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on Health Economics |
| By: | Stella Canessa; Gordon B. Dahl; Anna Hasselqvist; Costas Meghir; Susan Niknami; Mårten Palme; Helmut Rainer; Olof Rosenqvist; Pengpeng Xiao |
| Abstract: | Divorce reshapes family life, yet little is known about one of its most consequential features: the allocation of child custody. We study the impact of joint versus sole custody on both parents and children using rich administrative data from Sweden linked to over 25 years of newly-collected court custody rulings. To address selection concerns, we exploit random assignment of custody disputes to judges who differ sharply in their propensity to grant joint custody. For fathers, joint custody substantially raises earnings and improves mental health, consistent with sustained paternal involvement enhancing labor market attachment and psychological well-being. In contrast, there are no measurable labor market or mental health effects for mothers. Turning to children, joint custody increases standardized test scores and school quality without affecting mental health outcomes. Joint custody increases fathers’ chances of remarriage, keeps separated parents in closer geographic proximity, and has no effect on intimate partner violence allegations against either partner. These findings inform longstanding debates over the role of child custody in shaping post-divorce family life. |
| JEL: | J12 J13 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35482 |
| By: | René Karadakic; David C. Chan; Nancy L. Keating; Bruce E. Landon; Michael L. Barnett |
| Abstract: | We estimate the returns to specialization in medical oncology, in which subspecialists focus on specific cancer types. Using 2.2 million Medicare chemotherapy episodes from 2008–2020, we instrument for subspecialist access with differential distance to cancer-type-specific subspecialists versus general oncologists. Access to a relevant subspecialist reduces three-year mortality by 4.5 percentage points (10 percent), without increasing Medicare spending or measured provider fragmentation. Subspecialists also increase the use of newer therapies and diagnosis-specific clinical trials. These findings show that specialization raises productivity when expertise is closely matched to the task. |
| Keywords: | physician specialization, mortality, health care access |
| JEL: | I1 J24 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12937 |
| By: | Emily Cuddy; Janet Currie; Elisa Jácome; Lucy Manly |
| Abstract: | By age 17, a quarter of U.S. students have experienced a peer suicide. Using linked administrative data from South Carolina and a matched difference-in-differences design, we find that exposure to a peer's self-harm death increases the probability of a self-harm diagnosis by nearly 50% and both the incidence and frequency of mental health visits. Effects on care use and criminal behavior are concentrated among white boys, and responses diverge by prior mental health history: students without a prior diagnosis increase felony offending rather than care-seeking. Deaths from assault and transportation accidents produce no comparable rise in self-harm, consistent with contagion. |
| JEL: | I12 J13 K42 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35603 |
| By: | Michel Rizzo; Lisa Grazzini; Leonardo Grilli; Patrizia Lattarulo; Marika Macchi |
| Abstract: | The aim of this paper is to analyse whether Community Health Centers have improved territorial healthcare in the Tuscany region, in Italy. A fixed effect model is used to test whether Community Health Centers have improved two health outcomes: inappropriate accesses to hospital Emergency Departments and hospitalizations caused by complications for chronic diseases (diabetes, chronic obstructive pulmonary disease and heart failure). Our main results show that per-capita expenditure for Community Health Centers slightly reduces inappropriate accesses to hospital Emergency Departments; the number of General Practitioners working in a Community Health Center slightly reduces hospitalisations due to complications related to chronicity while the latter tends to increase when there is at least a facility in the healthcare district, presumably for the Community Health Center's ability to catch a latent demand. Such results seem to show that, up to now, territorial primary healthcare provided through Community Health Centers has only had a moderate impact on improving the quality of care in Tuscany, and lessons should be learned from such experience in view of a recent health reform passed in Italy in 2022, that will change the organization and governance of Community Health Centers. |
| Keywords: | Primary care, Community health centers, Inappropriate ED, Hospitalizations for chronicity. |
| JEL: | H51 I10 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:frz:wpaper:wp2026_11.rdf |
| By: | Hamid Noghanibehambari; Jason Fletcher |
