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on Health Economics |
| By: | Honglin Li; Chenyuan Liu; Justin R. Sydnor |
| Abstract: | How does community rating distort relative prices for vertically differentiated plans in insurance markets? We show that common community-rating approaches can distort price differentials in the opposite direction to the distortions in overall price levels. Partial age-based community rating in the U.S. private health insurance exchanges causes older individuals to pay marginal prices for generous coverage significantly above marginal cost, while younger enrollees are subsidized on the margin. These distortions are large enough that older individuals often face and sometimes choose dominated options. We present simulations and theoretical discussions of community rating’s impacts on efficiency and distributional outcomes. |
| JEL: | D0 I13 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34367 |
| By: | Giulia Montresor; Catia Nicodemo; Cristina Bellés Obrero |
| Abstract: | This paper estimates the causal effects of extreme temperatures and a related adaptation policy on workplace accidents in Spain, combining administrative records on occupational accidents with high-resolution weather data. Both cold and heat raise the incidence of work accidents, though with different magnitudes: ice days (maximum temperatures |
| Keywords: | adaptation policy, climate change, temperature, work place accidents |
| JEL: | I1 J28 J81 Q54 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1519 |
| By: | Moritz Lubczyk; Maria Waldinger |
| Abstract: | What are the long-run effects of sustained exposure to air pollution? A unique natural experiment allows us to examine this question. In 1982, a sudden cut in Soviet oil forced Socialist East Germany to switch to highly polluting lignite coal. While the shock sharply increased air pollution near mining regions, authoritarian restrictions on mobility, housing, and jobs prevented sorting responses. We document persistent labor market impacts over three decades. Exposed individuals work less, earn lower wages, and retire earlier. Health is a key mechanism: infant mortality rises by 9\% and the long-run incidence of asthma and cardiopathy increases significantly. |
| Keywords: | air pollution, labour supply |
| JEL: | I15 J24 J60 N54 Q53 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12197 |
| By: | Klauber, Hannah (Potsdam Institute for Climate Impact Research); Koch, Nicolas (Potsdam Institute for Climate Impact Research); Pestel, Nico (Maastricht University) |
| Abstract: | This paper examines how prolonged exposure to heat affects the labor force's ability to work in the short and long run. Linking administrative public health insurance records for one-third of the German working-age population to the quasi-experimental occurrence of heat waves, we provide the first comprehensive characterization of the occupation-specific heterogeneity in how heat-induced health damages materialize in decreased labor supply, and its distributional implications. An average hot day increases the number of new sick leave cases, and the effects build with prolonged heat. After seven consecutive days of heat exposure, the impact is roughly three times greater than on the first day. Workers who are already disadvantaged in terms of their income and working conditions are more vulnerable to heat stress. Those who are more flexible in scheduling and adjusting their working hours are less at risk. Our results also reveal a longer-term decrease in labor supply in the years following heat wave exposure, and suggest sustained increases in expenditures for healthcare. |
| Keywords: | climate change, inequality, labor, heat, adaptation |
| JEL: | J20 J32 I18 Q50 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18176 |
| By: | Perlik, Kerstin; Corona Juárez, Nicolás; Priebe, Jan |
| Abstract: | Congenital disorders are a principal cause of early mortality, long-term disabilities, impaired cognitive development and constitute a major challenge to families, communities, and health care systems. The origins of congenital disorders are, however, not yet well understood. Using a high-dimensional fixed-effects model that includes municipality specific time and locality-by-month fixed effects, this study provides the first causal evidence on the role of high ambient temperature during pregnancy in affecting the onset of congenital disorders. We compiled a large dataset comprising about 19 million births from about 63, 000 Mexican localities during 20082021 and connect it with local temperature data. We estimate that a 1C increase in the average monthly maximum temperature during gestation is associated with a rise in the incidence of congenital disorders by 2.4 percent (0.022 percentage points). Furthermore, we provide suggestive evidence that newborns from indigenous mothers are more likely to develop congenital birth disorders compared to children from non-indigenous parents when exposed to high ambient temperatures. |
