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on Health Economics |
| By: | Juan Pablo Atal; Tomás Larroucau; Pablo Muñoz; Cristóbal Otero |
| Abstract: | Occupational licensing is a widespread quality regulation that potentially increases the quality of labor but reduces its quantity. We provide a theoretical framework to empirically quantify this trade-off in public hospitals, where both clinical quality and physician shortages are critical concerns. Using quasi-exogenous variation driven by a recent and unprecedented migration of physicians to Chile, together with growth in domestic medical schools, we show that more physicians improve patient outcomes, while lower-quality physicians—as measured by licensing exam performance—worsen them. Incorporating these findings into our theoretical framework, we evaluate the implications of locally changing the stringency of the licensing policy. |
| JEL: | I18 J24 J44 J45 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35855 |
| By: | Georgina Cisneros; Brandyn F. Churchill |
| Abstract: | We provide evidence on the extent to which food assistance affects spending on sugary items by studying the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided funds to families of children who lost access to free and reduced-price school meals due to COVID-19 pandemic school closures. Leveraging state-level variation in the timing of P-EBT disbursements using a stacked difference-in-differences identification strategy with NielsenIQ Consumer Panel data, we find that P-EBT disbursement was associated with a 16-percent increase in weekly spending on sugary items among SNAP-eligible households with school-aged children. Notably, this increase exceeded the percentage increase in overall food spending for this group, suggesting that SNAP-eligible households with school-aged children allocated a disproportionately large share of their P-EBT-driven purchases toward sugary items relative to their pre-period baseline. We do not detect changes among households unlikely to have received P-EBT benefits or in placebo disbursement years. |
| JEL: | D12 H53 I12 I18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35835 |
| By: | Joshua S. Graff Zivin; Johnny Huynh; Timothy Frank Justicz; Adriana Lleras-Muney; Matthew J. Neidell |
| Abstract: | We provide the first causal evidence on how long-term exposure to fine particulate matter (PM2.5) at contemporary ambient levels contributes to the development of chronic disease in a young, initially healthy population. Our analysis links detailed personnel records for roughly 150, 000 U.S. Army soldiers to high-resolution annual measures of PM2.5. Because soldiers enter service exceptionally healthy and receive uniform access to care, new diagnoses reflect pollution’s physiological impact rather than preexisting conditions or differential health care access. They are also required to relocate based on the needs of the Army, which provides us with quasi-random variation in initial duty-station assignments that we use as an instrument for average annual pollution exposure over a soldier’s career. We find that sustained PM2.5 exposure substantially increases circulatory disease, particularly hypertension, with mixed evidence on respiratory conditions that are sensitive to specification. Exposure over shorter durations, by contrast, has little detectable effect, a pattern consistent with the cumulative nature of pollution’s health burden. These findings demonstrate that even moderate long-term exposure to air pollution can erode health capital in ways that are invisible to studies focused on short-run variations or mortality alone, and they highlight the importance of regulatory standards that account for chronic exposure risks. |
| JEL: | I10 J10 Q53 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35871 |
| By: | Alden Cheng; Riley League |
| Abstract: | We study strategic responses by firms to threshold-based regulations. We document extensive bunching in response to additional staffing requirements for California nursing homes with at least 100 beds. To estimate the regulation’s effect on staffing, we develop a novel treatment effects estimator for threshold-based regulations under precise manipulation, by decomposing firms into response types based on counterfactual and realized staffing and size, separating causal effects from selection. We estimate that higher staffing above the threshold is nearly entirely due to selection, with low-staffing facilities manipulating their size to avoid the regulation. These size distortions limit access, particularly for disadvantaged patients. |
| JEL: | I11 I18 L51 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35849 |
| By: | Peter Haan; Julia Schmieder; Izabela Wnuk-Soares |
| Abstract: | We study how immigration affects prices through changes in labor supply. Using policy-driven increases in immigration to Germany and administrative data covering the universe of nursing homes, we find that one additional foreign-born woman per 100 residents reduces nursing-home care prices by 2.6 percent. The price effects are concentrated in more competitive markets. Examining potential mechanisms, we find that immigration lowers labor costs as nursing homes shift toward lower-paid foreign-born workers. We find no evidence of declines in inspection-based measures of quality or of scale effects. Finally, immigration increases the use of informal care, potentially strengthening competitive pressure from the broader care market. |
