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on Health Economics |
| By: | Abby E. Alpert; Atul Gupta; Michael R. Richards; Sarah D. Schutz; Christopher M. Whaley |
| Abstract: | Direct-to-consumer advertising is pervasive in US healthcare markets, but little evidence exists on the effects of advertising by hospitals, second only to drug manufacturers in medical marketing. Advertising may help facilities increase market share by stealing existing patients, expand the market for hospital care, or do both. Regardless, it has important public finance implications due to the large sums of taxpayer funds spent by federal and state governments to subsidize hospital operations and finance care through public insurance programs. This paper provides the first causal evidence, to our knowledge, on the market expansion effects of hospital advertising. To obtain causal estimates, we leverage the fact that spikes in political advertising significantly crowd out hospital advertising in the same market, motivating an instrumental variables design. Using claims data on the universe of Traditional Medicare beneficiaries, we find that advertising expands aggregate patient volume and spending on inpatient care – though to a modest degree (implied elasticities of 0.06 and 0.05, respectively). Although the overall effect of advertising on hospital outpatient care is muted, for-profit hospitals obtain higher outpatient Medicare volume and revenue with greater advertising. Across both care settings, therefore, Medicare spending increases with hospital advertising. |
| JEL: | H51 I11 M3 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34657 |
| By: | Orazio Attanasio |
| Abstract: | This paper reviews recent developments in the economics of human development, focusing on the early years of life as a critical period for shaping long-term outcomes. Early childhood development is inherently multidimensional: cognitive and socioemotional skills evolve dynamically and interact with health, nutrition, and environmental influences. Economists have contributed to this field by providing a conceptual unifying framework that highlights how key drivers of development reflect the choices of individuals operating under incentives and constraints. Within this framework, the paper emphasizes two central challenges: understanding the interactions among multiple dimensions of development and identifying causal links - particularly the effects of different inputs at different ages. Measurement issues are a recurring theme, given the difficulty of assessing young children and the need for comparability across contexts. The paper also stresses these issues’ policy relevance for poverty reduction and social mobility by discussing early childhood interventions in both developed and developing countries. |
| JEL: | D1 J24 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34651 |
| By: | Bhalotra. Sonia (Department of Economics, University of Warwick, CAGE, IFS, CEPR, RFBerlin, IZA, CESifo); Clarke, Damian (Department of Economics, Universidad de Chile, University of Exeter, and IZA); Venkataramani, Atheendar (Department of Medical Ethics and Health Policy, University of Pennsylvania and NBER) |
| 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 gains on all outcomes, alongside substantial heterogeneity by race and gender. On average, Black men exhibit smaller schooling gains than white men but larger employment and earnings gains. Among Black men (and women), we identify a pronounced gradient in gains 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. There is no similar gradient among white Americans. Women of both races exhibit smaller education and earnings gains than men on average, consistent with cultural and institutional barriers to women’s work. Our findings highlight the role of opportunities in shaping the extent to which investments in early-life health translate into longer run economic gains. |
| Keywords: | early childhood ; medical innovation ; race; human capital production ; education ; income ; disability ; systemic discrimination ; institutions ; infectious disease ; pneumonia ; antibiotics ; sulfa drugs JEL codes: I10 ; I14 ; J71 ; H70 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:wrk:warwec:1594 |
| By: | Sam Bock; Jasmin Moshfegh; Jonathan Zhang |
| Abstract: | The arrival of GLP-1 medications has been described as one of the most important health care innovations in recent years. We provide large-scale quasi-experimental evidence on their real-world impacts by exploiting variation in the eventual prescribing propensities of patients’ pre-existing primary care providers. Using a panel intent-to-treat design, we compare outcomes for 1.4 million diabetic or obese veterans based on their 2018 provider’s eventual propensity to adopt GLP-1s, leveraging comprehensive electronic health records and biomarker data from the Veterans Health Administration, a setting with minimal insurance attrition and low-cost access to these drugs. Patients whose providers become higher propensity adopters experience substantial improvements in glycemic control and clinically meaningful weight loss; our treatment-on-the-treated estimates closely match estimates from clinical trials. Despite these metabolic benefits, we find no statistically significant effects on emergency department utilization, mental health and substance use outcomes, or non–GLP-1 medical spending through 2024. |
| JEL: | H51 I1 I12 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34667 |
| By: | Coady Wing; Sih-Ting Cai; Daniel W. Sacks; Kosali I. Simon |
