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on Health Economics |
| By: | Anna Chorniy; Amy Finkelstein; Matthew J. Notowidigdo |
| Abstract: | We estimate and compare impacts of cash and in-kind transfers on the consumption of temptation goods in the same population, and explore normative implications. We use two decades of data from South Carolina on cash benefits from Supplemental Security Income (SSI) and in-kind benefits from the Supplemental Nutrition Assistance Program (SNAP) linked to detailed data on adults’ health care use. Our empirical strategy examines outcome changes in the several days following each transfer’s scheduled monthly payout. Emergency department visits for drug and alcohol use increase by 20-30 percent following SSI receipt, but do not respond to SNAP receipt. Fills of prescription drugs for new illnesses also increase following SSI receipt but do not respond to SNAP receipt. Motivated by these non-fungibility results, we develop a model of a paternalistic social planner choosing the mix of cash and SNAP for a fixed-budget transfer program when consumers have self-control problems and may engage in mental accounting. We show that the planner’s optimal SNAP share is strictly positive and weakly increasing as self-control worsens. Moreover, with heterogeneity in self-control and mental accounting, the planner may choose to use SNAP even when they have access to a uniform Pigouvian tax on the temptation good. |
| JEL: | H53 I10 I38 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34506 |
| By: | Marianne Bitler; Danea Horn; Esra Kose; Maria Rosales-Rueda; Arian Seifoddini |
| Abstract: | This paper examines the effect of nutrition—delivered during pregnancy via the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—on infant health. We contribute to the literature by adding new data on WIC rollout from the National Archives, employing novel methods, investigating new mechanisms, and analyzing previously unexplored infant outcomes, including the distribution of birth weight. We find robust evidence that access to WIC in a woman’s county of residence by the start of their second trimester led to a reduction in the probability of an infant being of low birth weight and to a higher average birth weight, with larger in magnitude effects for infants with Black mothers than for those with White mothers. Our results suggest a lower bound for treatment-on-the-treated effects for low birth weight of -0.9 percentage points and for birth weight of around 33 grams for infants with Black mothers, both economically significant. For White mothers, the effects on low birth weight are much smaller in magnitude and statistically insignificant. These findings show WIC reduced overall disparities between Blacks and Whites in low birth weight by 3.6 percent. |
| JEL: | H53 I18 I38 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34521 |
| By: | Kimberly A. Clausing; Christopher R. Knittel; Catherine Wolfram |
| Abstract: | Climate change is already increasing temperatures and raising the frequency of natural disasters in the United States. In this paper, we examine several major vectors through which climate change affects US households, including cost increases associated with home insurance claims and increased cooling, as well as sources of increased mortality. Although we consider only a subset of climate costs over recent decades, we find an aggregate annual cost averaging between $400 and $900 per household; in 10 percent of counties, costs exceed $1, 300 per household. Costs vary significantly by geography, with the largest costs occurring in some western regions of the United States, the Gulf Coast, and Florida. Climate costs also typically disproportionately burden lower-income households. Our work suggests the importance of research that looks beyond rising temperatures to extreme weather events; so far, natural disasters account for the bulk of the burden of climate change in the United States. |
| JEL: | H23 Q53 Q54 Q58 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34525 |
| By: | del Salto-Calderón, Katherine (Max Planck Institute for Demographic Research); Wilde, Joshua (University of Oxford) |
| Abstract: | This study estimates the effect of climate change on contraceptive use in a global context. We link women’s monthly contraceptive calendar data from the Demographic and Health Surveys in 44 low- and middle-income countries with high resolution daily temperature data, exploiting the random component of local temperature deviations to causally estimate this effect. We find that high temperatures impact contraceptive use, driven by changes in short-acting reversible contraception. However, these impacts are region- specific: while temperature shocks reduce contraceptive use in sub-Saharan Africa and Latin America, they increase in South and Southeast Asia. We find clear heterogeneities by education, age, parity, and urban/rural status. Our estimates imply that temperature-related climate change in sub-Saharan Africa – the most impacted region – will reduce contraceptive use by 2.4-4.3 percent by 2100. We conclude that the disproportionate worsening of climatic conditions in low- and middle-income countries will exacerbate already-existing global disparities in contraceptive access and use. |
