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on Health Economics |
| By: | Jason Abaluck; Leila Agha; Sachin Shah |
| Abstract: | The FDA does not formally regulate representativeness, but if trials under-enroll vulnerable patients, the resulting evidence may understate harm from drugs. We study the relationship between trial participation and the risk of drug-induced adverse events for cancer medications using data from the Surveillance, Epidemiology, and End Results Program linked to Medicare claims. Initiating treatment with a cancer drug increases the risk of hospitalization due to serious adverse events (SAE) by 2 percentage points per month (a 250% increase). Heterogeneity in SAE treatment effects can be predicted by patient's comorbidities, frailty, and demographic characteristics. Patients at the 90th percentile of the risk distribution experience a 2.5 times greater increase in SAEs after treatment initiation compared to patients at the 10th percentile of the risk distribution yet are 4 times less likely to enroll in trials. The predicted SAE treatment effects for the drug's target population are 15% larger than the predicted SAE treatment effects for trial enrollees, corresponding to 1 additional induced SAE hospitalization for every 25 patients per year of treatment. We formalize conditions under which regulating representativeness of SAE risk will lead to more externally valid trials, and we discuss how our results could inform regulatory requirements. |
| JEL: | C93 I1 O38 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34534 |
| By: | Benjamin R. Handel; Jonathan A. Holmes; Jonathan T. Kolstad; Kurt J. Lavetti |
| Abstract: | Private health insurers play a central role in determining the cost and quantity of health care in the United States. Despite this centrality, there has been limited empirical work studying how insurers differentially affect spending and consumption, especially for expensive and pervasive chronic conditions. We use hundreds of natural experiments involving employers switching their primary health insurer, together with a movers design, to estimate these causal effects. We find meaningful differences in total cost and prices for medical and pharmaceutical spending. Within-person changes in spending caused by forced reassignment across pairs of insurers, holding fixed plan generosity, are as large as 30% of total medical spending and 37% of drug spending. We also find substantial dispersion in insurer causal effects on health care spending and quantities for patients with diabetes, hypertension, and other chronic conditions. We find strong evidence for drug offsets as insurers who causally increase drug utilization also reduce medical costs and quantities overall and by condition. Finally, we find that employers do not select plans that reduce costs for their employees based on the match between employee conditions and estimated plan treatment effects, leaving significant cost savings on the table. |
| JEL: | G52 I11 L1 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34561 |
| By: | Liran Einav; Amy Finkelstein; Yunan Ji; Neale Mahoney |
| Abstract: | Governments often concurrently deploy multiple policy instruments to tackle a common objective, yet researchers typically analyze each policy's impacts independently. We study interactions across policies and their implications within the context of efforts to reduce Medicare-financed home health services. We consider two geographically targeted policies: strike force prosecutions of suspected fraud and moratoria on the entry of new home health agencies. Depending on location and time, we observe either both, one, or neither policy in place. Individually, each policy reduced home health use substantially, and was well-targeted to places with higher treatment effects. Although we estimate only a modest interaction between the two policies, we find that optimally allocating them across the areas that received at least one policy could have increased their total impact by about 20% relative to the observed placement. Our exercise highlights the potential gains from coordination across different policy instruments pursuing similar objectives. |
| JEL: | H0 I0 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34554 |
| By: | Anwar Assamidanov; Dhaval M. Dave; Jooyoung Kim; Brandy Lipton; Xuechao Qian; Joseph J. Sabia |
| Abstract: | Paid sick leave mandates (PSLs), which have been adopted by 18 states and the District of Columbia, require employers to provide regular wages when workers take short-term leave for their own or a family member’s medical needs. This study is the first to explore the effects of PSL adoption on participation in the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs, as well as the health of persons with disabilities. We find that statewide PSLs are associated with a 6-9 percent increase in initial claims for SSI and joint SSI/SSDI benefits. These applications translate to an increase in beneficiaries, strongest among children under age 18. An exploration of the primary mechanisms likely underlying this result reveals PSL-induced (1) increases in time spent offering informal caregiving of those with disabilities, which may reduce the costs of applying to SS(D)I programs, and (2) increases in health care utilization among children with disabilities. Evidence for negative work hours effects of PSLs is weaker, concentrated among spouses of persons with disabilities. Finally, we find that PSL mandates lead to modest improvements in health among both children and adults with disabilities. |
| JEL: | J14 J18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34542 |
| By: | Rahi Abouk; Johanna Catherine Maclean; Rosalie Liccardo Pacula |
| Abstract: | Studies show that U.S. state cannabis legalization has increased adult cannabis use, but the effects on youth use are mixed. This study considers whether omission of enforcement of the minimum legal sales age (MLSA) might help explain prior mixed findings. We combine biennial survey data for 6th, 8th, 10th, and 12th grade students from the 2010-2023 Washington Healthy Youth Survey with administrative data on premise and compliance checks from the Washington State Liquor and Cannabis Board (WSLCB). Premise checks educate retailers on any potential violations but do not involve penalties or fines. Compliance checks, on the other hand, involve increasing penalties imposed on retailers if they are found to be noncompliant with sales to minors. We use difference-in-differences (DID) methods that are robust to a staggered policy rollout with dynamic and heterogeneous treatment effects and assess impacts of both types of inspections on past month cannabis use. We conduct a series of sensitivity and robustness checks of the impact of both types of inspections based on student’s grade, length of time since inspection, inclusion of alcohol/tobacco retail compliance checks, and alternative measures of cannabis use. Our research suggests that the implementation of regular random compliance checks with stiff penalties on retailers for noncompliance may help reduce the influence of legal markets on youth use. Unobserved heterogeneity within and across states in the enforcement of MLSAs may contribute to mixed findings of the impact of legalization on youth cannabis use. |