| Keywords: | Immigration, labor supply, prices, nursing homes |
| JEL: | J61 F22 J30 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26224 |
| By: | Daniel S. Grossman; Kole T. Reddig; Jane Ruseski; Fotinos Panagakos |
| Abstract: | This paper studies the utilization of dental services during the recent implementation of an adult (age 21 and over) Medicaid dental benefit in West Virginia. We analyze claims data and find: 1) before implementation, quarterly utilization of preventative and restorative services falls from 8% at age 20 to virtually 0% at age 21; 2) post-implementation, utilization falls from 8% at age 20 to 5% at age 21, implying a net increase of 50% of baseline utilization; 3) the net effect of the dental benefit is significantly larger in counties with a larger number of oral health care provider practices. Our results provide evidence that public health insurance expansions are dampened in markets with a limited supply of provider practices. |
| JEL: | H75 I1 I12 I13 I18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35844 |
| By: | Michelle Escobar Carías; Victoria Baranov; Sonia Bhalotra; Pietro Biroli; Joanna Maselko |
| Abstract: | Does past treatment for depression create resilience to future shocks? We study a randomized CBT-based intervention for prenatally depressed mothers in Pakistan and exploit variation in COVID-19 restriction stringency six years after childbirth. Treated women were protected against restriction-induced anxiety, depression, comorbidity, and functional impairment. Protection extended to spousal relationships, offsetting restriction-driven declines in relationship quality and increases in marital conflict. This resilience operates through psychological channels: the intervention builds locus of control and self-efficacy, strengthens family and partner support, and reduces how overwhelmed women feel when shocks arrive. The resulting psychological capital has returns well beyond the treated condition. |
| Keywords: | Resilience, mental health, functioning, spousal conflict, restrictions |
| JEL: | G18 I12 J12 J16 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26225 |
| By: | Dhaval M. Dave; Jooyoung Kim; Joseph J. Sabia |
| Abstract: | Licensure sales requirements are commonly justified as consumer protection regulations intended to improve seller compliance and reduce harm associated with risky products. However, licensure effects may differ across communities with heterogeneous enforcement intensity and seller responses. We study this question in the context of e-cigarette retail licensure laws (ERLLs), a policy intended to regulate access to e-cigarettes among youth. We find that state ERLLs with strong penalties for non-compliance reduce nicotine vaping among Black youths by 2.5-4.0 percentage points but have no effect on White youths. This racially disparate finding is driven by heterogeneous supply-side responses to increased regulatory burden. Vendors in Black neighborhoods are more likely to be targeted for inspections than those in White neighborhoods despite having lower pre-treatment rates of infractions. Moreover, vendors in Black neighborhoods are also less likely to sell e-cigarettes following ERLL adoption, consistent with a racially disparate regulatory burden. Together, our results suggest important distributional consequences of licensure requirements. |
| JEL: | H22 I12 I18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35848 |
| By: | Christopher M. Worsham; Charles Bray; Joshua Rothman; Brian Kwan; Anupam Jena |
| Abstract: | Observational research into the relationship between maternal acetaminophen use during pregnancy and a child’s subsequent risk of attention deficit hyperactivity disorder (ADHD) or autism has been limited by confounding factors. Using two large national U.S. insurance claims databases and a novel natural experiment, we assessed differences in prevalence of ADHD and autism among children whose gestational periods were impacted by a nationwide Tylenol recall issued in 1982, following deaths from Tylenol capsules containing potassium cyanide. Prevalence of ADHD and autism was not significantly different in birth cohorts exposed to the recall during gestation, when maternal acetaminophen use would have been reduced; interrupted time series models showed no significant differences compared to underlying temporal diagnostic trends. These findings are inconsistent with a clinically meaningful effect of maternal acetaminophen use on subsequent development of neurodevelopmental disorders. |
| JEL: | I1 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35873 |
| By: | Ralph I. Lawton; Duncan Thomas; Elizabeth Frankenberg; Cecep Sumantri; Teresa Seeman; Eileen Crimmins; Daniel Hochbaum |
