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on Health Economics |
| By: | Carol Propper |
| Abstract: | In the last two decades European policy makers have sought to increase the use of market mechanisms in the delivery of healthcare. These reforms introduce competition and choice into previously heavily constrained environments. This leads to a set of interesting economic issues that have been addressed in a range of papers, both theoretical and empirical. This paper examines whether this popular reform model has resulted in improvements in outcomes for patients and/or taxpayers. It synthesises the existing economic analyses, highlights what is known and what is not, and signals potential next steps for economic research. |
| Keywords: | choice, competition, healthcare markets, policy reform |
| JEL: | I11 H42 H44 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12852 |
| By: | R. Anton Braun; Karen A. Kopecky |
| Abstract: | Long-term care is costly. About 45 percent of 65-year-old Americans will require formal long-term care assistance during their lifetime and one in twelve will incur out-of-pocket expenses of $200, 000 or more. Surprisingly, only 10 percent of retirees have private long-term care insurance. We use a quantitative structural model to show that an obstacle to increasing coverage is disagreement across the income distribution: scaling back Medicaid expands the private market and benefits the affluent but imposes large welfare losses on the poor, while universal public insurance does the opposite. We then show that making Medicaid the primary rather than the secondary payer of longterm care costs, while retaining its means tests, raises welfare for nearly all Americans. Private insurers respond by offering smaller, more profitable policies, and total coverage against long-term care risk rises with only a modest increase in public expenditures. |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:cnn:wpaper:26-012e |
| By: | Kotschy, Rainer; Bloom, David; Scott, Andrew |
| Abstract: | Analysis of population aging is typically framed in terms of chronological age. However, chronological age itself is not necessarily deeply informative about the aging process. This paper reviews literature and conducts empirical analyses aimed at investigating whether chronological age is a reliable proxy for physiological functioning when used in models of economic behavior and outcomes. We show that chronological age is an unreliable proxy for physiological functioning due to appreciable differences in how aging unfolds across people, health domains, and over time. We further demonstrate that chronological age either fails to predict economic variables when used in lieu of physiological functioning, or that it predicts additional effects on economic behavior and outcomes that are largely unrelated to physiological aging. Continued reliance on chronological age as a proxy for physiological functioning might impede the ability of societies to fully harness the benefits of increasing longevity. |
| Keywords: | Population aging; Longevity |
| JEL: | I10 I30 J10 |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19655 |
| By: | Pichler, Stefan (University of Groningen); Prinz, Christopher (OECD); Thewissen, Stefan (Nyenrode Business University); Ziebarth, Nicolas (Center for European Economic Research (ZEW Mannheim) & University of Mannheim) |
| Abstract: | This article examines the economics of paid sick leave from both theoretical and empirical perspectives. Research on paid sick leave has evolved dynamically over the last decade, primarily driven by the spread of U.S. sick pay mandates, which have increased paid sick leave access from 63 percent to 77 percent in all U.S. jobs. We begin by discussing the economic rationales for government regulation of paid sick leave, particularly the negative externalities associated with contagious diseases when individuals work while sick. After that, we discuss the key trade-offs in the general design of paid sick leave schemes, along with the trade-offs when setting specific policy parameters. Finally, we review economic modeling approaches to study optimal paid sick leave policies. |
| Keywords: | paid sick leave, statutory sickness insurance, medical leave, work disability, work incapacity, long-term absenteeism, presenteeism, paid time off, social insurance, externalities |
| JEL: | I12 I18 J22 J28 J32 J38 J88 H75 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18853 |
| By: | Daysal, N. Meltem (University of Copenhagen); Fredrickson, Camille (University of Chicago); Kristiansen, Ida (University of Copenhagen); Trandafir, Mircea (Rockwool Foundation Research Unit); Zhang, Jonathan (Duke University) |
| Abstract: | We estimate the causal impacts of GLP-1 treatment on labor market outcomes using linked Danish administrative data and a matched stacked difference-in-differences design. We compare patients who initiate GLP-1 treatment during the first two years of Semaglutide availability to observably similar patients who initiate four years later. We find that GLP-1 treatment reduces long-term sickness leave by 17.3%. We estimate total fiscal benefits of GLP-1 initiation of approximately 1.3–1.5% of annual labor income per employed individual. We do not detect statistically significant or economically meaningful impacts on income, labor force participation, or employment over four years. |
| Keywords: | GLP-1, diabetes, obesity, fiscal spillover |
| JEL: | H51 I10 I12 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18787 |
| By: | Stella Canessa (LMU Munich; ifo Institute); Gordon B. Dahl (UC San Diego; NBER; ifo Institute; CESifo; CEPR; RF-Berlin; IZA); Anna Hasselqvist (DIW Berlin; BSoE); Costas Meghir (Yale University; IFS; IZA; CEPR; NBER); Susan Niknami (SOFI, Stockholm University); MŒrten Palme (Stockholm University; IZA); Helmut Rainer (LMU Munich; ifo Institute; CESifo); Olof Rosenqvist (IFAU; Uppsala University); Pengpeng Xiao (Duke University) |
| Abstract: | Divorce reshapes family life, yet little is known about one of its most consequential features: the allocation of child custody. We study the impact of joint versus sole custody on both parents and children using rich administrative data from Sweden linked to over 25 years of newly-collected court custody rulings. To address selection concerns, we exploit random assignment of custody disputes to judges who differ sharply in their propensity to grant joint custody. For fathers, joint custody substantially raises earnings and improves mental health, consistent with sustained paternal involvement enhancing labor market attachment and psychological well-being. In contrast, there are no measurable labor market or mental health effects for mothers. Turning to children, joint custody increases standardized test scores and school quality without affecting mental health outcomes. Joint custody increases fathersÕ chances of remarriage, keeps separated parents in closer geographic proximity, and has no effect on intimate partner violence allegations against either partner. These findings inform longstanding debates over the role of child custody in shaping post-divorce family life. |