| Keywords: | Birth outcomes;Climate shocks;Indigenous |
| JEL: | I14 I31 Q54 |
| Date: | 2025–08 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:14291 |
| By: | Albanese, Andrea (LISER); Deschenes, Olivier (University of California, Santa Barbara); Gathmann, Christina (LISER); Nieto Castro, Adrian (Lund University) |
| Abstract: | This paper provides novel evidence of the impact of temperature fluctuations on retirement behavior and underlying mechanisms, combining 30 years of rich longitudinal survey data with granular daily weather information. Exposure to cold and hot temperatures accelerates transitions into retirement, particularly among individuals unaccustomed to such conditions, and the effects are strongest among vulnerable populations facing greater health challenges and limited access to healthcare. Extreme temperatures deteriorate health through a higher incidence of cardiovascular diseases and strokes, reducing individuals' ability to work, while better access to healthcare mitigates the adverse effects of extreme temperatures on retirement behavior. |
| Keywords: | retirement, health, temperature, healthcare |
| JEL: | I14 I18 J26 Q54 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18161 |
| By: | Leila Agha; Na'ama Shenhav; Myles Wagner |
| Abstract: | Work disruptions among women are common and costly for workers and firms, but do consumers also shoulder some of these costs? We study the impact of physicians’ births—a large, temporary shock to women’s labor supply—on their patients’ access to care, using administrative Medicaid claims data from California. Female physicians reduce their office visits by 85% in the quarter after giving birth, but return nearly to pre-birth levels within two years. These supply disruptions generate persistent effects on child patients: those whose primary care physician gives birth are less likely to see their usual physician for up to two years and receive less preventative care, including a 50% reduction in vaccination claims and a 42% reduction in lead testing. In contrast, we find little impact on adult patients. The lasting effects on children coincide with fewer pediatrician encounters overall, consistent with limited availability of substitute providers and the central role of pediatricians in monitoring children’s preventative care. Our findings demonstrate how shocks to women’s labor supply can generate persistent consumer welfare losses. |
| JEL: | I10 I30 J16 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34360 |
| By: | Brandyn F. Churchill; Emily C. Lawler |
| Abstract: | We provide novel evidence on how healthcare decision-making responds to changes in government recommendations by studying the United States Preventive Services Task Force’s 2009 decision to stop recommending mammogram screenings for women aged 40-49. Using a difference-in-differences identification strategy, we find that the guideline revision reduced mammography among 40-49-year-old women by 6-10 percent (from a baseline rate of 48.8 percent) relative to their older counterparts. We also identify large spillovers onto women aged 30-39 who were subsequently 25 percent less likely to receive a mammogram recommendation (from a baseline rate of 22.8 percent) and up to 60 percent less likely to receive a mammogram (from a baseline rate of 12.6 percent). Additional analyses suggest the revision reduced overdiagnosis of early-stage tumors. Finally, we find that the 2009 update increased confusion about recommendations for preventing cancer. |
| JEL: | I12 I18 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34368 |
| By: | Janet Currie; Kate Musen |
| Abstract: | We examine information versus hassle costs in the context of Medicaid prior authorization requirements for preschool antipsychotic prescribing. Such prescribing increased in the 1990s, despite substantial side effects and the absence of FDA approval. State Medicaid programs began to require prior authorization for antipsychotic prescribing to young children after 2005. We evaluate these policies using hand-collected policy data and national prescription data for 2006-2019. We find that prior authorization reduced prescriptions to children under six by 22-30% in the two years after implementation. There were no effects on privately insured or older children, suggesting little role for information spillovers. |
| JEL: | I12 I13 I18 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34369 |
| By: | Dubois, Pierre |
| Abstract: | We examine pharmaceutical regulations and incentives for innovation from an international perspective, highlighting the public good nature of healthcare innovation and its cross-border diffusion. We summarize the empirical evidence on how push and pull incentives shape R&D investment, innovation, and global access. We emphasize the role of strategic interdependencies and spillovers, including free-riding in R&D financing, learning-by-doing effects, drug shortages, reference pricing, and parallel trade. We then provide new evidence on the international spillovers of pull incentives on innovation, showing that international cooperation and innovative institutions are necessary to better align national regulations with the global objective of sustaining pharmaceutical innovation. |
