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on Health Economics |
| By: | Sonia Bhalotra; Damian Clarke; Atheendar Venkataramani |
| 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: | I10 I14 J71 H70 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12387 |
| By: | Sonia Bhalotra; N. Meltem Daysal; Louis Freget; Jonas Cuzulan Hirani; Priyama Majumdar; Mircea Trandafir; Miriam Wüst; Tom Zohar |
| 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: | I12 J13 J16 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12392 |
| By: | Amy Finkelstein; Matthew J. Notowidigdo; Steven X. Shi |
| Abstract: | We estimate the mortality impact of local labor market exposure to the 1994 North American Free Trade Agreement (NAFTA) as well as to other local area shocks, and provide a parsimonious empirical explanation for differently-signed mortality estimates across different sources of local labor market contractions. Leveraging spatial variation in exposure to Mexican important competition from NAFTA, we find that more exposed areas experienced larger increases in mortality. In the 15 years post-NAFTA, an area with average NAFTA exposure experienced an increase in annual, age-adjusted mortality of 0.68 percent (standard error = 0.19), an increase that more than erases prior estimates of the welfare gains from NAFTA’s nationwide economic benefits. Mortality increases appear across all broad age by sex groups, but are particularly pronounced among working-age men, a demographic that also experienced disproportionate NAFTA-induced declines in (primarily manufacturing) employment. Additional evidence from other local labor market shocks reveals a systematic pattern: declines in local area manufacturing employment increase mortality, while declines in local area non-manufacturing employment decrease mortality. These findings suggest that the sign and magnitude of any mortality impacts of future economic shocks likely depends critically on the extent to which employment declines are concentrated in the manufacturing sector. |
| JEL: | F1 I1 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34855 |
| By: | Hamid Noghanibehambari; Jason Fletcher |
| Abstract: | The implementation of the North American Free Trade Agreement (NAFTA) in 1994 resulted in a great restructuring in industry composition in the US, with substantial heterogeneity across local areas. In this paper, we investigate the effects of NAFTA on the mortality rates of the working-age population. We implement event studies and difference-in-difference analyses to examine dynamic changes in mortality rates in different years relative to NAFTA and in areas with differential exposure to NAFTA. Comparing areas with high versus low trade exposure measures, we find a 2.1 percent rise in the mortality rate of those aged 25-55. A back-of-the-envelope calculation suggests a 7.3 percent rise in mortality for the treated population, who lost their job due to NAFTA. Further analyses using a wide range of alternative data sources suggest that reductions in income-employment, reductions in wealth, increases in disability, decreases in health insurance coverage, decreases in private health insurance, and a higher likelihood of reliance on presumably lower quality public insurance as candidate mechanisms. |
| JEL: | F1 I1 J1 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34840 |
| By: | Gunes Asik; Bilge Erten; Erdal Tekin; Semih Tumen; Hakan Ulucan |
| Abstract: | Intimate partner violence remains one of the most serious threats to women's safety worldwide, yet existing evidence on the effectiveness of large-scale institutional protection systems is limited and mixed. This paper evaluates the impact of Violence Prevention and Monitoring Centers on intimate partner violence (IPV) against women in Türkiye. Exploiting the staggered rollout of centers across provinces, we find that the opening of a center reduces female homicides, particularly those perpetrated by intimate partners, by approximately 20 percent. Complementary survey evidence shows that the opening of a center also reduces women's self-reported exposure to physical IPV by 20 percent, with larger effects among younger and less-educated women. Exploring potential mechanisms, we find that centers primarily reduce violence by lowering barriers to help-seeking and improving coordination across police, legal, and social services: following the opening of a center, women become more likely to seek support from women's organizations and social services, while direct applications to prosecutors decline. We find no evidence of effects on gender attitudes, labor market outcomes, relationship status, marriage market outcomes, or mental health, suggesting violence reductions operate through improved access to protection rather than changes in norms or economic independence. The estimated effects are stronger in provinces with more gender-progressive norms and stronger institutional capacity, highlighting the importance of complementary social and institutional environments. |
| JEL: | I18 J12 J16 K42 O15 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34886 |