| JEL: | H0 I1 K0 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34567 |
| By: | Ashvin Gandhi; Andrew Olenski; Maggie Shi |
| Abstract: | Inspections are a common tool for acquiring information and incentivizing compliance. Although inspections are typically unannounced, their timing often follows a predictable schedule. We study how this predictability shapes firm effort and patient outcomes in U.S. nursing homes, leveraging detailed administrative data on staffing, care, and health outcomes. Nursing homes "slack" in the low-risk period following an inspection and ramp up effort as their next inspection approaches. Patient survival mirrors this pattern, suggesting that these fluctuations in effort have meaningful consequences for the quality of patient care. We embed these estimates in a dynamic model capturing how inspection regimes incentivize effort and provide information about quality. Our estimates indicate that moving to unpredictable inspections could induce as much additional effort as increasing the frequency of inspections by 12%, while only minimally reducing their informational value. |
| JEL: | I18 L51 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34491 |
| By: | Anaya-Montes, Misael; Grasic, Katja; Lomas, James; Anselmi, Laura; Asaria, Miqdad; Kypridemos, Christodoulos; Barr, Benjamin; Sutton, Matthew; Bentley, Chris; Cookson, Richard |
| Abstract: | Quasi-experimental studies of mortality variation and trends among large administrative areas of England in the 2000s and early 2010s have suggested that more deprived populations gain larger mortality benefits from marginal increases in public expenditure on secondary care. To identify causal effects of marginal changes in expenditure on mortality variation in 2018 among 32, 784 more and less deprived small areas of England, with a mean population of 1700, allowing more fine-grained measurements of deprivation and mortality. We used cross-sectional data on secondary-care funding allocated to 195 National Health Service administrative areas in England in 2018/19 and employed a well-established instrumental variable approach based on the "distance from target" component of the funding formula, which generates quasi-exogenous variation in funding based on historical factors unrelated to current need for secondary care. We found an inverted U-shape pattern of mortality gains by deprivation group, whereby the middle group gained significantly more than others. However, we could not reject the null hypothesis that the two more deprived groups received the same mortality gain as the two less deprived groups. These findings were robust to extensive sensitivity analysis using different levels of analysis, control variables, mortality outcomes, functional forms, first-stage regression specifications, and exclusions, and our preferred specifications all satisfied standard instrumental variable diagnostic tests. We found that the poor do not always gain more from marginal increases in public expenditure on secondary care and, conversely, might not always bear the largest share of the health opportunity costs of cost-increasing programmes. [Abstract copyright: © 2025. The Author(s).] |
| Keywords: | equity; health inequality; deprivation; geographical resource allocation; instrumental variables; mortality; secondary care expenditure; socioeconomic factors; small area variation |
| JEL: | J1 |
| Date: | 2025–12–16 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:130181 |
| By: | Dhaval M. Dave; Tessie Krishna; Yang Liang; Joseph J. Sabia |
| Abstract: | The rise in nicotine vaping among U.S. teenagers in the late 2010s prompted tobacco control advocates to press for higher electronic nicotine delivery system (ENDS) taxes to curb their use. This study is the first to explore how the effectiveness of e-cigarette taxation as an anti-vaping policy tool has evolved over time. Using data from several nationally representative data sources and a generalized difference-in-differences approach, we find that since 2020, the effectiveness of a one dollar increase in ENDS taxes in curbing youth nicotine vaping has declined by over 50 percent. This finding is consistent with the marginal youth vaper becoming more tax inelastic over time. Descriptive evidence shows that the composition of youth ENDS users appears to have shifted toward those with a higher addictive stock and a greater taste for risk, which could make youths less tax responsive. For adults, where nicotine vaping rates are stable or slightly rising and compositional shifts are somewhat less pronounced, we find much less evidence that ENDS tax effectiveness has changed over time. |
| JEL: | H71 I12 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34544 |
| By: | Ege Aksu; Charles J. Courtemanche; Dhaval M. Dave; Daniel L. Dench; Michael Grossman; Jooyoung Kim; Selen Ozdogan; Shubhsri Rajendra; Joseph J. Sabia; Henry Saffer |
| Abstract: | Policymakers at the state and federal levels have argued that restricting online sales of e-cigarettes is a crucial policy tool to curb youth vaping. This study is the first to explore the effectiveness of statewide restrictions on online sales of electronic nicotine delivery systems (ENDS) on teen and young adult ENDS use. Using data from four national datasets (Monitoring the Future, State and Combined Youth Risk Behavior Surveillance System surveys, Population Assessment of Tobacco and Health, and Behavioral Risk Factor Surveillance System survey) and a generalized difference-in-differences approach, we find no evidence that such laws are effective at curbing youth ENDS use. With 95 percent confidence, we can rule out that online sales restrictions reduced prior-month ENDS use by more than 3.6 percent of the pre-treatment mean vaping rate. An exploration of mechanisms suggests that (1) while restrictions on online sales may have a small negative effect on online purchases, youths are able to substitute to other sources for ENDS products to compensate for reduced online access, and (2) online sources are a very rare source of e-cigarettes for youths. Finally, we also find no evidence that online sales restrictions reduce adult ENDS use. |
| JEL: | I12 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34565 |
| By: | Titir Bhattacharya; Tanika Chakraborty; Prabal De |
