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on Health Economics |
| By: | Riccardo Di Francesco; Peter Hull; Seetha Menon |
| Abstract: | We study how firms’ orientation toward employee well-being shapes the health of their workers. Because this orientation is not directly observable, we measure it from the language Danish firms use in their public disclosures, applying language models to construct a firm-level well-being salience score. We link this score to population-wide administrative registers of health and sickness absence over 2013–2022, and exploit workers’ mobility between firms to estimate how workers respond to a change in the salience of their employer. We find an asymmetry: workers who move to higher-salience firms take substantially more sickness absence, while their use of health care does not change. Because worsening health would raise both, the absence response suggests a behavioral change rather than deteriorating health. Broadly, our results show that firms shape not only worker health but how workers act on it, and that the language of routine corporate disclosure can reveal economically meaningful features of the workplace that administrative data leave unrecorded. |
| JEL: | I12 J28 J32 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35760 |
| By: | Itzik Fadlon; Tal Gross; Alex Hoagland; Timothy Layton |
| Abstract: | We study the value of informal care from a spouse and how access to such care shapes optimal insurance coverage for long-term care. Using Medicare claims and a novel spousal crosswalk, we examine how the sudden incapacitation of a spouse affects their partner's use of formal care. A spouse's health shock increases their partner's probability of a nursing-home stay by 30%. We document significant negative health effects for the partner, but provide evidence that their increase in nursing-home stays is largely driven by substitution from informal care to formal care. When their partners are incapacitated, Medicare recipients become less sensitive to the price of formal care, consistent with a higher valuation of that care and reduced moral hazard. We develop a framework to interpret these findings. The framework translates differences in the level and price elasticity of demand for formal care into a lower-bound estimate of the value of informal care provided by a spouse. It also suggests that optimal insurance for long-term care should be designed at the household level with more generous coverage for those who do not have access to informal care. |
| JEL: | I13 I18 J12 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35784 |
| By: | Johannes Geyer; Peter Haan; Mia Teschner-Hofmann; Felix Weinhardt |
| Abstract: | Rising life expectancy and demographic change have increased the share of older workers, making their health and productivity central to aging societies. We study whether longer working lives translate into investments in work-related health before retirement. Exploiting a pension reform in Germany in a Regression Discontinuity Design, we show that women facing longer careers are more likely to apply for work-related rehabilitation, particularly those in poorer health or with weaker labor market attachment. Despite higher application and approval rates, this demand does not translate into higher rehabilitation completion. Together with intermediate outcomes, our findings are most consistent with capacity constraints in program delivery. |
| Keywords: | Rehabilitation, Aging Societies, Health Investments, Pension Reform |
| JEL: | H55 I12 J26 |
| Date: | 2026–09–22 |
| URL: | https://d.repec.org/n?u=RePEc:bdp:dpaper:0110 |
| By: | Richard Blundell; Monica Costa-Dias; Graham Mazeine; Costas Meghir; Tom Waters |
| Abstract: | Work experience has been found to be a key determinant of work and wages for educated women, but it seems to play a smaller role for the less educated. For them, welfare, tax credits and family composition matter more, and increasingly so does participation in disability programmes. Here we document how labor supply, wages, health, and disability claims have evolved in the UK over the last three decades, and examine how reforms to tax credits, disability benefits and other welfare programs have changed work incentives over this period. We then introduce these features into an empirical dynamic structural model of life-cycle labor supply, human capital and disability benefit application, in which human capital combines health capital, experience accumulated in work, and education. Estimating the model on a panel of working-age women in the UK, we examine the interactions between experience capital and health capital in driving life-cycle earnings across different education groups. Our results highlight the importance of interactions in the disability benefit, welfare and tax credit systems for understanding the life cycle pattern of hours, employment, earnings, and disability claims, and for evaluating policy counterfactuals. |
| Date: | 2026–01–30 |
| URL: | https://d.repec.org/n?u=RePEc:bri:uobdis:26/851 |
| By: | Dahlstrand, Amanda (University of Zurich); Huang, Shan (Stockholm School of Economics); Le Nestour, Nestor (Stockholm University); Michaels, Guy (London School of Economics) |
