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on Health Economics |
| By: | Hamish W. Low; Costas Meghir; Luigi Pistaferri; Alessandra Voena |
| Abstract: | The 1996 U.S. welfare reform introduced time limits on welfare receipt. We use quasi-experimental evidence and a rich life cycle model to understand the impact of time limits on different margins of behavior and well-being. We stress the impact of marital status and marital transitions on mitigating the cost and impact of time limits. Time limits cause women to defer claiming in anticipation of future needs and to work more, effects that depend on the probabilities of marriage and divorce. They also cause an increase in employment among single mothers and reduce divorce, but their introduction costs women 0.7% of lifetime consumption, gross of the redistribution of government savings. |
| Keywords: | Welfare; Welfare reform; Limited commitment |
| JEL: | D91 H53 J12 J21 |
| Date: | 2025–12–19 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fedhwp:102278 |
| By: | Bhalotra, Sonia R. (University of Warwick); Clarke, Damian (University of Chile); Venkataramani, Atheendar (Massachusetts General Hospital) |
| Abstract: | We leverage the introduction of the first antibiotic therapies in 1937 to examine the long-run effects of early-childhood pneumonia on adult educational attainment, employment, income, and work-related disability. Using census data, we document large average improvements across all outcomes, alongside substantial heterogeneity by gender and race. Among women, health gains led to changes in marriage and fertility that partially offset their labor market improvements. Among Black Americans, we uncover a pronounced gradient linked to systemic racial discrimination in the pre-Civil Rights era: individuals born in more discriminatory Jim Crow states realized much smaller gains than those born in less discriminatory states, despite larger reductions in pneumonia exposure. There is no similar gradient among white Americans. Together, these findings highlight the central role of institutional environments in shaping whether investments in early-life health translate into long-run socioeconomic gains. |
| Keywords: | infectious disease, institutions, systemic discrimination, disability, income, education, human capital production, race, medical innovation, early childhood, pneumonia, antibiotics, sulfa drugs |
| JEL: | I10 I14 J71 H70 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18327 |
| By: | Alexander Ahammer; Martin Halla; Pia Heckl; Rudolf Winter-Ebmer |
| Abstract: | Long-term unemployment among older workers is particularly difficult to overcome. We study the impacts of a large-scale job guarantee program that offered up to two years of fully subsidized employment to long-term unemployed individuals aged 50 and above. Using a sharp age-based discontinuity in eligibility, we find that participation increased regular, unsubsidized employment by 43 percentage points two years after the program ended. The gains are driven by transitions into new firms and industries, rather than continued subsidized employment, and we find no evidence of displacement effects for non-participants or spillovers to family members. The program had no measurable short-run health effects. |
| Keywords: | Long-term unemployment, temporary job guarantee, subsidized employment, health status |
| JEL: | J64 J08 J78 I14 H51 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:jku:econwp:2025-12 |
| By: | Libertad González Luna; Parijat Maitra |
| Abstract: | We examine the impact of early elective birth timing on children’s health and educational outcomes, focusing on cognitive development as measured by elementary school grades. We exploit a natural experiment in Spain: the abrupt termination of a generous child benefit at the end of 2010, which led to a sharp increase in elective deliveries during the final week of December. Children born during this spike had slightly shorter gestation periods and lower birth weights (within the normal range), and experienced a higher incidence of respiratory disorders during infancy. We find that the affected cohort of children had significantly lower academic performance at age seven (in second grade), suggesting large persistent effects on cognitive development. Our results provide causal evidence on the medium-term costs of early elective deliveries, and underscore the link between neonatal health and human capital. |
| Keywords: | education , health , birthweight , family benefits |
| JEL: | I2 I1 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:upf:upfgen:1933 |
| By: | Joan Costa-i-Font; Anna Nicinska |
| Abstract: | Education systems serve various purposes, including the enhancement of later-life health, though its effect can differ by socio-political regime. This paper examines the effects of exposure to communist education, which exposed children to a distinct cur-Curriculum and ideological content on later-life health. We exploit a novel dataset that collects information on compulsory education reforms in several European countries, with different cohorts exposed and unexposed to Soviet communist education. Using a difference-in-differences (DiD) design, we show that while the extension of compulsory education improved some relevant measures of health, communist education encompassed an additional health-enhancing effect. We document that the effect remains robust when using staggered DiD approaches and various robustness tests, and that it is explained by the priority given to physical education in school curricula, together with an increased likelihood of marriage. |