| By: | Chad D. Cotti; Dhaval M. Dave; Tessie Krishna; Erik T. Nesson; Joseph J. Sabia |
| Abstract: | Youths who vape nicotine rarely make in-person purchases of e-cigarettes from a vendor but instead rely on alternative methods to obtain electronic nicotine delivery system (ENDS) products. This study is the first to explore whether the informal social market and online purchasing options help to insulate youths from e-cigarette taxation. Using data from the State Youth Risk Behavior Surveillance Surveys, we find that ENDS taxation reduces both the likelihood of teens obtaining ENDS products through direct in-person retail purchases as well as the likelihood of relying on informal social sources for e-cigarettes such as borrowing vaping devices from friends or third-party purchases. Auxiliary analyses from the Population Assessment of Tobacco and Health are generally consistent with these findings and suggest that impacts are concentrated on the initiation margin; higher ENDS taxes deter youths initiating through direct retail purchases as well as through the social market. For older teens ages 18 and older, however, we find that informal social sources may attenuate the impacts of e-cigarette taxes. Finally, we detect some evidence that ENDS taxes increases the likelihood that teenagers shift to online sources to obtain e-cigarettes. |
| JEL: | I12 I18 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34880 |
| By: | Anna Barbeta-Margarit; Seema Jayachandran; Suanna Oh |
| Abstract: | Can questions about life satisfaction be used to measure parental preferences for daughters versus sons? Daughter preference has rarely been documented in the literature, even in matrilineal settings. One possible reason is that the commonly used measures of parental gender preference, such as fertility-stopping rules and sex ratio at birth, are ill-suited to high-fertility settings. We instead assess maternal preferences in Malawi by examining the life satisfaction of women who currently have one child, comparing those with a daughter to those with a son. We find that in matrilineal (but not patrilineal) households, having a daughter increases mothers' life satisfaction, relative to having a son. |
| Keywords: | daughter preference, life satisfaction, matrilineality |
| JEL: | I31 J13 J16 N47 O12 Z13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12463 |
| By: | Schlenker, Oliver |
| Abstract: | Healthcare systems worldwide face increasing nurse shortages, but the consequences remain poorly understood. This paper studies how nurse scarcity in hospitals affects care provision and patient health. I exploit the 2011 Swiss franc stabilization, which increased the salience to cross-border commute from Germany to Switzerland and led to an outflow of nurses in German hospitals depending on their distance to the border. Using rich universal patient-, hospital-, and county-level German and Swiss administrative data in a matched difference-in-differences design, I show that border hospitals lose around 12 percent of their nursing staff. This leads to lower care intensity and a reallocation of services towards urgent cases (triage) while healthcare demand or supply outside hospitals remains unchanged. Consequently, in-hospital mortality rises by 4.4 percent - concentrated among emergency and older patients - and life expectancy decreases by 0.28 statistical life years, with no evidence of offsetting gains in Switzerland. These results highlight that nurse scarcity shapes hospital production and widens health disparities across patients and regions. |
| Keywords: | Labor scarcity, cross-border commuting, nurse shortages, hospital production, healthcare provision, triage, patient mortality |
| JEL: | F22 I11 I18 J22 J61 R23 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:336756 |
| By: | Kronenberg; C.;; Miele; K.R.; |
| Abstract: | Despite universal healthcare coverage and clinical guidelines recommending psychotherapy after psychiatric hospitalization, only 26% of German patients receive it, and paradoxically, the sickest patients are least likely to get treatment. Using administrative claims data, we investigate whether increasing psychotherapy supply addresses this misallocation. For identification, we exploit quasi-random variation from Germany’s therapist license allocation system. A one standard deviation higher supply raises therapy uptake by 10%, modestly reduces waiting times, and lowers patient search frictions, but does not alter the composition of therapy recipients. These findings challenge the assumption that healthcare capacity constraints affect all patients equally. |
| Keywords: | mental health; healthcare markets; waiting time; |
| JEL: | I11 I18 H51 R53 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:yor:hectdg:26/02 |
| By: | Antonini, Marcello; Henriquez, Josefa; van Kleef, Richard; Melia, Adrian; Paolucci, Francesco |