| Abstract: | Many organizations use knowledge hierarchies (KHs): frontline workers attempt tasks and pass unresolved ones to experts. But the implications of using KHs are poorly understood, especially when firm revenues depend on who resolves tasks or the firm generates downstream externalities. We study a KH using 500, 000 patient cases from an online primary care firm, linked to outcomes and costs across Sweden's healthcare system, exploiting assignment variation from temporary doctor congestion. Nurses resolve 70% of KH cases, passing the rest to doctors. Relative to doctor-only care, the KH modestly increases external primary care and emergency department visits but has no adverse effects on hospitalizations, earnings losses, or mortality. Its mean effect on systemwide (including downstream) costs is small but masks heterogeneity. Compared with doctor-only care, the firm's selective KH use saves 1.6% of online primary care costs; however, crucially, reassigning cases within 15-minute windows to minimize systemwide costs would save 6.8%. |
| Keywords: | division of labor, productivity, healthcare |
| JEL: | J24 I19 L23 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18965 |
| By: | Arapakis, K.; French, E.; McCauley, J. |
| Abstract: | Most health care for the US population aged 65 and older is publicly funded through Medicare and Medicaid. Despite the massive expenditures of these systems, little is known about how redistributive they are. Using data from the Health and Retirement Study, matched to administrative Medicare, Medicaid, and Social Security earnings records, we estimate the distribution of lifetime Medicare and Medicaid benefits received and the distribution of lifetime taxes paid to finance these benefits. We find that benefits are greatest among the high income, largely because higher-income households live longer. Nonetheless, high income people pay more in the way of taxes. In present discounted values at age 65, households at the bottom of the income distribution gain the most from these programs, driven by high Medicaid benefits and low tax burdens. All income groups gain from these programs for the cohort we study: the lifetime tax contributions did not cover the medical benefits they received. This deficit must be paid by younger cohorts. |
| Keywords: | Medicare, Medicaid, Social Security, Means-Testing, Lifecycle, Savings, House-Hold Finance |
| Date: | 2026–09–21 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2677 |
| By: | Olesya Fomenko; Melissa McInerney; Sebastian Negrusa |
| Abstract: | A growing body of research shows that excessive heat increases the frequency of heat-related injuries at work. While interest in mitigating occupational risks from excessive heat is high, there is little evidence on whether legislation targeting heat exposure can reduce such injuries. Using a triple-differences approach and administrative data from workers’ compensation systems, we evaluate California’s heat standard – adopted in 2005 - and find that the standard substantially reduces the frequency of work injuries in the construction, agriculture, and transportation industries. The effects increase with outside temperatures and are larger among younger workers. Our findings have clear implications for workplace safety and contribute to ongoing policy debates. |
| JEL: | H0 I1 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35772 |
| By: | Costa-Font, Joan; Raut, Nilesh |
| Abstract: | Given the high and uncertain costs of long-term care (LTC), insurers commonly rely on medical underwriting to determine eligibility. We examine the impact of the rollout of the Long-Term Care Insurance Partnership (LTCIP) programme—a joint federal–state initiative aimed at promoting private LTCI in the United States by shifting catastrophic costs to Medicaid and reducing insurers' risk exposure—using a difference-in-differences framework with heterogeneous effects by pre-LTCIP health status and chronic conditions. Using longitudinal data, we find that LTCIP increased LTCI take-up among both healthier and higher-risk individuals, with a positive effect of 2.1 percentage points among individuals with chronic conditions and a larger effect of 4.8 percentage points among those without chronic conditions. These findings are consistent with a partial relaxation of underwriting constraints. |
| Keywords: | long-term care partnerships;long-term care insurance;Medicaid;underwriting;difference-in-differences;adverse selection;chronic disease |
| JEL: | I18 H11 H24 |
| Date: | 2026–12–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140540 |
| By: | Ana Armendariz |
| Abstract: | This paper estimates the causal effect of drug consumption room (DCR) openings on drug-related hospitalizations in Switzerland. I exploit the staggered introduction of DCRs across Swiss cities between 1998 and 2022, using individual-level hospital records and a difference-in-differences estimator. DCR openings reduce drug-related hospitalization rates by roughly 35\% within 5 km of a facility. The reduction is most pronounced for fatal outcomes, which fall by 35\% while narcotics poisoning hospitalizations rise by a comparable amount, consistent with DCRs converting potentially fatal overdoses into non-fatal hospitalizations. Mental and behavioral disorder hospitalizations decline by 32\% while estimates for Hepatitis and HIV are imprecise. The findings support the role of DCRs as an effective harm reduction strategy. |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2609.27732 |
| By: | Sevim, Dilek; Felder, Stefan |