| Date: | 2026–07–09 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2543 |
| By: | Hackmann, Martin (UCLA and NBER); Rojas, Juan (Charles River Associates); Ziebarth, Nicolas (ZEW) |
| Abstract: | Medicaid finances U.S. nursing home care through federal matching grants that reward verifiable volume, not quality. We show that states exploit this through creative financing, diverting funds earmarked for nursing homes. This turns the federal match into a pure volume subsidy and generates a novel allocative distortion we term public moral hazard. We develop the mechanism theoretically and test its predictions using 24 federal audits and administrative microdata from Indiana. Event studies show Medicaid dementia volume rises 12\%; structural quality estimates show the expansion concentrates in the lowest-quality facilities, reallocating patients toward worse providers and reducing one-year survival. |
| Keywords: | fiscal federalism, moral hazard, Medicaid, nursing homes, quality of care, joint funding, misallocation of matching funds |
| JEL: | H51 H75 I11 I13 I18 J14 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18860 |
| By: | Card, David (University of California, Berkeley); Cardoso, Ana Rute (IAE Barcelona (CSIC)); Silva, Pedro (Universitat Autònoma de Barcelona) |
| Abstract: | During the 2010 financial crisis, the Portuguese government enacted a series of reforms in its prescription drug reimbursement system. Over the next three years, value added per pharmacist in retail pharmacies fell by a third, reflecting a rise in generic substitution and reductions in the markups allowed for prescription drugs. This massive shock led to pay cuts for incumbent pharmacists and the introduction of a two-tier pay system for new hires, with little or no reduction in the growth of employment. We use detailed longitudinal records from the Quadros de Pessoal database, merged with collective bargaining settlements and firms' financial records, to study the impacts of the reforms. We estimate that between 2009 and 2022 average wages of pharmacists fell by a third, largely due to lower wages for entering cohorts. The implied responsiveness of wages to productivity is substantially above most estimates in the rent-sharing literature, arguably reflecting the strong attachment of workers to the sector and the steady inflow of newly graduating pharmacists. We then consider how wages of pharmacists have diverged relative to other health care professionals, and the decisions of recent college applicants to enter the profession. |
| Keywords: | pharmacist, collective bargaining, wages, education, retail pharmacy, Portugal |
| JEL: | J52 J31 J24 J33 I26 J44 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18842 |
| By: | Hector Chade (Arizona State University); Victoria Marone (Yale University); Amanda Starc (Northwestern University); Jeroen Swinkels (Northwestern University) |
| Abstract: | We analyze a multidimensional screening model in which a principal offers a menu of quality-price pairs to a consumer with multiple dimensions of private information and a quasilinear utility function. We derive necessary conditions for optimality, and use them to provide insight into optimal exclusion, positive trade, and screening. We then recast the problem in terms of incremental quality levels and prices, the so-called demand-profile approach (DPA). Under DPA, the problem decouples across increments and can be solved one at a time. We provide novel conditions under which DPA recovers the solution to the full problem exactly or approximately, and which make the necessary conditions sufficient for optimality: essentially, valuations must be sufficiently correlated across quality increments. Applied to empirical estimates of demand for health insurance, we show that DPA is approximately valid, and we apply it to understand equilibrium outcomes in a monopoly insurance market. |
| Date: | 2026–06–30 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2541 |
| By: | Barwick, Panle; Chen, Siyu; Fu, Chao; Li, Teng |
| Abstract: | Concerns about excessive mobile phone use among youth are mounting. We present estimates of both behavioral and contextual peer effects, along with comprehensive evidence on how students' own and their peers' app usage affect academic performance, physical health, and labor market outcomes. Our analysis draws on administrative data from a Chinese university covering three student cohorts over four years. We exploit random roommate assignments, differential exposure to a policy shock (gaming restrictions for minors), and differential exposure to a discrete event (the introduction of a blockbuster video game) for identification. App usage is contagious: a one s.d. increase in roommates' in-college app usage raises own usage by 5.8%. High app usage is harmful across all measured outcomes. A one s.d. increase in app usage reduces GPAs by 36.2% of a within-cohort-major s.d. and lowers wages by 2.3%. Roommates' app usage reduces a student's GPAs and wages through both disruptions and behavioral spillovers, generating a total negative effect that exceeds half the magnitude of the impact from the student's own app usage. Extending China's three-hour-per-week gaming restriction for minors to college students would boost their initial wages by 0.9%. High-frequency GPS and app usage data show that heavy app users spend less time in study halls, are more frequently late or absent from class, and get less sleep. |
| JEL: | E24 D91 I23 L82 L86 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19579 |
| By: | Klein, Tobias; Salm, Martin |
| Abstract: | This paper examines whether financial incentives for general practitioners (GPs) can effectively replace patient cost-sharing within a gatekeeper healthcare system in which the GP regulates access to specialist care. We estimate the effects of incentives provided to GPs by exploiting a field experiment in which treated GPs received a share of the cost savings they achieved. There was also a set of control practices. The patient population includes about 26, 000 individuals and is largely representative of the overall population in the Netherlands. We estimate the effects of incentives for patients provided by a deductible using a simulated instrumental variables approach. For both sets of analyses, we use the same measures of healthcare costs, the same time period, and the same population of patients. Our findings show that the incentives provided to GPs reduce costs by 4.3 percent, mainly by decreasing less-urgent specialist care. A small patient deductible of 375 euros per year reduces costs by 27.8 percent in each month in which patients still have to pay out-of-pocket and 10.4 percent at the annual level, impacting all types of care. In contrast, physicians discriminate by type and priority of care. We do not find clear patterns for the interaction of incentives provided to GPs and patients. Our results suggest that GP incentives may complement but not fully replace patient deductibles in managing healthcare costs effectively. |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19578 |
| By: | Astrid Krenz; Holger Strulik |