| Keywords: | Pharmaceutical Regulation, Innovation, R&D, International Spillovers |
| JEL: | L10 L20 I10 I11 I18 |
| Date: | 2025–10–10 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:131002 |
| By: | Delia Coculescu; Maximilian Janisch; Thomas Leh\'ericy |
| Abstract: | Pharmaceutical markets for life-saving therapies combine monopoly power with insurance coverage. We build a tractable sequential game in which a patent-holder chooses the drug price, a profit-maximising insurer sets its premium, and a population of heterogeneous agents decide whether to insure and, conditional on diagnosis, whether to purchase treatment. Two sufficient statistics - subjective illness probability and reservation price - capture heterogeneity and nest risk-aversion and liquidity-constraint motives within a unified framework. We prove existence of subgame-perfect Nash equilibria and show that entry of an insurer strictly raises producer profits but may raise or lower both drug prices and treatment uptake, depending on the joint distribution of the population statistics. Numerical experiments calibrated to flexible parametric families illustrate non-monotone comparative statics and quantify conditions under which insurance reduces access. Our results provide benchmarks for evaluating price negotiations, price caps, and subsidy schemes in high-cost drug markets. |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2509.16125 |
| By: | Carrillo, Bladimir; Branco, Danyelle; Ratcher, Laísa; Nunes, Leticia; Fontes, Luiz Felipe; Parfitt, Rafaela; Bauhoff, Sebastian; Duryea, Suzanne |
| Abstract: | This paper examines the impact of racial concordance between mothers and healthcare providers on childbirth practices and health outcomes in Brazilian public hospitals. Using a novel dataset linking patients and providers across 15 million births, we compare deliveries where providers and patients share the same race to those where they do not. We find that racial concordance slightly increases vaginal delivery anesthesia use, emergency medication and modestly reduces cesarean section rates, tubal ligation, hospital stay length, and medical exams performed. We also find evidence that these effects are especially pronounced among Black mothers attended by Black providers. Lastly, our results indicate no significant impacts on maternal or infant health outcomes. Our findings contribute to the literature on healthcare disparities by highlighting how racial concordance may improve care delivery patterns without necessarily translating into immediate health outcome differences. |
| Keywords: | Racial concordance;Healthcare disparities;Obstetric care;Public Health |
| JEL: | I12 J13 J15 I18 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:14290 |
| By: | Anam Mohammad (Institut des Politiques Publiques – DREES); Delphine Roy (IPP - Institut des politiques publiques); Maxime Tô (Institut des Politiques Publiques ‑ Institute for Fiscal Studies – CREST.); Todor Tochev (IPP - Institut des politiques publiques) |
| Abstract: | In this article, we analyse the links between earned income in the early years of an individual's career, and the risk that they will become beneficiaries of a disability pension at different points in later life, using the inter-pension schemes sample (EIC, 2009-2017). For men, we identify a clear gradient: the risk of benefiting from a disability pension is 1.5 times greater than the median for the lowest income deciles, and 2.5 times lower for the top decile. This gradient, which is less pronounced for women, remains present even when controlling for socio-professional status and health parameters in the early career, although it is attenuated. Inequality with regard to disability is particularly high at the ages when disability remains relatively rare (between the ages of 40 and 50), and has become more pronounced among more recent generations of men. The probability that an individual will receive a disability pension at an early age thus appears to be a relevant indicator of health inequality. |
| Abstract: | Cet article analyse le lien entre revenus du travail en début de carrière et risque de devenir bénéficiaire d'une pension d'invalidité à différents âges, à partir des échantillons interrégimes des cotisants (EIC, 2009-2017). Pour les hommes, nous mettons en évidence un gradient marqué : le risque d'invalidité est 1, 5 fois plus élevé pour les premiers déciles par rapport à la médiane, et 2, 5 fois plus faible pour le dernier décile. Ce gradient, moins prononcé chez les femmes, persiste après contrôle des caractéristiques socioprofessionnelles et de santé en début de carrière, même s'il est alors atténué. Les inégalités face à l'invalidité sont particulièrement fortes aux âges où elle est encore relativement rare (entre 40 et 50 ans) et se sont accentuées au fil des générations récentes, pour les hommes. La probabilité de bénéficier d'une pension d'invalidité de façon précoce semble donc être un indicateur pertinent d'inégalités de santé. |
