|
on Health Economics |
| By: | Pragya Kakani; Eric Yde; Genevieve Kanter; Richard G. Frank; Amelia M. Bond |
| Abstract: | We provide evidence of strategic transfer pricing by vertically integrated health care firms in response to insurer profit regulations. Insurers increased prices at vertically integrated pharmacies by 9.5% following the introduction of caps on insurer profits in Medicare Part D. We detect larger price increases by insurers that were at greatest risk of exceeding the allowable profit level. More than one-fifth of these higher prices were borne by the federal government. Our analysis illustrates that vertically integrated firms can evade profit regulation by “tunneling” profits to unregulated subsidiaries, undermining regulatory intent and increasing health care spending. |
| JEL: | I11 I13 I18 L14 L22 L41 L51 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35043 |
| By: | Ajin Lee; Maya Rossin-Slater; Becky Staiger; Amanda Su |
| Abstract: | An aging US population has raised important questions regarding the organization, delivery, and funding of long-term services and supports (LTSS), prompting many state Medicaid programs to shift from fee-for-service to managed care models for LTSS delivery. We analyze the effects of transitioning to managed LTSS (MLTSS) on health outcomes among dual-eligible Medicare-Medicaid beneficiaries aged 65 and older in Florida and New York. Using Medicare claims data and a differences-in-differences design leveraging county-by-county MLTSS rollouts, we find that MLTSS leads to a 4.2 percent increase in hospitalizations in Florida, but no significant change in New York. Analysis of preventive care suggests that declining flu vaccination rates in Florida may have contributed to increased hospitalizations from respiratory causes. These findings highlight important differences in MLTSS effects across states and underscore the value of Medicare data for measuring health effects in the dual-eligible population. |
| JEL: | I13 I18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35055 |
| By: | Tahir Andrabi; Benjamin Daniels; Jishnu Das |
| Abstract: | The poverty–mental health gradient varies substantially across populations, far more than sampling variation alone would predict. We treat this heterogeneity as a primary object of empirical interest. Using data collected four years after the 2005 Great Pakistan Earthquake from 126 villages spanning 0–75 km from the activated fault line, we show that in unaffected populations there is no correlation between consumption poverty and mental health. By contrast, among those nearest the fault, mental health improves by 0.12 standard deviations per log unit of consumption, while the relationship is a precise zero beyond 20 km. This gradient is robust to alternative distance thresholds, sample splits, and binary mental health measures, and is not mediated by acute household trauma. These results suggest that mass adversity can activate the poverty–mental health gradient, helping explain heterogeneity in the broader literature. |
| JEL: | I14 I15 O12 Q54 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35060 |
| By: | Fadlon, Itzik; Gross, Tal; Hoagland, Alex; Layton, Timothy |
| Abstract: | We use novel Medicare data that link spouses to examine how one spouse's sudden incapacitation affects their partner's need for formal care. A spouse's health shock causes their partner to be 18% more likely to visit a skilled nursing facility. That pattern reflects both a change in health and a shift from informal care to formal care. After one spouse is incapacitated, the other spouse becomes less sensitive to the price of formal care. We explore the implications for optimal health insurance contracts, showing that these within-household spillovers imply that the optimal health insurance contract should provide more generous coverage to those whose spouses are incapacitated relative to those whose spouses are available to provide care. |
| Keywords: | 3801 Applied Economics (for-2020), 3802 Econometrics (for-2020), 38 Economics (for-2020), 4203 Health Services and Systems (for-2020), 42 Health Sciences (for-2020), Health Services (rcdc), Aging (rcdc), Clinical Research (rcdc), Social Determinants of Health (rcdc), Generic health relevance (hrcs-hc), 3 Good Health and Well Being (sdg) |
| Date: | 2026–02–15 |
| URL: | https://d.repec.org/n?u=RePEc:cdl:ucsdec:qt5rw0629r |
| By: | Diego Ascarza-Mendoza (Tecnológico de Monterrey); Christian Velasquez (Banco Central de Reserva del Perú) |
| Abstract: | This paper studies the dynamics of mental health over the life cycle and introduces a parsimonious statistical model suitable for structural economic applications. Using data from the Panel Study of Income Dynamics (PSID), we document new facts on mental health dynamics: mental health generally improves with age, although it has worsened in more recent cohorts. Recovery rates are high and increase with age, and individuals are likely to remain in good mental health, with transitions depending on duration in the current state. Mental health is strongly correlated with fixed labor productivity and with the presence of depression early in life, suggesting that ex-ante conditions play a key role in shaping its evolution. Inequality in mental health remains stable across age. We estimate the model using the Simulated Method of Moments and show it replicates key empirical patterns. We then incorporate the statistical model into a life-cycle framework with endogenous labor supply decisions, calibrated to match observed differences in labor supply—both at the extensive and intensive margins—by mental health status. We find large monetary and welfare losses from depression symptoms, with significant heterogeneity by ex-ante conditions. |
