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on Health Economics |
| By: | Propper, Carol |
| Abstract: | In the last two decades European policy makers have sought to increase the use of market mechanisms in the delivery of healthcare. These reforms introduce competition and choice into previously heavily constrained environments. This leads to a set of interesting economic issues that have been addressed in a range of papers, both theoretical and empirical. This paper examines whether this popular reform model has resulted in improvements in outcomes for patients and/or taxpayers. It synthesises the existing economic analyses, highlights what is known and what is not, and signals potential next steps for economic research. |
| Keywords: | Choice |
| JEL: | I11 I18 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21559 |
| By: | Palme, Mårten; Seim, David; Spinnewijn, Johannes; Wikström, Jens |
| Abstract: | This paper studies the role of private supplemental health insurance (SHI) in universal healthcare systems. Linking novel microdata on SHI contracts to rich administrative data from Sweden, we document a steep income gradient in take-up: higher-income individuals are substantially more likely to enroll in SHI despite a greater healthcare need among lower-income individuals. Exploiting variation in the timing of employer-sponsored SHI, we find large and persistent increases in healthcare utilization (23 percent). The effects are even larger for low-income individuals and extend beyond specialist consultations to high-value treatments, consistent with binding rationing in public care. Focusing on cancer as a high-stakes condition, we find that SHI increases screening and diagnoses and reduces mortality. Although SHI is privately contracted, its effects materialize largely within the public healthcare system: coverage increases publicly financed utilization and reduces waiting times, generating negative fiscal and congestion externalities. |
| JEL: | I13 I14 I11 D62 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21502 |
| By: | Bloom, Nicholas; Dahl, Gordon; Rooth, Dan-Olof |
| Abstract: | There has been a dramatic rise in disability employment since the pandemic. At the same time, work from home (WFH) has risen four-fold. This paper asks whether the two are causally related. Controlling for compositional changes and labor market tightness, a 1 percentage point increase in WFH increases full-time employment by 1.0% for individuals with a physical disability. The postpandemic increase in working from home explains 68%-85% of the rise in full-time employment. Wage data suggests that WFH increased the supply of workers with a physical disability, likely by reducing commuting costs and enabling better control of working conditions. |
| Keywords: | Work from home |
| JEL: | J14 J42 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21377 |
| By: | Jason Abaluck; Oren Sarig; Jintaek Song |
| Abstract: | We analyze how social-planner insurers split cost-sharing between consumers and firms (e.g. patients and doctors, or drivers and car mechanics). With no contracting frictions, firm cost-sharing can replace consumer cost-sharing other than “visit copays.” Optimal firm contracts depend on the marginal rate of substitution between consumer and firm cost-sharing. For Medicare physician services, paying physicians more up front but less as spending increases reduces risk for both patients and providers; in our calibration, net benefits are twice those from eliminating Medigap externality. For prescription drugs, a dollar of physician paperwork costs is 45–110 times more impactful than a dollar of consumer cost-sharing. |
| JEL: | D82 I11 I13 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35352 |
| By: | Mahta Ghafarianghadim; Garth Heutel |
| Abstract: | Many effects of pollution exposure on health and education outcomes of children have been identified, but little is known about education effects on preschool-aged children. We estimate the effect of particulate matter air pollution on preschool attendance using restricted administrative data from the state of Georgia. We use thermal inversions, weather phenomena that trap pollutants, as an instrumental variable for pollution. A one-unit increase in the county-week average ambient particulate pollution level decreases attendance by around 2 percentage points. Effects seem to be larger for racial minorities and for children with working parents. |
| JEL: | I25 J13 Q50 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35367 |
| By: | Basso, Gaetano; De Paola, Maria; Lattanzio, Salvatore; Paradisi, Matteo |
| Abstract: | We study whether workplace flexibility is a key driver of the motherhood penalty. Exploiting the sharp and heterogeneous diffusion of work-from-home (WFH) contracts after COVID-19 in a difference-in-differences framework, we combine administrative data on the universe of Italian WFH contracts with matched employer--employee records, mother--father links, fertility records, and firm balance sheets. Greater exposure to flexible work substantially reduces mothers' post-childbirth earnings losses, primarily through higher weeks worked, lower part-time incidence, lower parental leave take-up, and improved career progression. IV estimates indicate that holding a WFH contract offsets about 77\% of mothers' earnings losses around childbirth. Gains are larger among younger, lower-earning, and commuting mothers, in households where the father is the dominant earner, and in occupations with steeper hours--earnings profiles, consistent with flexibility relaxing constraints where most binding. Fathers' own earnings do not respond to flexibility around childbirth, yet fathers' exposure to flexible work reduces mothers' earnings losses by a comparable magnitude, pointing to household-level time constraints as a central mechanism. Consistent with this interpretation, fertility, a joint household decision, rises for women more exposed to flexibility, as flexibility lowers the labor-market cost of the marginal child. A counterfactual exercise shows that the life-cycle widening of the gender earnings gap would have been 10.7\% smaller under current WFH diffusion and up to 29.4\% smaller if all remotable jobs had adopted flexible arrangements. |