| Abstract: | Establishment of public–private partnerships is an emerging model in health care delivery. This study evaluates a pioneering social health insurance program in India that enables eligible households to access private hospitals for tertiary care services free of cost, but does not build more facilities. Leveraging policy discontinuities at state borders, we identify the program’s causal effects on utilization of private facilities and associated out-of-pocket expenditures. The results indicate a pronounced substitution effect induced by relative price changes: the program substantially increases the incidence of deliveries in private hospitals while significantly reducing out-of-pocket spending. However, we find no statistically significant effects on fertility or a key health outcome, infant mortality. |
| Keywords: | public health insurance, public-private substitution, maternal and child health |
| JEL: | I13 I18 J18 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12370 |
| By: | Bhattacharya, Titir (University of Warwick); Chakraborty, Tanika (Indian Institute of Management); Mukherjee, Anirban (University of Calcutta) |
| Abstract: | We study why free public health insurance in India exhibits persistently low utilisation despite high out of pocket health expenses. Using panel data from the Young Lives Survey and the rollout of the Arogyasri scheme in Andhra Pradesh, we distinguish the roles of informal financial and information networks in shaping adoption. Empirically, households embedded in financial networks show higher take-up and utilisation, while information networks have no effect. To explain this pattern, we develop a simple theoretical framework in which informal financial networks act as mutual insurance: because members bear each other’s uninsured losses, the network has an incentive to push all members to enrol when the expected cost of shocks exceeds enrolment transaction costs. This generates corner solutions for network members and interior solutions for non-members, consistent with observed bimodal take-up patterns. The model clarifies why financial—but not informational—ties complement public insurance and highlights community-based mechanisms for increasing adoption. |
| Keywords: | adoption, informal network, health insurance, utilization, demand |
| JEL: | I13 I18 O17 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18316 |
| By: | Ahammer, Alexander (University of Linz); Halla, Martin (Vienna University of Economics and Business); Heckl, Pia (Ifo Institute for Economic Research); Winter-Ebmer, Rudolf (Johannes Kepler University Linz) |
| Abstract: | Long-term unemployment among older workers is particularly difficult to overcome. We study the impacts of a large-scale job guarantee program that offered up to two years of fully subsidized employment to long-term unemployed individuals aged 50 and above. Using a sharp age-based discontinuity in eligibility, we find that participation increased regular, unsubsidized employment by 43 percentage points two years after the program ended. The gains are driven by transitions into new firms and industries, rather than continued subsidized employment, and we find no evidence of displacement effects for non-participants or spillovers to family members. The program had no measurable short-run health effects. |
| Keywords: | subsidized employment, temporary job guarantee, long-term unemployment, health status |
| JEL: | J64 J08 J78 I14 H51 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18322 |
| By: | Salvatore Russo (Venice School of Management, Ca’ Foscari University of Venice); Mona Razaghzadeh Bidgoli (Venice School of Management, Ca’ Foscari University of Venice) |
| Abstract: | This study investigates the extent to which Health Technology Assessment (HTA) might have influenced health system performance in terms of healthcare cost performance, employment in health and social care, and mortality outcomes. By comprehensive descriptive and causal analyses combining Difference-in-Differences (DiD) with an Ordinary Least Squares (OLS) regression model. The research examines short-term as well as long-term effects of HTA implementation. The findings suggest that HTA uptake is linked to meaningful, sustained mortality reductions for myocardial infarction and ischemic stroke over the long term and short term, suggesting improvements in clinical quality and population health. While short-term effects on cost performance and employment are limited, the long-term analysis suggests that HTA contributes to reducing costs and resource optimization as technologies mature within health systems. |
| Keywords: | Health Technology Assessment; Health system performance; OECD |
| JEL: | H11 I18 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:vnm:wpdman:232 |
| By: | De Vera, Micole (Banco de España); Garcia-Brazales, Javier (CEMFI); Lin, Jiayi (Universitat Pompeu Fabra) |
| Abstract: | What determines long-term mental health and its intergenerational correlation? Exploiting variation in unemployment rates upon labor market entry across Australian states and cohorts, we provide novel evidence that the mental health of daughters is affected by the labor market entry conditions of their parents. In particular, a one standard deviation shock to the unemployment rate upon parental labor market entry worsens daughters' mental health during adolescence by 11% of a standard deviation. This effect is accompanied by lower levels of satisfaction with their health, financial situation, safety, and overall life. A mediation analysis suggests that a sizable proportion (24%) of the impacts on the descendants' mental health is explained by the worse mental health of their parents at mid-life. We do not detect any systematic impact of parental labor market entry conditions among sons. |
| Keywords: | intergenerational correlation, well-being, mental health, recession, Australia |
| JEL: | E32 I14 I31 J62 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18305 |
| By: | Richard Akresh; Damien de Walque; Harounan Kazianga; Abigail Stocker |
| Abstract: | Cash transfers are a critical part of social safety nets. However, integrated programs combining cash and parenting interventions through either group-based information meetings or home visits are recently being adopted to improve child development. Working with the Burkina Faso government, we conduct a randomized experiment in 225 rural villages to assess the impact of an integrated social safety net over the child’s life cycle. Villages were randomized to a control group or one of the following treatments: cash transfers; cash transfers plus government-run group-based information meetings focused on children’s health and psychosocial development; or cash transfers, information, and home visits reinforcing the information meetings. Fifteen months after treatment ended, households receiving cash, information, and home visits have fewer pregnancies, more medically assisted childbirths, enhanced health behaviors, and better educational outcomes. Adding home visits is essential for improving childhood development, while cash, with or without information, produces no lasting impacts. |