| Keywords: | fertility, temperature, climate change, contraception, demography |
| JEL: | I15 J13 Q54 O15 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18277 |
| By: | Connor, Dylan S.; Sheehan, Connor; Jang, Jiwon; Kemeny, Tom; Suss, Joel; Molina, Mercedes; Xie, Siqiao; Gu, Zhining; Saenz, Joseph L. |
| Abstract: | Using a new database on the net worth and self-reported cognitive impairment for almost two million adults, this paper provides the first large-scale evidence linking community wealth to age-related cognitive decline. This assessment is timely as widening geographic wealth gaps in the USA fuel disparities in access to public goods and amenities, positioning community wealth as a critical determinant of cognitive health. Conditioning on personal wealth and other risk factors, we find that a standard deviation increase in community wealth is associated with a 6.7% relative risk reduction in cognitive impairment across the national population of older adults, rising to 13.7% for those residing in the poorest fifth of communities. Community wealth matters more than relative inequality, and its associated protective effects are larger for non-white, non-college educated, and low net worth householders. This is plausibly because these individuals rely more on the public goods and services underwritten by local affluence. The economic fragmentation of American communities thus poses a growing threat to the cognitive health of Americans, especially among those from socially vulnerable and marginalized backgrounds. |
| Keywords: | spatial wealth inequality; aging; subjective cognitive impairment; cognitive health; ADRD |
| JEL: | N0 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:130328 |
| By: | Chakrovorty, Sanchita |
| Abstract: | The overall health of a population can be viewed as an indicator of social welfare. Yet, individual health itself is complex and multidimensional, influenced by endogenous choices, as well as exogenous environmental and genetic factors. Moreover, defining a mapping from individual health to social welfare can involve onerous assumptions. This paper adopts a nonparametric approach to ranking individual health as a function of several biomarkers--Body Mass Index (BMI), glycohemoglobin (HbA1c), total cholesterol, alanine aminotransferase (ALT), serum creatinine, white blood cell counts (WBC), etc. With this ranking in hand, we use a nonparametric approach to map individual health into social welfare using minimal assumptions (e.g., monotonicity and concavity). Results show that the distribution of wellbeing became worse-off from 1988 to 2018, although there has been a slight rebound since 2009. Moreover, the distribution has widened: those prone to a higher health status have become better-off while those prone to poorer health have become worse-off which, thereby raising inequality and here policy implications need to be focused on. Finally, we construct counterfactual distributions of wellbeing to explore if the change in the distribution is attributed to socio-demographic factors. Findings show that age, gender and race/ethnicity cells combined with education can explain very little of the negative shift than the attributes without education while leaving a substantial portion unexplained. |
| Keywords: | Consumer/Household Economics |
| Date: | 2024–07–27 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea24:344176 |
| By: | Yuichi Watanabe (Institute of Developing Economies, Japan External Trade Organization (IDE-JETRO), Chiba, Japan); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University, Tokyo, Japan) |
| Abstract: | There exists a globally growing concern regarding the prevention and control of noncommunicable diseases (NCDs), and Japan is no exception, as lifestyle-related NCDs have a significant impact on public health. To prevent the prevalence of metabolic syndrome and control rising healthcare costs, the Japanese government initiated a novel annual health checkup program in April 2008. We examine how organized prevention programs affect healthcare outcomes, separately identifying screening effects versus behavioral intervention effects while documenting substantial heterogeneity across demographic subgroups. Using comprehensive administrative data from Japan’s National Health Insurance system (FY 2011–2016), we employ instrumental variable estimation exploiting peer participation rates to address selection bias in voluntary health checkups, and difference-in-differences estimation leveraging systematic assignment rules for behavioral guidance interventions. Health checkup participation generates minimal average effects but substantial heterogeneity: younger participants (40–64 years) reduce hospitalization, while elderly participants (65–74 years) increase outpatient care expenditures. Males experience higher inpatient care costs; females