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on Health Economics |
| By: | Sumedha Gupta; Johanna Catherine Maclean; Christopher J. Ruhm; Kosali I. Simon |
| Abstract: | The United States lacks a federal paid sick leave policy. However, 18 states and the District of Columbia have adopted or announced paid sick leave employer mandates to increase access to this benefit, creating a quasi-experimental setting to study whether paid sick leave affects healthcare use. People enrolled in Medicaid are an important population to study in terms of state paid sick leave policies as the majority of non-disabled enrollees are employed, but frequently work in jobs without paid sick leave. Given enrollees’ lower incomes, losing earnings to receive healthcare may be a significant barrier to care. In this study, we examine the effect of state paid sick leave policies on Medicaid-financed dispensed prescription medications. Using difference-in-differences methods that are robust to bias associated with a staggered treatment rollout, we show that Medicaid-financed dispensed prescription medications increase by 6.7% following adoption of a state paid sick leave policy. These findings suggest that state paid sick leave policies promote engagement with the healthcare system and use of healthcare services among financially constrained populations. |
| JEL: | H0 I1 K0 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34485 |
| By: | Koning, Pierre (Vrije Universiteit Amsterdam); Prudon, Roger (Lancaster University) |
| Abstract: | Spikes in exits at unemployment insurance (UI) benefit exhaustion into other benefit schemes such as sickness insurance (SI) are well-documented. These spikes could be driven by relatively healthy workers maximizing their total duration of benefit receipt, or workers in ill health who remain on UI while incapable of working. While the first explanation calls for a stricter SI and UI system, the second highlights the need for increased information provision. We study the importance of these explanations by first documenting a spike in exits into SI at UI benefit exhaustion in the Netherlands. Comparing detailed health and labor market characteristics of exit cohorts, we show that the spike is unlikely to be driven by maximizing behavior of relatively healthy workers. Instead, our results point to catch-up of initial non-take-up of SI by workers with substantial mental and physical health conditions. This opposes earlier work on substitution between UI and SI/DI. |
| Keywords: | spikes, unemployment insurance, sickness benefits, non-take-up |
| JEL: | H53 H75 J65 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18264 |
| By: | Rachel Y. L. Fung (Department of Economics, University of Missouri); Lauren Hoehn-Velasco (Department of Economics, Georgia State University); Michael F. Pesko (Department of Economics, University of Missouri) |
| Abstract: | Cigarette smoking, a leading cause of preventable death in the United States, rose to widespread popularity in the early 20th century. Between 1893 and 1921, sixteen states enacted laws prohibiting the sale of cigarettes, but all such bans were repealed by 1927. We examine the impact of these repeals using data from the U.S. Veterans Mortality (Dorn) Study, collected in the 1950s, which allows for a retrospective analysis of early cigarette use. Using a staggered adoption difference-in-differences design, we find that repealing cigarette bans increased smoking initiation before ages 20 and 25 by over 13%. We also show that the distribution of cigarettes to soldiers during World War I increased smoking uptake and later-life mortality among men from states with active bans at the time of enlistment. Taken together, our findings suggest that the abandonment of early efforts to restrict cigarettes had long-lasting consequences for health. |
| Keywords: | Cigarette regulations; smoking; long-term; mortality. |
| JEL: | I12 I18 N31 N32 N41 N42 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:umc:wpaper:2513 |
| By: | Brad A. Davis (Department of Economics, University of Missouri); Abigail S. Friedman (School of Public Health, Yale University); Michael F. Pesko (Department of Economics, University of Missouri) |
| Abstract: | The rise of nicotine vaping products (NVPs) has led governments to consider banning or limiting flavored NVP sales to reduce their appeal. In particular, we study the effect of NVP flavor restrictions enacted in Canada, a country with historically high tobacco regulation, through July of 2023. Using a stacked DID model, we estimate that flavor restrictions increased cigarette sales by 9.6%. In gas and convenience stores, these restrictions nearly eliminated flavored non-menthol and menthol NVP sales while increasing tobacco and unflavored NVP sales by 123.4%. Substitution patterns arise in Canada despite its strict tobacco control environment, suggesting that patterns of substitution between e-cigarettes and cigarettes are generalizable across countries with different tobacco regulatory strengths. |
| Keywords: | e-cigarettes; tobacco policy; flavor ban |
| JEL: | I12 I18 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:umc:wpaper:2515 |
| By: | Arrizaga, Rubí (Universidad de Santiago de Chile); Clarke, Damian (University of Chile); Cubillos, Pedro (University College London); Ruiz-Tagle, Cristóbal (LSE) |