| JEL: | I12 I38 J13 O12 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34578 |
| By: | Christine Sevilla-Dedieu (MGEN Foundation for Public Health , Paris, France); Nathalie Billaudeau (MGEN Foundation for Public Health , Paris, France); Morgane Le Guern (MGEN Foundation for Public Health , Paris, France); Audrey Arnaud (Assistance Publique – Hˆopitaux de Paris (AP-HP), Paris, France); Alain Paraponaris (Aix-Marseille Univ., CNRS, AMSE, Marseille, France) |
| Abstract: | Tis paper examines the efectiveness of France’s organized cancer screening programs by leveraging age-based eligibility thresholds to identify causal efects on screening uptake. Using 2019 telephone survey data matched with medico-administrative records from 1, 411 women insured by MGEN, we employ a fuzzy regression discontinuity design to estimate Local Average Treatment Efects at program entry and exit ages. Our results reveal dramatic discontinuities in screening behavior: entering mammography screening eligibility at age 50 increases uptake probability by 59 percentage points (pp) (p <0.001), while exiting eligibility at age 75 decreases uptake by 39pp (p= 0.014). For cervical screening, we fnd no signifcant discontinuity at the entry age of 25, but observe a substantial decrease at the exit age of 66 (-30pp, p= 0.080). Importantly, these efects vary signifcantly according to individual risk atitudes measured using the DOSPERT scale. risk-takingwomen drive the positive entry efects for mammography screening (+74pp, p <0.001versus non-signifcant efects forrisk-aversewomen), whilerisk-aversewomen are particularly susceptible to negative exit efects (-31pp, p= 0.035). Tese fndings suggest that age-targeted screening policies create temporary behavioral changes rather than sustained health habits, with heterogeneous impacts based on individual risk preferences. Our results have important implications for designing more personalized public health interventions that account for individual psychological characteristics. |
| Keywords: | Cancer screening test uptake; fuzzy regression discontinuity; attitude towards risk |
| JEL: | C26 I12 I14 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:aim:wpaimx:2535 |
| By: | Vitt, Helena |
| Abstract: | Health care services are Germany's largest in-kind transfer, yet their distributional effects remain underexplored. Using a microsimulation model, we integrate detailed survey data on health care utilisation from the German Health Update Study (GEDA) with administrative expenditure records from the German Health Reporting system. In contrast to previous studies that allocate benefits using demographic proxies, we apply an actual-use, cost-based approach to assign thirteen categories of health care services to individuals based on reported utilisation. These services are monetised and added to equivalised household income to assess their redistributive effect. We find that total benefits are overall progressive: publicly insured individuals average about €3, 759 in benefits, while civil-servant-subsidised private insurance averages €4, 050, with public insurance raising household income substantially more due to its wider coverage and targeting of need. A KOB-decomposition at the 60% median-income threshold shows that the poor receive €1, 432 more in total benefits than the non-poor, with most of the explained gap driven by worse health status and activity limitations and further widened by employment composition. A lower prevalence of private insurance among the poor narrows the gap. Distribution-wide RIF results reveal that the explained component is sizable at P75 (+€1356) and very large at the 90th percentile (+€5480), reflecting steep need gradients at the top of the benefit distribution. By service type, hospital and GP benefits remain progressive, while specialist care shows no significant mean gap. However, composition effects still indicate that private insurance pushes specialist benefits toward the better-off. |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:ifsowp:334485 |
| By: | Tharp, Derek (University of Southern Maine) |
| Abstract: | Nearly one-fourth of Americans claim Social Security at age 62, while only one-in-ten wait until age 70—a pattern that has long puzzled economists who argue delay is financially optimal. This paper develops a series of dynamic programming models to examine whether early claiming reflects mistakes or rational responses to preferences overlooked in standard analyses. Three behavioral factors are incorporated: a claim-retire linkage (a preference to claim benefits at retirement rather than managing a separate "bridge" period); front-loaded consumption preferences (a desire to spend more in the early, active years of retirement); and source-dependent utility (greater comfort spending from regular income like Social Security than drawing down a retirement portfolio). Using Epstein–Zin recursive utility with stochastic investment returns, medical expenditure shocks, mortality risk, policy risk, and bequest motives, results show that incorporating these empirically documented factors substantially lowers optimal claiming ages. Under the full behavioral specification, claiming at 62 is optimal for households with up to $800, 000 in initial wealth—a wealth level that encompasses the vast majority of Americans approaching retirement. Results are qualitatively robust to alternative assumptions about mortality, bequest strength, tax treatment, and spousal or survivor benefits. These findings suggest that widespread early claiming may reflect genuine preferences rather than financial mistakes, though individual circumstances—including wealth, employment status, tax situation, and personal preferences—may provide incentives toward delay. Rather than uniformly prescribing delay, advisors should assess clients' goals, circumstances, and preferences and tailor recommendations accordingly. |
| Date: | 2025–12–19 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:wx6jn_v1 |
| By: | Sara Drango; Sarah Moshary; Bradley Shapiro |
| Abstract: | We evaluate the effect of California's 11 percent excise tax on firearms, introduced in July 2024, on retail prices. Using price quotes for 48 popular firearms from over 2, 200 licensed dealers, we compare California prices to those in other states and to pre-tax trends. We find that prices in California increase by about 10% in response to the 11% tax. Results are consistent across gun types and show no evidence of border spillovers. These findings indicate that firearm excise taxes can effectively raise consumer prices. |