| Keywords: | communist education, health education gradient, later-life health, physical activity, Europe, Soviet Communism |
| JEL: | I18 I26 P36 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12313 |
| By: | Nguyen, Ha; Mitrou, Francis |
| Abstract: | In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influence childbearing decisions among Australians of reproductive age. Using an individual fixed effects model and exogenous variation in cyclone exposure, we find a robust and substantial decline in fertility, occurring only after the most severe category 5 cyclones, with the effect weakening as distance from the cyclone’s eye increases. We find no evidence of delayed cyclone effects, indicating that the fertility loss attributable to these most severe cyclones is permanent. Our findings are robust to extensive validity checks, including a falsification test and various randomization tests. The fertility decline is most pronounced among younger adults, individuals with lower educational attainment, those childless at baseline, and those lacking prior private health or residential insurance. While physical health, financial constraints, and migration appear unlikely to drive the effect, the evidence points to reduced family formation, increased marital breakdown, child mortality, cyclone-induced home damage, elevated psychological stress, and heightened risk perceptions as plausible mechanisms. |
| Keywords: | Natural Disasters; Cyclones; Fertility; Marriage; Australia |
| JEL: | D1 J1 J12 J13 Q5 Q54 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:126989 |
| By: | Giorgio Chiovelli; Stelios Michalopoulos; Elias Papaioannou; Sandra Sequeira |
| Abstract: | We study the impact of conflict-driven displacement on human capital and occupational shifts, focusing on the Mozambican civil war (1977 - 1992), during which millions of civilians were forcibly displaced to the countryside, cities, and neighboring countries. Reconstructing the movements of the entire population during the civil war, we examine the consequences of multiple displacement trajectories within a unified framework. First, we characterize the education and sectoral employment of the universe of (non)displaced. Second, we exploit variation in displacement experiences among extended kin members during their school-going years to account for shared household characteristics. Displacement is associated with significant gains in education. Third, employing a “movers design, ” we show that minors displaced earlier to better districts experienced an increase in educational attainment. Focusing on moves during the intensification of the war and when comparing members of the same household, regional childhood exposure effects remain strong, whereas spatial sorting vanishes. Fourth, we jointly estimate place-based, spatial sorting, and uprootedness effects, showing that all forces are at play. Fifth, a small survey in Mozambique’s largest north- ern city reveals long-term effects: internally displaced report higher education than their siblings who stayed behind, but lower social capital and worse mental health relative to locals. Our findings demonstrate that displacement shocks can foster human capital accumulation, even in very low-income settings, albeit at the cost of enduring social and psychological traumas. |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:mnt:wpaper:2508 |
| By: | Alessandra Cassar (University of San Francisco, Department of Economics); Eeshani Kandpal (Center for Global Development); Miranda Lambert (Texas A&M University, Department of Economics); Christine Mbabaze Mpyangu (Makerere University, Department of Peace and Religious Studies); Danila Serra (Texas A&M University, Department of Economics and IZA) |
| Abstract: | Girls and women are disproportionately exposed to forced displacement and physical and sexual violence during armed conflicts. Between the mid-1980s and the mid-2000s, the Lord’s Resistance Army (LRA) abducted over 50, 000 people in Northern Uganda, including more than 25, 000 children. We study approximately 550 women in Northern Uganda, half of whom were abducted before or during adolescence. Leveraging the plausibly exogenous nature of LRA abductions and combining incentivized behavioral games with detailed survey data, we assess the long-term effects of childhood abduction on a range of socioeconomic and mental health outcomes, as well as on behavioral traits and preferences. Childhood abduction significantly reduces educational attainment but has little persistent effect on economic activity, marriage outcomes, or risk tolerance. In contrast, nearly two decades after the conflict ended, formerly abducted women still exhibit substantially higher rates of depressive symptoms and perceived stress, heightened stress responses, reduced social support and prosociality, and greater grit. These findings highlight the need for post-conflict interventions that prioritize long-term mental health and social reintegration, alongside standard investments in education and livelihoods. |
| Keywords: | war, childhood abduction, mental health, gender |
| JEL: | D74 J16 Z13 |
| Date: | 2025–12–17 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:wpaper:738 |
