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on Health Economics |
| By: | Dubois, Pierre |
| Abstract: | We examine pharmaceutical regulations and incentives for innovation from an international perspective, highlighting the public good nature of healthcare innovation and its cross-border diffusion. We summarize the empirical evidence on how push and pull incentives shape R\D investment, innovation, and global access. We emphasize the role of strategic interdependencies and spillovers, including free-riding in R\D financing, learning-by-doing effects, drug shortages, reference pricing, and parallel trade. We then provide new evidence on the international spillovers of pull incentives on innovation, showing that international cooperation and innovative institutions are necessary to better align national regulations with the global objective of sustaining pharmaceutical innovation. |
| Keywords: | Innovation |
| JEL: | L10 L20 I10 I11 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20728 |
| By: | Rebecca Diamond |
| Abstract: | GLP-1 medications generate large weight loss and may also alter social and economic outcomes. Using the Understanding America Study, I compare women starting GLP-1s for weight loss with matched women who would like to start a GLP-1 but have not. Single women’s marriage/cohabitation rates rise by 29 percentage points and employment among baseline non-employed women rises 27 percentage points after six or more quarters. Existing partnerships do not dissolve, and already-employed women show no upward job mobility. The pattern suggests that part of the female obesity penalty operates at new-match formation rather than only through health or incumbent productivity. |
| JEL: | I10 J01 J12 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35387 |
| By: | Fleitas, Sebastian; Fleming, Caitlyn; Gowrisankaran, Gautam; Lo Sasso, Anthony |
| Abstract: | The Affordable Care Act (ACA) changed incentives for individual and employer-sponsored insurance. Using unique small group market (SGM) data with detailed claims and enrollment information, we analyze the welfare gains across households in the SGM from alternative formulations of ACA health insurance exchanges (HIXs). Accounting for observable heterogeneity increases estimated demand elasticities. Shutting down the SGM would reduce equilibrium adverse selection in HIX-type markets, increasing welfare for households moved to HIXs by $842 annually. The majority of households would obtain higher equilibrium welfare from HIXs, stemming from having more choices. Adding the 2014 ACA penalties only modestly decreases adverse selection. |
| JEL: | L11 H30 I13 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20350 |
| By: | Brandyn F. Churchill; Georgina Cisneros; Kelli R. Marquardt |
| Abstract: | Health care reforms are often enacted before implementation, creating uncertainty that can shape firms’ decisions. We examine how Medicare Part D affected the retail pharmacy industry using 2000-2009 establishment-level data, leveraging the fact that Part D disproportionately affected counties with larger elderly populations. Consistent with predictions from a conceptual model in which pre-implementation uncertainty discourages entry and lower post-implementation margins prevent full recovery, we find that Part D was associated with a 5-percent reduction in pharmacies, driven by fewer openings rather than more closures. We also find suggestive evidence that reduced pharmacy access dampened Part D’s mortality benefits. |
| JEL: | D22 D81 I13 I18 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35380 |
| By: | Marika Cabral; David C. Chan Jr; Seth Neller |
| Abstract: | This paper examines the choice between public and private healthcare systems among elderly veterans, who are dually eligible to obtain care through the publicly operated Veterans Health Administration (VA) and through private providers financed by Medicare. We analyze health system choice among veterans who move across areas with differing rates of VA utilization to quantify the relative importance of individual-specific factors (e.g., preferences, income, health) and place-specific factors (e.g., local access, quality, and convenience). Our estimates indicate that 50–60% of geographic variation in VA use is attributable to demand-side individual factors, with the remainder explained by place-based factors. We also document important heterogeneity across types of care, with place-based factors playing a larger role for inpatient and emergency care than for outpatient and primary care. Additional analysis suggests that the supply-side features emphasized in recent legislation—distance to VA facilities and wait times—explain only a small share of estimated place effects. These findings highlight the importance of individual factors in health system choice and have implications for policies aimed at reducing geographic disparities in VA utilization. |
| JEL: | I11 I13 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35440 |
| By: | Bhalotra, Sonia; Delavande, Adeline; Font, Paulino; Maselko, Joanna |