| Keywords: | social protection, income, pension, health inequality, disability, revenu, protection sociale, retraite, inégalités sociales de santé, invalidité |
| Date: | 2025–09–30 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05302114 |
| By: | Yangyang Li |
| Abstract: | The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the probability among those with lower expenses. Concerning the probability of being very happy, the OHP only had a positive effect on being very happy and spending less, and its effect on those with high expenses was insignificant. These findings align with the benefit of Medicaid: alleviating financial burden, contributing to the well-being of distinct subgroups. |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2510.14909 |
| By: | Ashani Abayasekara (Health Economics Group, School of Public Health and Preventive Medicine, Monash University); Sonja de New (Centre for Health Economics, Monash Business School, Monash University); David Johnston (Centre for Health Economics, Monash Business School, Monash University) |
| Abstract: | As economies decarbonise and automate, entire industries within countries will disappear, raising questions about how displaced workers will fare and how policy can best support them. To provide evidence on this issue, this paper examines the economic and mental health consequences of the complete shutdown of Australia’s automotive manufacturing industry. Using linked administrative data, we estimate the medium-term effects of this large-scale closure relative to comparable workers in unaffected manufacturing and construction sectors. We find substantial and persistent declines in employment and salary income among displaced workers, with limited recovery over five years. These effects are concentrated among older and lower-skilled workers, who experience higher rates of joblessness, occupational downgrading, and transition into self-employment. In contrast, younger and higher-skilled workers recover more quickly. Despite substantial disruption, we find no increase in mental healthcare use, potentially reflecting the unusually comprehensive support programs provided before and after closure. |
| Keywords: | Job displacement, layoffs, Industrial transitions, employment, mental health |
| JEL: | I12 J63 J23 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:2025-15 |
| By: | Davillas, Apostolos (CINCH - Health Economics Research Center, Essen, Germany); Jones, Andrew M. (University of York) |
| Abstract: | We examine the role of baseline health in predicting future employment exits, alongside established socioeconomic, job-related and demographic predictors. Using UKHLS, we track employed respondents over 10 years to assess subsequent employment exits. Baseline health is captured using an unusually rich set of measures: self-assessed health (SAH), self-reported diagnosed conditions, psychological distress, allostatic load (composite biomarker index), and epigenetic biological age. Applying a LASSO penalised regression approach, we find that epigenetic biological age and SAH, rather than self-reported conditions, psychological distress, or allostatic load, predict subsequent employment exits, independent of other predictors. A Shapley-Shorrocks decomposition highlights epigenetic biological age as a stronger predictor than SAH. Nevertheless, chronological age is the dominant predictor of future employment exits. Epigenetic biological age measures do allow us to disentangle the role of chronological age, mainly reflecting institutional structures such as retirement eligibility and societal norms, from other contributions that capture age-related health decline that are more directly reflected in epigenetic biological age measures. |
| Keywords: | employment exit, supervised machine learning, LASSO, biomarkers, biological age, epigenetics, labour market |
| JEL: | C5 I10 J01 J20 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18167 |
| By: | Ventura, Leonardo |
| Abstract: | In epidemiology, standardization is an essential tool when comparing mortality between populations with different age structures. Using Italy, one of the oldest countries in the European Union, and the EU-27 aggregate as a case study, this methodological note demonstrates how comparisons between crude mortality rates can give misleading interpretations of disease burden. While crude rates suggested a higher mortality in Italy (≈280 per 100 000) compared to the EU-27 (≈259 per 100 000), standardized rates showed the reverse pattern (≈224 vs ≈239 per 100 000). A Kitagawa decomposition confirmed that the excess in crude mortality rates for Italy is almost entirely explained by the effect of age structure rather than true etiological factors. This methodological note illustrates the necessity of proper standardization in cancer epidemiology. All the instructions to download the official datasets and the Python scripts for the analysis are openly available on Zenodo (doi:10.5281/zenodo.17251977), offering both an educational example and a methodological reference for standardization to support students, policymakers, and researchers in applying these techniques. |