| Abstract: | We study the impacts of wildfires in Chile mapping local exposure to over 1, 000 large wildfires occurring over 20 wildfire seasons. We consider both how very local exposure patterns owing to changes in ambient conditions -- such as wind, atmospheric and topographic conditions -- affect exposure to air pollution from wildfires, as well as how this exposure shapes health and educational outcomes both contemporaneously and in the years following exposure. We use tens of millions of population records on admissions to hospital, birth outcomes (birth weight, size and gestational weeks), and students outcomes (GPA, standardized tests, and attendance rates). We find harmful effects of exposure to wildfires smoke on health, specifically among sensitive groups such as infants, and that these effects are transmitted over the life course onto worsen health and educational outcomes. This findings can be used for quantifying the benefits of fire prevention and suppression efforts as well as early warning and mitigation systems for wildfire smoke. |
| Keywords: | human capital, air pollution, wildfires, climate change, health, Latin America |
| JEL: | Q54 I18 R11 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18256 |
| By: | Giovanna D'Adda (University of Milan, Italy and CMCC); Simone Ferro (University of Milan, Italy); Tommaso Frattini (University of Milan, LdA, CEPR, RFBerlin); Alessio Romarri (Departament of Applied Economics, Universitat Autònoma de Barcelona, Spain & RFBerlin, Germany) |
| Abstract: | Using large-scale high-granularity data from a food delivery platform and granular pollution and weather information, we study how PM2.5 fluctuations affect riders' absenteeism, productivity, and accidents. Exploiting exogenous pollution variation from inverse boundary layer height, we find that higher pollution increases absenteeism for all workers and raises delivery times and accident rates only among (e-)bike riders, who must exert physical effort while working. Affected workers compensate productivity losses by working longer hours. Monetary incentives mitigate the effects on absenteeism but do not offset the decline in productivity and appear to exacerbate accident risk. |
| Keywords: | Air Pollution; Food Delivery Riders; Absenteeism; Labor Productivity; Workplace Safety. |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:uab:wprdea:wpdea2518 |
| By: | Antonini, Marcello (LSE); Costa-Font, Joan (London School of Economics) |
| Abstract: | Health status can alter individuals’ social preferences, and specifically individuals' preferences regarding fairness in the access to and financing of health care. We draw on a dataset of 73, 452 individuals across 22 countries and a novel instrumental variable strategy that exploits variation in health status resulting from cross-country exposure to the national childhood Bacillus Calmette–Guérin (BCG) vaccination schedules. We document causal evidence consistent with the unhealthy self-interest hypothesis, which indicates that better health increases preferences for a fairer health care system. We estimate that a one-unit increase in self-reported health increases support for fair health care access by 11% and the willingness to support fair financing by 8%. Our findings suggest that improving population health, they may give rise to stronger support for interventions to improve equitable health system access and financing. |
| Keywords: | social preferences, willingness to pay, preferences for healthcare financing fairness, health status, BCG vaccine, instrumental variables |
| JEL: | I13 I14 I38 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18255 |
| By: | Nyberg, Erik (Swedish National Road and Transport Research Institute (VTI)) |
| Abstract: | Air and noise pollution have in the medical literature been shown to have large negative health effects. However, the findings might exhibit the problem of endogeneity, i.e. that they are not causal. While literature focusing on causal relationships in the area has grown in the last decades, a comprehensive overview has not been performed in recent years. This study aims to provide a state-of-the-art review of the causal relationship between air and noise pollution and health outcomes by summarizing the findings from international peer-reviewed articles, as well as informing the reader of the methodological challenges in the field and knowledge gaps in the literature. In addition, we will contribute by comparing the economic literature regarding both air and noise pollution. To achieve these aims, we conducted a review of existing international literature. This review identified previous research linking air and noise pollution to health outcomes, focusing on causal estimations using primarily quasi-experimental settings. The empirical findings show that air pollution can be linked to several health outcomes, e.g., increased mortality, emergency room visits, and hospitalization, through different risk pathways. The number of studies focused on noise pollution are significantly fewer, with individual studies also finding negative health effects, e.g., sleeping problems, hypertension, and increased medication and healthcare utilization. The evaluation of air and noise pollution differs primarily in temporal aspects and the source of variation used. |