significantly reduce hospitalization. Income-based heterogeneity is absent, suggesting Japan’s universal coverage successfully minimizes financial barriers. Strikingly, light-touch motivational support proves more effective than intensive sixmonth guidance at increasing outpatient care utilization, with effects concentrated among elderly, female, and lower-income populations. These findings reveal fundamental misalignment in current program design: resource-intensive interventions target populations least responsive to behavioral guidance while the most responsive populations receive minimal support. Our results challenge conventional dose-response assumptions and have important implications for optimal prevention program design in aging societies worldwide, suggesting substantial efficiency gains through reallocation toward targeted light-touch interventions. |
| Keywords: | Health checkups, Behavioral guidance, Health care, Heterogeneous effects, Administrative data |
| JEL: | I12 I13 I18 J14 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2525 |
| By: | Ojha, Manini; Gupta, Sagnik Kumar; Dhamija, Gaurav |
| Abstract: | This paper evaluates the causal impact of women's exposure to the internet on their attitudes towards intimate partner violence (IPV) using data from the most recent round of the National Family Health Survey (NFHS-5). To address potential endogeneity, we exploit exogenous variation in district-level mobile tower density in India as an instrument for women's internet exposure. The instrumental variables estimation provides robust evidence that a woman's exposure to internet reduces her likelihood of justifying IPV by 21 percentage points. We also provide suggestive evidence that higher awareness and physical mobility are potential mechanisms through which internet exposure shapes attitudes. Our findings highlight the transformative potential of digital connectivity in challenging regressive gender norms. |
| Keywords: | Internet Exposure, Tower Density, Intimate Partner Violence, Attitudes, Instrumental Variable, NFHS, India |
| JEL: | C26 J12 J16 I30 O12 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1696 |
| By: | Sara Markowitz; Katie E. Leinenbach |
| Abstract: | Suicide rates among older adults have been rising over time in the United States. At the same time, more individuals have been suffering with chronic pain and illness, which are often underlying risk factors for suicide. As self-medication with marijuana has become common, we ask whether access to legal marijuana for medical and recreational purposes reduces suicides rates among older individuals. We find that suicide rates among older age groups decline following the opening of recreational marijuana dispensaries, especially among older Whites, and middle-aged White males and females with low levels of education. |
| JEL: | I0 K0 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34519 |
| By: | Luke N. Condra; Daniel B. Jones; Randall P. Walsh |
| Abstract: | How does the trauma associated with exposure to racial violence affect economic outcomes? We study this question in the context of lynchings of Black citizens in the American South between 1880 and 1940 and provide systematic evidence of long-run economic impacts of that violence for the broader community and the effects’ persistence across generations. First, using data on averted lynchings and matched placebos as counterfactuals, we show that children indirectly exposed to the racial trauma of lynchings (proxied by close proximity to the victim’s household location) exhibit a reduction in occupational income score and likelihood of holding a white collar occupation, in their prime earning years as adults. We also observe intergenerational effects: children of the individuals who were exposed (as children) to lynchings see, as adults observed in 1940, a reduction in their income relative to counterfactual individuals. By documenting long-run and intergenerational economic effects of exposure to lynchings, we add empirical evidence to an interdisciplinary literature that identifies racial trauma as a distinctive and durable form of psychological harm. |
| JEL: | N0 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34523 |
| By: | Sumit Agarwal; H. Luke Shaefer; Samiul Jubaed; William Schneider; Eric Finegood; Mona Hanna |
