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on Health Economics |
| By: | Leon Huetsch; Dirk Krueger; Alexander Ludwig |
| Abstract: | We build a unified quantitative theory of increasing adult life expectancy and income growth in the last two centuries, and the emergence of a modern health sector in the 20th century. We interpret the data as three phases of a dynamic equilibrium in which households are initially poor, the price of health goods is prohibitively high, and life expectancy is stagnant. As technological progress fuels income growth, households commence consuming basic health goods and life expectancy rises in the first half of the 19th century. 100 years later, further directed technological progress leads to the emergence of a modern health sector. Through the lens of the model, the quality-adjusted relative price of modern health goods declined by about 2.5% per year between 1940 and 2020 while the model-implied relative price that lacks quality adjustment increases in line with the BEA health price index. Counterfactual analyses suggest that almost one fourth of adult life expectancy gains between 1940 and 2020 are attributed to the emergence and expansion of modern health and that public spending on health R&D during World War II played an important role in the kickoff of the modern health sector. |
| JEL: | E13 I15 O41 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35092 |
| By: | Prati, Alberto (University College of London); Senik, Claudia (Paris School of Economics) |
| Abstract: | We revisit the famous Easterlin paradox by considering that life evaluation scales refer to a changing context, hence they are regularly reinterpreted. We propose a simple model of rescaling based on both retrospective and current life evaluations, and apply it to unexploited archival data from the USA. When correcting for rescaling, we find that the well-being of Americans has substantially increased, on par with GDP, health, education, and liberal democracy, from the 1950s to the early 2000s. Using several datasets, we shed light on other happiness puzzles, including the apparent stability of life evaluations during COVID-19, why Ukrainians report similar levels of life satisfaction today as before the war, and the absence of parental happiness. |
| Keywords: | happiness, life satisfaction, subjective well-being, rescaling, Easterlin paradox, Cantril ladder, Gallup |
| JEL: | I31 N32 O10 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18536 |
| By: | Angelucci, Manuela (University of Texas at Austin); Fabregas, Raissa (UT Austin); Vazquez, Antonia (UT Austin) |
| Abstract: | AI-powered mental health apps have attracted growing interest as a low-cost way to expand care. Yet questions remain about their effectiveness, safety, and whether they may crowd out psychotherapy. We evaluate one such app in a randomized controlled trial among 1, 964 Mexican women with mild to severe psychological distress. Over six months, app access improved mental health by 0.3 standard deviations with no evidence of harm, improved sleep quality, increased healthful behaviors, and reduced missed work, yielding considerably larger benefits than costs. Treated participants were also more likely to seek traditional psychotherapy, but this increase does not explain most of the mental health gains. App use was high in the first month but then declined, as is common in digital interventions. Despite this drop in use, treatment effects persisted. Participants continued to implement practices promoted by the app, suggesting that even short-term engagement can produce durable improvements through sustained behavioral change. |
| Keywords: | digital mental health, AI-powered care, well-being, randomized controlled trial, Mexico, behavioral change, mental health apps, sleep quality, labor productivity, psychotherapy |
| JEL: | I12 O33 J24 C93 I15 I31 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18538 |
| By: | Adriaan Kalwij; Arie Kapteyn |
| Abstract: | In the Netherlands, life expectancy has continued to rise over the last two decades and the distribution of the age of death has narrowed, which suggests a decrease in health inequality. For the same period, however, the income-mortality gradient has increased, which suggests that the health gains have been unequally distributed across the income distribution. We examine the latter suggestion using data for the Netherlands of the longitudinal Survey of Health, Ageing and Retirement in Europe. Our empirical findings show no significant changes in income-based physical and mental health inequalities during the last two decades. Arguably, larger samples, such as administrative data which is often used to analyze the income-mortality gradient, are needed to investigate in more detail the evolution of physical and mental health inequalities before drawing firm conclusions. |
| JEL: | I00 I14 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35097 |
| By: | Joshua S. Graff Zivin; Siyuan Li; Huanhuan Wang; Zhiqiang Zhang |
| Abstract: | Incomplete performance metrics distort incentives. Exploiting the staggered roll-out of China’s national air monitoring network, we document a pollutant substitution effect: PM₂.₅ fell significantly, yet O₃ surged. We trace this to strategic behavior: facing binding PM₂.₅ targets, local governments prioritized abatement of particulate precursors while neglecting ozone precursors. Critically, this was not a benign trade-off. Although the policy reduced PM₂.₅-attributed deaths, the policy-induced O₃ surge increased O₃-attributed mortality and reduced biodiversity (measured by bird abundance). Conservative estimates suggest these costs reduced the policy’s net benefits by approximately 23.8%. Our findings highlight the hidden social costs of narrow performance targeting. |
| JEL: | D73 H77 Q53 Q57 Q58 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35087 |
| By: | Takashi Oshio; Satoshi Shimizutani |
| Abstract: | This study examined how health inequalities with respect to income have changed among older adults in Japan from 2001 to 2022. The past two decades have witnessed a series of public pension reforms and increased labor force participation among older individuals. The pro-rich concentration of good health has become less clear for self-rated health and activities of daily living among older men. However, income-related inequality in stress/anxiety increased over time in men, and no clear trend was observed for health deficiencies or conditions. Compared to men, women showed more mixed results, with widening inequalities in health deficiencies and conditions. |
| JEL: | H55 I14 J14 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35094 |
| By: | Garcia-Hombrados, Jorge (Universidad Autónoma de Madrid); Perez Parra, Daniel (Université Gustav Eiffel); Ciacci, Riccardo (Universidad Pontificia de Comillas) |
| Abstract: | Health-harmful norms persist because they fulfill a socially valued function. In many Nigerian communities, female genital cutting (FGC) is practiced because it is believed to discourage sex outside marriage, outweighing its perceived costs for many households. This paper examines the impact of the expansion of fast internet on FGC in Nigeria. Our findings indicate that exposure to fast internet reduces both the prevalence of FGC and support for it. The effect does not appear to be driven by exposure to explicit anti-FGC content online. Instead, we find that fast internet affects FGC by reducing premarital sex stigma, thereby decreasing the perceived benefits of the practice. These findings provide evidence on how health-harmful norms evolve as the value of their function changes, with implications for designing effective interventions. |
| Keywords: | harmful norms, cultural change, female genital cutting |
| JEL: | O32 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18524 |
| By: | Yaa Akosa Antwi; Marion Aouad; Nathan Blascak |
| Abstract: | We examine the financial consequences of the 2007 California Fair Pricing Law, which places a price ceiling on hospital bills for financially vulnerable individuals. Using cross-sectional variation in exposure to the law, proxied by county-level uninsured rates, we estimate its impact on individual financial outcomes. We find that the law reduces the likelihood of incurring non-medical debt in collections and the number of non-medical accounts in collections. In addition, we find evidence that credit scores increased and suggestive evidence that the number of delinquent accounts decreased for individuals in more exposed counties. Our results suggest hospital billing regulations can improve targeted individuals’ financial outcomes. |
| JEL: | G51 I1 I18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35080 |
| By: | Loux, Travis (Saint Louis University College for Public Health and Social Justice); Wankum, Ethan |
| Abstract: | Studying of the effect of racial differences on health outcomes is a difficult task for reasons including varying definitions of race - many of which may not adhere to current best practices - its philosophical acceptance as a well-defined exposure, and appropriate utilization of factors with important roles in the relationship between race and outcome. Inattentive approaches to any of these issues can lead to biased, irrelevant, or unreplicable study findings. We highlight these concerns paying special focus to the issue of covariates in analyses of racial causal effects. We show that mis-identifying many common covariates as confounding variables can bias estimates of racial causal effects. Rather than defaulting to using covariates as confounding variables, researchers should carefully consider the role each variable plays in the relationship between race and outcome and how accounting for each will affect effect estimates and their interpretability. |
| Date: | 2026–04–14 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:835ga_v1 |
| By: | Moriam Khanam; Mohammad Hajizadeh; Casey Warman |
| Abstract: | This study leverages exogenous variation from a secondary school stipend program for female students in rural Bangladesh to estimate the causal effect of maternal education on early childhood development. Using data from the 2019 Bangladesh Multiple Indicator Cluster Survey, we find that the five years of stipend eligibility increase mothers' schooling by about one year. Instrumental variable estimates show that an additional year of maternal education improves early childhood development scores by 0.5 points on a scale of 0-10, with gains in overall developmental readiness (7.5 percentage points) and in the literacy–numeracy (7.7 percentage points) and physical (1.9 percentage points) domains. The results are robust across specifications. We also estimate the effects of maternal education on potential mechanisms, including children's nutrition, home learning environment, parenting practices, and use of early childhood education and care. The findings show that improvements in maternal education increase weight-for-age Z-scores, reduce stunting, improve the probability of having toys from shops, and increase the likelihood of an adult household member playing with the child. The positive effects of maternal education on children's developmental outcomes imply the importance of investment in improving educational attainment, particularly for females in low- and middle-income countries. |
| JEL: | H52 I10 I25 J24 O15 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35075 |
| By: | Nicoleta-Elena Heghes (Acad. Andrei Rădulescu Institute of Legal Research of the Romanian Academy); Claudia Ghita (University of Medicine and Pharmacy Grigore T. Popa, Romania) |
| Abstract: | Medical assistance in dying has emerged as one of the most debated issues in contemporary bioethics, with growing attention to its extension beyond terminal somatic illnesses to include psychiatric disorders. While current discussions emphasize patient autonomy and the right to selfdetermination as fundamental principles, the application of assisted suicide in psychiatric contexts raises distinct clinical, ethical, and societal concerns. This article critically examines key arguments supporting physician-assisted suicide for individuals with mental illness, focusing on the challenges of determining irremediability, assessing decision-making capacity, and distinguishing autonomous choice from symptoms of the underlying disorder. Particular attention is given to the fluctuating course of psychiatric conditions, the absence of objective biomarkers, and the evolving landscape of therapeutic options, all of which complicate prognostic certainty. Finally, the analysis explores concerns related to vulnerability, social pressure, and the potential normalization of assisted death in contexts marked by stigma and structural inequities. The paper argues for heightened caution in extending medical assistance in dying to psychiatric populations given these unresolved complexities. |
| Keywords: | Medical Assistance, Dying, Psychiatric Disorders, Psychiatric Conditions, Suicide |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:smo:raiswp:0633 |
| By: | Dr Nat O’Connor (Social Policy, University College Dublin, Ireland); Prof Farhana Sharif (Social Policy, University College Dublin, Ireland) |
| Abstract: | Fetal Alcohol Spectrum Disorders (FASD) are the most common preventable neurodevelopmental disabilities. Despite international recognition of FASD as a major public health challenge, such as in the World Health Organization’s Global Alcohol Action Plan, this recognition has not always translated into concrete policy responses, even in high-income countries with high levels of alcohol consumption. The case of Ireland illustrates how a lack of high-level strategic recognition of FASD as a public health and social policy challenge has resulted in limited state action and a high prevalence of FASD. The paper provides an overview of FASD and presents a comparison of ten high-income countries with high alcohol consumption rates but markedly different estimates of FASD prevalence. It then provides an analysis of Ireland’s policy response to FASD, identifying its strengths, gaps, and implications for international policy learning. |
| Keywords: | Fetal Alcohol Spectrum Disorders; FASD; Public Health; Public Policy; Alcohol Policy |
| JEL: | I18 K23 |
| Date: | 2025–10–31 |
| URL: | https://d.repec.org/n?u=RePEc:ucd:wpaper:202507 |
| By: | Lansink, Xander (RS: GSBE other - not theme-related research, ROA / Labour market and training); Montizaan, Raymond (RS: GSBE UM-BIC, ROA / Labour market and training); Patel, Salman (RS: GSBE other - not theme-related research, ROA / Labour market and training) |
| Abstract: | Rising statutory retirement ages and population aging have increased interest in why individuals work beyond retirement. This systematic literature review synthesizes evidence from 103 studies, including 11 with causal designs, on post-retirement employment. We examine the roles of financial incentives, health, job characteristics, intrinsic motivation, family, and institutional context. Causal studies show modest effects of pension reforms, tax incentives, and abolitions of mandatory retirement, while employer practices and workplace flexibility strongly shape opportunities. Observational evidence highlights heterogeneous patterns across socioeconomic groups, sectors, and welfare-state regimes: financial necessity dominates in liberal systems, whereas voluntary engagement and identity motives are more important in social-democratic contexts. The findings underscore the need for multidimensional, coordinated policy approaches, combining macro-level incentives with firm-level practices and flexible work arrangements, to effectively extend working lives. |
| Keywords: | Post-retirement employment, Determinants, Institutional Context |
| JEL: | J26 J14 J32 H55 |
| Date: | 2026–04–21 |
| URL: | https://d.repec.org/n?u=RePEc:unm:umarot:2026002 |