| Abstract: | Several mandatory health insurance schemes include some consumer choice of coverage (e.g., in terms of deductible levels). Premiums in these schemes are typically community-rated per insurance plan. While community-rated premiums help achieve objectives of fairness, they can also lead to adverse selection across coverage options. Consequently, consumers may sort inefficiently across these coverage options resulting in forgone welfare gains. This paper aims to explore under what conditions risk rating of incremental premiums for more comprehensive coverage (compared to a basic plan) can improve consumer sorting. In a simulation analysis on Chilean data, results show that under perfect risk adjustment, risk rating of incremental premiums can improve consumer sorting. With imperfect risk adjustment, however, the effects of risk rating on consumer sorting are ambigous as incremental premiums will not just reflect the direct effect of more comprehensive coverage on healthcare spending, but also the under/overcompensation from the (imperfect) risk adjustment system. Moreover, we find that in the presence of imperfect risk adjustment, risk rating improves welfare over community rating but does not fully solve the problem of inefficient sorting. |
| Keywords: | health insurance; coverage options; community rating; risk rating; risk adjustment; moral hazard |
| JEL: | F3 G3 |
| Date: | 2026–03–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137182 |
| By: | Nicolau Martin-Bassols; Pietro Biroli; Elisabetta De Cao; Massimo Anelli; Stephanie von Hinke; Silvia Mendolia |
| Abstract: | The establishment of the UK National Health Service (NHS) in July 1948 was one of the most consequential health policy interventions of the twentieth century, providing universal and free access to medical care and substantially expanding maternal and infant health services. In this paper, we estimate the causal effect of the NHS introduction on early-life mortality and we test whether survival is selective. We adopt a regression discontinuity design under local randomization, comparing individuals born just before and just after July 1948. Leveraging newly digitized weekly death records, we document a significant decline in stillbirths and infant mortality following the introduction of the NHS, the latter driven primarily by reductions in deaths from congenital conditions and diarrhea. We then use polygenic indexes (PGIs), fixed at conception, to track changes in population composition, showing that cohorts born at or after the NHS introduction exhibit higher PGIs associated with contextually-adverse traits (e.g., depression, COPD, and preterm birth) and lower PGIs associated with contextually-valued traits (e.g., educational attainment, self-rated health, and pregnancy length), with effect sizes as large as 7.5% of a standard deviation. These results based on the UK Biobank data are robust to family-based designs and replicate in the English Longitudinal Study of Ageing and the UK Household Longitudinal Study. Effects are strongest in socioeconomically disadvantaged areas and among males. This novel evidence on the existence and magnitude of selective survival highlights how large-scale public policies can leave a persistent imprint on population composition and generate long-term survival biases. |
| Keywords: | early-life, health systems, survival bias, infant mortality, genetics, polygenic Index, UK biobank, ESSGN |
| JEL: | I10 I38 C21 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12445 |
| By: | Benjamin Krebs; Matthew J. Neidell |
| Abstract: | We study how private information affects household responses to environmental risk. Using data from residential air quality monitors, we exploit the timing of monitor installation and high-frequency fine particulate matter (PM2.5) readings to identify responses to new information about indoor pollution risk. We find that indoor PM2.5 concentrations decline by 2.5 ug/m3 over the 12 weeks following installation, conditional on contemporaneous outdoor pollution, with effects significantly larger among households with high initial indoor pollution. The indoor–outdoor pollution gradient declines over time, indicating that households become increasingly effective at mitigating exposure when marginal health damages are highest. Using machine learning techniques to infer cooking activity and air purifier adoption, we show that households respond primarily through durable defensive investments rather than reductions in pollution-generating behavior, with back-of-the-envelope calculations implying positive net benefits. Our results suggest that personalized risk information increases the salience of indoor pollution as a controllable risk for households, in contrast to spatially coarse public information that frames pollution primarily as an outdoor threat requiring avoidance. |
| JEL: | D81 D83 Q53 Q55 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34875 |
| By: | Joan Costa-i-Font; Mario Gyori; Belen Saenz-de Miera |