| Abstract: | This paper examines the long-term effects of early-life exposure to county health departments (CHDs), a public health initiative aimed at providing affordable healthcare access to disadvantaged and underserved areas during the early decades of the 20th century, on later-life longevity. We employ Social Security Administration death records linked with the 1940 census and implement a difference-in-differences estimation strategy to compare the longevity of individuals exposed at different ages to the county-specific year of CHD establishment. We find that exposure to a CHD opening in the county of birth during fetal development and early years of life is associated with a 1-4-month increase in longevity. We observe considerable heterogeneity in the results, such that the effects are more concentrated among non-white individuals and individuals with lower-educated parents. Contemporaneous fertility and infant mortality data suggest reductions in infant mortality rates and increases in birth rates following CHD openings. Additionally, we find significant improvements in educational attainment, socioeconomic status, and income in early adulthood. We argue that enhancements in the fetal environment, improved fetal survival, and better early life health capital resulting from CHD exposure contribute to improvements in human capital during adulthood, with potential implications for later-life longevity. |
| JEL: | I1 I18 J14 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35533 |
| By: | Daniel R. Arnold; Michael R. Richards; Yashaswini Singh; Christopher M. Whaley |
| Abstract: | The diffusion of technological innovation depends on incentives, regulations, and firms’ strategic behaviors. We study these intersections within cardiac procedure markets following Medicare’s expansion of non-hospital facility options for treatment, enabled by clinical advancements. State-level regulations restrain federal pro-competition policy. Where market entry occurs, business stealing is concentrated among the lowest cost treatment settings, rather than high-cost hospitals––increasing Medicare spending by approximately $2.5 million. Medicare policy also generates externalities for untargeted procedures and other payers, except when hospitals and physicians are vertically integrated. Federal rulemaking interacts with and is mitigated by complex market dynamics––including in potentially unanticipated ways. |
| JEL: | H44 H51 H75 I11 I18 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35645 |
| By: | Haruo Kakehi (University of Wisconsin-Madison); Yoko Ibuka (Keio University) |
| Abstract: | When regulated prices cannot clear shortages, non-price mechanisms determine who bears the cost. We study this in Japan's drug market, where pharmacists choose among differently priced substitutes, exploiting a government-ordered suspension of a major generic manufacturer. Out-of-pocket spending rose by up to 21%, driven by temporary shifts to brand-name drugs and larger, persistent shifts to higher-priced generics. Pharmacists' dispensing choices vary with financial incentives, yet the government's pay-for-performance program rewards generic use rather than lower-priced generics and cannot prevent within-generic cost increases. We evaluate targeted incentives to reduce spending, and find evidence of lower adherence and higher discontinuation of treatment. |
| Keywords: | Supply disruptions, Drug prices, Generic drugs, Pharmacies, Drug shortages |
| JEL: | D12 I11 I18 |
| Date: | 2026–08–26 |
| URL: | https://d.repec.org/n?u=RePEc:keo:dpaper:dp2026-019 |
| By: | Chiara Campana; Pierre Koning; Maarten Lindeboom |
| Abstract: | While evidence points at potentially strong effects of stricter screening and tightening eligibility criteria for Disability Insurance (DI), little is known about their targeting effects: are screened-out workers also those with better future health and more ability to work? To shed light on this, we employ Regression-Discontinuity-in-Time regressions that compare the long-term outcomes of DI application cohorts just before and after a reform in the Netherlands. The reform led to stricter screening in the sickness period before DI application and reduced the number of applicants by 33%. Up to 18 years after application, we find persistently lower survival rates and lower employment rates of post-reform cohorts. Using detailed information on the future chronic diseases of these cohorts and the application diagnoses, we next construct indices capturing long-term expected survival (a “Survival Health Index”, SHI) and long-term employment prospects (a “Work Ability Index”, WAI) for DI applicant cohorts in the years following application. These indices allow us to assess whether the reform primarily deterred applicants with health-related disabilities, work-related disabilities, or both. We find that the self-screening induced by the reform was stronger for applicants with work disabilities (low WAI scores compared to their SHI scores) than for health disabilities (low SHI scores compared to their WAI scores). This is largely due to a decline in applications of workers with mental and musculoskeletal health conditions that have high survival rates, but lower employment rates. |
| Keywords: | Disability Insurance, (Mental) health, Screening, Targeting |
| JEL: | H2 I3 |
| Date: | 2026–09–02 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:paper_1788312395330_653 |
| By: | Hunt Allcott; Amy Finkelstein; Anna Grummon; Matthew J. Notowidigdo |