| Abstract: | We investigate the importance of subjective expectations of returns to and effort costs of the two principal investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in rural Pakistan in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and that this contributes to explaining heterogeneity in investments. We find no significant differences across women in preferences for child developmental outcomes. We simulate the impact of alternative policies on investments. Our findings highlight the relevance of interventions designed to address maternal depression and reduce perinatal fatigue alongside interventions that increase perceived returns to investments. |
| Keywords: | beliefs |
| JEL: | I12 I15 J24 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20586 |
| By: | Elizabeth Frankenberg; Cecep Sumantri; Duncan Thomas |
| Abstract: | We investigate the short- and long-run impacts of unexpected mortality on psychosocial health in the context of a large-scale high-mortality natural disaster, the 2004 Indian Ocean earthquake and tsunami. The effects of the tsunami-related mortality measured at the community level are contrasted with the effects of individual-specific loss of close kin using population-representative longitudinal survey data from the Study of the Tsunami Aftermath and Recovery. In the short-run, two years post-tsunami, both community and individual-level mortality exposures are significant predictors of elevated depression and post-traumatic stress symtoms. In the longer-run, ten years post-tsunami, individual-level exposures are slightly attenuated but remain significant predictors of both psychosocial health measures; in contrast, community-level mortality predicts post-traumatic stress but not depression symptoms. Mortality is linked to smaller household sizes in the short- and long-run and to less social support in the long-run, although the latter effect differs substantially for males and females. The estimates adjust for other tsunami exposure measures and, in the individual-level analyses, we compare people living in the same community at the time of the tsunami who were exposed to the same community-level mortality rate. |
| JEL: | I1 O12 Q54 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35462 |
| By: | Joan Costa-i-Font; Sergi Jimenez-Martin; Juan Oliva; Cristina Vilaplana-Prieto; Analía Viola |
| Abstract: | The growing prevalence of cognitive impairment (CI) is one of the main drivers of age-related demand for health and long-term care (LTC). In Spain, CI is estimated to affect 18.5% of Spaniards over 65, and 45.3% in those aged 85 and above. This paper draws on a pooled pre-COVID data from a longitudinal sample of individuals aged 65+ to examine the effect of CI and physical limitations on health and long-term care utilisation, estimates its costs, and financial burden. We report four sets of findings. First, we find that socioeconomic status at older age to be the strongest predictor of CI. Second, while both CI and physical limitations increase health and care adult care use, physical impairment is a stronger predictor of overall care utilisation (73% versus 55% for CI alone) and nursing home residence (2.0% versus 0.9%). Third, informal caregiving constitutes the overwhelming majority of dementia costs, accounting for 69–81% of the total. Finally, we estimate that the replacement cost of informal care would exhaust the full budget of Spain’s LTC system (SAAD). |
| JEL: | I18 I38 J14 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35464 |
| By: | Joan Costa-i-Font; Wanying Wang |
| Abstract: | Although flexible employment policies can help employed individuals balance caregiving and paid work, limited evidence has been devoted to examining the effect of working flexibly on the supply of care to older adults. In this paper, we study the impact of flexible working conditions on the supply of informal adult care and mental health. We exploit variation from the 2014 expansion of the Right to Request Flexible Work (RRFW) to employees in the UK. Our findings point to a gendered response to increased employment flexibility. We document a 1.3-percentage-point increase in the likelihood that men provide informal care within the household, alongside less regular daytime work, greater control over working hours, and higher engagement in home production. In contrast, among potential female caregivers, we find that the reform reduced the probability of high-intensity caregiving, which is typically incompatible with employment or related activities. We document that the increased workplace flexibility not only encourages caregiving but also helps reduce gender disparities in unpaid care. We additionally find suggestive evidence of improved mental health outcomes, particularly among men. |
| Keywords: | flexible working, informal care, right to request flexible work, mental health, United Kingdom |
| JEL: | J14 J22 I13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12825 |
| By: | Arapakis, Karolos; French, Eric; Jones, John Bailey; McCauley, Jeremy |