| By: | Hsinyu (Samuel) Tseng; Douglas A. Webber |
| Abstract: | We use the longitudinal component of the Current Population Survey to compare transition rates into and out of disability and employment prior to and after the onset of the pandemic. We find that one-third of the increased employment rate among disabled people is due to the excess incidence of disability seen following the pandemic, while the other two-thirds is attributable to higher participation among people whose disabilities were unrelated to the pandemic. Further, we find evidence that these increases are concentrated in occupations with higher rates of telework. |
| Keywords: | Disability; Labor force; Employment |
| JEL: | J22 J14 |
| Date: | 2025–10–15 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fedgfe:2025-95 |
| By: | Frantisek Bartos (Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands); Martina Luskova (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Ksenyia Bortnikova (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Karolina Hozova (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Klara Kantova (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Zuzana Irsova (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Tomas Havranek (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic) |
| Abstract: | Physical exercise is widely believed to enhance cognition, yet evidence from meta-analyses remains mixed. Here we compile a study-level dataset of 2, 239 effect-size estimates from 215 meta-analyses of randomized controlled trials examining the effect of exercise on general cognition, memory, and executive functions. We find strong evidence of selective reporting and large between-study heterogeneity. Analyses adjusted for publication bias reveal average effects much smaller than commonly reported (general cognition: standardized mean difference, SMD, = 0.227, 95% credible interval 0.116 to 0.330; memory: SMD = 0.027, 95% credible interval 0.000 to 0.227; executive functions: SMD = 0.012, 95% credible interval 0.000 to 0.147), along with wide prediction intervals spanning both negative and positive effects. Subgroup analyses identify specific population-intervention combinations with more consistent benefits. Overall, broad claims of generalized cognitive enhancement resulting from physical exercise appear premature; the evidence supports targeted, population- and intervention-specific recommendations. |
| Keywords: | Publication bias, Bayesian, Brain health, Evidence, Policy |
| JEL: | I12 I10 J24 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:fau:wpaper:wp2025_31 |
| By: | Siwar Khelifa; Jie He |
| Abstract: | This paper provides the first evidence from a developing-country setting on the long-term educational impacts of early-life exposure to a major environmental regulation. We study China's 1998 Two Control Zones policy and implement a difference-in-differences design comparing adjacent birth cohorts in targeted and non-targeted counties. We find no detectable effects of early-life exposure to the policy on long-term educational outcomes. Across a wide range of measures, including high school attendance, academic versus vocational track placement, and high-quality school attendance around age 15, as well as college entrance exam participation, exam scores, and post-secondary enrollment around age 18, the estimates are statistically indistinguishable from zero. These null results are robust across alternative specifications and hold in subgroups defined by gender and maternal education. |
| Keywords: | Education, environmental regulation, TCZ policy, early-life conditions, China |
| JEL: | I18 I24 J24 Q51 Q56 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:irn:wpaper:25-08 |
| By: | Stacciarini, João Henrique Santana (Federal University of Goiás) |
| Abstract: | In recent decades, the pharmaceutical industry has consolidated itself as one of the most powerful sectors of the global economy and, beyond innovation, sustains part of that power through controversial strategies of marketing, lobbying, and influence over research, regulation, clinical guidelines, and medical practice itself. This science report synthesizes the main findings of the study “Relationships and Influences of the Pharmaceutical Industry on Medical Practice”, based on an analysis of Open Payments (CMS), the United States’ public system that records transfers of value to physicians and teaching hospitals. The data indicate that, between 2015 and 2024, manufacturers reported about US$ 23.2 billion in payments to physicians and US$ 23.3 billion to teaching hospitals, highlighting the scale of a mechanism that operates through both large contracts and everyday “courtesies.” The reviewed international literature converges in associating these benefits with changes in prescribing patterns - often subtle and even unconscious - including a greater preference for brand-name drugs, closer alignment with products from paying companies, and increased costs for health systems, sometimes with marginal clinical gains. Edge cases, such as controversies involving Xarelto and the Insys/Subsys promotional scheme amid the opioid crisis, illustrate how incentives and promotion can approach illicit practices, although the more common influence is discreet and routine. The report discusses explanatory mechanisms from social psychology and communication - reciprocity, self-serving bias, and the third-person effect - and highlights the central role of meals and small gifts, with evidence of a dose–response effect, suggesting that repeated interactions may increase receptivity to promotional messages even without physicians’ conscious awareness. Finally, it addresses the “hidden curriculum” in medical schools and argues that transparency and caps on gifts are insufficient, advocating structural responses: stronger restrictions and transparent, institutional funding models with independent governance to protect clinical integrity, reduce conflicts of interest, and preserve public trust. |