| Abstract: | Glucagon-like peptide-1 receptor agonists (GLP-1s) represent a major improvement in treatment of diabetes, obesity, and cardiovascular risk reduction, but they are also among the most expensive drugs in widespread use and the subject of significant policy debate. The high price of these drugs may overstate their net cost if the health improvements they produce lead to reduced downstream health care use and medical spending, that is, cost offsets. We estimate such offsets using insurance claims data, examining the effects of GLP-1 initiation on subsequent GLP-1 use and spending, and on other non-GLP-1 spending. We use a stacked difference-in-differences design, comparing patients initiating GLP-1 medication to not-yet-treated controls who initiate GLP-1s several months or years later, allowing us to control for underlying time trends and baseline characteristics. Overall, we do not find a reduction in downstream medical spending. Although GLP-1 initiation reduces spending on other diabetes medications, total non-GLP-1 spending increases, driven by higher outpatient health care use; GLP- 1 drug spending rises mechanically. For health care payers, the relevant cost of GLP-1 initiation therefore extends beyond the sticker price of the drug. We find similar results across subgroups of GLP1 initiators including those with prior cardiovascular disease and those without diabetes (consistent with obesity indication). Our main results examine spending responses over the first year after initiation. However, we also estimate longer run effects in a smaller sample and find no cost offsets even five years after GLP-1 initiation. Taken together, these results suggest that payers facing the costs of GLP-1 coverage are unlikely to see large savings from reduced spending on other care. If GLP-1 therapies ultimately yield cost savings, they are likely to occur only over longer horizons or through non-medical channels. |
| JEL: | I11 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34678 |
| By: | Maya Rossin-Slater; Adrienne Sabety; Aileen Wu |
| Abstract: | We find that preschools facilitate early diagnosis and treatment of conditions that can hinder learning. Low-income children born shortly before their state's school-entry cutoff date are 16.9, 9.3, and 14.8 percent more likely to be diagnosed with Attention Deficit Hyperactivity Disorder, a speech or language disorder, and a hearing or vision condition at ages three and four, compared to children born after the cutoff. They are also more likely to receive downstream services. Findings emphasize the role of earlier and longer exposure to public preschool in driving diagnostic gaps previously attributed to elementary school-entry and within-grade peer comparisons. |
| JEL: | I18 J13 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34677 |
| By: | Bhalotra. Sonia (University of Warwick); Daysal, N. Meltem (University of Copenhagen); Freget, Louis (Paris-Dauphine PSL); Hirani, Jonas Cuzulan (VIVE); Majumdar, Priyama (University of Warwick); Trandafir, Mircea (Rockwool Foundation); Wust, Miriam (University of Copenhagen); Zohar, Tom (CEMFI) |
| Abstract: | Using Danish administrative data linked to two independent, validated postpartum depression screenings, we study how postpartum mental health shocks shape women’s labor market trajectories. Event-study estimates show no pre-birth differences in trends between depressed and non-depressed mothers, but persistent employment gaps that widen immediately after birth. Health-care utilization patterns indicate that these differences reflect acute mental health shocks rather than pre-existing trends. The penalties are concentrated among less educated mothers and those in less family-friendly jobs. Our results highlight postpartum depression as a meaningful and unequal contributor to the motherhood penalty. |
| Keywords: | Postpartum depression ; motherhood penalty ; labor market inequality JEL codes: I12 ; J13 ; J16 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:wrk:warwec:1595 |
| By: | Amy Finkelstein; Matthew Gentzkow |
| Abstract: | A large literature has documented widespread variation in health care spending per capita across areas of the United States without correspondingly better health outcomes. Recent work has used mover designs to estimate the causal impact of place on both health care spending and mortality. In this paper, we investigate whether places that increase health care spending also tend to be places that increase health. We find that they do not and discuss the implications. |
| JEL: | H51 I1 I11 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34682 |
| By: | Jing Li; Kathleen M. McGarry; Lauren Hersch Nicholas; Jonathan S. Skinner |
| Abstract: | Existing evidence suggests that wealth may decline before dementia onset, but the mechanisms underlying these reductions are poorly understood. Using longitudinal data from the Health and Retirement Study, we compare household finance trajectories for individuals who later develop dementia and those who do not. We find that wealth divergence between the two groups is not explained by reduced earnings, higher healthcare spending, intentional “spend-down” to qualify for Medicaid coverage, state-dependent utility, or reverse causation by which wealth declines cause dementia. Instead, our results point to impaired financial decision-making beginning about six years prior to clinically recognizable dementia. |
| JEL: | G51 I10 I3 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34659 |
| By: | Onur Altındağ; Jane Greve; Yulya Truskinovsky |
| Abstract: | We use population-wide administrative data from Denmark and an event-study design spanning nearly two decades to examine the impact of having a parent with dementia on adult children’s labor market, physical health, and mental health outcomes. We find no meaningful effects on labor supply, earnings, or physical health care use. In contrast, mental health care use increases substantially, driven by daughters, beginning five years before a parent’s dementia-related death, peaking around the time of death, and converging to the counterfactual trend over seven years. Results suggest that robust long-term care policy can largely insulate adult children economically from parental dementia, but mental health spillovers persist, spurring nearly a decade of elevated use. |
| JEL: | D13 I12 J14 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34635 |