| Abstract: | Healthy life expectancy is conventionally computed by combining life-table mortality with independently observed health information. This paper proposes an alternative approach that computes healthy life expectancy from mortality schedules alone. Building on the empirical regularities that adult mortality follows Gompertz's law and that mortality is related to the frailty index by a power law, we introduce Mortality-Implied Continuous Health-Equivalent Life Expectancy (MICHELE). The framework is validated using the Health and Retirement Study, where MICHELE closely reproduces directly observed Continuous Health-Equivalent Life Expectancy, and using Healthy Life Expectancy from the Global Burden of Disease Study, where mortality-implied health weights explain almost all age-related variation in disability-based health weights. The results suggest that mortality schedules contain substantially more information about the biological aging process underlying healthy longevity than has generally been recognized and provide a simple approach for estimating healthy life expectancy when comparable health data are unavailable. |
| Keywords: | healthy life expectancy, health data, frailty index, Gompertz law, mortality, biological aging |
| JEL: | I10 I12 J10 J11 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12868 |
| By: | Gregory F. Veramendi |
| Abstract: | Children's mental health has deteriorated across high-income countries since the early 2010s, coinciding with the mass adoption of smartphones among young people. I provide the first quasi-experimental evidence on delaying children's smartphone ownership through a community-led policy. Since 2024 the Smartphone Free Childhood movement has coordinated families across the United Kingdom through a "Parent Pact" to delay giving children a smartphone until age 14. Using a matched difference-in-differences design, I compare changes in children's mental-health needs in English schools where a large share of parents signed with changes in similar schools where very few did. Where at least one fifth of families signed, school-recorded social, emotional and mental health need falls by around 8 percent of the counterfactual. At the same time, child psychiatric disability claims, determined independently by the Department for Work and Pensions, also fall by about 6 percent in the same communities. The effects are larger among younger children who are less likely to already have a phone and in neighborhoods where more parents sign the pledge. The findings support coordinated ownership delay as a near-zero-cost complement to school phone bans and statutory age limits, and they give parents causal evidence for delaying a child's first smartphone through the primary-school years. |
| Keywords: | smartphones, child mental health, ownership delay, parental coordination, special educational needs, disability benefits. |
| JEL: | I12 I18 I21 I38 J13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12864 |
| By: | Hill, Andrew (Montana State University); Regmi, Krishna (Florida Gulf Coast University); Swensen, Isaac (Montana State University) |
| Abstract: | Unprecedented increases in unemployment insurance (UI) claims and dramatic changes in UI delivery across the U.S. in recent years stress the importance of understanding the wide-ranging effects of UI receipt. We estimate the short-run effect of UI on suicide and drug overdose mortality following mass layoff events. Using quarterly county-level data from 1995-2010 and leveraging interactions between state-specific UI generosity and mass layoff events, our two-way fixed effects models and event studies show that more generous UI reduces suicide at the county level. These mitigation effects coincide with otherwise large spikes in mortality following mass layoff events in local communities. We find no effect on drug overdose deaths. |
| Keywords: | unemployment insurance, job loss, mortality, suicide, drug abuse |
| JEL: | J65 H53 I38 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18776 |
| By: | Prudon, Roger (Lancaster University) |
| Abstract: | To increase the uptake of mental health care and reduce the burden of mental health, many countries have introduced programs offering easily accessible talk therapy. Despite their widespread introduction and continued expansion, causal evidence on these programs' effectiveness is lacking. I estimate the impact of a Dutch program that introduced talk therapy provided by nurse practitioners at GP practices nationwide. The reform increased talk therapy uptake by 6 percentage points among individuals seeking care but also widened existing disparities in care utilization. The increased take-up of talk therapy did not significantly improve the health and employment outcomes of patients. |
| Keywords: | mental health care, talk therapy, employment, health care inequalities |
| JEL: | J08 I1 J22 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18773 |
| By: | Chakrovorty, Sanchita; Smith, Travis |
| Abstract: | Managing chronic medical conditions requires daily adherence to pharmaceutical regimens, yet low-income families frequently face unstable budget constraints that force immediate spending trade-offs between nutrition and out-of-pocket healthcare costs. This paper explores how the time since benefit receipt of the Supplemental Nutrition Assistance Program (SNAP) affects healthcare access for low-income families managing chronic medical conditions. Empirical estimation reveals significant fluctuations in medication use, particularly during Days 20–23, when benefits are nearly exhausted. We observe a unique dual-peak pattern in medication use: an initial spike right after benefits are received (Days 0–3) due to immediate shopping disruptions, followed by a sharp increase in medication rationing around three weeks later, driven by liquidity constraints. We also identify sub-population heterogeneity based on benefit adequacy and food insecurity. Low-allotment households exhibit a 23 percentage point increase in medication non-adherence early in the cycle (Days 8–11) compared to those with higher allotments. Conversely, while high-allotment households remain stable early on, their adherence rates decline significantly by the third week, indicating depleted financial buffers. These results suggest that improving SNAP benefit amounts and adjusting issuance frequency could enhance medication adherence and alleviate healthcare access challenges for vulnerable families. |
| Keywords: | Food Consumption/Nutrition/Food Safety |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404554 |
| By: | Lenzen, Sabrina; Connelly, Luke B.; Whittaker, William |