| Abstract: | Stressful events are associated with long-term adverse health impacts, but the causal mechanisms linking exposures to disease remain poorly understood. One mechanism is persistent changes to hormonal signaling that regulate metabolic homeostasis. We examine the long-term impacts of stress associated with exposure to the 2004 Indian Ocean tsunami on levels of free triiodothyronine (FT3), a circulating measure of biologically active thyroid hormone, using data from the Study of Tsunami Aftermath and Recovery. Biomarkers are measured 20 years post-tsunami in a population-representative sample age 35y+ in 2024 who, at the time of the tsunami, were living along the coast of Aceh, Indonesia, the area hardest-hit by the tsunami. Because respondents were first interviewed before the tsunami and subsequently tracked regardless of migration, the sample avoids selection bias common in long-term disaster studies. We identify the causal effect of tsunami exposure using variation in community-level tsunami mortality, comparing communities within the same sub-district. We find that greater tsunami exposure reduced levels of FT3 20 years later. Exposure also altered relationships between FT3, body composition, and cortisol and increased cardiometabolic risk. These findings identify persistent alteration of thyroid hormone physiology as a potential pathway linking severe stressful exposures to long-term cardiometabolic disease risk. |
| JEL: | I1 O12 Q54 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35858 |
| By: | Harsha Thirumurthy; Elizabeth F. Bair; Dean Yang; Teniola I. Egbe; Benard Ayieko; Julius Wesonga; Sue Napierala; Connie Celum; Mary E. Putt; Carol S. Camlin; Mark Ayallo |
| Abstract: | Alcohol use, transactional sex, and gambling carry significant health and economic consequences. We conducted a randomized controlled trial in Kenya to assess whether these behaviors could be altered with a savings intervention that provided lottery-based interest, goal-setting support, and savings reminders. Over 24 months, the intervention increased formal savings and assets, financed primarily by lower spending on alcohol, transactional sex, and gambling. It also reduced hazardous drinking by 26 percent and intimate partner violence by 15 percent. HIV/STI incidence declined by 8 percent, though this was not statistically significant. Savings interventions can simultaneously boost financial security and change health behavior. |
| JEL: | I12 O15 O16 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35833 |
| By: | Venkatesh, Shrathinth; Skarda, Ieva; Villadsen, Aase; Asaria, Miqdad; Boehnke, Jan R.; Brennan, Alan; Krekel, Christian; Mon-Williams, Mark; Ploubidis, George; Tiffin, Paul A.; Cookson, Richard |
| Abstract: | Economic evaluation of early childhood interventions is challenging because it is hard to extrapolate the full range of long-term benefits and public cost savings from short-term effectiveness evidence. It is also cumbersome and expensive to gather long-term evidence. One way to address this issue is through the use of microsimulation. This paper introduces a childhood microsimulation model, LifeSim Childhood, that is capable of extrapolating the long-term effects of many childhood risk factors on a broad range of health, educational, and social outcomes and public cost savings up to age 17 in the UK. It is based on bespoke modelling of longitudinal birth cohort data. The aims of this paper are to describe the general modelling approach and methods underpinning LifeSim Childhood, to present a simple illustration of how the model can be used to simulate the effects of early childhood poverty, and to compare our illustrative results with estimates from quasi-experimental studies. Our model is based on analysis of data from the Millennium Cohort Study which follows children born in the UK around the year 2000. Our causal inference strategy is to focus on causal pathways that can be explicitly justified by existing inter-disciplinary scientific knowledge and to estimate the total magnitude of long-term causal effects by controlling for an explicitly justified set of confounding variables. As well as describing our data inputs, regression analysis methods and simulation methods, we illustrate how the model can be used to evaluate four hypothetical income-shifting scenarios in early childhood and estimate the general magnitude of long-term public cost savings and wellbeing benefits, alongside a battery of more specific outcomes. |
| JEL: | J1 |
| Date: | 2026–09–18 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:130315 |
| By: | Keita Sunada; Yukitoshi Matsushita; Taisuke Otsu |
| Abstract: | Quadratic-form test statistics are widely used in econometrics, and their performance depends on accurate variance estimation. Conventional plug-in estimators are consistent under the null hypothesis, but under alternatives the drift in the residuals inflates them and the test loses power. We develop a general framework for variance estimation in such statistics, replacing one of the two squared-residual factors by an auxiliary linear combination of the residuals (``cross-fitting'') chosen to annihilate the drift. We characterize the conditional bias of each estimator exactly. The drift enters the plug-in estimator squared, multiplied by quantities bounded away from zero, so its bias is positive whenever the drift is non-degenerate. It reaches the cross-fit estimator only through the part that survives