| By: | Costa-Font, Joan; Frank, Richard; Raut, Nilesh |
| Abstract: | The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level variation in stock market wealth from 1996 to 2016, we show that exogenous wealth shocks significantly reduce the probability of LTCI coverage, without altering Medicaid eligibility among people with housing and financial assets. The effect of shocks to liquid wealth strongly dominates the effect of housing wealth changes. A $100 K increase in housing (financial) wealth reduces the likelihood of LTCI coverage by 1.24 (3.22) percentage points. |
| Keywords: | long-term care insurance; housing assets; Medicaid; house prices; stock market price index; instrumental variables |
| JEL: | I18 J14 |
| Date: | 2026–03–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:130325 |
| By: | Ai, Dan; Crago, Christine L.; Mullins, Jamie T. |
| Abstract: | We examine the impact on mortality of co-exposure to hot temperatures and power outages using a county-level data set in the United States from 2015 to 2019. We find that each additional hour of power outage is associated with a 0.04% increase in monthly mortality rate. Furthermore, we show that the mortality effects of hot days are exacerbated by the co-occurrence of power outages, with each hour of power outage in a month increasing the harm from a hot day by 3%. Larger magnitudes of both of these effects are identified for longer and more widespread outages. We also show heterogeneity across climate regions in the estimated relationships, which is consistent with heavier reliance on technological adaptations to heat such as air conditioning in hotter climate regions. Taken together, our results suggest that the reliability of electricity grids serves as an important means of adaptation to high temperatures and climate change. |
| Keywords: | Health Economics and Policy |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360929 |
| By: | Weiwei Chen; Johanna Catherine Maclean; Michael T. French |
| Abstract: | Cannabis is the most used illicit drug in the United States. Though cannabis possession and consumption are prohibited federally, states are increasingly implementing laws that legalize this substance, initially for medical use and, more recently, for recreational use. We study the impact of recreational cannabis laws (RCLs) that allow all adults 21 years and older to legally consume and possess this substance on reports of child maltreatment and post-investigation service use. To do so, we combine difference-in-differences methods with administrative data on child maltreatment reports 2010-2022. Overall, we find no evidence that child maltreatment reports or service use are influenced by RCL adoption, though we find that physical abuse reports decline. Our findings indicate that recent efforts to legalize cannabis for recreational consumption have not led to an increase in child maltreatment reports. |
| JEL: | H0 I12 K0 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34673 |
| By: | Xudong An; Stuart A. Gabriel; Nitzan Tzur-Ilan |
| Abstract: | While exposure to wildfire smoke is adverse to human health, little is known about related impacts on household economics. In this paper, we link granular wildfire burn, smoke plume, air pollution, and consumer credit data to estimate the impact of extreme wildfire and related dispersed air pollution effects on consumer financial health. We find material effects including increased credit card and personal loan delinquencies among households distant from the burn perimeter but exposed to high levels of pollution. Further analysis of confidential supervisory data reveals elevated spending and indebtedness among pollution-treated households, which corroborates and explains the delinquency findings. Finally, we present evidence of health spending and work disruption channels of smoke effects. Findings indicate that the adverse effects of extreme wildfires are salient to substantial dispersed populations, including those distant from the fire zone. |
| Keywords: | Wildfires; Air Pollution; Consumer Credit; Financial Distress; Health |
| JEL: | G5 Q54 D12 |
| Date: | 2026–01–15 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fedpwp:102335 |
| By: | Agar Brugiavini; Raluca Elena Buia; Giacomo Pasini; Guglielmo Weber |
| Abstract: | Using data from the Survey on Health, Ageing and Retirement in Europe (SHARE), we explore whether the recent pension reforms enacted in Italy had an impact on the inequality in health among individuals. We construct a set of indexes measuring several health outcomes (both physical and mental) and analyze their evolution along time (across SHARE waves) from 2004 to 2022, by relating them to the households’ income. While we can observe some differences in the health-income gradient between genders, we do not find evidence of a positive relationship between the introduction of the pension reforms and an increase in inequality. |
| JEL: | I14 I38 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34655 |
| By: | Jason Abaluck; Robert Pless; Nirmal Ravi; Anja Sautmann; Aaron Schwartz |
| Abstract: | We deployed large language model (LLM) decision support for health workers at two outpatient clinics in Nigeria. For each patient, health workers drafted care plans that were optionally revised after LLM feedback. We compared unassisted and assisted plans using blinded randomized assessments by on-site physicians who evaluated and treated the same patients, as well as results from laboratory tests for common conditions. Academic physicians performed blinded retrospective reviews of a subset of notes. In response to LLM feedback, health workers changed their prescribing for more than half of the patients and reported high satisfaction with the recommendations, and retrospective academic reviewers rated LLM-assisted plans more favorably. However, on-site physicians observed little to no improvement in diagnostic alignment or treatment decisions. Laboratory testing showed mixed effects of LLM-assistance, which removed negative tests for malaria but added them for urinary tract infection and anemia, with no significant increase in the detection rates for the tested conditions. |