| Abstract: | Infants are most vulnerable to child maltreatment, which may be due in part to economic instability during the perinatal period. In 2024, Rx Kids was launched in Flint, Michigan, achieving near 100% aggregate take up and providing every expectant mother with unconditional cash transfers during pregnancy and infancy. Synthetic difference-in-differences was used to compare changes in allegations of maltreatment within the first six months of life in Flint before and after implementation of Rx Kids relative to the corresponding change in control cities without the program. In the three years prior to the implementation of Rx Kids, the proportion of infants with a maltreatment allegation within the first six months of life was 21.7% in Flint and 19.5% among control cities. After implementation of Rx Kids in 2024, the maltreatment allegation rate dropped to 15.5% in Flint, falling below the maltreatment allegation rate of 20.6% among the control cities. Rx Kids was associated with a statistically significant 7.0 percentage-point decrease in the maltreatment allegation rate (p = 0.021), corresponding to a 32% decrease relative to the pre-intervention period. There was a decrease in the rate of neglect-related, non-neglect-related, and substantiated allegations; these were directionally consistent with the primary outcome but not statistically significant. Results were robust to alternative model specifications. The Rx Kids prenatal and infant cash prescription program led to a significant reduction in allegations of maltreatment among infants. These findings provide important evidence about the role of economic stability in preventing child welfare system involvement. |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2511.19570 |
| By: | Izabela Jelovac (GATE Lyon Saint-Étienne - Groupe d'Analyse et de Théorie Economique Lyon - Saint-Etienne - UL2 - Université Lumière - Lyon 2 - UJM - Université Jean Monnet - Saint-Étienne - EM - EMLyon Business School - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | In this note, we revise the theoretical condition in Regan (2008) under which the price of brand-name drugs increases with the number of generic competitors—a phenomenon known as the generic paradox. We show that this condition derives from the analysis of an interior solution while it actually excludes the existence of an interior solution. Therefore, the theoretical result in Regan (2008) arises from an internal inconsistency. |
| Keywords: | Generic entry, Price competition, Market segmentation |
| Date: | 2025–11–20 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05375917 |
| By: | Huang, Junhua; Valizadeh, Pourya; Bryant, Henry; Priestley, Samuel |
| Abstract: | During the COVID-19 pandemic, the United States government introduced various pandemic-related relief measures to support low-income households participating in the Supplemental Nutrition Assistance Program (SNAP). Among these changes was the emergency allotment (EA), which provided additional benefits to help SNAP beneficiaries maintain access to essential food items during these challenging times. However, beginning in 2021, the expiration of EA, a temporary increase, led to a minimum reduction of $95 per month in benefits for program participants. This study estimates the impact of EA expiration on monthly fresh fruit and vegetable (FV) spending of SNAP households. Drawing on novel transaction-level food purchase data, we identify SNAP households based on method of payments, specifically Electronic Benefit Transfer (EBT) card usage, which is derived from uploaded food purchase receipts rather than self-reporting. Our general research design leverages variation across states and over time due to the staggered expiration of EA payments via difference-in-differences estimators. Our findings indicate a robust negative impact on fresh FV spending following the termination of EA, with a reduction of approximately 4%, translating into a decrease of roughly $8 per month for the average SNAP household, or $2.20 per person per month. This reduction suggests that, although statistically significant, the decrease is not substantial in terms of its impact on health. Indeed, we find that fresh FV spending is highly inelastic with respect to the SNAP benefit level, and simple changes to that level are unlikely to improve diet quality among poor households, if that is a policy goal. |
| Keywords: | Agribusiness, Consumer/Household Economics, Food Security and Poverty |
| Date: | 2024–07–23 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea24:344186 |
| By: | Paula Eugenia Gobbi; Anne Hannusch; Pauline Rossi |
| Abstract: | Much of the observed cross-country variation in fertility aligns with the predictions of classic theories of the fertility transition: countries with higher levels of human capital, higher GDP per capita, or lower mortality rates tend to exhibit lower fertility. However, when examining changes within countries over the past 60 years, larger fertility declines are only weakly associated with greater improvements in human capital, per capita GDP, or survival rates. To understand why, we focus on the role of family institutions, particularly marriage and inheritance customs. We argue that, together with the diffusion of cultural norms, they help explain variations in the timing, speed and magnitude of the fertility decline. We propose a stylized model integrating economic, health, institutional and cultural factors to study how these factors interact to shape fertility transition paths. We find that family institutions can mediate the effect of economic development by constraining fertility responses. |
| Keywords: | Fertility transition, culture, Family institutions |
| JEL: | J13 |
| Date: | 2025–11–28 |
| URL: | https://d.repec.org/n?u=RePEc:eca:wpaper:2013/397122 |