| Abstract: | Ambiguity-averse physicians tend to overtreat under diagnostic ambiguity and to undertreat under therapeutic ambiguity. This paper analyzes the optimal cost-sharing mechanism between the payer and the physician when diagnostic and therapeutic ambiguity are jointly present. We derive the first-best cost share when the physician’s altruism is common knowledge. This share lies above the ambiguity-neutral benchmark when diagnostic ambiguity dominates therapeutic ambiguity, and below it when therapeutic ambiguity dominates. When physician altruism is privately known, the payer screens physicians through a menu of contracts, moving the cost share toward zero relative to the full-information benchmark. Under sufficiently strong diagnostic ambiguity, the second-best cost share may nevertheless remain above its ambiguity-neutral level. |
| JEL: | D81 D82 I12 |
| Date: | 2026–09–28 |
| URL: | https://d.repec.org/n?u=RePEc:bsl:wpaper:2026/07 |
| By: | Cotofan, Maria; Krekel, Christian; Oparina, Ekaterina |
| Abstract: | Community-based lifestyle interventions combining physical exercise with volunteering are promoted as low-cost, scalable support for those with mental health problems, and feature prominently in social prescribing. Yet robust evidence that they are effective at scale, outside controlled trials, remains scarce. We evaluate a nationwide UK intervention that combines exercise and volunteering in local communities. Using three waves of incentivised surveys (February 2023 to March 2024; 3590 observations from 2856 respondents) linked to administrative data on participation, we compare participants with those who signed up but did not participate, including for plausibly exogenous reasons. Participation is associated with lower mental ill health and loneliness, and higher feelings of belonging, connectedness, and trust. The estimates are sizeable and persist beyond six months. Benefits substantially exceed costs. Our findings suggest that community-based exercise and volunteering can deliver meaningful mental health improvements at low cost and at scale, offering policy-makers a cost-effective means of relieving pressure on stretched health services. |
| Keywords: | physical exercise;volunteering;mental health;social capital;social value-for-money analysis |
| JEL: | I10 I12 I31 D64 D61 |
| Date: | 2026–11–30 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140940 |
| By: | Fan, Junwei (University of Glasgow, Adam Smith Business School); Montoya-Blandon, Santiago (University of Glasgow, Adam Smith Business School); Proto, Eugenio (University of Birmingham, CAGE) |
| Abstract: | We examine how social comparison within endogenously formed peer networks affects different measures of young adult mental health. Using over 2 million smartphone-based communication records from the NetHealth Study, we construct objective social networks among university students and estimate a structural model in which individuals choose their peers and mental health depends on the income of chosen peers. When networks are treated as exogenous, higher average peer income predicts better mental health; once network formation is modelled endogenously, the relationship reverses: exposure to higher-income peers significantly worsens depressive symptoms. Income gaps harm mental health in both directions, consistent with inequality aversion rather than relative deprivation. The reversal survives extending binary links to message-weighted networks, and counterfactual exercises show that policies reducing the volume of messages exchanged with peers improve mental health, increasingly so with the size of the reduction, though the effect of targeted reductions depends on which ties are attenuated. Ignoring endogenous peer selection can thus yield qualitatively misleading conclusions about peer effects on mental health. |
| Keywords: | social networks; relative status; mental health; network formation. JEL Classification: D63, D85, D91, I14, I31 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:cge:wacage:824 |
| By: | Benjamin W. Cowan; Mohamed Hafis Zida |
| Abstract: | This paper estimates the causal effect of fertility on mothers’ work arrangements, with a particular focus on remote work. Using harmonized individual-level data from the American Community Survey (ACS) for the period 2003--2024, we exploit exogenous variation in fertility generated by the sex composition of the first two children and twin births at the second parity. We find that fertility significantly reduces labor force participation across our sample period, consistent with existing evidence, but its effects on remote work are nuanced. Prior to the COVID-19 pandemic, an additional child increases the likelihood of working remotely. However, these effects turn negative after 2020 when remote work became common. We show that these patterns are not driven by changing selection into teleworkable occupations nor by changes in the observable characteristics of compliers over time. The limited feasibility or attractiveness of remote work for many women, combined with changes in the nature of remote work over time, are more likely explanations. Taken together, these findings suggest that remote work, in its current form, has limited potential to meaningfully reduce child penalties for higher-order births. |
| JEL: | J13 J16 J22 J24 J32 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35763 |
| By: | Amanda Dahlstrand; Shan Huang; Nestor Le Nestour; Guy Michaels |