| JEL: | J13 J16 J22 J31 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21486 |
| By: | Barwick, Panle; Xia, Hongyuan; Xia, Tianli |
| Abstract: | This paper examines China's transition from pharmaceutical ``free rider'' to global innovator over the last decade. In 2010, China accounted for less than 8% of global clinical trials; by 2020, it had surpassed the US in annual registered clinical trial volume. To study this transformation, we compile a comprehensive, synchronized database spanning the pharmaceutical drug development supply chain, covering scientific publications, clinical trials, drug development milestones for China, the U.S., and Europe, alongside drug sales and government policies over the same period. We provide strong evidence that China's rise was primarily driven by the National Reimbursement Drug List (NRDL) reform, which dramatically expanded the effective market size for innovative drugs. We document a sharp rise in both the quantity (86% increase) and novelty of drug trials post reform, with growth concentrated in reform-exposed disease categories, first- or best-in-class drugs, and among domestic firms. A decomposition exercise reveals that the NRDL reform accounts for 43% of the growth in oncology trial activity, nearly doubling the combined contribution of upstream knowledge accumulation and talent flows (24%), while other government policies play a minor role. Finally, dynamic gains from induced innovation exceed the reform's static gains in consumer access to innovative drugs by threefold, underscoring the importance of accounting for the reform's long-run effects on innovation incentives in addition to near-term improvements in drug affordability. |
| Keywords: | China |
| JEL: | O38 I18 O31 L65 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21286 |
| By: | Nicole Black; Lachlan Deer; Johannes S.Kunz; David W. Johnston |
| Abstract: | National public health awareness campaigns that emphasize peer-to-peer support are increasingly adopted, but evidence on the effects of peer-based programs at scale remains limited. Using quasi-experimental methods, we examine whether the prominent nationwide “R U OK? Day” campaign affects short-term mental health outcomes in Australia. Leveraging survey and administrative data, we find R U OK? Day leads to a 4% of a standard deviation increase in self-reported mental wellbeing, with the effect particularly pronounced among middle-aged males who experience a 9% of a standard deviation increase. We find no detectable effects on mental health care utilization, and we detect no statistically significant changes in suicide-related deaths in the short run, though the mortality outcomes are rare and power is limited. Our results underscore that peer-based campaigns can improve mental wellbeing, especially for high-risk groups, and point to a distinction between short-run psychological responses and outcomes that require behavioural follow-through. |
| Keywords: | Public Health Awareness Campaigns; Peer-to-Peer; Mental Health; Program Evaluation; Suicide Prevention |
| JEL: | I12 I18 M37 M31 |
| Date: | 2026–07–02 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:paper_1782953089612_801 |
| By: | Linnros, Evelina; Nilsson, J Peter |
| Abstract: | We estimate the long-term mental health impact of an alcohol policy experiment on individuals exposed to the policy in utero. The policy lasted for 8.5 months and significantly expanded access to alcohol, especially for those under age 21. Armed with administrative data on healthcare visits, drug prescriptions, and psychological assessments and applying a triple-differences strategy, we show that prenatal policy exposure had a substantial, early, and persistent impact on the mental health of the children of young mothers. The exposed cohorts conceived just before the policy started are 16% more likely to be diagnosed with a mental condition in midlife. We find effects on common midlife conditions such as depression and anxiety, on the ability to cope with psychologically stressful situations at age 18, and on neurodevelopmental disorders that manifest in early childhood. Among individuals with predicted mental health care needs, the impact of the policy on midlife earnings is significantly lower when they reside in areas with lower barriers to accessing mental health care, with a one–standard-deviation increase in local treatment intensity reducing the negative earnings effect by about one-third. Our findings indicate that policies increasing access to mental health treatments could substantially improve labor market outcomes, even for conditions with early-life origins. |
| JEL: | I12 I14 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21467 |
| By: | Costa-Font, Joan; Györi, Mario; Saenz De Miera, Belen |
| Abstract: | Extending health insurance coverage to previously uninsured populations can improve access to preventive services by relaxing financial barriers to health information and care, including those related to weight management. However, in the presence of ex ante moral hazard, insurance coverage may weaken incentives for preventive effort, potentially increasing unhealthy behaviours among already obese individuals. This paper examines these competing mechanisms using evidence from the introduction of universal public insurance, namely Mexico’s Seguro Popular (SP) in the 2000s. We exploit plausibly exogenous variation in the timing of SP rollout across municipalities generated by differential implementation speeds. We find no evidence that the rollout of SP modifyied individuals body mass index (BMI) or their obesity. Further, heterogeneity analysis suggests that SP exposure leads to a significant reduction in BMI and a 2 percentage point decline in smoking prevalence. These results provide no evidence of ex ante moral hazard in weight related health behaviours after the expansion of universal insurance. |