the cross-fitting, and then only through off-diagonal entries of a residual-maker matrix. From this calculation we obtain conditions under which the cross-fit estimator remains consistent under alternatives while the plug-in estimator does not. At a common critical value the cross-fit test therefore rejects whenever the plug-in test does, and against distant alternatives the plug-in statistic converges to a finite limit, small when few observations carry the departure: its power can tend to zero where the cross-fit test's tends to one. We verify the conditions under primitive assumptions in nonparametric specification testing, overidentification testing, and testing many linear restrictions, and illustrate the procedure on the Oregon Health Insurance Experiment. |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2610.06119 |
| By: | Nara Chung; Marwil Davila Fernandez |
| Abstract: | This paper extends Goodwin's (1967) predator-prey growth-cycle model to incorporate the negative impact of Opioid Use Disorder (OUD) on labor productivity. Using U.S. state-level data for 1998--2019, we first document that deteriorations in the labor share are followed by rising drug-induced mortality. We then build this link into the model through a novel discrete-choice mechanism in which the probability of OUD decreases with the wage share, so when real wages fail to keep pace with productivity growth, opioid use rises. This behavioral health channel feeds back into the economy through a productivity damage function. Applying the existence part of the Andronov-Hopf bifurcation theorem, we show that the resulting three-dimensional nonlinear system admits a limit cycle, as confirmed by our numerical simulations. Along the cycle, rising OUD paradoxically raises the employment rate, as falling productivity requires more labor per unit of output; across steady states, however, higher OUD prevalence is associated with a lower employment rate, consistent with evidence that opioid use disorder reduces labor force participation. Moreover, our numerical experiments show that OUD sensitivity to income widens fluctuations, while productivity sensitivity to OUD counterintuitively compresses them through a self-correcting feedback that speeds the recovery of the wage share. Policies that weaken the link between income and OUD, such as stronger social safety nets, stabilize the resulting dynamics. |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2610.10356 |
| By: | Claus Thustrup Kreiner; Paul Bingley; Benjamin Ly Serena |
| Abstract: | Socioeconomic inequality in longevity is typically measured using a single indicator, such as education or income. When indicators are imperfect proxies for socioeconomic status, this approach understates inequality. Using multiple indicators can improve measurement by better capturing latent socioeconomic status. We combine education, income, occupation, wealth, and IQ scores using machine learning. Using Danish population-wide data spanning 40 years, we estimate life expectancy at age 40 for the 1942-44 birth cohorts. Individuals at the top of the socioeconomic distribution live nearly 25 years longer than those at the bottom. The estimated gradient is 50-150% steeper with multiple indicators. |
| Keywords: | Life Expectancy, Inequality, Machine Learning |
| JEL: | I14 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26234 |
| By: | Gabriele Letta; Luca Salmasi (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro CuoreAuthor-Name: Lorenzo Cappellari); Gilberto Turati (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore) |
| Abstract: | We study how uncertainty about future household income affects the decision to continue an ongoing pregnancy. To distinguish the role of uncertainty from that of realized income losses, we exploit the Italian labour-market response to the first wave of the COVID-19 pandemic. While the temporary suspension of non-essential economic activities substantially increased uncertainty about future economic prospects, workers affected by mandatory closures continued to receive income support through the national short-time work scheme. Using nationwide administrative records on voluntary pregnancy terminations and births, we combine this institutional setting with geographic variation in exposure to temporary work suspensions across municipalities. Differencein- differences estimates show that abortion rates declined throughout Italy following the lockdown, but the decline was significantly smaller in municipalities more exposed to work suspensions. The effect is concentrated among married women outside the labour force and is strongest in municipalities with greater industrial employment. This pattern is consistent with uncertainty affecting households whose economic prospects were more exposed to temporary work suspensions. We find no corresponding effects on births. The estimates suggest that uncertainty about future household income can substantially affect pregnancy decisions even in the absence of permanent job loss. |
| Keywords: | Household income uncertainty; Pregnancy decisions; Abortion; Temporary work suspensions; COVID-19. |
| JEL: | J13 I12 I18 J22 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:ctc:serie1:def157 |