| Abstract: | Many modern organizations use knowledge hierarchies, where frontline workers try to resolve tasks and pass those they cannot resolve to experts. But the implications of this organization of expertise are not well understood, especially if firm revenues depend on who resolves each task or the firm generates downstream externalities. We study a knowledge hierarchy (KH) using 500, 000 patient cases from an online primary care firm, linked to outcomes and costs across Sweden's healthcare system. We use variation in assignment arising from temporary doctor congestion, controlling for date-by-three-hour windows and flexible case characteristics. Within the KH, nurses resolve 70% of cases and pass the remainder to doctors. Relative to doctor-only care, the KH modestly increases external primary care and ED visits but has no adverse effects on hospitalizations, earnings losses, or mortality. Although the mean effect of KH on systemwide (firm plus downstream) production costs is small, this masks substantial heterogeneity. Compared to using only doctors, the savings from the firm's selective use of the KH equal 1.6% of online primary care costs. However, our main finding is that reassigning cases between the direct-to-doctor and KH routes within 15-minute windows to minimize systemwide production costs would save 6.8% of online primary care costs. |
| Keywords: | division of labor, productivity, healthcare |
| JEL: | J24 I19 L23 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13012 |
| By: | Senan Hogan-Hennessy; Seungmin Lee; Christopher B. Barrett; John Hoddinott; Matthew P. Rabbitt |
| Abstract: | Veterans face multiple hardships after they leave the military. Is food insecurity one of these hardships? This paper examines the long-term effects of military service on food insecurity using new data from the PSID. Military veteran-headed households experienced lower food insecurity than non-veteran-headed households, and participated less in federal nutrition assistance programs. We use the Vietnam-era lottery draft to identify causal effects, and find no evidence that military service adversely affects food insecurity. Our results suggest policies that assist currently enlisted service members, and veterans unlikely to head a traditional household, may most effectively tackle food insecurity among military veterans. |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2609.39932 |
| By: | Dora L. Costa; Matthew E. Kahn |
| Abstract: | We show how fertility delays compound across generations to raise age at first grandmotherhood. Under the 1960 first-birth schedule median grandmotherhood came at 44. Under the 2024 schedule it is 57, cutting the healthy years with grandchildren from 28 to 15. Longer life does not make up the loss of years when the grandmother is healthy enough to supply money and care. Delay is most pronounced among the college-educated, with reproductive-control access accounting for over half the fall in grandmotherhood by age 55 among White college graduates. When a daughter times her first birth to maximize her own payoff, the loss her choice imposes on her mother is external to her calculation. We call this the Rotten Adult Kid Problem. Delay raises both the price of a grandmother's care and wealth per grandchild. |
| JEL: | D13 J13 J14 N32 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35773 |
| By: | Claude Diebolt; Joel Huesler |
| Abstract: | This chapter synthesizes global evidence on how climate-related and disaster shocks affect human capital formation through educational attainment, learning outcomes, child health, and long-run economic mobility. Drawing on quasi-experimental and experimental evidence from low-, middle-, and high-income countries, the review documents substantial heterogeneity in impacts driven by shock type, timing, baseline poverty, and institutional capacity. Short-run disruptions to school attendance and health are well-documented, though evidence on learning losses and long-run earnings effects remains considerably thinner and warrants urgent attention. Key transmission mechanisms are mapped—including household budget constraints, child labor responses, school infrastructure damage, disease burden, and fetal and early-life programming—alongside a critical evaluation of causal identification strategies and their limitations. Policy evidence indicates that well-designed social protection programs, resilient school infrastructure, early warning systems, and education continuity planning can mitigate impacts, though rigorous evaluations remain scarce and external validity concerns persist. Five priority research gaps are identified: measuring and mitigating learning losses; understanding cumulative effects of repeated shocks; evaluating cost-effective adaptation strategies; linking childhood exposure to long-run labor outcomes; and studying behavioral adaptation to increasing climate risk. |
| Keywords: | Human Capital, Climate Shocks, Natural Disasters, Child Health, Education, Economic History |
| JEL: | I25 J24 N30 N50 Q54 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ulp:sbbeta:2026-34 |
| By: | Marco Alberto De Benedetto; Maria De Paola; Marco Francesconi |