| Keywords: | obesity; overweight; insurance expansion; Seguro Popular; ex-ante moral hazard; income effects; prevention; health behaviours |
| JEL: | I18 J50 |
| Date: | 2026–06–11 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:138363 |
| By: | Yulia Chikish; Gregory J. Colman; Dhaval M. Dave; Brad R. Humphreys; Zachary Santamaria; Zachary Winship |
| Abstract: | Large cities worldwide have adopted congestion pricing to reduce urban traffic, with well-documented benefits for travel speeds, accident rates, and air quality. This paper identifies a novel external benefit: faster emergency medical service (EMS) response times. We provide the first evidence on how the congestion pricing program in New York City – the first comprehensive cordon-based congestion pricing system in the U.S. that was implemented on January 5th, 2025 – affects EMS performance. Exploiting the sharp geographic boundary of New York City’s congestion relief zone at 60th Street and a difference-in-discontinuities design, we first document substantial changes in traffic and mobility near the boundary: vehicular traffic declines by roughly 18 to 21 percent, accompanied by increases in pedestrian and bicycle activity. Consistent with these first-stage mechanisms, we find that congestion pricing improves EMS performance, reducing total travel times by 63–70 seconds (approximately 5–6 percent). Effects emerged quickly and show little evidence of displacement to adjacent areas. A concurrent FDNY directive requiring transport to the nearest hospital confounds standard difference-in-differences estimates but not our boundary-based design. These findings suggest that cost-benefit analyses of congestion pricing systematically understate net social benefits by omitting emergency response improvements. |
| JEL: | H41 I11 I18 R41 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35414 |
| By: | Margaris, Panos; Wallenius, Johanna |
| Abstract: | We develop a life cycle model that features food consumption, exercise, and deviation from reference BMI, which represents local social norms, to rationalize spatial concentration and the educational gradient in body mass in the US. BMI is determined by caloric balance and affects health and medical spending, the probability of survival, and the level of utility. We find that occupational strenuousness, food prices, medical expenditures, and labor income explain only a modest share of BMI differences across regions and education groups. Preference differences matter, but they account for the patterns only when amplified by social norms. To demonstrate the policy relevance of the social norm, we introduce a GLP-1 treatment policy targeting individuals with the highest food preferences. We find substantial direct effects on average BMI, with reductions of up to more than 6 pounds. Importantly, we document meaningful spillover effects arising from endogenous adjustment of reference BMI that further amplify these effects. The BMI reductions translate into substantial life expectancy gains for both treated individuals and untreated individuals through spillover effects. |
| Keywords: | Obesity |
| JEL: | I12 I14 D15 E21 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21370 |
| By: | Wang, Huan; Baranov, Victoria; Dickerson, Sarah; Barofsky, Jeremy |
| Abstract: | Antiretroviral therapy (ART) for HIV/AIDS has expanded rapidly across low-income countries since 2000, generating large gains in life expectancy. Exploiting spatial and temporal variation in ART availability, this paper examines the health and economic consequences of ART introduction across a comprehensive set of outcomes in rural Malawi, a low-income setting with high HIV prevalence. We find that ART substantially reduces prime-age mortality. Although these health gains raise individual prime-age labor supply, total household labor supply and household earnings are unchanged. We show that this divergence reflects the outward migration of prime-age household members, particularly men. Consistent with this mechanism, households receive sizable increases in remittances. Our findings identify migration as an important, but previously overlooked channel through which health shapes household economic outcomes. |
| Keywords: | Malawi |
| JEL: | I15 I18 I21 O15 O18 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:21553 |
| By: | De Donder, Philippe; Lefèvre, François; Leroux, Marie-Louise; Roquebert, Quitterie |
| Abstract: | This paper investigates how marginal utility varies with health status (e.g. health-state dependence) while allowing this relationship to differ across income levels. Building on the existing literature, we develop a framework that quantifies the income adjustments necessary to maintain individuals’ wellbeing when they become disabled. Using SHARE data, we empirically estimate how health affects the marginal utility of consumption across the income distribution for older adults in Europe. Our results show that health-state dependence is negative among low-income individuals, indicating that their marginal utility of consumption declines when their health worsens. In contrast, at the very top of the income distribution, health-state dependence is positive, implying that marginal utility of consumption rises as health deteriorates. |
| Keywords: | Health-state dependence, Marginal utility of consumption, Income heterogeneity, SHARE; survey |