| JEL: | H21 H22 H23 I18 K34 L11 L68 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34527 |
| By: | Alden Cheng; Martin B. Hackmann |
| Abstract: | We provide causal evidence that patient peer effects generate mortality impacts comparable to provider quality differences. Drawing on administrative records covering 2.6 million stays (2000–2010) across 7, 200 U.S. nursing homes, we exploit plausibly exogenous roommate assignments identified through unique room identifiers. We estimate that assignment to a roommate diagnosed with Alzheimer’s disease (AD) or Alzheimer’s disease related dementias (ADRD), relative to placement in a private room, increases 90-day mortality by 2.1 percentage points (14% of baseline)—equivalent to receiving care at a nursing home one full standard deviation worse in quality. Effects differ sharply by patient type: patients with AD/ADRD benefit substantially from cognitively healthy roommates but not from private rooms, suggesting important peer monitoring and support roles. In contrast, mortality of patients without AD/ADRD does not depend on roommate cognitive health but is reduced in private rooms. A simple assignment rule exploiting this heterogeneity could reduce overall mortality by 0.8 percentage points without additional resources. |
| JEL: | D62 I11 I12 I18 J14 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34538 |
| By: | Sylvain Chassang |
| Abstract: | This paper argues that in long-term consumer–producer relationships, menus of contracts can often be advantageously replaced by a single generous contract such that, at any point in time, a consumer’s cumulative transfers equal the cumulative transfers they would have made under the contract that would have been best for them in hindsight. Such generous long-term contracts can increase skeptical consumers’ demand for complex and higher-powered contracts while approximately implementing the same outcomes as the underlying menu evaluated by a rational decision maker. Applications include voluntary load shedding in retail electricity markets and cost sharing in health insurance. |
| JEL: | D47 D82 D86 I13 Q41 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34593 |
| By: | Marianne Simonsen; Lars Skipper; Jeffrey Andrew Smith |
| Abstract: | This paper uses register-based data to analyze the consequences of a recent major Danish welfare reform for children’s academic performance and well-being. In addition to work requirements, the reform brought about considerable reductions in welfare transfers. We implement a comparative event study that contrasts outcomes for individuals on welfare at the time of reform announcement before and after the implementation of the reform with the parallel development in outcomes for an uncontaminated comparison group, namely those on welfare exactly one year prior. Our analysis documents that mothers’ propensity to receive welfare decreased somewhat as a consequence of the reform, just as we observe a small increase in hours worked. At the same time, we do not detect negative effects on children’s short-run academic performance. We do find small negative effects on children’s self-reported school well-being and document substantial upticks in reports to child protective services for children exposed to the reform. |
| Keywords: | welfare reform, child outcomes, Denmark |
| JEL: | I38 J13 J22 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12369 |
| By: | Sarah Miller; Petra Persson; Maya Rossin-Slater; Laura R. Wherry |
| Abstract: | One in three births in the United States is delivered by cesarean section (c-section). This paper studies the labor market and health effects of c-sections, using newly linked administrative data that combines the universe of California birth records with mothers’ quarterly earnings. We analyze the impact of an intervention that reduced c-section rates among low-risk first-time births, and find that mothers exposed to the intervention appear to have a higher likelihood of employment in the quarter following birth, as well as a higher likelihood of returning to their pre-birth employer. These impacts attenuate over time—suggesting that a c-section primarily delays return to the labor market following childbirth—but attachment to the pre-birth employer remains higher five quarters post-birth. We find no evidence of significant impacts on maternal or infant health, indicating that the intervention-induced decline in c-sections did not come at the cost of worse outcomes. Further, among mothers who have another child, we find that exposure to the intervention at the first birth leads to a lower likelihood of c-section and preterm delivery at the second one, implying that both the economic and health benefits of reduced c-sections may compound with birth order. |
| JEL: | I14 I15 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34556 |
| By: | Manho Kang; Xiangtao Meng; Katheryn N. Russ; James Waters |
| Abstract: | Have recent tariffs resulted in increased costs for the US healthcare system? We examine US trade data and compile a database of statutory tariff changes. Tariffs on medical goods narrowly defined resulted in $3.4 Billion in duties assessed between February and July 2025—more than 10 times the same period in 2024, with a 55.8 percent rate of pass-through at the US border. We estimate that had medical goods imports observed in 2024 been subject to the statutory tariff levels prevailing in August 2025, assessed duties would have been $15.8 Billion, almost 30 times higher than those observed in real-time. Our aggregates understate imports of medical goods and other imports used in healthcare settings, as data limitations compel us to omit purchases of imported goods for construction, maintenance, and operations of facilities, as well as imports under certain HS10 and HS6 tariff codes that are used when identifying medical goods in many contexts but contain a mixture of imports for medical and non-medical purposes. |
| JEL: | F10 F13 F14 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34531 |
| By: | Pavanello, Filippo; Valenti, Giulia |
| Abstract: | In 2004, Italy introduced a national program to address heat-related health risks, combining public awareness campaigns, heat-wave warning systems, and hospital protocols. Leveraging administrative mortality data and high-frequency temperature variation, we show that the program reduced heat-related mortality by more than 57% on days at or above 30°C. To identify the mechanisms, we exploit the staggered introduction of heat-wave warning systems across provinces and show that treated areas experienced substantially larger reductions in heat-related mortality. We further document that information disclosure plays a key role in driving these reductions. Overall, our findings underscore the importance of public adaptation policies that rely on information provision to cost-effectively mitigate the health impacts of extreme temperatures. |