| Abstract: | Extending health insurance to previously uncovered populations can improve access to preventative health care alongside income effects resulting from lower need of out-of-pocket. However, theoretically, in the presence of ex-ante moral hazard, it can also give a disincentive to preventative efforts to lose weight among the already obese population. This paper draws on evidence from the introduction of the Mexican Seguro Popular (SP) in the 2000s to examine its effects on individuals' obesity and body mass index (BMI). We exploit the arbitrary timing of SP’s rollout across Mexican municipalities, namely the exogenous variation resulting from the different speeds in the implementation of SP. We document no significant average effects of SP rollout on BMI and obesity. We document a reduction in the average BMI among those individuals who were already overweight at the time of the introduction of SP and a reduction of 2 pp in the probability of smoking. This evidence suggests no evidence of ex-ante moral hazard in Mexico. |
| Keywords: | obesity, overweight, insurance expansion, Seguro Popular, ex-ante moral hazard, income effects, prevention, health behaviours. |
| JEL: | I18 J5 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12423 |
| By: | Ho, Christine; Kim, Dahye; Ray, Rohan; Teerawichitchainan, Bussarawan |
| Abstract: | Health and well-being in mature adulthood are important concerns given the prevalence of individuals aging without children. We exploit two new instruments for childlessness—infertility and the number of childless siblings—and condition our analyses on a rich set of covariates including childhood health and financial status, to investigate the causal relationship between childlessness and health in middle age and older adulthood. Using a nationwide dataset of 1500 Singaporeans aged 50 and above, we show that OLS underestimates the negative effects of childlessness on health. We find that childlessness leads to higher likelihood of poorer self-reported health and mental distress. The results are robust to a battery of sensitivity analyses, including bounding the effects by relaxing the exclusion restrictions. |
| Keywords: | health and well-being; childlessness; instrumental variable; bounds; aging |
| JEL: | I10 I31 J13 J14 |
| Date: | 2026–04–30 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137147 |
| By: | Huesmann, Katharina; Wambach, Achim |
| Abstract: | Banning money in markets for goods like education or health is a common policy to prevent unfair access by the wealthy. We investigate whether this policy is well-targeted for its intended goal. For this, we introduce a fairness criterion called discrimination-freeness which requires that goods are allocated independently of wealth. Using a model where willingness to pay increases with income, we find the answer depends critically on the level of wealth inequality. When inequality is high, a transfer ban is a well-aligned policy. It is then no more restrictive than requiring discrimination-freeness. The resulting allocations are constrained-efficient, meaning that any Pareto improvement would be discriminatory. When inequality is low, however, a transfer ban can be overly restrictive, as using monetary transfers may improve outcomes without causing discrimination. Our findings suggest that societies with more equitable wealth distribution may have more flexibility to use price mechanisms than those with high inequality. |
| Keywords: | repugnance, inequality, market design, matching markets |
| JEL: | D47 D63 H42 I00 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:zewdip:336758 |
| By: | Tim Laurence (Perma Analytics Ltd); Caroline Moore (Perma Analytics Ltd); Janeen Madan Keller (Center for Global Development); Rosie Eldridge (Center for Global Development) |
| Abstract: | Since 2022, mpox has triggered two public health emergencies of international concern, with sustained transmission across Africa and beyond. We conducted a modelling study to assess the cost-effectiveness of routine mpox vaccination in endemic African provinces as a strategy to reduce disease transmission and strengthen pandemic prevention and response. Although mpox imposes a substantially lower disease burden than malaria, tuberculosis, or diarrheal disease in the Democratic Republic of the Congo (DRC), routine mpox vaccination would still be health-positive for more than half of the DRC population (53.5 million people), including 23.2 million children. From a local health benefits perspective, routine vaccination of children aged 0–9 years may be cost-effective at $10 per dose compared with no vaccination in the two highest-burden provinces of the DRC. From a global healthcare payer perspective, routine vaccination of 8.5 million children aged 0–9 years in endemic regions of the DRC over a 10-year period—at an estimated cost of $203 million—could reduce the probability and size of mpox pandemics outside Africa—yielding an return on investment exceeding 3:1, even if the vaccine is used considerably past the point of local cost-effectiveness. However, under current budget constraints, additional donor financing would be required to realize these benefits for global pandemic prevention. We recommend: (1) expanding data on mpox vaccine efficacy and epidemiology; (2) advancing realistic financing strategies that account for trade-offs; (3) assessing routine vaccination for other high-risk pathogens; and (4) convening partners to assess the development of combination vaccines for mpox and other pathogens. |