| Abstract: | The share of young Australians reporting poor mental health has risen sharply over the past two decades, a pattern mirrored across many high-income countries. A central question is whether this reflects a genuine deterioration in underlying mental health or shifts in how different birth cohorts report their symptoms. Using 22 years of nationally representative longitudinal survey data from Australia (2002-2023), we construct a predicted mental health index from respondents' socioeconomic characteristics, childhood conditions, physical health, life events, and financial circumstances, and compare it against self-reported mental health to isolate cohort-specific reporting differences. We find that the answer is both, namely, that younger cohorts apply lower thresholds when reporting distress, reflecting greater willingness to acknowledge poor mental health, and underlying mental health has genuinely deteriorated among recent cohorts, particularly females. Adjusting for cohort-specific reporting thresholds flattens the apparent rise in poor mental health, though a deterioration remains. After adjustment, the age gradient steepens, revealing that poor mental health peaks in mid-life, a life-cycle pattern that is obscured in raw self-reports. Our findings underscore the importance of accounting for reporting heterogeneity when interpreting mental health trends and planning health services. |
| Keywords: | Mental Health, Birth Cohort, Reporting Heterogeneity |
| JEL: | I12 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1783 |
| By: | Wilson, Kaitlyn; Jones, Jordan W. |
| Abstract: | Work requirements are a central feature of U.S. welfare program design. The Supplemental Nutrition Assistance Program (SNAP) imposes a time limit on benefit receipt for able-bodied adults without dependents (ABAWDs) who do not meet work requirements. This time limit was suspended nationally during the Great Recession and the COVID-19 pandemic, with staggered reimplementation occurring at the county level following each suspension. We construct a novel county-month panel dataset on ABAWD waiver status and pair it with American Community Survey microdata to estimate the effects of time limit reimplementation using a triple-difference design that exploits variation across counties and age groups on either side of the work requirement eligibility cutoff. We find that reimplementation significantly reduced SNAP participation among ABAWDs subject to work requirements following the Great Recession suspension and increased employment and labor force participation among these adults in both reimplementation periods. We also identify impacts on similar older adults who were not subject to the work requirements, especially in the form of reduced SNAP participation, suggesting the role of indirect costs of par- ticipation associated with work requirements. Estimates on ABAWD SNAP benefits and earned income are consistent with the participation and employment findings, and mechanism analysis suggests the participation decline is at least partly driven by ABAWDs moving to employment and exiting SNAP—the generally intended effect of work requirements. |
| Keywords: | Labor and Human Capital |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404777 |
| By: | Gruber, Anja; Van Sandt, Anders; Loveridge, Scott; Carpenter, Craig |
| Abstract: | Compared to metropolitan residents, rural residents face a disparity in access to local mental health providers that is even larger than for other health care services. Telehealth appears to be a natural solution to this issue: Patients should be able to more easily access providers from metro areas, reducing disparities in access to mental health care. In this paper, we consider the flip side of this argument, which has not yet received enough attention. Mental health providers, especially in areas where demand for their services exceeds supply, become more easily able to access patients and therefore may become more selective. We show evidence that access to telehealth services is 8-9 percentage points lower for non-metro residents, even after accounting for potential differences in stigma and internet access. We also show that self-payment is a significant predictor of telehealth utilization in mental health and provide suggestive evidence that the increase of telehealth in mental health treatments has coincided with reduced access to mental health care for publicly insured patients, despite growth in provider numbers across counties. We caution that expansions in telehealth need to be combined with policies to promote equitable reimbursement and reduce barriers for independent providers to bill public and private insurance. |
| Keywords: | Health Economics and Policy |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404595 |
| By: | Rippley, Samantha |
| Abstract: | This study examines the public health impact of early dairy regulation in the United States by analyzing the relationship between raw milk laws and child mortality from 1850 to 1950. Using linked census microdata from the Integrated Public Use Microdata Series (IPUMS) full-count datasets, intercensal child mortality rates are constructed for children aged 0-5, and a staggered adoption difference-in-differences design is employed to estimate the causal effects of dairy regulations. The identification strategy exploits the heterogeneous timing of raw milk law adoption across counties, with regulations emerging in 1914. The analysis tracks approximately 54.8 million children across ten decade pairs, focusing on families with successfully linked parents to minimize measurement error in mortality estimation. Results indicate that comprehensive dairy regulations did not, on average, reduce child mortality. The preferred specification restricts estimation to individually-verified municipal ordinance counties, the jurisdictions where mandates were most plausibly binding, and is the only specification satisfying the parallel trends assumption. Remaining specifications fail the parallel trends test, consistent with positive selection of urbanizing, lower-mortality counties into treatment. The null result is consistent with voluntary pre-adoption, weak enforcement outside major cities, and declining milk-borne exposure as concurrent water infrastructure improvements reduced competing causes of child death. |
| Keywords: | Food Consumption/Nutrition/Food Safety |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404546 |
| By: | Lídia Farré; Christina Felfe; Libertad González; Patrick Schneider |
| Abstract: | Social norms are an important barrier to gender convergence in economic outcomes. We study whether a public policy designed to promote gender equality at home can pave the way towards gender convergence by shaping gender norms in the next generation. We exploit the introduction of paid paternity leave in Spain in 2007, which granted fathers 13 days of non-transferable paid leave after childbirth. Eligibility depended sharply on the child’s date of birth. We combine this policy variation with original survey data collected from adolescents and implement a within-school difference-in-differences design comparing children born just before and after the reform cutoff within the same school cohort, using adjacent cohorts as controls. Children exposed to paternity leave eligibility display more egalitarian gender attitudes and beliefs in early adolescence. They are also more likely to engage in counter-stereotypical household chores, and hold less gender-stereotypical expectations regarding future work and family roles. The effects largely disappear in late adolescence. |
| Keywords: | gender equality, gender norms, paternity leave permits |