| Abstract: | As of July 2026, 23 states had approved policies that disallow spending of SNAP benefits on sugary drinks. The effects of such restrictions on consumption are unclear, however, since most households can simply switch to buying sugary drinks with non-SNAP funds. Using a difference-in- differences design with nationwide grocery purchase panel data, we estimate that restrictions in the first 10 states reduced the average SNAP household’s retail purchases of excluded drinks by 12.4 percent (standard error = 1.0) over the first half of 2026. In states that excluded only some sugary drinks, SNAP households partially substituted to non-excluded drinks. Surveys we carried out before and after implementation show that the restrictions increased SNAP recipients’ perceptions of stigma. We combine our estimated consumption reductions with external parameters to model welfare effects given an over-consumption internality and a fiscal externality via public health care spending. In our model, excluding all sugary drinks from SNAP nationwide would provide benefits of about $1.1 billion per year, of which about 70 percent is from reduced health care costs. |
| JEL: | H0 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35659 |
| By: | John Cawley; Mallory Dreyer; Kosali I. Simon |
| Abstract: | One of the most comprehensive fiscal policies to improve diet was adopted by the Navajo Nation; the Healthy Diné Nation Act (HDNA) of 2014-15 consists of two parts: 1) an exemption from sales tax for healthy foods and beverages; and 2) a tax increase on unhealthy foods and beverages. Together, they create a price wedge of 7-8% between healthy and unhealthy foods. We estimate difference-in-difference models and event studies that estimate the effect of the HDNA on a variety of health conditions relating to diet and weight for newborns and mothers which are recorded in birth certificate data. We find no evidence that the HDNA improved these outcomes; our estimates are precise enough to rule out improvements in gestational diabetes as large as those reported for U.S. city SSB taxes. Possible explanations for the null results include incomplete retailer implementation and cross-border shopping. |
| JEL: | H20 H30 I12 I18 J13 J15 L66 Q18 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35662 |
| By: | Kevin Callison; Rena M. Conti; Jonathan Gruber; Jacob Wallace |
| Abstract: | How should payers balance fiscal sustainability with access to transformative medical technology? We study Louisiana’s 2019 Medicaid subscription model for hepatitis C (HCV), the first example of a U.S. state employing a two-part tariff to secure unlimited access to curative medicines. Using a differences-in-differences design comparing spending on beneficiaries with HCV to those with diabetes or HIV, we find that treatment volume tripled, medical spending fell, and new HCV diagnoses declined 23 percent. The state’s $37 million in incremental spending on antivirals generated $266 million in five-year savings. Innovative financing models can generate health benefits and near-term savings for payers. |
| JEL: | I11 I13 I18 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35583 |
| By: | Mamiko Kishida; Akira Hibiki |
| Abstract: | This study examines the association between pollen exposure and monthly suicide mortality in Japan. It combines prefecture-level daily pollen counts with monthly suicide mortality data for 2009-2020 and estimates panel models with prefecture and year-by-month fixed effects. The estimates indicate that additional high-pollen days are positively associated with overall suicide mortality. The association is statistically significant in several specifications for women, although the female-specific estimates are sensitive to model specification and the difference between women and men is not directly tested. Results from the pollen-season sample support the main overall association. Because the estimated relationship is not monotonic across pollen categories and the age-specific analysis entails multiple testing, the heterogeneity and mechanism results should be viewed as exploratory. |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:toh:tupdaa:87 |
| By: | Rui Mao; Tingliang Huang; Houcai Shen |
| Abstract: | Artificial intelligence (AI) is increasingly integrated into medical decision-making, yet its liability implications remain complex, particularly when physicians differ in diagnostic skills and their quality is unobservable. This paper develops a principal-agent model in which a social planner designs medical liability to regulate a physician with private quality information who chooses between a standard treatment, a personalized judgment-based treatment, or following an imperfect AI recommendation. Our analysis yields several novel insights. First, we show that the optimal mechanism under asymmetric information is surprisingly simple: a uniform, one-size-fits-all liability level for all physician types who deviate from the standard of care. Despite physician heterogeneity, this simple policy often achieves the full-information first-best outcome, particularly when standard care is reliable or AI is highly accurate. Second, the relationship between AI accuracy and optimal liability is non-monotonic. Contrary to common intuition, better AI does not always imply more relaxed liability. As AI accuracy increases, the optimal liability either decreases monotonically or follows an inverted-U pattern, depending on the uncertainty of the standard treatment. Third, asymmetric information does not universally reduce social welfare. Welfare loss arises only when standard care is unreliable and AI accuracy is too low; even then, its magnitude follows an inverted U-shape, initially increasing as AI complicates the regulatory problem, but declining as more accurate AI helps mitigate it. Finally, we find that information asymmetry is a double-edged sword in the presence of AI, and greater transparency does not benefit all stakeholders equally. |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2608.03114 |