| Date: | 2025–10–06 |
| URL: | https://d.repec.org/n?u=RePEc:osf:metaar:kzac4_v1 |
| By: | Deschacht, Nick (KU Leuven); Guillemyn, Inés (University of Antwerp); Vujic, Suncica (University of Antwerp) |
| Abstract: | Using data from the Survey of Health, Ageing and Retirement (SHARE), this paper examines occupational pension income and coverage gaps between men and women. The focus is on a group of countries with comparable occupational pension regulations: Germany, Sweden, the Netherlands and Switzerland. The results show that after accounting for observable characteristics, over half of the gender gap in occupational pension coverage is explained, largely driven by women’s shorter labour market participation, greater part-time work, and lower wages. Factors driving this gap remain constant across birth cohorts. Conditional on receiving an occupational pension, women receive nearly 40 percent less occupational pension income than men, partly due to part-time work and industry of employment. Selection into pension receipt has only a limited impact on the gender pension gap. While pension coverage gap decomposition shows little variation across countries, this is not the case for the gender pension gap, notably with cross-country differences in part-time work. |
| Keywords: | Oaxaca-Blinder decomposition, gender occupational pension income and coverage gaps, Yun decomposition, selection, Europe |
| JEL: | H75 I38 J32 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18163 |
| By: | Kevin Momanyi |
| Abstract: | In this paper, we develop a theoretical model that links the demand for telecare to the length of stay in hospital and formulate three models that can be used to derive the treatment effect by making various assumptions about the probability distribution of the outcome measure. We then fit the models to data and estimate them using a strategy that controls for the effects of confounding variables and unobservable factors, and compare the treatment effects with that of the Propensity Score Matching (PSM) technique which adopts a quasi-experimental study design. To ensure comparability, the covariates are kept identical in all cases. An important finding that emerges from our analysis is that the treatment effects derived from our econometric models of interest are better than that obtained from an experimental study design as the latter does not account for all the relevant unobservable factors. In particular, the results show that estimating the treatment effect of telecare in the way that an experimental study design entails fails to account for the systematic variations in individuals' health production functions within each experimental arm. |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2509.22706 |
| By: | Benedict Clements (Universidad de las Américas in Ecuador); Huy Nguyen (International Monetary Fund); Ratna Sahay (National Council of Applied Economic Research); Mehak Jain (National Council of Applied Economic Research) |
| Abstract: | This paper assesses the impact of women's participation in national governments (as parliamentarians and ministers) on social spending and outcomes in emerging market and developing economies (EMDEs). We find that the representation of women in politics has increased over time, with substantial variation across regions and countries. Latin America and the Caribbean lead among EMDE regions, while Middle East and Central Asia and Emerging and Developing Asia have lower female representation. The higher shares of women in parliaments and cabinet positions go hand-in-hand with increased government health spending, both as a share of GDP and total spending. The results on education outlays are broadly similar. Greater representation of women in policymaking is also associated with positive effects on social outcomes, such as a reduction in infant and under-five mortality rates, greater access to basic water services, and higher learning-adjusted years of schooling. The case studies presented in the paper highlight the importance of identifying national priorities on health and education and increasing the share of female political leaders (including through quotas where gender biases are entrenched). |
| Keywords: | women in parliament; women in cabinets; social spending; health outcomes; education outcomes |
| JEL: | H51 H52 I00 J16 |
| Date: | 2025–10–01 |
| URL: | https://d.repec.org/n?u=RePEc:nca:ncaerw:187 |