| Abstract: | We estimate the labor market effects of Italy's statutory priority to work from home (WFH) for parents of children under age twelve. Using population-wide administrative data and a sharp regression discontinuity design, we find that eligibility raises mothers' annual earnings by 1.6-2.3 percent in high-WFH-intensity firms, alongside increases in paid days and weeks. Mothers in low-WFH-intensity firms and fathers in general show no detectable effects. The estimates have an intention-to-treat interpretation and persist beyond the pandemic. Placebo tests show no effects before the pandemic, in firms that never adopted WFH, or among manual workers, consistent with a WFH mechanism. |
| Keywords: | flexible work arrangements, female labor supply, work-family policy, remote-work intensity, work organization, regression discontinuity |
| JEL: | C31 J16 J22 J31 J81 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13010 |
| By: | Yvan Guillemette |
| Abstract: | This paper presents updated estimates of long-run fiscal gaps for 35 OECD and accession candidate countries using the OECD Global Long-Term Model. The long-run fiscal gap measures the fiscal adjustment required at the 2060 horizon to keep public debt ratios stable near current levels while maintaining current service standards and benefit entitlements. The methodology incorporates several refinements, including projected increases in defence spending and a more detailed treatment of primary expenditure. In the absence of additional policy action, the median country would require a fiscal adjustment of 4.7 percentage points of GDP between 2027 and 2060 to stabilise debt, with substantially larger adjustments in some countries. Population ageing is the main driver of long-run fiscal pressures through higher pension, health and long-term care spending, compounded in many cases by weak initial fiscal positions. The paper also assesses the sensitivity of fiscal gaps to key assumptions and policy scenarios. |
| Keywords: | fiscal pressure, fiscal sustainability, long-run fiscal gap, long-term projection |
| JEL: | C53 E17 H68 O57 H55 |
| Date: | 2026–09–30 |
| URL: | https://d.repec.org/n?u=RePEc:oec:ecoaaa:1877-en |
| By: | Pierre Dubois (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - Comue de Toulouse - Communauté d'universités et établissements de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Elissa Gentry (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - Comue de Toulouse - Communauté d'universités et établissements de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Tuba Tunçel (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - Comue de Toulouse - Communauté d'universités et établissements de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, FSU - Florida State University [Tallahassee], CEPR - Center for Economic Policy Research) |
| Abstract: | Off-label use regulation has the potential to change pharmaceutical firms' behavior and—consequently—affect patient welfare. We investigate the impact of changes in off-label regulation on pharmaceutical firms' behavior in seeking formal marketing ap proval for supplemental uses. In 2012, a US court decision protected truthful off-label promotion, providing pharmaceutical companies more leeway to promote off-label uses of their drug. Using a unique data set of pharmaceutical firms' research and development projects, we exploit this regulatory change to understand how firms react to government policies. Results demonstrate that the hazard of approval declined for supplemental uses, relative to original uses, after the policy change. Patent protection, potential market size, and competition are also important determinants of the hazard of approval. These results have implications not only for innovation policy but for the creation of high-quality data for certain indications. |
| Keywords: | Off-label drugs, Drug efficacy, Prescription drugs, Pharmaceutical firm behavior |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05752206 |
| By: | Hilde Stevens; Georges Siotis; Micael Castanheira De Moura; Mathias Dewatripont; Sanaé Akodad; Sam Daems; Alain Fischer; Michel Goldman |
| Abstract: | Orphan drug policy in the European Union faces a double price-and-innovation gap: a small fraction of rare diseases receive important resources while the overwhelming majority are under- or un-researched, leaving most rare disease patients facing high unmet medical needs. The European Commission's reform proposals, notably the Pharma Package and the European Biotech Act, seek to rebalance incentives by adjusting market exclusivity. We argue that, while these reforms move in the right direction, they are insufficient to foster meaningful innovation while safeguarding affordability, and that a broader, more structural approach is needed. We show how proposals from the Draghi Report could complement the reforms through an EU-level HTA Coordination Office, a US-style EU ARPA-H, and expanded regulatory sandboxing. We then propose two additional instruments: public-private Special Purpose Vehicles to de-risk high-need innovation, and EU-level joint procurement to strengthen affordability and create predictable demand. Ultimately, only a coherent, well-calibrated framework can align industrial policy with the EU's ambition of leaving no rare-disease patient behind. |
| Keywords: | Access; Affordability; Draghi Report; Drug pricing; EU Biotech Act; EU Pharma Package reform; Innovation incentives; Market exclusivity; Orphan medicinal products (OMPs); Policy; Rare diseases; Regulation |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:ulb:ulbeco:2013/414127 |