| Keywords: | Air pollution; Noise pollution; Health outcomes; Quasi-experimental design; State-of-the-art review |
| JEL: | C21 C23 C26 I18 Q53 |
| Date: | 2025–11–18 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:vtiwps:2025_006 |
| By: | Masato Oikawa (Faculty of Education and Integrated Arts and Sciences, Waseda University); Takumi Toyono (WISH, Tokyo, Japan); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University; WISH, Tokyo, Japan); Akira Kawamura (Faculty of Human Sciences, Waseda University; WISH, Tokyo, Japan) |
| Abstract: | This study examines how gender-specific labor market opportunities affect child welfare, focusing on fatal child maltreatment. Using Japan’s comprehensive vital statistics and a shift-share identification strategy exploiting differential regional exposure to national industry employment shocks (2005-2018), we find striking opposite effects by gender. A 0.5% point increase in male employment growth increases child abuse deaths by 116%, while the same increase in female employment growth reduces these deaths by 93%. We identify maternal mental health as a key mechanism, with male employment growth correlating with deteriorating maternal well-being, while female employment opportunities improve women’s psychological health. Effects are most pronounced among the vulnerable with lower socioeconomic status — precisely those most susceptible to economic shocks. Our findings reveal that aggregate employment policies can mask offsetting gender-specific effects with profound consequences for child welfare. The results suggest that targeted interventions enhancing women’s economic opportunities could simultaneously reduce child maltreatment and advance gender equality. More broadly, this research demonstrates the critical importance of gender-disaggregated analysis in economic policy design, as standard employment measures may conceal significant distributional effects on family welfare. |
| Keywords: | child fatal maltreatment, gender-specific employment shocks, shift-share research design, maternal mental health |
| JEL: | I10 J12 J13 J16 J23 R23 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2523 |
| By: | Voraprapa Nakavachara |
| Abstract: | This paper investigates the relationship between AI use and worker well-being outcomes such as mental health, job enjoyment, and physical health and safety, using microdata from the OECD AI Surveys across seven countries. The results reveal that AI users are significantly more likely to report improvements across all three outcomes, with effects ranging from 8.9% to 21.3%. However, these benefits vary by generation and gender. Generation Y (1981-1996) shows the strongest gains across all dimensions, while Generation X (1965-1980) reports moderate improvements in mental health and job enjoyment. In contrast, Generation Z (1997-2012) benefits only in job enjoyment. As digital natives already familiar with technology, Gen Z workers may not receive additional gains in mental or physical health from AI, though they still experience increased enjoyment from using it. Baby Boomers (born before 1965) experience limited benefits, as they may not find these tools as engaging or useful. Women report stronger mental health gains, whereas men report greater improvements in physical health. These findings suggest that AI's workplace impact is uneven and shaped by demographic factors, career stage, and the nature of workers' roles. |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2511.11021 |
| By: | de León, Adrian; Straw, Isabel |
| Abstract: | Healthcare services around the world are undergoing a rapid process of digitalisation that presents novel threats to healthcare workers and patients across humanitarian settings. This review evaluates the key mechanisms by which emerging digital technologies are reshaping humanitarian practice and posing new challenges to patients, practitioners and policy-makers in low-resource environments. First, we examine emergent physical and psychological harms stemming from digital technologies at the individual patient level, summarising the latest evidence on injuries from drone-induced trauma, multi-robotic systems (MRS) and electromagnetic (EM) weapons. Second, we discuss population-level risks in global health settings, detailing the clinical harms associated with hospital cyberattacks in hybrid warfare and the novel challenges of AI-enhanced technologies for non-profit agencies attempting to deliver care (e.g., misinformation and “Deepfakes”). Further, we illustrate the new vulnerabilities that emerge as humanitarian agencies transition to electronic and biometric databases, highlighting the associated privacy risks for asylum seekers and refugees. Drawing together the latest insights from frontline practitioners, the World Health Organisation (WHO) and the United Nations (UN), we showcase specific technological threats affecting vulnerable patient groups, such as the deployment of GPS trackers and implants by sex trafficking groups, and the use of social media by modern slavery networks. This article introduces global health and humanitarian practitioners to essential digital concepts that are increasingly relevant to their work in the field, including Swarm Intelligence technologies, UAVs (Unmanned Aerial Vehicles), Large Language Models (LLMs), Cyberwar, Netwar and electromagnetic (EM) warfare. Framed through the lens of clinical care, we shine a light on the neglected intersection of humanitarian practice and digital technology, demonstrating that patients who are marginalised globally are often at greatest risk from technological harm. |