| Date: | 2026–02–23 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:ppaper:379 |
| By: | Vogel, Justus; Fu, Enqi; Lang, Charlotte; Ehlig, David; Geissler, Alexander |
| Abstract: | Acute somatic hospital care accounts for a major share of Swiss healthcare expenditures. Reports of hospital deficits have increased in recent years, making them a major concern for health policy. These two factors raise questions about the adequacy of the hospital landscape and inpatient service provision, especially regarding the efficient utilization of human resources and infrastructure. Care planning is an important lever for efficient service provision. From 2012 onwards, all cantons have adopted Zurich's Hospital Capacity Planning Model (HCPM), which allocates service mandates to hospitals based on hospital planning service groups (SPLGs), complemented by national regulation on inter-cantonal planning of highly specialized medicine (IVHSM). Despite these reforms, current planning still insufficiently reflects actual patient flows across cantons and does not integrate inpatient and outpatient need for care. This study provides empirical evidence and impulses to inform the future development of hospital - and more broadly - care planning in Switzerland. The research questions (RQs) are: (1) To what extent does current cantonal hospital planning align with real-world patient flows and service mandate utilization? (2) How should SPLGs be allocated to different regional planning levels, considering complexity and urgency? (3) What are health system stakeholders' priorities for care planning (e.g., inter-cantonal planning, inter-sectoral planning)? |
| Keywords: | Hospital Capacity Planning, Health Policy Design, Real-world Evidence, Health Policy Reform |
| JEL: | I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:hsgmed:202601 |
| By: | Krzysztof Karbownik; Helena Svaleryd; Jonas Vlachos; Xuemeng Wang |
| Abstract: | Work-related burnout and stress-related sickness absence have become increasingly prevalent, but evidence on which workplace features shape workers’ mental health remains limited. Using population-level Swedish register data covering all lower- and upper-secondary teachers from 2006–2024, we show that schools serving more disadvantaged students exhibit substantially higher rates of sickness absence, particularly for stress-related diagnoses. Exploiting within-teacher variation across student cohorts, we separate sorting from exposure and find that a one standard deviation increase in student disadvantage raises overall and stress-related sick leave by 3.6% and 8.7%, respectively. Survey evidence indicates that these effects operate through classroom conditions rather than workload or organizational differences. The findings establish client composition as a distinct and policy-relevant determinant of worker health in contact-intensive occupations. |
| Keywords: | student composition, mental health, contact-intensive occupations |
| JEL: | I10 I21 J63 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12468 |
| By: | Robben, Jens (University of Amsterdam); Barigou, Karim (Université catholique de Louvain, LIDAM/ISBA, Belgium); Kleinow, Torsten (University of Amsterdam) |
| Abstract: | This paper develops a granular regime-switching framework to model mortality deviations from seasonal baseline trends driven by temperature and epidemic shocks. The framework features three states: (1) a baseline state that captures observed seasonal mortality patterns, (2) an environmental shock state for heat waves, and (3) a respiratory shock state that addresses mortality deviations caused by strong outbreaks of respiratory diseases due to influenza and COVID-19. Transition probabilities between states are modeled using covariate-dependent multinomial logit functions. These functions incorporate, among others, lagged temperature and influenza incidence rates as predictors, allowing dynamic adjustments to evolving shocks. Calibrated on weekly mortality data across 21 French regions and six age groups, the regime-switching framework accounts for spatial and demographic heterogeneity. Under various projection scenarios for temperature and influenza, we quantify uncertainty in mortality forecasts through prediction intervals constructed using an extensive bootstrap approach. These projections can guide healthcare providers and hospitals in managing risks and planning resources for potential future shocks. |
| Keywords: | granular mortality modeling ; regime-switching ; environmental shocks ; respiratory shocks |
| Date: | 2025–03–10 |
| URL: | https://d.repec.org/n?u=RePEc:aiz:louvad:2025006 |
| By: | Brahma, Dweepobotee; Sangwan, Nikita |