| Keywords: | Mental health, recovery, depression, physical health. |
| JEL: | D91 E21 I13 I18 J22 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:rbp:wpaper:2025-010 |
| By: | Bastien Michel; Soeren Albeck Nielsen; Morten Hesse; Kristine Roemer Thomsen; Marianne Simonsen |
| Abstract: | Access to mental health care is often rationed through waiting lists, yet there is limited causal evidence on the consequences of delayed access. We study whether eliminating waiting time for psychological support improves outcomes for young adults who grew up with parental substance misuse. Using a randomized waitlist-controlled trial in Denmark combined with survey and administrative data, we find that immediate access leads to sizable short-run improvements in psychological health. These gains persist three to four years after randomization, even after both groups have received the intervention. By contrast, we find limited evidence of large average effects on broader health or labor market outcomes. Our results highligth the importance of treatment timing in capacity-constrained settings. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2604.13545 |
| By: | Bahnsen, Lewe; Neusius, Thomas |
| Abstract: | In 1995, Germany established a two-tier compulsory long-term care insurance scheme. While the public branch, with its pay-as-you-go character, lacks sustainable financing due to demographic circumstances, the capital-funded private branch is supposed to be sustainably financed through its special financial architecture. However, specific legal regulations restrict the calculation of premiums, as is the case in a free competitive insurance market with capital funding, and make the inclusion of transfer elements necessary. We present a synopsis of actuarial expertise on German private compulsory long-term care insurance. Therefore, we make the existing German-speaking literature available to an international audience. In doing so, we provide a comprehensive overview of how private compulsory long-term care insurance in Germany works. Considering recent debates on reforming long-term care insurance financing, understanding the functioning and sustainability of the private branch is of increasing interest. As the financial strain on the public sector intensifies, questions arise about the potential future role of capital-funded private long-term care insurance. |
| Keywords: | Private long-term care insurance, equivalence principle, capital funding, premiums, ageing provisions, Germany |
| JEL: | G22 I11 I13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:wifinw:340009 |
| By: | Tomas J. Philipson; Deyu Zhang; Shumaila Abbasi; Noah Fisher |
| Abstract: | This paper estimates the economic value to the United States of eliminating cancer mortality over a 35-year horizon beginning in 2030, which would eliminate 30.7 million cancer deaths with a total mortality burden of 380 million life-years. We quantify the economic value of this substantial reduction in cancer mortality by incorporating the monetized value of increased longevity. To value the longevity gains in monetary terms, we utilize the valuations used by the U.S. federal government in its cost-benefit evaluations of regulations. Eliminating cancer mortality generates $197 trillion in economic benefits over 35 years, corresponding to approximately $16, 282 per American per year, or $41, 684 per American household per year. If cancer elimination is viewed as an R&D investment, it yields an enormous internal rate of return, ranging from 570% to 1, 024%, based on benchmarked R&D costs. In addition, we perform a sensitivity analysis by varying the elimination durations and the degree of success, using the benchmark case scenario in which cancer mortality is reduced by 80 percent over a 20-year transition. This achieves about 70 percent of the total economic value of full elimination above, corresponding to aggregate benefits of about $134 trillion, or approximately $11, 112 per person per year. |
| JEL: | I0 I1 I10 I15 I18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35052 |
| By: | Nicholas Bloom; Gordon B. Dahl; Dan-Olof Rooth |
| Abstract: | There has been a dramatic rise in disability employment since the pandemic. At the same time, work from home (WFH) has risen four-fold. This paper asks whether the two are causally related. Controlling for compositional changes and labor market tightness, a 1 percentage point increase in WFH increases full-time employment by 1.0% for individuals with a physical disability. The postpandemic increase in working from home explains 68%-85% of the rise in full-time employment. Wage data suggests that WFH increased the supply of workers with a physical disability, likely by reducing commuting costs and enabling better control of working conditions. |
| Keywords: | work from home, disability employment |
| JEL: | J14 J42 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12604 |
| By: | Haidong Lu; Gregg S. Gonsalves; Fan Li; Guanyu Tong; Lee Kennedy-Shaffer |