| JEL: | J08 J13 J16 J18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12863 |
| By: | Annibali, Claudio; Bergemann, Annette; Alessie, Rob |
| Abstract: | Health screenings are potentially powerful tools to mitigate adverse health and labour outcomes. We conduct a comprehensive evaluation of the labour market and health effects of a diabetes warning in a country that has not introduced such a screening system. Using data from over 160, 000 participants in Lifelines, a Dutch cohort study, and a multidimensional regression discontinuity design, we estimate the short- and long-run impacts of a diabetes risk warning. Individuals under 40 increase their employment rate following a warning, with effects that are especially pronounced and persistent for women. These employment gains are accompanied by improvements in self-reported health among women and reduced smoking among men. Among older individuals, the responses are more heterogeneous: Women are more likely to retire and reduce alcohol consumption, while men are less likely to receive disability benefits and more likely to visit their general practitioner in the short term. Our findings provide novel evidence that health information can influence labour market outcomes through gender- and age-specific behavioural adjustments. |
| Keywords: | diabetes, diabetes screening, employment, health behaviour, undiagnosed diabetes, multi-dimensional regression discontinuity design |
| JEL: | I12 J16 I10 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1799 |
| By: | Schneider, Eric B. |
| Abstract: | This paper examines how acute pollution exposure in historical London (1892–1919) affected child health. I proxy acute, extreme pollution exposure using daily data on fog events, which reflect meteorological conditions where pollution emitted in the city was not dispersed across space leading to a sharp spike in pollution. I also use rich individual-level data on child health drawn from the Queen Charlotte Hospital, a maternity hospital, and the Foundling Hospital, an orphanage. I find no effect of pollution exposure at birth on birth or growth outcomes or on upper respiratory morbidity. However, exposure on the day of birth had persistent effects on health, increasing mortality risk in childhood and adolescence from respiratory diseases and raising incidence, prevalence and sickness duration of influenza and measles. There was no persistent effect of in utero and postnatal pollution exposures. These mixed results show that extreme pollution at birth had lasting impacts on specific, but also limited, dimensions of child health. |
| Keywords: | ambient air pollution;morbidity;child growth;respiratory disease;health transition |
| JEL: | N33 Q53 |
| Date: | 2026–07–16 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140269 |
| By: | Carpenter, Craig Wesley; Cotti, Chad |
| Abstract: | Research shows that the receipt and timing of income can significantly influence behavior, including risky behaviors and health indicators such as mortality and emergency department visits. These effects have been linked to the timing of income benefits and transfers, such as those provided by the U.S. Supplemental Nutrition Assistance Program (SNAP). We leverage exogenous variation in the monthly date on which individuals receive SNAP benefits, combined with linked individual-level state and federal administrative microdata, to estimate: (1) the causal effects of days since SNAP (income) receipt within a monthly benefit cycle, and (2) the causal effects of the monthly distribution date (income smoothing) on labor market and health outcomes across months. We show that (1) as the days since SNAP distribution increases, work absenteeism increases and labor market participation decreases until just before the next monthly issuance of SNAP benefits, when outcomes begin to improve again. We directly test food insecurity and health as mechanisms for these labor market cycles and show that they also follow the 30-day benefits cycle. Controlling for these 30-day benefit cycles, we then estimate (2) the causal effect of monthly distribution date on labor market participation, health, and food insecurity. We find evidence that if states distributed SNAP in the middle of a calendar month, rather than the beginning or end of a month, SNAP recipient labor market participation would increase, reported disability would decrease, food insecurity would decrease, and the lifespan of SNAP participants—which we capture by linking the universe of Social Security Administration individual death records—would increase by 101 days (0.5%), on average. |
| Keywords: | Health Economics and Policy |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404593 |
| By: | Aoki, Yu (University of Aberdeen); Arulampalam, Wiji (University of Warwick); Lloyd, Neil (University of St Andrews) |
| Abstract: | We estimate the causal effect of exposure to fast-food outlets on adolescent z-BMI using the UK Millennium Cohort Study linked to comprehensive geospatial data. We develop a novel approach to modelling z-BMI persistence by clustering early childhood z-BMI trajectories, allowing us to distinguish baseline obesity susceptibility from contemporaneous environmental effects. Identification exploits the near-universal transition from primary to secondary school, generating plausibly exogenous variation in exposure to fast-food outlets around schools. We find that adolescents with at least one major-brand outlet near school have, on average, a 0.158 standard-deviation higher z-BMI. Effects decline with distance, are limited around the home, and do not extend to other food outlets. |
| Keywords: | adolescent obesity, body mass index, fast food, school food environment |
| JEL: | I12 I18 R14 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18770 |
| By: | Guimbeau, Amanda (University of Sherbrooke); Ji, James (University of Guelph); Menon, Nidhiya (Brandeis University); Witoelar, Firman (Australian National University) |
| Abstract: | Mangroves provide vital ecosystem services, including fisheries support, carbon sequestration, and natural protection against coastal erosion, but their health consequences are less well understood. We study their impacts on mental health and cognitive functioning in Indonesia, which has the most extensive and biodiverse mangroves in the world. Decades of deforestation, fueled by climate pressures, oil palm expansion, and aquaculture, have led to widespread mangrove loss in the country, disproportionately affecting vulnerable coastal communities. By merging high-resolution satellite data on coastal land use change with individual-level panel data from the Indonesian Family Life Survey (IFLS), we find that a one-standard-deviation increase in local mangrove cover reduces the likelihood of clinical depression by 4.5 percentage points. These effects operate through reduced flood exposure, higher household income, and improved food consumption. We also find that restoration potential matters more than blue carbon potential, cash transfers, or social capital in shaping the mangrove-mental health relationship. Our results show that mangrove conservation and restoration can generate important local human capital and welfare benefits. |