| Date: | 2026–01–02 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:bkrq9_v1 |
| By: | Stacciarini, João Henrique Santana (Federal University of Goiás) |
| Abstract: | With annual revenues of around US$ 1.5 trillion, the pharmaceutical industry has, in recent decades, consolidated itself as one of the most powerful sectors in the global economy, exerting significant influence over knowledge production and medical practice. This article critically examines relationships between the pharmaceutical industry and medical education and practice, focusing on transfers of value – such as payments, gifts, and financial incentives – directed to physicians and academic institutions, from undergraduate training to professional practice. The study combines a descriptive documentary analysis of data from the Open Payments program in the United States – where such transfers are regulated and publicly disclosed – with a narrative review of the international literature. Empirically, it is observed that between 2015 and 2024, reporting entities under Open Payments (including drug and medical device manufacturers) transferred approximately US$ 23.2 billion to physicians and US$ 23.3 billion to teaching hospitals in the United States, primarily in the form of meals, travel, educational support, consulting, research, and other remuneration. In light of the international literature, these transfers are examined as part of engagement and influence strategies targeting prescribers: observational studies indicate associations – often operating unconsciously – between receiving benefits and increased prescribing of products from paying companies, a greater share of brand-name drugs at the expense of generics, the promotion of products with marginal clinical benefit, and higher costs for health systems. Drawing on theoretical frameworks and concepts from social psychology, behavioral economics, and communication theory – such as reciprocity, self-serving bias, unconscious influence, and the third-person effect – the article discusses how even low-value benefits, such as meals, can function as mechanisms of socialization and become embedded in the “hidden curriculum” of medical training, normalizing conflicts of interest and shaping professional identities. Finally, the article argues for transforming the logic governing relationships between industry and the medical field through greater transparency, restrictions on gifts, and the strengthening of institutional models of funding and governance aligned with public health. |
| Date: | 2025–12–16 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:q8w3z_v1 |
| By: | Maciej Albinowski; Piotr Lewandowski; Karol Madoñ; Mateusz Smoter |
| Abstract: | The report analyses patterns of nicotine product consumption in Poland and the potential effects of regulatory interventions. The survey (June 2025, over 4, 500 respondents aged 18–64) shows that traditional cigarettes remain the dominant product, although their popularity and frequency of use are lower in younger age groups. While most traditional cigarette users do not combine them with other products, consumers of alternative products typically use more than one nicotine product. Perceived harmfulness is low, especially for alternative products: only 38% of daily e-cigarette users consider them very harmful, and among heated tobacco users this figure is just 30%. Demand is price sensitive, with multiproduct users responding more strongly, though they are less likely to quit nicotine altogether. Price increases for e-cigarettes introduced in 2025 may reduce the number of primary e-cigarette users by 659 thousand (62%), of whom 178 thousand would quit nicotine. To substantially reduce the number of nicotine consumers, price increases for traditional cigarettes are also necessary. |
| Keywords: | Nicotine consumption, excise tax |
| JEL: | I18 D12 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:ibt:report:rr012025 |
| By: | Maciej Albinowski; Piotr Lewandowski; Karol Madoń; Mateusz Smoter |
| Abstract: | Problem: High consumption of nicotine products generates significant social costs. An increase in excise duty on individual products may have a limited impact on consumption if consumers are switching between products. Main message: The September 2025 excise increase on e-cigarettes significantly altered product choices but only moderately reduced the number of nicotine consumers. A substantial reduction in the consumer base requires simultaneous excise increases across all products. There is scope for stronger public education policies, as many users underestimate the harms of alternative products. |
| Keywords: | Nicotine consumption, excise tax |
| JEL: | I18 D12 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:ibt:ppaper:pp042025 |