| Date: | 2025–11–08 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:n25r6_v1 |
| By: | Gobbi, Paula (Université Libre de Bruxelles); Hannusch, Anne (University of Bonn); Rossi, Pauline (CREST) |
| Abstract: | Much of the observed cross-country variation in fertility aligns with the predictions of classic theories of the fertility transition: countries with higher levels of human capital, higher GDP per capita, or lower mortality rates tend to exhibit lower fertility. However, when examining changes within countries over the past 60 years, larger fertility declines are only weakly associated with greater improvements in human capital, per capita GDP, or survival rates. To understand why, we focus on the role of family institutions, particularly marriage and inheritance customs. We argue that, together with the diffusion of cultural norms, they help explain variations in the timing, speed and magnitude of the fertility decline. We propose a stylized model integrating economic, health, institutional and cultural factors to study how these factors interact to shape fertility transition paths. We find that family institutions can mediate the effect of economic development by constraining fertility responses. |
| Keywords: | marriage, family institutions, fertility, inheritance |
| JEL: | J1 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18262 |
| By: | Nguyen, Ha Trong; Mitrou, Francis |
| Abstract: | In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influence childbearing decisions among Australians of reproductive age. Using an individual fixed effects model and exogenous variation in cyclone exposure, we find a robust and substantial decline in fertility, occurring only after the most severe category 5 cyclones, with the effect weakening as distance from the cyclone's eye increases. We find no evidence of delayed cyclone effects, indicating that the fertility loss attributable to these most severe cyclones is permanent. Our findings are robust to extensive validity checks, including a falsification test and various randomization tests. The fertility decline is most pronounced among younger adults, individuals with lower educational attainment, those childless at baseline, and those lacking prior private health or residential insurance. While physical health, financial constraints, and migration appear unlikely to drive the effect, the evidence points to reduced family formation, increased marital breakdown, child mortality, cyclone-induced home damage, elevated psychological stress, and heightened risk perceptions as plausible mechanisms. |
| Keywords: | Natural Disasters, Cyclones, Fertility, Marriage, Australia |
| JEL: | J12 J13 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1694 |
| By: | Stefanie J. Fischer; Shuhei Kaneko; Heather Royer; Corey D. White |
| Abstract: | Cesarean section rates vary widely across U.S. counties, yet it remains unclear how much of this variation reflects demand-side factors (such as patient risk or preferences) versus supply-side factors (such as physician practices or hospital incentives). We develop a new empirical strategy to isolate the influence of supply-side forces. Exploiting hospital obstetric unit closures from 1989–2019 that reallocate some mothers to counties with different C-section rates, we find that a one–percentage-point increase in the delivery county’s rate raises a mother’s likelihood of a C-section by roughly one point. The results point to a dominant role for provider behavior and local practice norms in driving geographic variation in C-section use, the most common major surgery in the United States. |
| JEL: | I18 I38 J08 J13 J18 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34469 |
| By: | Maria Delgado; Valeria Paz Jiménez; Wilson Guzmán Espinoza |
| Abstract: | This study examines the impact of Ecuador's “Bono 1, 000 días” (1, 000 Days Bond), an unconditional cash transfer program that includes a conditional component, aimed at reducing childhood stunting. Implemented in 2022, this program targets pregnant women and children up to two years old living in poverty, providing them with financial assistance to improve early childhood nutrition and health outcomes. |
| Keywords: | Stunting, Cash transfers, Children, Healthcare, Ecuador |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:unu:wpaper:wp-2025-82 |
| By: | Zhen, Shihang; Xia, Xianli; Huang, Luchen; Cao, Yihan; Fu, Hanliang; Ren, Yanjun |