| Keywords: | Mangroves, mental health, depression, CESD-10, cognitive ability, ecosystem, aquaculture, restoration, conservation |
| JEL: | Q57 Q50 O1 O13 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18818 |
| By: | Yuyu Chen; Hongbin Li; Lingsheng Meng; Xinyao Qiu; Qingxu Yang |
| Abstract: | Generative AI is fast becoming the first place people turn for expert advice. The advice it provides can be directional rather than neutral, shaped in part by the choices of its designers and regulators. When clients consult AI before meeting an expert, they carry this directional advice into a relationship that once rested on the expert's judgment alone. We study its consequences in healthcare through a large-scale preregistered field experiment at a Chinese hospital, where we randomize patients' access to an AI chatbot before their outpatient visit. Examination of the conversation logs shows that the chatbot routinely cautions against the use of medications, especially Traditional Chinese Medicine and antibiotics, while issuing clean recommendations for diagnostic testing, consistent with the liability-driven guardrails encoded in AI training. This directionality propagates into clinical practice. Prescription rates decline among treated patients while diagnostic testing increases, and these effects are more pronounced among physicians who are receptive to patient input and those with more intensive prescribing styles. Beyond shifting healthcare utilization, survey results show that AI access reduces patient compliance and satisfaction, shifting the balance of authority between patients and physicians. |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2607.08706 |
| By: | Adhikari, Prabin; Kassas, Bachir; Nayga, Rodolfo |
| Abstract: | Rising temperatures may influence everyday food choices in ways that have important implications for nutrition and public health. This paper studies how short-run exposure to extreme temperatures affects the composition of household grocery purchases in the United States. Using a nationally representative household panel dataset of grocery transactions merged with local weather information, we exploit within-household variation and estimate two-way fixed effects models to identify causal effects. We find that hotter weeks consistently shift food purchases toward less healthy items and reduce overall diet quality, with little change in total grocery spending. In contrast, unusually cold weeks lead to slight increases in total spending but do not significantly alter the nutritional composition of purchases. These results suggest that heat exposure primarily induces households to reallocate spending toward less healthy foods rather than to change how much they spend, whereas cold exposure mainly affects the volume of groceries purchased. The heat-induced effects on healthiness of food purchases are modest in the short run but are highly robust and more pronounced for households with less healthy baseline purchasing patterns. These findings highlight an underexplored channel through which rising temperatures may degrade diet quality, underscoring the potential public health and welfare costs of climate change. |
| Keywords: | Environmental Economics and Policy |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404461 |
| By: | Barai, Dipanwita |
| Abstract: | Fertility is a complex amalgamation of human choice, economic conditions, and environmental factors. While the biological toxicity of wildfire-induced air pollution is well-documented to have severe detrimental effects on human health and the reproductive system, reproductive outcomes are not dictated by biology alone. They are profoundly shaped by human behavioral responses. This study analyzes the net effect of wildfire exposure, alongside economic shocks and non-parametric temperature extremes, on fertility in the United States. Utilizing a comprehensive county-monthyear panel dataset from 2010 to 2023, the analysis employs a Poisson Pseudo-Maximum Likelihood (PPML) regression incorporating high-dimensional county and year-month fixed effects. The primary findings reveal a statistically significant positive relationship between wildfire exposure and fertility. Utilizing SafeGraph mobility data, this study empirically isolates the behavioral mechanism driving this result: wildfires cause a highly significant increase in the proportion of the population sheltering completely at home, altering daily routines in a manner that overrides the biological detriments of smoke exposure. Furthermore, a continuous interaction analysis reveals a stark environmental justice divide: while the shelter-in-place "baby bump" occurs universally across income groups, economically vulnerable counties suffer severe fertility depressions from the economic anxiety accompanying disasters, significantly muting the behavioral bump. A 500iteration randomization inference (placebo) test confirms the causal robustness of these findings, yielding an empirical p-value of < 0.01. |
| Keywords: | Health Economics and Policy |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404592 |
| By: | Farhad V. Farahani |
| Abstract: | Over the last decade a wave of U.S. states began reimbursing doula services through Medicaid, hoping to improve infant health and narrow stark racial gaps in birth outcomes. I evaluate these mandates using the staggered 2021-2024 rollout, a panel of 32.1 million births from CDC WONDER (2016-2024), and a newly assembled measure of the state doula workforce drawn from the national provider registry. Identification comes from the policy's timing rather than from comparing doula users to non-users, addressing the selection problem that limits the existing observational literature. On average I find no detectable effect on low birth weight (LBW). Consistent with the heterogeneity emphasized by Peet (2022) and the maternal-health-disparities literature, however, the effect concentrates among the group at greatest risk: Black mothers, for whom LBW falls by roughly half a percentage point (about 5% of the baseline) in the states with the longest exposure, with flat pre-trends and a coherent upward shift in the birth-weight distribution. The estimate is marginal once I use inference valid for few treated clusters, and the binding constraint is statistical power: most mandates took effect in 2024-2025, at or beyond the end of the data. A two-stage least squares analysis shows that coverage roughly doubles the doula workforce (first-stage F approximately 21-35), and that the induced increase in doula supply is associated with lower Black LBW, though imprecisely. I read the results as credible early evidence that doula mandates work where they have had time to operate and where the need is greatest, rather than as a finished causal claim. |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2607.07770 |
| By: | Flynn, James (Miami University); Stevenson, Amanda (University of Colorado Boulder); Yeatman, Sara (University of Colorado Denver); Genadek, Katie (United States Census Bureau); Menken, Jane (University of Colorado Boulder); Mollborn, Stefanie (Stockholm University); Root, Leslie (University of Colorado Boulder) |
