testing the limited attention hypothesis directly, our results have implications for welfare economics, policy-design, and public health. |
| Keywords: | Limited attention, rationality, pharmacology |
| JEL: | B41 C91 D01 D60 D91 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:zur:econwp:476 |
| By: | Congdon Fors, Heather (Department of Economics, School of Business, Economics and Law, Göteborg University); Durevall, Dick (Department of Economics, School of Business, Economics and Law, Göteborg University); Isaksson, Ann-Sofie (The Institute for Futures Studies); Lindskog, Annika (Department of Economics, School of Business, Economics and Law, Göteborg University) |
| Abstract: | Teenage childbearing has serious consequences for young mothers, their children, and society. This study estimates the impact of foreign aid projects on teenage fertility in Malawi. We combine georeferenced data on aid projects from 1998–2016 with individual-level fertility data. Identification relies on spatial and temporal variation in aid exposure and survey timing, with controls for project placement and teenage childbearing among older women not exposed to the intervention. Results show that aid to sexual and reproductive health, HIV/AIDS, and education significantly reduce teenage fertility, while other aid types have limited effects. Women who were exposed to relevant aid while of critical age were 15-25 percent less likely to have given birth as teenagers. Likely mediators include increased time in school, delayed entry into relationships, and postponed marriage. |
| Keywords: | Teenage fertility; Early childbearing; Foreign aid; Malawi |
| JEL: | F35 O12 O15 |
| Date: | 2025–10–28 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:gunwpe:0858 |
| By: | Colleen Cunnningham (University of Utah); Florian Ederer (Boston University); Charles Hodgson (Yale University); Zhichun Wang (Yale University) |
| Abstract: | Policies that mandate disclosure of innovative project outcomes aim to increase innovation by limiting wasteful duplicative innovation. Yet, such policies change not only the ex-post information environment but also firms' ex-ante innovation incentives. Firms may slow down their own innovation efforts in anticipation of increased disclosure by others. We examine the innovation-related impacts of the 2017 FDA Final Rule amendment, which mandates disclosure of clinical trial results for pharmaceutical firms. We show that the policy hastened and increased disclosure of results for clinical trials post-completion, but also increased the time to completion of clinical trials, the time between early phases of clinical trials, and delays in development-related investments. We provide evidence consistent with mandated disclosure leading firms to wait to learn from their competitors. Our results suggest that mandating disclosure may slow innovation when there is value to waiting. |
| Date: | 2025–10–08 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2465 |
| By: | Luisito Bertinelli (Department of Economics and Management, University of Luxembourg); Evie Graus (Department of Economics and Management, University of Luxembourg); Jean-François Maystadt (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES)); Silvia Peracchi (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES)) |
| Abstract: | This paper examines the causal impact of road access on child health in Sub-Saharan Africa between 1980 and 2012 by combining geolocated data on child anthropometric outcomes with spatial data on road networks. To address endogeneity, we employ an instrumental variable approach based on the inconsequential units framework, constructing hypothetical road networks that connect historical cities and active mines. Our results show that closer proximity to paved roads significantly improves child health. The main mechanisms operate through improved healthcare access and utilization, higher household wealth, early signs of structural transformation, and cropland expansion. We find no evidence that these gains are offset by adverse environmental or epidemiological effects of improved road access. Overall, the findings underscore the role of road infrastructure in fostering development across Sub-Saharan Africa. |
| Keywords: | roads, Sub-Saharan Africa, child health, causal analysis |
| JEL: | O15 I15 O18 O55 |
| Date: | 2025–10–24 |
| URL: | https://d.repec.org/n?u=RePEc:ctl:louvir:2025017 |
| By: | Kirui, Oliver K.; Ahmed, Mosab; Raouf, Mariam; Abushama, Hala; Siddig, Khalid |
| Abstract: | This study investigates the determinants of access to safe water and reliable energy for households in Sudan using nationally representative data from a recent labor market survey. The results show that urbanization, education, and wealth significantly enhance the access households have to these essential services, while rural areas and less developed regions, particularly in the Darfur and Kordofan regions, face substantial challenges. Access to reliable energy correlates with better food security and health outcomes within households, and improved access to safe water significantly enhances the health of household members. Policy recommendations supported by these research results include targeted rural infrastructure investments, educational improvements, and regional interventions to address disparities in household access to safe water and reliable energy across Sudan. |
| Keywords: | Sudan; Africa; Northern Africa; capacity development; households; water; energy; food security; health; socioeconomic environment; rural urban relations |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:fpr:ssspwp:22 |