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on Health Economics |
| By: | Long, Chengxu; Lin, Zhuoer; Swearinger, Hazal; Ailshire, Jennifer; Qian, Yuting; Ming, Wai-Kit; Zhao, Huitong; Hou, Xiaohui; Wu, Bei; Yang, Wei; Chen, Xi; Chen, Shanquan |
| Abstract: | Despite the growing global demand for end-of-life care resulting from rapid social transformations, significant gaps exist in cross-national research examining unmet end-of-life care needs. Using harmonized end-of-life survey data (2010-2021) from the United States, 28 European countries, South Korea, China, and Mexico, here we show that the United States, Europe, and South Korea exhibited higher overall unmet end-of-life care needs than China and Mexico, where limited formal care provision was compensated with high levels of informal care. Death at institutions was associated with lower overall unmet end-of-life care needs in the United States and South Korea, with Mexico presenting an exception. Similarly, urban areas in Europe and South Korea exhibited lower unmet formal end-of-life care needs compared to rural areas. Among married individuals, only Mexico exhibited significantly lower unmet overall end-of-life care needs compared to unmarried individuals. Having children was consistently linked to lower unmet informal end-of-life care needs across the United States, Europe, and South Korea. Our findings highlight the complex interplay between care systems and family demographic structures in shaping end-of-life care access, and underscore the need for tailored policy approaches that strengthen both formal and informal care systems while addressing sociodemographic disparities in care access. |
| Keywords: | End-of-life care, Unmet care needs, Informal care, Long-term care insurance, Cross-national comparison |
| JEL: | I14 I18 J14 D13 O57 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1842 |
| By: | Alex Chan; Ayush Gupta; Yetong Xu |
| Abstract: | Cadaveric organ shortages leave thousands without life-saving transplants each year. Countries differ in using opt-in (informed consent) or opt-out (presumed con sent) systems for donor registration. Using newly assembled cross-country panel data and an event-study design, this paper shows that presumed-consent laws are associated with increased organ donation only when strictly enforced and fam ily veto power is limited; weak opt-out regimes show negligible or even negative changes. A theoretical signaling model provides a plausible mechanism that de termines when opt-in or opt-out yields more donations, emphasizing the roles of donation propensity, signaling costs, and the family’s ability to overturn defaults. A large laboratory experiment further tests this mechanism, showing that opt-in generally produces equal or higher donation rates unless signaling is costly and family veto power is minimal. The results underscore that defaults alone rarely increase donations unless paired with strong institutional enforcement. |
| Keywords: | Defaults, Nudge, Organ Transplantation, Market Design, Donation, Healthcare, Giving, Behavioral Economics |
| JEL: | C92 D64 D47 H00 I11 I18 |
| Date: | 2026–11 |
| URL: | https://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2025_792 |
| By: | Dimico, Arcangelo; Narciso, Gaia |
| Abstract: | Forced sterilization represents one of several coercive population control measures enacted during the 20th century. This paper examines the short- and long-run effects of coerced sterilization, drawing evidence from the experience of Native American women in the 1970s. Beyond reduced fertility, our findings indicate that, in the long run, Native American women exposed to forced sterilization experienced worse health outcomes, lower labor market participation, lower income, and decreased investment in their children's education. We also examine the intergenerational transmission of fertility choices and find suggestive evidence of a reversal: children of mothers exposed to forced sterilization have higher fertility. |
| Keywords: | Sterilization, fertility, human capital, intergenerational transmission |
| JEL: | I15 J13 J15 N32 O12 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1849 |
| By: | Temulun Borjigen |
| Abstract: | How physicians form and update practice styles remains central to understanding persistent variation in care. Using quasi-random patient reallocation following primary care clinic closures in Denmark, I examine whether antibiotic prescribing practice styles are transmitted across clinics through patient mobility. I find that clinics receiving more patients with prior antibiotic use increase prescribing intensity among their existing patients. A twofold increase in incoming patients with prior antibiotic use raises prescribing intensity to existing patients by 2.3 percent. The response is stronger among newer clinics and is accompanied by increased use of diagnostic tests, consistent with physicians learning from the prescribing histories of incoming patients rather than responding only to patient volume. The findings highlight patient mobility as an important, informal channel of information transmission in healthcare markets and show that prescribing practices can diffuse across clinics through patient reallocation. These spillovers have implications for the persistence of practice variation and for the design and evaluation of policies aimed at improving antibiotic stewardship. |
| Keywords: | Practice style, physician learning, prescribing behavior, patient mobility, information diffusion, antibiotic stewardship |
| JEL: | I11 I12 I18 D83 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:diw:diwwpp:dp2188 |
| By: | Meybodi, Morteza; Vandenberghe, Vincent |
| Abstract: | This paper examines how career-long emotional/interpersonal work demands are associated with mental health among adults aged 50 and older. Using retrospective work histories from SHARE combined with ISCO-4-level occupational characteristics from O*NET, we construct employment trajectories capturing cumulative exposure to emotionally/interpersonally demanding work and examine its association with later-life depressive symptoms, measured by the EURO-D scale. Our findings show that careerlong emotional/interpersonal demands are associated with a higher risk of depression after age 50, although their relative importance is modest. Career instability, such as employment gaps, redundancies, and part-time work, emerges as a stronger predictor. Pre-labour-market factors, including childhood health and educational attainment, also play a substantial role, highlighting the lasting importance of early-life circumstances for later-life mental health. |
| Keywords: | mental health, depressive symptoms, working conditions, emotional/ interpersonal demands, career arduousness |
| JEL: | J14 I1 J26 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1850 |
| By: | Costa-Font, Joan; Garcia Corchero, Juan David |
| Abstract: | We examine the effect of the expansion of patient choice of health care provider on measures of process delivery and clinical outcomes central to the functioning of a health system, using a quasi-natural experiment in Spain over 2002–2019. We draw on a staggered adoption of provider choice reforms across Spanish regional health ser vices and a heterogeneity-robust difference-in-differences estimator applied to region year panel data alongside individual-level survey data. We estimate that the avail ability of provider choice reduced specialist waiting times by approximately 17 days (19% of the pre-reform mean) and the use of private specialist visits, without increasing public health spending. The waiting-time and private-utilisation results are robust to excluding the region where the 2009 reform bundled choice with new hospitals, public–private partnerships, and a budget increase. Although we cannot reject zero effects on some clinical outcomes, the evidence is consistent with the thesis that provider choice improves the “quality needle”, namely it improves observable process quality without affecting less-visible clinical dimensions. |
| Keywords: | provider choice;difference-in-differences;waiting times;health outcomes;Spain;public-private substitution |
| JEL: | I11 I18 D82 H75 |
| Date: | 2026–11–04 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140904 |
| By: | Yukihiro Nishimura; Pierre Pestieau; Jerome Schoenmaeckers; Nikolaos Theodoropoulos |
| Abstract: | We examine how two adult siblings share the care of an ageing parent, combining a theoretical model with evidence from the Survey of Health, Ageing and Retirement in Europe (SHARE). The model distinguishes how siblings make decisions from how their care contributions combine. When their contributions are interchangeable, care can be concentrated on the sibling with the lower effective cost. When their contributions are complementary, both siblings may provide care even if they decide independently. In the preferred specification, care by one sibling is associated with a 30.9 percentage-point higher probability that the other provides care. Formal home care is positively associated with sibling participation, while help from other informal caregivers is negatively associated with it. The positive association between siblings’ contributions is consistent with mutually reinforcing care, although the estimates cannot establish whether siblings coordinate their decisions. |
| Keywords: | formal and informal care, long term care, location decision, complementarity, SHARE |
| JEL: | I11 I13 I18 J14 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13121 |
| By: | Carter, Samantha; Jee, Edward; Karlan, Dean; Premand, Patrick |
| Abstract: | Multifaceted poverty Graduation programs that aim to increase income generating activities for low-income households are being rapidly adopted and scaled by nonprofit organizations and governments. This paper conducts a Bayesian hierarchical meta-analysis of 49 studies (encompassing 81 treatment variations) on poverty Graduation programs, defined as containing at least three of five components: consumption support, savings facilitation, skills training, coaching, and a lump-sum transfer. The analysis finds large gains across economic and psychosocial outcomes: monthly consumption rises by 38 USD PPP (11 percent), income by 28 USD PPP (15 percent), alongside improvements in savings, assets, food security, mental health, and women’s empowerment. Beyond these average treatment effects, three results stand out. First, programs with large transfers (at least 400 USD PPP) have larger treatment effects but are not more cost-effective. Second, more expensive programs generate larger treatment effects, but the improvements are not commensurate with the cost increases; thus, lower cost programs tend to be more cost-effective. Third, programs implemented from 2016 onward perform considerably better than those implemented prior to 2016: benefit-cost ratios from 2016 onward are 5.39, compared to 2.89 through 2015. Neither changes in cost nor in high-level design (components) explain this upward trend. Considering other heavily studied interventions, the results show a similar upward trend for treatment effects on behavior change from financial education but not for unconditional cash transfers. The paper hypothesizes a mechanism of continuous sector-community learning and improved implementation quality. |
| Date: | 2026–10–30 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11494 |
| By: | Bäckmann, Malte Henning; Bles, Per; Vitt, Mats Philipp |
| Abstract: | Artmann et al. (2022) investigated the influence of informal access to medical expertise by examining the effect of having a doctor as a child on the mortality and the health care use of the parents using admission lotteries to medical school as an instrumental variable. The authors found mostly small and non-significant effects for both mortality and health care utilization and concluded that informal access to medical expertise is not an important cause for any differences in mortality or health care use. We reproduce the results of this article with the replication package provided by the authors. Due to differences in the provided data, we are unable to exactly replicate the results of the authors. However, the differences between the original and our reproduced estimates are small and our conclusions do not deviate from those of the authors. Furthermore, we test the robustness of these findings by conducting a pooled parental mortality analysis and using updated data, restricting analysis to parents born before 1955, and by assessing the health care use among parents born before 1945. All original results are robust to the checks. We conclude, that although computational reproducibility was only partly possible, the interpretations of the results do not change: Among parents of medical school applicants, informal access to medical expertise is not an important cause for any differences in mortality or health care usages. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:i4rdps:333 |