| Abstract: | We use birth records from the National Vital Statistics System to document the full age and parity fertility effects of the Colorado Family Planning Initiative (CFPI). Prior work has demonstrated effects on fertility at ages 15-29. We estimate the fertility effect of the CFPI for all age groups (15-44) and for first and non-first births using the synthetic control method. We find large and significant reductions in birth rates for 15-24-year-olds that line up with other studies, but we find important heterogeneity across parity. For teenagers, we find reductions in first birth rates of 9%, but larger reductions in non-first birth rates of 17-25%. We also find reductions in overall fertility for 20-24 and 25-29-year-olds, but these are entirely driven by reductions of 5-9% in non-first births. For 30-39-year-olds, we find small but significant reductions in fertility of 3-7% across parity levels, and we find a 6% reduction in fertility for 40-44-year-olds. We also conduct inference using synthetic difference-in-differences (SDID) and placebo-based methods. When we do this, our estimates are similar, though confidence intervals are wider, with specifications on older age groups no longer significant. |
| Keywords: | family planning, long-acting reversible contraception (LARC), fertility |
| JEL: | J13 I18 I12 J16 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18852 |
| By: | Moretti, Margherita (Bocconi University); Balbo, Nicoletta; Tosi, Marco; Alburez-Gutierrez, Diego |
| Abstract: | Disability is usually framed as an individual condition, yet its associated consequences may extend through kinship networks. Despite this, the population reach of disability through kin remains unknown. We use demographic kinship matrix models combining fertility and mortality schedules with disability prevalence, to estimate population exposure to disability through grandparents, parents, siblings, children, and grandchildren across ages in Europe in 2021. We quantify exposure using three complementary measures: the probability of having at least one kin with disability, the population-level number of individuals exposed, and the proportion of kin with disability. Our results show that exposure is both widespread and substantial: across all ages and kin types, 70% of women in Europe, corresponding to about 160 million women, have at least one close kin with disability. In childhood and early adulthood, more than half to three-quarters of European women have at least one grandparent with disability, with the age-specific number of exposed women peaking at about 1.5 million; in midlife, about one-third to nearly one-half have at least one parent with disability, with the population-level exposure peaking at about 1.4 million women. Throughout much of women’s lives, between 20% and 40% of their close kin have disability. These findings show that disability is not only an individual experience but also a relational exposure amplified by kinship structures. Exposure to kin disability constitutes a hidden source of inequality that accumulates over the life course and intersects with gender and socioeconomic inequalities. |
| Date: | 2026–07–06 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:udmkh_v1 |
| By: | Atella, Vincenzo; Ceschin, Nicola; Decarolis, Francesco |
| Abstract: | This paper quantifies the price effects of a merger between two major producers of orthopedic prostheses. It shows that, in the public procurement markets where these products are purchased, the effect of the merger hinges on the characteristics of both the procurement design and the organizational structure of the buyers. Using data from all public procurement events in Italy between 2012 and 2019, and exploiting a difference-in-differences model where pacemakers play the role of the control group, we find that the merger led to a 7.6% increase in prices and that this effect is concentrated in the first three years post-merger. Further insights are: (i) a heterogeneous impact among gender and age groups such that most of the burden is on female patients aged 65 and above; (ii) short term quality does not change, but patenting activity declines; (iii) there is no evidence of the merger triggering ex post coordinated effects in the form of bidding and entry patterns compatible with firm collusion. |
| JEL: | I18 J18 C21 |
| Date: | 2024–12 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19737 |
| By: | Palmer, John |
| Abstract: | This comment argues that the recent revival of the corporate practice of medicine (CPOM) doctrine as a tool for limiting private equity (PE) involvement in healthcare is misguided and ill-suited to the realities of the modern healthcare system. After tracing the development of the CPOM doctrine from its origins in early twentieth-century concerns about corporate interference with physician autonomy, the comment examines the rise of healthcare corporatization, the growth of PE investment, and the widespread use of management services organization-professional corporation structures. The author reviews recent litigation and the wave of state legislation enacted or proposed in 2025, including laws in Maine, Oregon, and California that seek to restrict PE ownership, prohibit certain corporate arrangements, or strengthen prohibitions on non-physician influence over clinical decision-making. The comment contends that contemporary efforts to revive the CPOM doctrine rest on flawed assumptions about PE and overlook broader structural challenges facing healthcare providers, including consolidation, declining financial stability, reimbursement pressures, and rural hospital vulnerability. It argues that many concerns attributed to PE, such as cost-cutting, market concentration, and financialization, are not unique to PE-owned entities and are also present among nonprofit and other healthcare organizations. The author further maintains that modern CPOM laws may produce unintended consequences by reducing access to capital, discouraging investment in struggling providers, accelerating consolidation by large health systems, and limiting opportunities for independent physician practices. Rather than relying on an antiquated doctrine designed for a markedly different healthcare environment, the comment advocates owner-neutral regulatory approaches, including transaction review requirements, antitrust enforcement, and targeted restrictions on harmful business practices. The comment concludes that policymakers should focus on systemic healthcare reform and financial sustainability rather than attempting to curb healthcare corporatization through a revived CPOM framework. [This abstract was written by Microsoft Copilot, a generative artificial intelligence.] |
| Date: | 2026–08–03 |
| URL: | https://d.repec.org/n?u=RePEc:osf:lawarc:zk7md_v1 |
| By: | Nikolova, Milena; Milanova, Viliana; Wang, Feicheng |