| Abstract: | We study whether digital platforms for high-skilled professionals level the playing field or reproduce traditional gender inequalities. Using high-frequency data on physicians, we examine gender differences in labor supply, pricing, patient engagement, and platform visibility. Although the platform equalizes supply-side margins of working hours and fees, female physicians experience lower demand, reduced search visibility, and lower reputation metrics. Investigating the underlying mechanisms, experimental evidence indicates taste-based discrimination, while text-analysis of patient reviews finds no gender differential. These findings underscore the potential role of platforms in reducing institutional constraints but not demand-side biases, with reputation metrics playing a crucial mitigation role. |
| Keywords: | gender bias, digital platforms, healthcare, high-skilled professionals |
| JEL: | J16 J24 I11 O33 L86 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:qmsrps:202602 |
| By: | Karina Colombo (European University Institute); Elisa Failache (Universidad de la República (Uruguay). Facultad de Ciencias Económicas y de Administración. Instituto de Economía) |
| Abstract: | We conduct an information experiment on screen exposure in early childhood by providing caregivers with recommendations based on recognized health institutions through an online video and digital leaflet. We evaluate the effectiveness of this light touch intervention using original data on the quantity and quality of screen exposure.We find null effects for screen time and quality of exposure in the overall sample, with mild effects on parental beliefs. However, caregivers belonging to vulnerable groups improve their beliefs and their child’s quality of screen exposure.In addition, we find suggestive evidence of strong survey effects from the self-assessment of parenting practices motivated by the completion of the questionnaire. These results provide evidence to design policies that promote skill acquisition from digital technologies by changing parental beliefs and practices. |
| Keywords: | information experiment, parental beliefs and investments, screen media, infants and toddlers |
| JEL: | C93 D83 O15 J13 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:ulr:wpaper:dt-09-25 |
| By: | Teresa Corzo Santamaria; Jose Portela; Eduardo S. Schwartz |
| Abstract: | Geopolitical tensions, supply-chain concerns and policy risk have moved to the forefront of the pharmaceutical industry. This paper develops a real options valuation model of drug R&D that captures sequential clinical investment with technical failure, stochastic costs, uncertain cash flows, and optimal abandonment. We incorporate two regulatory shocks: a reduction in effective exclusivity period and a price-control shock that reduces net cash flows. Calibrating to an incremental CNS program, we find that project value at initiation is highly right-skewed: the mean is USD 69.6m but the median is negative, so expected value is driven by rare high-upside outcomes. Regulatory risk mainly compresses this upside. Both reductions in effective exclusivity and price-based interventions substantially weaken investment incentives, even when they occur with moderate probability. Value is strongly convex in exclusivity length, with the final years carrying the highest marginal value. We introduce iso-value maps that summarize how time-based and price-based policies substitute in their impact on project valuation, to clarify the trade-offs inherent in regulatory design: losing two years of exclusivity is comparable to roughly a 30% cash-flow contraction. Using a standard revenue-to-R&D elasticity, these valuation effects imply a 10% to 25% long-run contraction in investment. The framework provides a transparent mapping from policy design to project value and investment incentives. |
| JEL: | G1 I18 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34863 |
| By: | Sofiana Sinani |
| Abstract: | This paper investigates whether a mother's extended provision of full-time childcare shapes her children's preferences for occupation choices. I analyze a natural experiment in the Czech Republic that extended parental allowances by one year. This induced many mothers to remain out of the workplace and caused them to face a higher likelihood of long-term employment. This shift reinforced a more traditional, mother-as-homemaker dynamic within households. Using a regression discontinuity design, I measure their children's later occupational preferences via their university applications. I find that boys who were exposed to the reform during early childhood were 20% less likely to apply to stereotypically feminine fields in adulthood, with no corresponding effect observed for girls. I examine potential channels and find no evidence that the reform altered children's academic ability (proxied by high school track) or their preferences for research- and mathematicsoriented tracks. The results are therefore consistent with the interpretation that longer exposure to a stay-at-home mother, which may accentuate traditional gender roles, can reduce boys openness to nurturing- and care-oriented careers. This study provides the first causal evidence that the duration of maternal care can influence the gender-specific occupational choices. |
| Keywords: | maternal care, field-of-study choice, occupation, RDD |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:cer:papers:wp812 |