| JEL: | I10 I15 I18 O15 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34660 |
| By: | Serrano Bellido, Álvaro |
| Abstract: | In this paper, we analyze the relationship between telework and the mental health of workers in Austria, focusing specifically on depression, work–life balance, and subjective well-being. To do so, we use data from the 2021 European Working Conditions Survey (EWCS) and estimate several econometric models (linear probability models, ordinary least squares, and logit models) in order to assess the significance of the effects of telework on these indicators of individual well-being. The results show that, once sociodemographic and job-related controls are applied, telework does not exhibit a direct and robust effect on either subjective well-being or the probability of suffering from depression. In the case of work–life balance, telework initially appears to generate negative effects; however, after incorporating sociodemographic and labor controls, this significance disappears. Overall, therefore, the evidence suggests that the effects of telework on workers’ individual well-being depend more on labor and personal conditions than on the teleworking modality itself. This reinforces the importance of a contextualized analysis and is consistent with the findings of the existing literature. |
| Keywords: | Teletrabajo, depresión, bienestar subjetivo, conciliación laboral, salud mental. |
| JEL: | D69 I1 I3 J4 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:127620 |
| By: | Richard Yun |
| Abstract: | Homelessness in American cities is becoming an ever more prominent issue, but its causes remain contested, ranging from mental health and substance abuse to housing affordability and local labor markets. To shed light on this issue, I construct a novel MSA-level national panel of homelessness counts using data from the U.S. Department of Housing and Urban Development. Using a long-differencing regression specification with the changes in rent entered in piecewise linear form, I find that rent increases predict large increases in homelessness rates, but decreases have little to no effect. The same conclusions are reached when I use a quasi-differencing moment condition, assuming a multiplicative mean specification. Then, I propose a theoretical model of the low-end housing market that explains the asymmetry I find in the data. Finally, I outline an IV strategy that instruments rent changes with a Bartik instrument of predicted employment growth interacted with local housing-supply elasticities. My findings suggest that homelessness is a housing problem; however, because the response is sticky downward, effective policy must complement housing-market interventions with measures that address barriers faced by people experiencing homelessness. |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2601.00914 |
| By: | Rajashri Chakrabarti; Thu Pham; Beckett Pierce; Maxim L. Pinkovskiy |
| Abstract: | Among people in prime working age (25-54), around 7 percent have a disability of some kind. In this set of companion posts, we will examine how prime-aged workers with disabilities have fared in the labor market compared to the year prior to the pandemic. In this first post, we will show that people with disabilities are far less likely to be employed than people without disabilities, with both lower labor force participation and higher unemployment playing a role. We will also show that although employment rates of people with disabilities are very low, they have risen rapidly during the post-pandemic period, largely because of rising labor force participation. Our results are consistent with an increased prevalence of work from home (WFH) arrangements in the post-COVID period differentially benefiting people with disabilities. |
| Keywords: | disability; employment; unemployment; labor force participation |
| JEL: | J60 |
| Date: | 2026–01–12 |
| URL: | https://d.repec.org/n?u=RePEc:fip:fednls:102317 |
| By: | Elena Bassoli (ETH Zürich - Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology [Zürich]); Mathieu Lefebvre (BETA - Bureau d'Économie Théorique et Appliquée - AgroParisTech - UNISTRA - Université de Strasbourg - Université de Haute-Alsace (UHA) - Université de Haute-Alsace (UHA) Mulhouse - Colmar - UL - Université de Lorraine - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Jérôme Schoenmaeckers (ULiège - Université de Liège = University of Liège = Universiteit van Luik = Universität Lüttich) |
| Abstract: | In this paper, we present estimates of the effect of different care settings on health and well-being outcomes. We use data from the French CARE Survey, which interviews individuals aged 60 and above, to assess the differential effect of living at home or in a nursing home on mortality, morbidity and well-being indicators. In addition, we differentiate the effect between for-profit and non-profit nursing homes. To do so, we apply a propensity score matching approach that controls for selection on observables by matching people living at home with those living in nursing homes. Our results are threefold. First, we observe a positive effect of being in a nursing home on health outcomes but a negative effect on other well-being indicators such as happiness and nervousness. Second, the ownership status of the nursing home matters and the positive effect is stronger for non-profit and public nursing homes. Third, residents in for-profit nursing homes appear to to be worse off than those in nonprofit institutions. These findings raise important questions for the future organization and the funding of long-term care. |
| Keywords: | Private vs public, Care, Propensity score matching, Nursing homes, Health outcomes |
| Date: | 2025–09–07 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05460270 |