| Abstract: | Both cluster randomized trials and quasi-experimental designs are used to evaluate the impact of health and social policies and interventions. Stepped-wedge cluster randomized trials randomize a staggered adoption approach, while recent difference-in-differences methods allow analysis of non-randomized settings where similar policies are adopted at different time points. These approaches have become common, but the sheer variety of methods for analyzing observational studies with staggered adoption makes it challenging to clearly design and report such studies. We propose that observational and quasi-experimental study investigators can address these challenges by emulating stepped-wedge cluster randomized trials in the target trial emulation framework. The conceptual framework and reporting standards of trial emulation will encourage consideration of key features of these designs, such as policy heterogeneity and time-varying effects, and clear reporting of the estimand and assumptions. It also highlights areas where those interested in randomized trials and quasi-experimental designs can benefit from one another's experience by bringing insights across disciplines. Questions of treatment effect heterogeneity, power, spillovers, and anticipation effects, among others, are common to both fields and can benefit from cross-pollination. This article also demonstrates how trial emulation can identify settings that are not well-served by either approach, thereby avoiding studies unlikely to generate high-quality causal evidence. Finally, it informs the bias-variance-generalizability trade-off that arises with design and analysis choices made in these settings, supporting better evidence generation and interpretation in settings where important questions can be answered. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2604.12900 |
| By: | Lavee, Doron; Steidl, Florian |
| Abstract: | Over the past years, governments have made substantial progress in tobacco control through higher taxes, advertising bans, and public smoking restrictions. Yet, in many advanced economies, smoking rates have stopped falling despite these strong measures. This stagnation suggests that traditional approaches, focused solely on discouraging all nicotine use, may have reached their limits. Simultaneously, the emergence of novel nicotine delivery systems - such as e-cigarettes, heated tobacco products, and nicotine pouches - has introduced a new dynamic. Although these products are not risk-free, they are generally associated with a significant reduction in toxicant exposure relative to conventional cigarettes. Policy responses to this technological development vary: some countries have adopted regulatory frameworks that differentiate products based on their relative health risks, while others apply uniform restrictions across all nicotine-containing products. This study analyzes the effect of these divergent regulatory frameworks on smoking prevalence across a cohort of 42 highly developed countries (Human Development Index (HDI) > 0.83). Using Ordinary Least Squares (OLS) regression models controlling for development levels (measured by HDI index) and taxation levels, the findings indicate that countries adopting a differentiated, risk-proportionate policy exhibit smoking rates approximately 7 percentage points lower than those maintaining non-differentiated regulatory regimes. Furthermore, the analysis reveals that in this high-HDI cohort, differences in taxation levels alone no longer explain the variance in smoking prevalence, highlighting the importance of product substitution toward lower-risk nicotine products in sustaining progress in tobacco control. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:kitwps:340002 |
| By: | Hua Wang; Yuhan Deng; Donald S. Kenkel; Alan D. Mathios; Sen Zeng |
| Abstract: | A growing body of economic research explores the impacts of U.S. e-cigarette regulations on consumer tobacco choices, but less is known about e-cigarette regulation in China, the world’s largest tobacco market. We study China’s ban of flavored e-cigarettes. The ban of all flavors in e-cigarettes other than tobacco was part of a comprehensive package of regulatory policies adopted in 2022. We collected stated preference data through two discrete choice experiments conducted in 2021 and 2023, with about 600 subjects each. All subjects were adult current smokers. In the experiments, subjects made hypothetical choices between cigarettes, e-cigarettes, and quitting. Product prices and the attributes of e-cigarettes were experimentally varied, allowing us to identify the impact of flavor availability on stated preferences. We use the data to estimate conditional logit models and to predict the impact of the flavor ban and other policies. The empirical results suggest that a ban of flavored e-cigarettes decreases stated preferences for e-cigarettes but also has the unintended consequence to increase stated preferences for cigarettes. Despite the predicted decrease in e-cigarette choices, the predicted choice share of flavored e-cigarettes when they are illegal but loosely enforced is 53% of the predicted share when legal. This large illegal share is consistent with anecdotal evidence and with the evidence from our 2023 background survey that flavored e-cigarettes remain popular after the ban although fewer vapers reported getting their e-cigarettes from specialty or general retailers. |
| JEL: | I12 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35048 |
| By: | Vinod J. Kannankeril Joseph (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | This paper investigates the association between thermal stress and child health outcomes in India by linking individual-level data from the National Family Health Survey (2019–21) with high-resolution climate reanalysis data. The study examines the effects of multiple thermal indicators, 2 m temperature, mean radiant temperature, and Universal Thermal Climate Index on stunting, wasting, underweight, and concurrent stunting and wasting among children under five. Logistic regression models adjusted for socioeconomic and maternal characteristics indicate that the likelihood of acute undernutrition (wasting and underweight) increases significantly with higher heat exposure, particularly among socioeconomically disadvantaged households, whereas stunting levels decrease. The analysis identifies heterogeneity by sex, residence, maternal education, and access to electricity. The findings underscore the role of heat stress as a determinant of acute child malnutrition, particularly in socioeconomically disadvantaged populations. Integrating climate information into public health and nutrition programs is critical to safeguarding child growth and resilience in a warming climate. |