| By: | Vishal R. Patel; Christopher M. Worsham; Michael Liu; Anupam B. Jena |
| Abstract: | Modern smartphones present new threats to road safety beyond talking and texting, but the real-world effects are difficult to study. One way to causally assess the impact of smartphones on road safety is to identify arbitrarily timed events during which smartphone-related distraction may exogenously increase – i.e., a situation that relies not on plausibly random variation in who uses smartphones while driving, but when smartphones are used. We investigated the impact of smartphones on road safety by examining traffic fatalities on days when smartphone use likely surges: the release of major music albums. Using event study analysis, we show that music streaming – an indicator for smartphone use, where streaming most often occurs – sharply increases, by nearly 40%, on dates of major music album releases, while U.S. traffic fatalities increase by nearly 15% on those same days. Mobile device use while driving is a known safety issue, but today’s smartphones present new and greater opportunities for driver distraction. Our study indicates how features of these phones may have important impacts on distracted driving and traffic fatalities. |
| JEL: | I1 I12 R40 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34866 |
| By: | Doms, Hortense (Université catholique de Louvain, LIDAM/ISBA, Belgium); Legrand, Catherine (Université catholique de Louvain, LIDAM/ISBA, Belgium); Lambert, Philippe (Université catholique de Louvain, LIDAM/ISBA, Belgium) |
| Abstract: | In cancer clinical trials, health-related quality of life (HRQoL) is an important endpoint, providing information about patients’ well-being and daily functioning. However, missing data due to premature dropout can lead to biased estimates, especially when dropouts are informative. This paper introduces the extJMIRT approach, a novel tool that efficiently analyzes multiple longitudinal ordinal categorical data while addressing informative dropout. Within a joint modeling framework, this approach connects a latent variable, derived from HRQoL data, to cause-specific hazards of dropout. Unlike traditional joint models, which treat longitudinal data as a covariate in the survival submodel, our approach prioritizes the longitudinal data and incorporates the log baseline dropout risks as covariates in the latent process. This leads to a more accurate analysis of longitudinal data, accounting for potential effects of dropout risks. Through extensive simulation studies, we demonstrate that extJMIRT provides robust and unbiased parameter estimates and highlight the importance of accounting for informative dropout. We also apply this methodology to HRQoL data from patients with progressive glioblastoma, showcasing its practical utility. |
| Keywords: | Bayesian joint models ; Informative dropout ; Item response theory ; Quality of life |
| Date: | 2025–01–01 |
| URL: | https://d.repec.org/n?u=RePEc:aiz:louvad:2025005 |
| By: | Bauer, Annette; Gregoire, Alain; Salehi, Naz; Weng, Jessica; Knapp, Martin |
| Abstract: | Economic evaluations of mental health problems typically only include short-term measures from an individual healthcare perspective. In perinatal mental health, which spans generations, this is likely to lead to an underestimation of interventions' potential benefits. We sought to understand the spectrum of outcomes of perinatal mental health problems that have economic consequences and how they are captured in economic evaluations. We conducted a systematic search of the peer-reviewed literature to identify two types of evidence: (i) synthesised evidence (i.e. systematic reviews, meta-analyses) or recent cohort studies that measured the outcomes of perinatal mental health problems, (ii) economic evaluations. After presenting the evidence narratively, we derive an overview of different types of outcomes to include in economic evaluations. Evidence on the many, wide ranging adverse outcomes with short- and long-term economic consequences is rich, ranging from those that can be measured during the perinatal period (e.g., mother's employment), those that require a longer-term follow-up period (e.g., children's mental health service use) and those that can be used as predictors in modelling studies (e.g., birth weight). Only a small subset of economic consequences, and their predictors (e.g., child maltreatment, poor attachment), are currently measured in economic evaluations. We make some recommendations how more and new types of economic evaluations might start addressing the gap in knowledge. To inform decisions about reducing the costs of perinatal mental health problems, economic evaluations that provide knowledge of interventions' abilities to reduce the short- and long-term economic consequences are urgently needed. [Abstract copyright: Copyright © 2025. Published by Elsevier Inc.] |
| Keywords: | economic evaluation; perinatal mental health problems; child outcomes; parenting |
| JEL: | J1 |
| Date: | 2025–06–02 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:127084 |