| Abstract: | With the prominence of nutrition-related health issues worldwide, functional food is supposed to be an efficient way to address this challenge by achieving its nutrition and health benefits. However, whether consumers are willing to pay (WTP) for high-nutritional value foods of this kind and what is the role of consumers’ risk preferences in their WTPs are unclear. This study employs a discrete choice experiment (DCE) to investigate the effect of risk preferences on consumers’ preferences and WTPs for functional food, focusing on four attributes of dairy products: origin, organic label, functionality and price. We also seek to understand the physiological mechanisms underlying this effect by a lab experiment using eye-tracking technology. The results show that consumers have various preferences and WTPs for different attributes of milk, but they are reluctant to pay for functional milk. Compared to consumers with low-risk preferences, consumers with high-risk preferences are more willing to purchase functional milk. The evidence from eye-tracking experiments indicates that visual attention to the attributes considered positively correlates with their consumption preference. Consumers with high-risk preferences tend to pay more attention to the functional attribute and therefore have a higher prob- ability of purchasing functional milk. This study implies that consumers’ risk preferences should be considered when promoting consumers to purchase functional food, as different consumers have significantly distinct preferences. |
| Keywords: | Food Consumption/Nutrition/Food Safety, Institutional and Behavioral Economics |
| Date: | 2024–08–07 |
| URL: | https://d.repec.org/n?u=RePEc:ags:iaae24:344293 |
| By: | Llorca, Manuel (Department of Economics, Copenhagen Business School); Rodriguez-Alvarez, Ana (Oviedo Efficiency Group, Department of Economics, University of Oviedo) |
| Abstract: | Energy poverty refers to the inability of households to afford adequate energy services, connected to negative impacts on health, well-being, and economic opportunities. It is a social policy issue that exacerbates inequality and limits access to essential services, particularly among vulnerable populations. In Spain, energy poverty has become an increasing concern, with many low-income households struggling to meet their energy needs despite various social protection mechanisms. This paper analyses the effectiveness of the Bono Social Eléctrico (BSE), a Spanish social electricity voucher aimed at alleviating energy poverty among vulnerable households. Departing from a microeconomic theoretical framework and a applying a Stochastic Frontier Analysis (SFA) approach, the study evaluates the gap between observed and potential energy poverty levels. The empirical analysis employs Spanish household panel data from 2021 to 2023, capturing key household characteristics and subsidy information. The findings indicate that, while the BSE contributes to reducing energy poverty, its impact is constrained by insufficient coverage of the poorest households and inefficiencies in allocation. The study suggests policy recommendations to enhance the voucher’s targeting mechanisms and explores strategies for more effective interventions to address energy poverty. |
| Keywords: | Energy poverty; Policy evaluation; Stochastic frontier analysis; Spain; Bono social eléctrico |
| JEL: | C23 D12 I38 Q48 |
| Date: | 2025–04–23 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:cbsnow:2025_004 |
| By: | Cobb-Clark, Deborah A. (University of Sydney); Lepinteur, Anthony (University of Luxembourg); Menta, Giorgia (LISER) |
| Abstract: | This paper examines the stability of self-control over time using nationally-representative longitudinal data from Australia. We track the same individuals between 2019 and 2023, a period encompassing one of the most disruptive global crisis in recent history: the COVID-19 pandemic. Despite these extraordinary circumstances, self-control remained remarkably stable: its mean and distribution were unchanged, and individuals largely preserved their relative positions. Within-person changes were small, and unrelated to variations in state-level exposure to both the spread of the virus and the policy responses that ensued. The evidence we report suggests that self-control is a deeply rooted, trait-like characteristic that persists even under extreme societal stress. |
| Keywords: | stability, HILDA, self-control, COVID-19 |
| JEL: | D91 D01 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18270 |
| By: | Chang Zhai; Ping Chen; Zhuo Jin; David Pitt |
| Abstract: | Epidemic risk assessment poses inherent challenges, with traditional approaches often failing to balance health outcomes and economic constraints. This paper presents a data-driven decision support tool that models epidemiological dynamics and optimises vaccination strategies to control disease spread whilst minimising economic losses. The proposed economic-epidemiological framework comprises three phases: modelling, optimising, and analysing. First, a stochastic compartmental model captures epidemic dynamics. Second, an optimal control problem is formulated to derive vaccination strategies that minimise pandemic-related expenditure. Given the analytical intractability of epidemiological models, neural networks are employed to calibrate parameters and solve the high-dimensional control problem. The framework is demonstrated using COVID-19 data from Victoria, Australia, empirically deriving optimal vaccination strategies that simultaneously minimise disease incidence and governmental expenditure. By employing this three-phase framework, policymakers can adjust input values to reflect evolving transmission dynamics and continuously update strategies, thereby minimising aggregate costs, aiding future pandemic preparedness. |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2511.16932 |