| JEL: | D12 I1 J14 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:131900 |
| By: | Koonal Shah; Juan Manuel Ramos-Goñi; Nancy Devlin; Oliver Rivero-Arias |
| Abstract: | This Research Paper describes a study examining adolescent and adult responses to a discrete choice experiment (DCE) containing EQ-5D-Y health states in order to determine whether the two groups exhibit different preferences. This Research Paper describes a study examining adolescent and adult responses to a discrete choice experiment (DCE) containing EQ-5D-Y health states in order to determine whether the two groups exhibit different preferences. One of the challenges with generating an EQ-5D-Y value set is that traditional methods are cognitively demanding and may not be appropriate for younger individuals. However, asking adults to complete a valuation task from the perspective… |
| Keywords: | Clinical Outcomes, EuroQol, UK |
| JEL: | I1 |
| Date: | 2026–01–07 |
| URL: | https://d.repec.org/n?u=RePEc:ohe:grafun:002539 |
| By: | Simone Ferro; Elena Meschi; Caterina Pavese |
| Abstract: | We estimate the causal effect of air pollution on primary school students' cognitive performance in Italy, exploiting daily within-municipality variation in pollution across exam dates. Using INVALSI administrative data on the universe of students over ten cohorts and a specification with individual fixed effects, we find that a 10 μg/m³ increase in PM2.5 reduces test scores by 4.4% of a standard deviation. Effects are concentrated in reasoning-intensive items, with no significant effect on knowledge-based items, are stronger for lower-achieving and emotionally vulnerable students, and are substantially mitigated by school mechanical ventilation and air-conditioning systems. These results highlight the cognitive costs of short-term pollution exposure and the potential of targeted infrastructure investments to reduce environmental inequality in education. |
| Keywords: | air pollution, PM2.5, test scores, memory and reasoning |
| JEL: | J01 I1 I2 Q53 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12738 |
| By: | Cassidy, Rachel; Das, Smita; Delavallade, Clara; Kipchumba, Elijah; Sulaiman, Munshi |
| Abstract: | This paper evaluates a socio-emotional skills training programme for 4, 728 urban Tanzanian youth who were not in full-time employment, education, or training. A randomized design compared awareness (for example, self-awareness, empathy, and active listening), management (for example, self-control, personal initiative, and negotiation), and combined curricula. Socio-emotional skills were measured using self-reported and behavioral indicators. Training increased self-reported socio-emotional skills in the short run across both domains, but had limited effects on behavioral measures, and all socio-emotional skills gains faded after one year. Modest but sustained employment gains were observed among men who were job seekers at baseline. Training did not improve labor market outcomes for women. No differential effects were found across training types, and each training affected skills in the alternative domain, suggesting that socio-emotional skills domains are interrelated. These findings indicate that socio-emotional skills training may improve labor market outcomes only for specific subgroups, particularly in the absence of complementary interventions tackling barriers to employment. |
| Date: | 2026–05–29 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11399 |
| By: | Julien Albertini (Université Lumière Lyon 2, Université Jean-Monnet Saint-Etienne, emlyon business school, GATE, 69007, Lyon, France); Tony Berthonneau (Le Mans Université, GAINS-TEPP; Université Lumière Lyon 2, Université Jean-Monnet Saint-Etienne, emlyon business school, GATE, 69007, Lyon, France); Anthony Terriau (Le Mans Université, GAINS-TEPP) |
| Abstract: | We study the interplay between informality, health, and education in South Africa. Using data from the National Income Dynamics Study, we document large disparities in health and labor market outcomes over the life cycle. We develop and estimate a life-cycle search-and-matching model with endogenous education and a dual labor market. We show that informal employment and poor health reinforce each other, generating a persistent poverty and poor-health trap. Policy experiments show that the optimal reform combines tertiary education subsidies, a broader tax base, and a lower average tax burden on earnings, increasing employment, welfare, and health while preserving fiscal balance. |
| Keywords: | Informality, Health, Education, Human Capital, Search and Matching |
| JEL: | I14 J24 J46 J48 J64 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:gat:wpaper:2607 |
| By: | Joan Costa-i-Font; Melcior Rossello-Roig; Caroline Rudisil; Luca Salmasi |
| Abstract: | We study the formation of risk perceptions— subjective probability beliefs— of three adverse events—COVID-19 contagion, influenza contagion, and food poisoning—at the onset and outset of the COVID-19 pandemic in the United States, using survey data. We show that perceived risk levels for COVID-19 are similar to those for influenza but are not significantly influenced by proximity to infection and are shaped instead by an individual's gender, education, and employment status. Using an instrumental variable strategy, we assess whether these perceptions influence a number of protective behaviors. Although risk perceptions are associated with various protective behaviors, we only find a causal impact in increasing the likelihood of phone or online medical consultations by only about a percentage point |
| Keywords: | risk perception, subjective probability, risk proximity, COVID-19, influenza, food poisoning, health consultations, protective behaviours |
| JEL: | I13 D81 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12724 |