| Keywords: | Climate Change, Sustainability |
| Date: | 2025–12–27 |
| URL: | https://d.repec.org/n?u=RePEc:ags:feemwp:386192 |
| By: | Hao, Zhuang; Zhang, Xudong; Li, Gucheng; Tennekoon, Vidhura S.; Tian, Zerui |
| Abstract: | Farming households face intertwined uncertainties in health and agricultural production, raising critical questions about how ongoing efforts of developing countries on social insurance provision and expansion influence agricultural production decisions. This paper investigates the impact of health insurance on agricultural investments, leveraging the phased rollout of a nationwide basic insurance scheme integration in China that enhanced the affordability and accessibility of health care services for rural residents. We provide robust evidence that insurance integration leads high health-risk farming households to significantly reduce investments in food crop production, with expenses on seeds, fertilizers, pesticides, and films decreasing by 7.5%, 8.5%, 7.6%, and 7.3%, respectively. Empirical results suggest that insurance integration mitigates health risks, encouraging farming households to assume greater production risks. This is reflected in reduced food crop diversification, which may explain the decline in its investment. However, there is no significant evidence of increased engagement in other risky agricultural production activities, such as expanding sown areas or investing in cash crops. Importantly, the reduction in food crop investments does not compromise household income. These findings highlight the complex interplay between health insurance and agricultural decision-making, offering valuable insights into social policies aimed at reducing rural vulnerabilities. |
| Keywords: | Health Economics and Policy |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360927 |
| By: | Sumedha Gupta; Yimin Ge; Johanna Catherine Maclean; Matthew D. Eisenberg |
| Abstract: | Opioid use disorder (OUD) among pregnant women in the United States has risen more than fourfold since 1999, making substance use a leading cause of maternal mortality. Medicaid finances the majority of births and substance use disorder treatment in the U.S., yet until recently, coverage typically ends 60 days postpartum, potentially disrupting care continuity. The American Rescue Plan of 2021 extends postpartum Medicaid coverage from two months to 12 months, creating a natural experiment to evaluate the impact of coverage on access to medications for OUD (MOUD), the gold-standard treatment. We use linked nationwide all-payer medical and retail pharmacy claims from IQVIA in a difference-in-differences framework comparing postpartum MOUD continuity between Medicaid- and commercially-insured parents with a prenatal history of MOUD use. Extended Medicaid postpartum coverage increases Medicaid-financed MOUD months by 8.55%, the likelihood of continuing MOUD beyond 60 days by 5.12%, and total MOUD supply days by 7.99%. These gains are slightly offset by other payer reductions, yet result in a net 5.10% increase in overall MOUD months and 4.64% rise in treatment adherence. Findings highlight the importance of coverage duration as a practical lever to sustain MOUD treatment in the crucial first year after delivery period. |
| JEL: | H0 I1 K0 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34541 |
| By: | Lauren Hoehn-Velasco; Nikita Dhingra; Mayra Pineda-Torres |
| Abstract: | Do restrictions on public funding create unintended reliance on social assistance? In this paper, we study the 1976 Hyde Amendment, which barred federal funding for abortion. Using county-level data and an event-study design, we show that reduced federal funding for abortion increased fertility among young women by 2%. These effects were concentrated among non-white women, who subsequently experienced greater welfare participation in states with larger abortion funding declines. The consequences extend into the next generation: non-white girls born after Hyde were more likely to rely on public assistance in adulthood. Abortion funding restrictions reinforce long-run economic inequality across generations. |
| JEL: | D6 H51 H53 I13 I18 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34548 |
| By: | Menezes, Tais; Countryman, Amanda M. |
| Abstract: | African swine fever (ASF) represents a serious threat to the U.S. pork industry and global agricultural markets due to its high mortality rate and the absence of a commercial vaccine. This study evaluates the potential economic consequences of a hypothetical ASF outbreak in the U.S. using the Global Trade Analysis Project (GTAP) computable general equilibrium model. For our preliminary analysis, we simulate four outbreak scenarios, varying in scale and trade disruption, to estimate impacts on production, trade flows, prices, and welfare across major global regions. Preliminary results indicate that small, localized outbreaks have limited domestic and global economic effects, while large-scale outbreaks could trigger severe welfare losses for the U.S. (up to $11.4 billion), along with substantial price increases and trade realignments. Competing exporters such as Canada, Brazil, and the European Union benefit from reduced U.S. market presence, while import-dependent regions face welfare losses. Welfare decomposition analysis reveals that U.S. losses in small outbreaks are driven primarily by deteriorating terms of trade, whereas losses in large outbreaks stem from technological shocks to domestic productivity. Although preliminary, these findings highlight the importance of early detection, containment, and international regionalization agreements as key strategies to mitigate economic disruption. The study provides evidence to inform U.S. animal health policy and highlights the global interdependence of pork markets in the face of transboundary animal diseases. |
| Keywords: | Agricultural and Food Policy |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360646 |
| By: | Kim, Hannah; Hultgren, Andrew; Janzen, Sarah |