| Keywords: | India, child nutrition, climate, health |
| JEL: | J1 Z0 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:dem:wpaper:wp-2026-011 |
| By: | Kulshreshtha, Shobhit; Bhattacharya, Leena; van Soest, Arthur |
| Abstract: | Rising temperatures due to climate change pose significant challenges to how much and how effectively individuals can work, particularly in low- and middle-income countries such as India, where exposure to extreme heat is becoming more common. While existing research documents adverse effects of heat on labor outcomes, little is known about how individuals adjust their work patterns within a day. This study examines the impact of ambient temperature on time allocation, with a focus on intraday substitution of time spent on paid work. The study uses nationally representative data from the 2019 Indian Time Use Survey combined with high-frequency temperature data measured at 30-minute intervals. We estimate the effect of temperature on total daily time spent on paid work and on the likelihood of working during specific periods of the day. Our results show that extreme heat has limited effects on overall daily work hours but leads to substantial intraday reallocation of labor. Individuals shift work from the hottest periods midday toward early morning or late evening. This pattern is primarily driven by younger men and workers in self-employed or agricultural jobs, who have greater flexibility in their schedules and are more exposed to ambient heat. In contrast, salaried workers reduce work during peak heat without compensatory increases at other times. These findings highlight the importance of flexible work arrangements and targeted heat-mitigation policies to sustain productivity and worker well-being in a warming climate. |
| Keywords: | Climate change, time use, paid work, India |
| JEL: | J22 J24 Q54 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1738 |
| By: | Doan-Pham, Phil; Mavisakalyan, Astghik; True, Jacqui |
| Abstract: | Can legal reforms shift social norms around intimate partner violence (IPV)? We examine Vietnam's 2007 Law on Domestic Violence Prevention and Control using a difference-in-differences strategy that leverages the greater relevance of legal protections for married and cohabiting women relative to single women, generating differential exposure to the reform. Using nationally representative data from the Vietnam Multiple Indicator Cluster Survey, we find significant reductions in women's acceptance of IPV following the law's introduction. The effects are particularly pronounced among disadvantaged groups, including women with lower education, ethnic minority women, and rural residents. These findings indicate that legal reforms can meaningfully reshape social norms surrounding gender-based violence, with particularly strong impacts among marginalized populations that may face higher barriers to change. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1743 |
| By: | Moya, Dr Rhianne Rhiana Olanre |
| Abstract: | The concept of principlism is defined by Keeling and Bellefleur (2016), as “a normative ethical framework designed for practical decision making in health care.” They also highlight the approach as focusing “on what people generally agree upon” - in the form of mid level principles, and refer to Beauchamp and Childress’ statement (1994:17), that “ the rules and principles shared across these theories, typically serve practical judgment more adequately than theories”, as well as highlighting the fact that “often little is lost in practical moral decision making by dispensing with general moral theories.” Balancing principles from a practical perspective, is required for sound decision making, rather than approaching it from a purely theoretical perspective. This is particularly important in contexts where ethical principles conflict with one another. As well as explaining the four individual ethical principles, this paper highlights how such conflicts occur. Further, questions relating to the balancing of ethical principles – as well as communication barriers and issues will addressed. |
| Keywords: | principlism, dignity, autonomy, beneficence, non maleficence, justice |
| JEL: | I0 I15 I2 I24 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:127953 |
| By: | Geir H. M. Bjertnæs; Erling Holmøy; Roger Hammersland (Statistics Norway) |
| Abstract: | This study evaluates the costs and benefits of alternative COVID-19 strategies for Norway, drawing on ex-post evidence from countries that pursued markedly different approaches. We argue that an elimination strategy—combining strict infection control with stringent border measures until a vaccine becomes available—delivers the greatest net benefits when a successful vaccine is expected within a short timeframe. Under vaccine uncertainty, both elimination and mitigation, the latter allowing gradual community spread, remain viable options. Norway adopted a suppression approach based on extensive TTIQ measures. Our findings suggest that this strategy was inferior compared to both elimination and mitigation. Finally, we compare ex-post assessments of costs and benefits with those emphasized in ex-ante evaluations, highlighting key discrepancies. |
| Keywords: | COVID-19; Strategies; Cost-benefit analysis |
| JEL: | H51 I18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:ssb:dispap:1032 |