| By: | Yvonne Krabbe-Alkemade; France Portrait; Maarten Lindeboom; Marjolein Broese van Groenou; Hendrika J Luijen; Dorly Deegdijk |
| Abstract: | This study examines the causal effect of labor market restrictions faced by women in early adulthood on later-life cognitive functioning. To identify this effect, we exploit an exogenous policy change in the Netherlands that removed restrictions on married women's access to paid employment in 1957. Our study draws on data from the Longitudinal Aging Study Amsterdam, an ongoing cohort study of older individuals. We focus on individuals aged 75 and older born between 1928 and 1947. We first examine how work restrictions in early adulthood shape lifetime employment. Next, we assess how these work restrictions affect women’s later-life cognitive outcomes exploiting an exogenous change in labor restriction laws and complement this with an instrumental variables approach. The estimation results indicate that restricted access to paid employment for women in early adulthood reduced labor force participation and occupational prestige over the life course. These reduced labor market opportunities, in turn, led to poorer cognitive functioning after age 75. We also find some suggestive evidence that these restrictions resulted in faster cognitive decline. Taken together, our findings indicate that restrictions on women’s access to paid employment adversely affect cognitive functioning, thereby contributing to cognitive disparities between men and women in later life. More broadly, they highlight the long-term cognitive benefits of sustained labor market engagement and cognitively stimulating work, with potential implications for dementia prevention. |
| Keywords: | Cognitive functioning at older age, dementia, access to paid employment, gender disparities |
| JEL: | J16 J19 J24 |
| Date: | 2026–09–03 |
| URL: | https://d.repec.org/n?u=RePEc:mhe:chemon:paper_1788391888415_642 |
| By: | Joan Costa-i-Font; Sergi Jiménez-Martín; Cristina Vilaplana-Prieto |
| Abstract: | We estimate the health and wellbeing effects of subsidized access to long-term care (LTC). Our analysis exploits the staggered implementation of Spain’s 2007 System of Autonomy and Care for Dependent People (SAAD), which expanded publicly funded and universal LTC subsidies and supports, as well as its subsequent reform. Using two decades worth of administrative and survey data and leveraging exogenous regional and individual-level variation in program exposure, we find that access to SAAD benefits reduces the care receiver’s depressive symptoms by about 1 percentage point, increases its survival probability by 2.6–3 percentage points, and raises its life satisfaction by 0.24–0.50 scale points. Cost-effectiveness estimates indicate that the implied cost per quality-adjusted life year (QALY) gained lies below commonly accepted efficiency thresholds for public health spending in Europe. These findings document sizeable health returns and efficiency gains from publicly subsidized LTC provision |
| Keywords: | long-term care subsidies, long-term care supports, old age care, Spain, mortality, cost per QALY, survival, mental health, and life satisfaction. |
| JEL: | I18 J14 J16 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12943 |
| By: | Elsa Perdrix; Axel H. Börsch-Supan; Johannes Geyer; Peter Haan; Sami Louahlia |
| Abstract: | Germany experiences an increase in LTC recipients, due to population ageing but also to reforms which made LTC benefits easier accessible for individuals with cognitive impairments. Previous studies documented the cost of long-term care, and how it evolved. However, less is known about the specific case of elderly people suffering from cognitive impairment. Thus, we measure the economic costs of cognitive impairment, which include extensive medical, nursing care and at-home long-term care. We use the SHARE, the Survey on Health, Ageing and Retirement in Europe, Wave 9. We observe 4% of elderly people living at home with severe cognitive impairment (SCI) (Langa et al. (2017) definition). These individuals are 30% more likely to receive any care, and obtain on average 6 more hours of formal care and 6 more hours of informal care per week. The main driver is not the cognitive impairment per-se but the limitation in activities of daily living (ADLs) which SCI leads to. Thus, once controlling for ADLs, SCI does not explain any additional probability to use care. However, because people with SCI are more likely to have ADLs, the annual cost of their care is estimated to 10, 000 euros per year per individual on average. |