| Abstract: | Weather extremes in early childhood can disrupt child growth and nutrition outcomes, but global evidence across developing countries remains limited. We examine the impact of temperature and precipitation variations on early childhood malnutrition across 57 low and middle income countries using over 1.2 million children from Demographic and Health Surveys linked to high-resolution ERA5 weather data. Using bin regression and restricted cubic splines, we identify nonlinear weather effects on stunting, underweight, and wasting probability while controlling for national, seasonal, and regional confounding factors. Our results show that both temperature and precipitation variations increase the probability of childhood malnutrition. We find that temperature has a nonlinear effect on stunting, where both high temperatures (above 90°F) and low temperatures (below 50°F) increase the probability by 1.3-1.4 percentage points relative to moderate conditions. Exposure to heat is associated with underweight and wasting, with months above 90°F increasing these outcomes by 1.2 and 1.0 percentage points, respectively. Precipitation effects vary by outcome type. Drought conditions below 5mm monthly precipitation increase underweight probability by 0.5 percentage points, while heavy rainfall above 250mm increases wasting risk by 0.4 percentage points. Effects vary across child age groups, with temperature showing more precise impacts on stunting among older children, while precipitation effects remain largely insignificant across age groups. Rural children show greater vulnerability to precipitation extremes, particularly for heavy rainfall effects on underweight and wasting. |
| Keywords: | Environmental Economics and Policy |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360729 |
| By: | Christopher L. Foote; Ellen Meara; Jonathan S. Skinner; Luke R. Stewart |
| Abstract: | The education-mortality gradient has increased sharply in the last three decades, with the life-expectancy gap between people with and without a college degree widening from 2.6 years in 1992 to 6.3 years in 2019 (Case and Deaton 2023). During the same period, mortality inequality across counties rose 30 percent, accompanied by an increasing rural health penalty. Using county- and state-level data from the 1992–2019 period, we demonstrate that these three trends arose due to a fundamental shift in the geographic patterns of mortality among college and non-college populations. First, we find a sharp decline in both mortality rates and geographic inequality for college graduates. Second, the reverse was true for people without a college degree; spatial inequality became amplified. Third, we find that rates of smoking play a key role in explaining all three empirical puzzles, with secondary roles attributed to income, other health behaviors, and state policies. Less well-understood is why “place effects” matter so much for smoking (and mortality) for those without a college degree. |
| JEL: | I1 I12 I14 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34553 |
| By: | Acerenza, Santiago; Wich, Hannah; Bartalotti, Otavio; Kreider, Brent |
| Abstract: | This study introduces a novel nonparametric approach to partially identify the causal average treatment effect (ATE) of SNAP participation on mental health, such as nonspecific psychological distress (NPD). In our application, the ATE reveals how the fraction of low-income adults in good mental health would differ if all participated in SNAP versus all not participating. Point-identifying the ATE requires strong, and arguably untenable, assumptions about the data, how participants behave, and the factors leading to SNAP participation. Most importantly, respondents are not randomly assigned into the program. A selection problem arises because the choice to participate depends on unobserved factors such as financial stability, human capital characteristics, disability, and motivation toward work, all thought to be jointly related to SNAP participation and mental health outcomes. Instead of attempting to point-identify the ATE, we establish bounds on this quantity by leveraging state-level variation in SNAP program eligibility rules. These rules, which affect the difficulty in joining the program, plausibly affect participation without otherwise affecting mental health status. Our approach partially identifies the ATE by extrapolating from the population of SNAP compliers – i.e., those who respond to the variation in eligibility rules. Partial identification in this setting relies on two assumptions: (i) costs associated with receiving SNAP – such as stigma or administrative burdens – are monotonically related to psychological distress, and (ii) SNAP participation does not, on average, exacerbate psychological distress. |
| Keywords: | Food Consumption/Nutrition/Food Safety |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360893 |
| By: | Hoffmann, Bridget; Suárez, Nicolás; Rud, Juan Pablo |
| Abstract: | This paper uses high-frequency data on fine particulate matter air pollution (PM 2.5) to study the effects of high pollution on health outcomes in Mexico City. We combine hourly monitoring station data on air pollution and weather conditions with a rich dataset of 10 million health episodes between 2003 and 2019, including deaths, hospitalizations, and urgent care visits. We disaggregate daily mean concentrations of PM 2.5 using the daily share of hours with PM 2.5 concentration above each WHO threshold to uncover a positive non-linear and convex relationship between hourly air pollution concentrations and same-day respiratory health outcomes of all severities. Specifically, a 1% increase in the share of hours with PM 2.5 concentrations above the highest WHO interim threshold (IT1) increases the number of respiratory deaths, hospitalizations, and urgent care visits per 1 million inhabitants by 0.001, 0.0008, and 0.024, respectively. We find that hours above IT1 have effects on respiratory health outcomes that are 20 to 30 times greater than those of additional hours above the air quality guideline, the most restrictive (i.e. lowest) WHO threshold. Furthermore, one additional hour a day with PM 2.5 above IT1 has the same effects on respiratory health outcomes as does increasing the daily average concentration of PM 2.5 in Mexico City by 41 µg/m3. We find that the effects of PM 2.5 on respiratory mortality and morbidity are distributed differently across ages and that the effect of PM 2.5 on respiratory deaths is driven by individuals with lower educational attainment. |
| JEL: | I10 Q53 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:14425 |
| By: | Melo, Grace; Palma, Marco; Chomali, Laura; Ribera, Luis |