| Abstract: | This paper provides the first causal evidence that merely attributing identical creative work to AI rather than to a human affects how much meaning people derive from a task and how much effort they are willing to contribute. We conducted a preregistered survey experiment in nationally representative samples from the United States (N = 1, 511) and the Netherlands (N = 2, 117). Participants evaluated identical public health campaign slogans that were randomly attributed either to an AI system or to a human professional, allowing us to isolate the causal effect of AI attribution while holding the creative output constant. AI attribution reduced perceived task meaning modestly and made participants 13% less likely to contribute a slogan of their own, indicating lower voluntary effort. These findings suggest that AI can influence work not only by changing productivity but also by altering the perceived value of human contribution itself. |
| Keywords: | Artificial intelligence (AI), Meaning, Effort, Survey experiment |
| JEL: | C91 J01 I30 O33 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1788 |
| By: | Sergi Jiménez-Martín |
| Abstract: | We estimate causal effects of the 2011 Spanish pension reform—which raised the normal retirement age (NRA) from 65 to 67, conditioning access on accumulated contribution years—on retirement timing, exit route, and premature mortality. Using data from the Muestra Continua de Vidas Laborales we find that the reform delayed retirement by about eight months on average for fully treated individuals belonging to the 1948-1957 cohorts, the cohorts observable in our data. Because the reform phases in gradually until the 1962 cohort—the first to face the fully phased-in rules, which then apply unchanged to all later cohorts—the total effect will be larger as more intensely affected cohorts complete their working lives. The dominant response is a reallocation away from retirement at and before age 65 toward retirement after 65, and is markedly larger for women, who are less likely to meet the long-career exemption. The reform raises premature mortality, significantly so for men; the implied gender differential widens the male mortality excess and narrows the female survival advantage, though sample-weighted gaps are sensitive to the large share of male controls. |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:fda:fdaeee:eee2026-23 |
| By: | Brooks, Matthew; Usmani, Faraz |
| Abstract: | Over 2.8 billion people are chronic ally exposed to hazardous levels offine particulate matter air pollution. This paper provides novel evidence that workers in such settings partially adapt to chronic exposure but that adaptation does not offset cumulative harm. We estimate the effect of PM2.5 on labor productivity using individual-level performance data from 14 years of professional cricket in India (2008–2022), paired with a machine learning data product providing daily PM 2.5 estimates at 10 km resolution. Leveraging variation in day-to-day exposure generated by league scheduling rules, we find that a 10 μgm−3 increase in same-day PM 2.5 (half a standard deviation) reduces bowler performance by about 1 percent relative to batters, consistent with bowlers’ heightened exposure via higher respiration rates. Effects are non-linear, with the largest marginal damages above approximately 50 μgm−3—levels common in developing countries but uncommon in causal studies. Using variation in chronic exposure from player assignment to teams according to salary cap rules, we find that acute shocks harm those with the highest past exposure approximately 40 percent less than those with median exposure histories, indicating adaptation over both 30-day and career-spanning horizons. Nevertheless, chronic exposure degrades performance by more than adaptation offsets, except under extremely rare pollution conditions. These findings underscore the importance of regulating these cond moment of the pollution distribution: non-linearity implies that marginal damages are largest when pollution is in the uppertail, while partial adaptation implies that spikes above mean levels amplify marginal damages. |
| Keywords: | Environmental Economics and Policy |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ags:aaea26:404434 |
| By: | Poli, Lucas Luiz; Couleau, Anabelle; Pérez Urdiales, María; Tojal Ramos Dos Santos, Carolina |
| Abstract: | Ensuring safe drinking water depends not only on infrastructure but on effective regulatory compliance. This paper studies compliance with drinking water quality regulations through a three-layer framework that distinguishes among whether providers report monitoring data at all, whether those that do report collect the required number of samples, and whether the samples collected reveal violations of regulatory quality thresholds. Because each layer is a necessary condition for the next, failures in reporting and sampling can prevent official statistics from accurately reflecting underlying water quality risks. Using comprehensive administrative data from Brazil covering more than 5, 500 municipalities between 2010 and 2022, we show that failures at each compliance layer are widespread, non-random, and systematically correlated with municipal characteristics. Non-reporting and under-sampling are concentrated in poorer and lower-capacity municipalities, while over-sampling is prevalent among larger providers. Over-samplers report fewer violations than municipalities that comply exactly with the prescribed sample count, a pattern that admits several interpretations and that the administrative record alone cannot adjudicate. The reported violation share is therefore jointly determined with sampling behavior, and this joint determination is systematically related to the municipal characteristics that also predict contamination risk. Treating reported violations as the sole measure of regulatory performance yields a misleading picture of drinking water safety and obscures the importance of monitoring compliance with reporting and sampling requirements alongside quality thresholds. |
| JEL: | Q25 O54 Q53 I18 L51 D82 H75 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:14693 |
| By: | Costa-Font, Joan; Gatti, Nicolò; Turati, Gilberto; Wiesen, Daniel |
| Abstract: | We study the extent to which exposure to COVID-19 relates to healthcare professionals’ prosociality. Drawing on empirical evidence from an incentivized experiment and a companion survey of healthcare professionals (HCPs) at a large Italian hospital (N = 194), we find that different forms of exposure to COVID-19 predict their altruistic motivation in heterogeneous ways. HCPs who worked in COVID 19 wards or had a close relative or friend severely affected by the virus are more than 5 percentage points more likely to prioritize patient welfare over personal gain, with the association for professional exposure being mostly driven by female HCPs, especially nurses. Conversely, personally contracting COVID-19 is associated with a 6 percentage point decline in prosociality. Our results highlight that different experiences of need shape prosocial behavior in hospital settings. |
| Keywords: | COVID-19;provider altruism;healthcare professionals;medical decision-making;prosocial behavior;experiment |
| JEL: | C91 D64 D81 I12 |
| Date: | 2026–07–16 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140229 |