| JEL: | I1 J14 P46 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35469 |
| By: | Gurung, Nirmal |
| Abstract: | Fiscal federalism in Nepal has conditional grants as one of its key features. These grants are a way for the federal government to send money to state and local governments for certain purposes, especially for health and education. This paper explores whether conditional health grants translate into better delivery of local health services, or are mostly an administrative burden for local governments. The analysis, which is based on publicly available data from the National Natural Resources and Fiscal Commission, the Ministry of Health and Population, the Ministry of Finance and international organizations including the World Bank, the Asian Development Bank and the World Health Organization, presents a mixed picture. Conditional health grants have increased local health expenditure and helped to sustain basic health services during Nepal's transition to federalism. For example, local governments now constitute a significant proportion of total public health expenditure and immunization coverage has been sustained in the face of significant institutional reforms. But the grant system also creates a lot of administrative work, limits local flexibility, slows the flow of funds and does not always result in better health outcomes. However, many municipalities have continued to experience low health grant execution rates and key health indicators such as stunting and neonatal mortality have not improved significantly. The paper argues that conditional grants are a transitional mechanism that maintains service continuity while local governments build their own capacity. It proposes reforms to simplify conditional grants, increase local discretion through block grants, strengthen performance-based elements and build local capacity for health planning and financial management. The findings contribute to the larger literature on intergovernmental transfers and local service delivery in decentralized systems. |
| Date: | 2026–08–15 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:wrtdy_v1 |
| By: | Viktoria Falk; Andreas Madestam; Emilia Simeonova |
| Abstract: | This study examines the persistence of fertility-related health problems across generations within the same family, and the utilization of assisted reproductive technologies (ART). Using comprehensive Swedish registry data, we document significant intergenerational transmission of fertility difficulties for both daughters and sons, independent of parental socioeconomic status. Daughters whose parents reported such problems are 2.6 percentage points, or 19.4 percent, more likely to experience fertility problems themselves. Sons whose parents reported fertility difficulties experience a 1.7 percentage point, or 13.5 percent, increase. These associations persist across alternative measures and samples. Comparing biological and adopted children raised in the same households, we find that this phenomenon is unlikely to be driven by family awareness of fertility issues, pointing to biological and other factors that biological children share with their parents but adopted children do not. Medical technology works equally well for those who use it, and we find no significant association between the success of advanced fertility treatments and parental backgrounds. However, past generations’ fertility difficulties are associated both with higher medical expenses and with social costs such as increased likelihood of divorce. |
| JEL: | I10 J13 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35585 |
| By: | Cristina Bellés Obrero; Maria Lombardi; Camila Navajas-Ahumada; Julián Pedrazzi |
| Abstract: | This paper estimates the causal impact of first-time motherhood on the onset of physical or sexual intimate partner violence (IPV). We use retrospective data from Peru's Demographic and Health Surveys (2004–2019), and conduct a stacked difference-in-differences estimation comparing first-time mothers to observationally similar women who conceive three years later, matching on pre-conception characteristics. Unlike previous studies based on administrative data, we address the key empirical challenge of constructing a credible counterfactual by exploiting detailed survey data on pre-conception relationship characteristics and incorporating these characteristics into the matching procedure. We find that motherhood increases the likelihood of IPV onset by 4.3 percentage points (a 29% increase) within two years after conception. Importantly, we find that failing to account for pre-conception relationship characteristics when constructing the comparison group leads to substantial upward bias, highlighting their importance for credibly identifying the causal effect of motherhood on IPV. |
| Keywords: | cohabitation, Intimate partner violence, motherhood |
| JEL: | J12 J13 J16 I12 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1589 |
| 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, exposure |
| JEL: | G18 I12 J12 J16 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12939 |
| By: | Jessen, Lasse J.; Köhne, Sebastian; Nüß, Patrick; Ruhose, