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on Health Economics |
| By: | Simon S. Bensnes; Ingrid Huitfeldt; Victoria Marone |
| Abstract: | Patient cost-sharing is used as a tool to limit over-utilization of insured healthcare services in almost all high-income countries. We study its distributional consequences in the context of a publicly-funded universal health insurance system, where consumers (as tax-payers) are residual claimants on insurer spending. We highlight the distinction between consumers' elasticity of demand for healthcare services—which moderates how cost-sharing rules affect healthcare utilization—and their baseline level of demand—which moderates how cost-sharing rules affect out-of-pocket costs. Using detailed administrative data on the Norwegian national health insurance scheme, we study a 2010 policy change that raised the age threshold for cost-sharing exemption, thereby increasing patient cost-sharing substantially for adolescents. We find that females and native-born Norwegians have higher average utilization and thus have more at stake financially from cost-sharing, but are relatively less responsive to cost-sharing. In contrast, lower-income individuals as well as individuals with a chronic health condition have both higher average healthcare utilization as well as higher responsiveness. Cost-sharing therefore places a larger burden on these groups both in terms of the financial cost of out-of-pocket spending and in terms of reduced quantities of healthcare used. |
| JEL: | I12 I14 I18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34700 |
| By: | David G. Blanchflower; Alex Bryson |
| Abstract: | The worsening mental health of young workers in the United States drives the disappearance of the U-shape in wellbeing and the hump-shape in illbeing in the last decade. Illbeing declines in age among workers but is hump-shaped among non-workers across all US states. This has been the case for some time and is apparent in our analyses of two large US datasets with long time runs - the Behavioral Risk Survey System 1993-2025 and the National Health Interview Survey of 1997-2024. Although the mental health of workers and non-workers has been declining it has been deteriorating most quickly among young workers, leading to a steepening in the age gradient of mental illbeing for workers. Improvements in worker wellbeing (and declines in worker illbeing) with age are mirrored in age differences in reported working conditions in the American Job Quality Survey of 2025: six measures of job quality rise with age. Declines in mental health are most pronounced among the youngest workers ages 18-22 who are likely drawn from lower socio-economic classes and report the greatest difficulties making ends meet. |
| JEL: | I31 J28 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34696 |
| By: | Paul Goldsmith-Pinkham; Chenhao Tan; Alexander K. Zentefis |
| Abstract: | We study how radiologists use AI to diagnose pulmonary embolism (PE), tracking over 100, 000 scans interpreted by nearly 400 radiologists during the staggered rollout of a real-world FDA-approved diagnostic platform in a hospital system. When AI flags PE, radiologists agree 84% of the time; when AI predicts no PE, they agree 97%. Disagreement evolves substantially: radiologists initially reject AI-positive PEs in 30% of cases, dropping to 12% by year two. Despite a 16% increase in scan volume, diagnostic speed remains stable while per-radiologist monthly volumes nearly double, with no change in patient mortality -- suggesting AI improves workflow without compromising outcomes. We document significant heterogeneity in AI collaboration: some radiologists reject AI-flagged PEs half the time while others accept nearly always; female radiologists are 6 percentage points less likely to override AI than male radiologists. Moderate AI engagement is associated with the highest agreement, whereas both low and high engagement show more disagreement. Follow-up imaging reveals that when radiologists override AI to diagnose PE, 54% of subsequent scans show both agreeing on no PE within 30 days. |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2601.13379 |
| By: | Cavallo, Mariagrazia; Dhuey, Elizabeth; Fumarco, Luca; Halewyck, Levi; ter Meulen, Simon |
| Abstract: | This article reviews the growing literature on age at school entry (ASE) and its effects across the life course. ASE affects a wide range of outcomes, including education, labor-market performance, health, social relationships, and family formation. We synthesize the evidence using a conceptual framework that distinguishes four empirically intertwined ASE components: starting age, age at outcome, relative age, and time in school. While ASE effects are often substantial and persistent, many studies estimate bundled impacts without isolating specific components. A central lesson from the literature is that most estimated effects reflect bundled timing and institutional mechanisms rather than isolated maturity advantages, with interpretation depending on outcome construction and empirical design. We conclude by highlighting key gaps, particularly around relative age and long-run outcomes, and directions for future research. |
| Keywords: | age at school entry, starting age, age at outcome, relative age, time in school, institutional mechanisms, quasi-experimental methods |
| JEL: | I12 I21 I24 I31 J12 J13 J24 K42 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1707 |
| By: | Minhaj Mahmud (Asian Development Bank); Yujie Zhang (University of Pennsylvania) |
| Abstract: | This study examines the interplay between extreme temperatures and air pollution risks, the geographic and temporal distribution, as well as the population burden of climate shocks in Bangladesh, Indonesia, Pakistan, Thailand, and Viet Nam—countries severely impacted by climate change. Using ERA5-HEAT temperature data and PM2.5 pollution data, we first identify “hotspots” within and across the countries by analyzing district level trends in heat stress and pollution exposure. We further explore the correlation between temperature and pollution shocks. Finally, jointly considering the spatial distribution of populations and key climate and pollution hazards, we highlight the most vulnerable groups with population weighted exposure measures. Our findings reveal distinct country-specific patterns in both the correlation between heat stress and air pollution risk, and the population exposure to the hazards across demographic profiles. These results emphasize targeted policies to mitigate the compounded effects of climate and air pollution hazards on vulnerable populations across Asia. |
| Keywords: | heat;air pollution;climate change;Asia;population exposure |
| JEL: | J10 Q53 Q54 Q56 |
| Date: | 2026–01–27 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:022144 |
| By: | Jacob M. Sims Speyer; Ari Ne'eman; Norma B. Coe; Ellen Meara |
| Abstract: | Nearly eight million Americans use Medicaid home and community-based services (HCBS) to support long-term services and supports for people with disabilities. Recent legislative changes to Medicaid will require states to make difficult choices about how best to meet these long-term services and supports needs. This paper first characterizes the unique goals of HCBS, which differ from those of traditional medical care services, and the state-federal financing and administrative structure of HCBS. Next, based on a review of the literature and input from a panel of experts in HCBS policy and research, we summarize existing evidence and knowledge gaps regarding the quality and cost implications of HCBS at the federal, state, and direct service provision levels. Based on gaps in the evidence, we propose a research agenda related to state-federal incentives, state program choices regarding HCBS financing and delivery models, and the settings and supports for direct service provision. Finally, we describe existing and novel data sources and other opportunities that could accelerate research to fill these evidence gaps and support states and others in designing, implementing, and delivering sustainable, high-quality HCBS. |
| JEL: | I1 I11 I18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34701 |
| By: | Andreas Stoller |
| Abstract: | This study assesses the impact of tobacco billboard bans on smoking in Switzerland, exploiting their staggered adoption across regions, i.e., the cantons. Based on retrospective smoking histories from the Swiss Health Survey, a panel of individuals' annual smoking status is reconstructed, containing more than one million observations from 1993 to 2017. Estimation relies on staggered difference-in-differences as well as a complementary latent factor model, which relaxes the common trends assumption. The findings indicate that tobacco billboard bans lead to a reduction in smoking rates. Reductions of up to 0.9 percentage points correspond to an approximate 3% decline in the smoking rate. The effect is driven by women and individuals aged 25-44 and 65+. Overall, this evidence suggests that even partial tobacco advertising bans, such as billboard bans, can effectively reduce smoking rates and serve as a valuable policy tool within comprehensive tobacco prevention strategies. |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2601.08352 |
| By: | Motta, Matt (Boston University School of Public Health); Callaghan, Timothy; Lipson, Sarah K; Ross, Jennifer; Strombotne, Kiersten; Louis, Christopher |
| Abstract: | The recent discovery that a class of drugs collectively known as “GLP-1s” (Glucagon-Like Peptide-1) can promote weight loss has led to a surge in pharmaceutical production, demand, and advertising. While previous research has considered the impact that advertising exposure may have on public demand for using GLP-1s for weight management, few have considered the broader public health impacts (both positive and negative) of GLP-1 advertising. For example, increased GLP-1 advertisement exposure could make people more self-conscious about their own weight and physical appearance. It could also promote destigmatizing views toward those who use GLP-1 products for weight management. In a nationally representative survey of N = 1, 000 US adults, we find that people exposed to higher levels of GLP-1 advertising tend to hold more negative views about their own weight and physical appearance. We find no evidence that ad exposure is associated with destigmatizing views about those who use GLP-1 products, although we find strong evidence that exposure can stimulate demand for GLP-1 products. These results hold across a wide range of measures and model specifications. We conclude by discussing the potential public health risks of GLP-1 advertising, in a changing regulatory landscape. |
| Date: | 2026–01–16 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:gs5x4_v1 |
| By: | Sokolovska, Olena |
| Abstract: | This study provides an overview of main academic research on insurance literacy. We identify main challenges of quantitative measurement of financial or insurance literacy of the population. We made an attempt was made to identify the set of factors that determine the level of insurance coverage (with accident and health insurance as an example), which can be used to predict the level of insurance literacy. |
| Keywords: | financial literacy, insurance literacy, accident and health insurance |
| JEL: | G20 G22 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:127219 |
| By: | Kornhauser, Lewis; Lu, Yijia; Tontrup, Stephan |
| Abstract: | In this study, we suggest that crowding-out effects are unlikely when incentivizing behaviors that we refer to as mixed-motive-that is, behaviors motivated by both self-interest and prosociality. Vaccination is the prominent example we analyze: people vaccinate both to protect their own health and to contribute to herd immunity by protecting others. Building on signaling theory, we assume that people derive utility from signaling their prosociality. Incentives can crowd out prosocial motivation when they block the opportunity to send a clear prosocial signal, as in purely prosocial behaviors like charitable giving. Mixed-motive behaviors differ: they never allow for a clean prosocial signal in the first place, because self-interest is always a plausible motive. As such, providing financial incentives does not further constrain signaling opportunities, and we therefore predicted no crowding-out effects to emerge when incentivizing mixed-motive behaviors. Experimental evidence supports this prediction, and the pattern aligns with field studies suggesting that incentives may not crowd out vaccination uptake. |
| Keywords: | Crowding-Out, Incentives, Mixed Motives Behavior |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:esprep:335207 |
| By: | Klemick, Heather; Shadbegian, Ron; Guignet, Dennis; Bui, Linda T.; Hoang, Anh |
| Abstract: | We examine the relationship between childhood lead exposure and special education using data on over 800, 000 North Carolina 3rd-8th grade students. We use matching and panel data techniques to estimate the effect of lead exposure on the probability of having a learning disability that qualified students for special education and to estimate the effect of special education on lead-exposed students’ academic performance. We find that higher lead exposure significantly increased participation in special education, and special education significantly increased lead-exposed students’ test scores. These results indicate that special education can help mitigate academic deficits for lead-exposed students with learning disabilities. |
| Keywords: | Environmental Economics and Policy, Health Economics and Policy |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ags:nceewp:388973 |
| By: | Arpita Khanna (National University of Singapore); Minhaj Mahmud (Asian Development Bank); Nidhiya Menon (Brandeis University) |
| Abstract: | This study empirically investigates the impact of climate change on the incidence of noncommunicable diseases among older population in India. Using demographic and health surveys from 2019–2021 linked with georeferenced meteorological data at local levels, and a specification that controls for long-term local climate trends as well as individual and household characteristics, we show that unanticipated heat shocks have significant impacts on the prevalence of hypertension, high blood glucose levels, and overweight or obese status. The impact of heat shock on hypertension is somewhat more evident among urban, lower caste, and lower educated men, while the impact on glucose levels is more pronounced among the higher educated in urban settings. Body mass index is particularly sensitive to heat shocks in older rural women and individuals with higher education. Engagement in occupations more exposed to outdoor work (agriculture/manual) and lifestyle factors tied to wealth status are some explanatory mechanisms. |
| Keywords: | climate;temperature;older people;blood pressure;glucose level;BMI;India |
| JEL: | Q54 I12 J14 O13 |
| Date: | 2026–01–26 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:022142 |
| By: | Wen Lou; Adri\'an A. D\'iaz-Faes; Jiangen He; Zhihao Liu; Vincent Larivi\`ere |
| Abstract: | Clinical trials shape medical evidence and determine who gains access to experimental therapies. Whether participation in these trials reflects the global burden of disease remains unclear. Here we analyze participation inequality across more than 62, 000 randomized controlled trials spanning 16 major disease categories from 2000 to 2024. Linking 36.8 million trial participants to country-level disease burden, we show that global inequality in clinical trial participation is overwhelmingly structured by country rather than disease. Country-level factors explain over 90% of variation in participation, whereas disease-specific effects contribute only marginally. Removing entire disease categories, including those traditionally considered underfunded, has little effect on overall inequality. Instead, participation is highly concentrated geographically, with a small group of countries enrolling a disproportionate share of participants across nearly all diseases. These patterns have persisted despite decades of disease-targeted funding and increasing alignment between research attention and disease burden within diseases. Our findings indicate that disease-vertical strategies alone cannot correct participation inequality. Reducing global inequities in clinical research requires horizontal investments in research capacity, health infrastructure, and governance that operate across disease domains. |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2601.04660 |
| By: | Leonardo Viotti; Luis Diego Herrera; Garo Batmanian; Franck Berthe; Rachael Kramp |
| Abstract: | Diseases originating from wildlife pose a significant threat to global health, causing human and economic losses each year. The transmission of disease from animals to humans occurs at the interface between humans, livestock, and wildlife reservoirs, influenced by abiotic factors and ecological mechanisms. Although evidence suggests that intact ecosystems can reduce transmission, disease prevention has largely been neglected in conservation efforts and remains underfunded compared to mitigation. A major constraint is the lack of reliable, spatially explicit information to guide efforts effectively. Given the increasing rate of new disease emergence, accelerated by climate change and biodiversity loss, identifying priority areas for mitigating the risk of disease transmission is more crucial than ever. We present new high-resolution (1 km) maps of priority areas for targeted ecological countermeasures aimed at reducing the likelihood of zoonotic spillover, along with a methodology adaptable to local contexts. Our study compiles data on well-documented risk factors, protection status, forest restoration potential, and opportunity cost of the land to map areas with high potential for cost-effective interventions. We identify low-cost priority areas across 50 countries, including 277, 000 km2 where environmental restoration could mitigate the risk of zoonotic spillover and 198, 000 km2 where preventing deforestation could do the same, 95% of which are not currently under protection. The resulting layers, covering tropical regions globally, are freely available alongside an interactive no-code platform that allows users to adjust parameters and identify priority areas at multiple scales. Ecological countermeasures can be a cost-effective strategy for reducing the emergence of new pathogens; however, our study highlights the extent to which current conservation efforts fall short of this goal. |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2601.13349 |
| By: | Javier Guzman (Center for Global Development); Ainhoa Petri-Hidalgo (Center for Global Development) |
| Abstract: | Access to safe, effective, and quality-assured health technologies in low- and middle-income countries (LMICs) has historically depended on the World Health Organization’s Prequalification Programme (WHO PQ), a centralized mechanism designed to support global procurement efforts. While WHO PQ has played a critical role in expanding access, it is increasingly misaligned with current priorities, including regional manufacturing, supply chain resilience, and the growing regulatory capacity of LMICs. The March 2025 draft revision of WHO PQ marks the most significant update in two decades, signaling a shift toward reliance, yet leaving key operational gaps unresolved. This paper examines the limitations of the existing regulatory framework—including its narrow scope, delayed timelines, and lack of automatic in-country approval—and assesses the extent to which newer global and regional efforts, such as the WHO Global Benchmarking Tool, WHO Listed Authorities (WLAs), and African regulatory harmonization initiatives, address these gaps. Drawing on recent developments in Africa and beyond, the paper proposes a three-part reform agenda: modernizing WHO PQ into a rapid, reliance-based validator; diversifying regional and national pathways through twinning, WLA designation, and mutual recognition; and aligning downstream enablers such as procurement rules, transparency standards, and legal frameworks. These reforms are essential for creating a more inclusive, efficient, and regionally grounded regulatory system that supports timely access to essential health products and aligns with the realities of LMICs today. |
| Date: | 2026–01–15 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:ppaper:377 |