| Abstract: | We document racial disparities in total and out-of-pocket medical expenditures, using data from the Health and Retirement Study linked to Medicare and Medicaid records. While White, Black, and Hispanic households have similar total annual medical expenditures, minorities benefit from higher Medicaid recipiency and face lower out-of-pocket spending. At age 65, White, Black, and Hispanic households incur on average $136, 000, $59, 000, and $68, 000, respectively, in out-of-pocket medical spending over the remainders of their lives. We use our model to evaluate a policy reform that expands public nursing home insurance. Given that White households currently pay the most out-of-pocket, they have the most to gain from the reform. In the absence of a highly redistributive funding scheme, this reform will on average redistribute financial resources from minorities to White households, illustrating how expanding public insurance can have unintended distributional consequences. |
| Keywords: | Medicaid; Race |
| JEL: | I11 I13 I14 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20738 |
| By: | Banks, James; French, Eric; McCauley, Jeremy |
| Abstract: | This paper examines the nature of long-term care for older adults with cognitive impairments in England. Long-term care (LTC), which in England is commonly referred to as adult social care, is care that supports daily activities of living for older and disabled individuals to enhance their quality of life. This includes care services ranging from nursing home stays to home-based assistance with tasks like washing, dressing, and eating. For older people with cognitive impairment, such as dementia for example, there may be additional specialized care and support that is necessary. This paper shows that the high care needs of older individuals is largely attributable to those with cognitive impairments: approximately half of the total care costs of the age 65+ population in England are attributable to the 8.5% of individuals with cognitive limitations. |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20783 |
| By: | De Nardi, Mariacristina; French, Eric; Jones, John Bailey; McGee, Rory |
| Abstract: | We estimate a model of savings for retired couples and singles who face longevity and medical expense risks, and in which couples can leave bequests both when the first and last spouse dies. We show that saving motives vary by marital status, permanent income, and age. We find that most households save more for medical expenses than for bequests, but that richer households and couples, who hold most of the wealth, save more for bequests. As a result, bequest motives are a key determinant of aggregate retirement wealth. |
| Keywords: | Bequests |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20743 |
| By: | Banks, James; McCauley, Jeremy; French, Eric |
| Abstract: | This paper describes the state of Long-Term Care (LTC) in England. LTC, which is generally referred to in England as adult social care, supports activities of daily living for older and disabled individuals to improve their quality of life. This includes stays in nursing homes as well as home-based help with tasks such as washing, dressing, and feeding. |
| Keywords: | Long term care |
| JEL: | I10 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20740 |
| By: | Andy Chung (Department of Economics, University of Reading); Junsen Zheng (Zhejiang University and Chinese University of Hong Kong) |
| Abstract: | This paper develops and tests a life-cycle hypothesis of sleep investment. Motivated by evidence from psychology, aging, and sleep research that the consequences of insufficient sleep become increasingly severe with age, we argue that individuals facing stronger productivity incentives should increasingly preserve sleep as they age. We formalize this idea in a simple life-cycle framework in which sleep is a productive activity that competes with work and leisure for time. We test the framework using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We focus on adolescent physical attractiveness and college education as two characteristics associated with occupational sorting and long-run productivity incentives. While both characteristics exhibit little association with sleep duration in early adulthood, their relationships with sleep become increasingly positive over the life cycle. Attractive individuals and college graduates experience substantially less negative declines in sleep duration with age and increasingly sleep longer relative to their counterparts in later adulthood. Additional analyses show that these patterns are strongest among workers and are not readily explained by mental health, sleep difficulties, social participation, or reverse causality through sleep affecting later attractiveness. More broadly, the findings suggest that differences in long-run productivity incentives contribute to divergent sleep trajectories over adulthood and support a life-cycle perspective on sleep investment. |
| Keywords: | sleep, life cycle, health investment, physical attractiveness, college education |
| JEL: | I12 J22 J24 |
| Date: | 2026–07–22 |
| URL: | https://d.repec.org/n?u=RePEc:rdg:emxxdp:em-dp2026-07 |
| By: | Krekel, Christian; Kremser, Tim; Melios, Georgios |
| Abstract: | Overemployment – working more hours than desired – affects nearly one-third of European workers, yet its consequences remain understudied. Using data from the German Socio-Economic Panel (SOEP, 1984-2019, N = 43, 570) and individual fixed-effects models with leads and lags, we examine whether overemployment is associated with a deterioration in wellbeing and health, and whether potential adverse impacts persist as long as the overemployment state continues or whether people get used to working long hours. We find that overemployment is associated with a substantial decline in mental health, with impacts that intensify rather than attenuate over time. Specifically, the SF-12 mental health summary scale declines by 0.44 points in the first year of overemployment, deepening to between 0.80 and 1.13 points (8–11% of a standard deviation) thereafter. We obtain similar results for work, leisure time, health, and overall life satisfaction. Meanwhile, the association between overemployment and physical health is smaller and less consistent. Our findings suggest that overemployment may lead to an increased risk of persistent symptoms of poor mental health and low wellbeing, with implications for working time regulations and workplace wellbeing and health policies. |
| Keywords: | overemployment;working-hours mismatch;hedonic adaption;wellbeing;health |
| JEL: | I10 I31 J21 J22 |
| Date: | 2026–09–30 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:138858 |
| By: | Matavelli, Ieda; Grosjean, Pauline; De Haas, Ralph; Baranov, Victoria |
| Abstract: | While economists have extensively studied gender norms affecting women, masculinity norms---social norms about how men should behave ---remain underexplored. This review first synthesizes how other disciplines have studied masculinity, providing economists with conceptual foundations and empirical patterns for understanding masculinity norms. We then discuss how the study of masculinity norms can inform the economics literature on gender gaps and men's outcomes across multiple domains: health behavior, labor supply and occupational choice, violence and aggression, and political preferences. We also discuss paths for the transmission and persistence of these norms. Finally, using novel survey data from 70 countries, we present five stylized facts about masculinity norms. We document substantial global variation in these norms and demonstrate their predictive power for various socioeconomic and political outcomes. |
| JEL: | D91 I12 J16 J24 Z13 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20549 |
| By: | Cristina Bellés Obrero; Caoimhe T. Rice; Judit Vall Castelló |
| Abstract: | Healthcare providers are a frontline channel for detecting intimate partner violence (IPV): physicians are legally required to report suspected criminal injuries to the authorities and can refer victims to support and protection services. We study how restricting healthcare access affects the detection and formal reporting of IPV, exploiting a 2012 Spanish reform that withdrew public healthcare entitlement from undocumented immigrants while leaving emergency care universally accessible. Using a difference-in-differences design that compares foreign and Spanish-national women before and after the reform, we find that foreign women's use of public primary care fell by 4.9%, with no corresponding drop in emergency care use. IPV cases reaching the courts and applications for protection orders subsequently declined by about 12% among foreign relative to Spanish women, with larger effects in regions that enforced the restriction more strictly. The decline is concentrated in cases initiated through medical injury reports, and we find no accompanying change in self-reported victimization or in female homicide, suggesting a drop in detection rather than in underlying violence. Restricting healthcare access thus weakened the detection and formal reporting of IPV, an overlooked cost of policies that limit marginalized groups' access to public services. |
| Keywords: | healthcare access, Intimate partner violence, reporting, undocumented immigrants |
| JEL: | I10 I12 I14 I31 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1586 |
| By: | Gazzè, Ludovica; Gupta, Tanu; Huang, Allen; Londono, Valentina; Saavedra, Santiago; Toma, Mattie |
| Abstract: | There is limited evidence on the non-health impacts of air pollution, including productivity in the workplace and behavior. We examine the effect of air pollution on participation, collaboration, and feedback provision in a workplace setting. Our experiment randomly assigns air purifiers to rooms at three large academic conferences to investigate the causal impact of air pollution on participants' engagement behavior. We construct a participant engagement index based on 12 presentation-level behavioral outcomes directly measured by conference observers through an online form and weigh each behavioral outcome using weights elicited from an expert survey. Conference rooms treated with air purifiers exhibit 48% less PM2.5 concentration compared to control rooms. However, we do not find a statistically significant change in engagement. Communication in the workplace might not be a large driver of the empirical relationship between air quality and productivity, albeit more research is needed across workplaces and measures of communication. |
| Keywords: | Engagement; Field experiment |
| JEL: | Q53 J24 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20676 |
| By: | Garcia, Paul |
| Abstract: | This paper examines how early socio-emotional skills shape adolescent offending in England and the school pathways through which they operate. I use administrative data linking teacher-reported child development assessments at age five to school and criminal justice records through age 17. Factor analysis of these assessments reveals two underlying domains of early difficulty, cognitive and socio-emotional. Both raise the probability of a caution or conviction between ages 11 and 17 by around 15%, but through distinct channels. Cognitive difficulties act primarily through academic attainment, while socio-emotional difficulties operate largely through school exclusions yet retain a substantial direct effect, accounting for around 40% of the total effect. The socio-emotional effect is robust to unobserved school and family heterogeneity and shapes both the type and frequency of offending. Statutory support for learning difficulties and social care services attenuates the associations between early skill deficits and offending. These findings suggest that differentiated support is needed based on the type of difficulty. |
| Date: | 2026–07–14 |
| URL: | https://d.repec.org/n?u=RePEc:ese:iserwp:2026-02 |
| By: | Castanheira, Micael; Mariani, Giovanni Paolo; Tricaud, Clemence |
| Abstract: | Public goods are meant to be universal, but they are inherently place-based. This paper systematically measures spatial access to public goods and quantifies the implications of distance to public facilities for income inequality. First, we map all schools and hospitals across Belgium. We compute the distance to facilities for each of the 20, 000 neighborhoods and document large spatial inequalities in access to public facilities. Second, we find that this unequal distribution favors high-income neighborhoods: allocating public goods spending proportionally to our access index increases income inequality compared to measures based solely on disposable income. Third, we show that the positive relationship between income and access can be rationalized by a simple model of public goods allocation with an inequality-neutral social planner. Finally, we provide evidence that access is strongly correlated with educational and health outcomes, emphasizing the need to consider the place-based nature of public goods when measuring inequality. |
| Keywords: | Inequality; Geography |
| JEL: | D63 H11 H41 R28 |
| Date: | 2025–07 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20446 |
| By: | David Schönholzer; Gregory Lane; Erin M. Kelley |
| Abstract: | Road traffic injuries are the leading cause of death among people aged 5–29. Where traffic laws are weakly enforced, it is unclear whether road safety interventions can change behavior. We run a randomized controlled trial among 203 Kenyan minibuses, testing whether an incentive scheme improves safety overall or merely shifts unsafe driving to unmonitored times. Drivers reduce speeding by 29 percent and harsh braking by 13 percent, improving a safety index by 0.096 standard deviations. Labor-supply and earnings effects are modest, with little displacement across times or places. Improvements fade quickly, suggesting lasting change requires sustained enforcement or stronger incentives. |
| JEL: | K42 O12 O18 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35394 |
| By: | Fabian Kindermann; Carla Krolage; Sebastian Kunz; Manuel Pannier; Karoline Ströhlein |
| Abstract: | This paper provides causal evidence on how pension income affects labor supply after retirement. We exploit the introduction of the German Earned Income Pension Credit (Grundrente), which permanently increased pension income for retirees with long contribution histories and comparatively low lifetime earnings. The reform generates exogenous variation in non-labor income without creating additional labor supply distortions, allowing us to isolate pure income effects. Using administrative data covering the universe of German retirees and a difference-in-differences design, we find that a 1, 200 euro increase in annual pension income reduces unconditional labor earnings by approximately 122 euros, implying a marginal propensity to earn out of unearned income of −0.1. Two thirds of this response reflects extensive margin adjustments, which operate through both increased exit and reduced re-entry, with the remainder driven by intensive margin reductions. Effects are stronger for younger, more labor-market-attached cohorts. |
| Keywords: | post-retirement labor supply, pension income, income effects, older workers, pension reform, Grundrente, labor force participation, administrative data |
| JEL: | H31 H55 J14 J22 J26 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12757 |
| By: | Arapakis, Karolos; French, Eric |
| Abstract: | In this paper we evaluate the challenges of funding retirement in the aftermath of the Covid pandemic. We first show that the pandemic had only modest effects on life expectancy and employment. These effects were small relative to longer term trends. Nevertheless, they worsened pension funding problems, highlighting the need for future pension reforms. Next, we highlight key evidence on how labor supply responds to pension reforms. Evidence suggests that incentivising later retirement can reduce pension deficits. |
| Keywords: | Retirement |
| JEL: | J22 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:20739 |