| Abstract: | Being able to accurately predict the marketing effectiveness of product labels is critical for business profitability. Do industry experts (e.g., domain-specific and domain-general marketers) understand and accurately predict which messages appeal most to consumers? There is limited knowledge in this area, specifically around two essential food attributes: health and taste. Consumers perceive health and taste as trade-offs, which makes their reaction to such marketing information challenging to forecast. This study is the first to quantify the extent to which domain-general vs domain-specific experts can accurately predict consumer responses to health and taste information via marketing labels. We conducted three incentivized studies: Study 1 investigated consumer preferences for simple health versus taste labeling messages with actual consumers. Study 2 uncovered industry domain-specific ‘industry experts’ predictions for average consumers’ willingness-to-pay (WTP) for the messages providing incentives for accuracy. Study 3 employs domain-general ‘marketing experts’ (cross-industry) and evaluates the role of market intelligence in improving consumer valuation forecasts. We found that while both expert types made optimistic predictions that marketing health-related information would effectively increase consumer valuations, consumers did not respond to such information. Moreover, despite exhibiting greater confidence in their predictions than domain-general experts (63% vs 70%), domain-specific industry experts overestimated consumer valuations by 33% relative to the average consumer WTP of $6.80 for an 8 oz. bag of pecans. In contrast, domain-general experts overestimated consumer valuations by only 5%, suggesting possible motivated reasoning among industry-specific experts. Releasing market intelligence to domain-general experts for the baseline valuation (control) improved the accuracy of the forecast for the control, but forecasting inaccuracies for specific labeling messages prevailed. |
| Keywords: | Institutional and Behavioral Economics |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360812 |
| By: | Meerza, Syed Imran Ali; Mottaleb, Khondoker; Dsouza, Alwin |
| Abstract: | Zinc rice has the potential to address zinc deficiency, particularly among vulnerable populations like women of reproductive age and children, as zinc deficiency can lead to impaired growth, compromised immune function, and various other health issues. However, ensuring sufficient consumer acceptance and market adoption of zinc rice is crucial for maximizing its positive public health impact. This study investigates the effects of sequential information framing – whether positive information is provided first or negative information comes first – and recency bias on consumer valuations of zinc rice using a non-hypothetical laboratory experiment involving 400 participants. Our findings indicate that the sequence of information presented significantly affects consumers' willingness to pay (WTP) for zinc rice. Specifically, initial positive information results in higher valuations; however, the subsequent negative information neutralizes these positive effects. Interestingly, when consumers are first exposed to negative information followed by positive details, their valuations of zinc rice increase significantly. Notably, the recency bias plays an important role, as the last piece of information presented has a stronger effect on consumer valuation. The results suggest that marketing and informational campaign strategies should emphasize potential risks, followed by health benefits, to enhance consumer demand for zinc rice. |
| Keywords: | Consumer/Household Economics |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea25:360597 |
| By: | Antoine Bozio; Maxime Tô; Julie Tréguier |
| Abstract: | This study analyzes the distributional effects of French pension reforms from 1993 to 2014 across different socioeconomic groups. Using administrative data for individuals born between 1934 and 1950, we examine the impact on social security wealth (SSW) across lifetime earnings deciles and genders. Our methodology incorporates differential life expectancy and exploits the PENSIPP model for counterfactual scenarios. Results show that reforms generally decreased SSW across all income groups, with regressive tendencies. The 1993 reform had the most significant impact, reducing SSW by over 15% for men in the lowest earnings decile compared to 5% for the highest. Subsequent reforms had milder effects. These findings contribute to understanding the long-term consequences of pension reforms on inequality and inform future policy decisions in countries facing similar demographic challenges. |
| JEL: | H55 J14 J26 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34576 |
| By: | Filippo Pavanello; Ian Sue Wing |
| Abstract: | This paper investigates the consequences of inequality in access to heat adaptation, examining the effectiveness of alternative cooling technologies in mitigating mortality associated with extreme heat in India for the period 2014-2019. Our empirical results highlight a critical trade-off in heat adaptation. Air conditioning is highly effective in moderating heat-related mortality, but it is expensive, with generally low ownership that tends to be restricted to high-income cities. Conversely, many Indian households, including low-income ones, purchase evaporative coolers, which are much cheaper but do not provide robust protection against humid heat. Exploring the mechanisms, we show that coolers' limited effectiveness is due to their inability to operate in the humid ambient conditions that prevail over the Indian subcontinent for much of the year, and the small amount of indoor temperatures reduction they provide. Our findings provide the first evidence that income-driven differences in adaptation technology choice translate into unequal health risks under rising heat exposure, potentially reinforcing existing socioeconomic disparities. |
| Keywords: | heat, humidity, adaptation, mortality, inequality, India |
| JEL: | D12 O13 O15 F24 Q4 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12365 |
| By: | Michel Lubrano (Aix-Marseille Univ., CNRS, AMSE, Marseille, France); Pierre Michel (Aix-Marseille Univ., CNRS, AMSE, Marseille, France) |
| Abstract: | During the Covid-19 pandemic, the Omicron wave was notable for its highly transmissible and contagious variant of concern, coinciding with the availability of a vaccine that has been rolled out well earlier. In this paper, we address two key questions. First, we seek todesign a simple epidemiological model that can best capture the dynamics of Omicron infections. We demonstrate that combining the SIRDand SISD models provides an adequate solution. The second question examines the benefits of vaccination, in terms of both economicactivity and lives saved, once the model is implemented. Our results show that without vaccination, the human cost would have been fivetimes higher, and production losses would have doubled, due to stricter con- finement measures and a higher death toll. We also quantify the cost of vaccine hesitancy at more than 8, 000 extra deaths. |
| Keywords: | Compartment models, COVID-19, Omicron wave, vaccination benefit, vaccine hesitation |
| JEL: | C32 I18 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:aim:wpaimx:2528 |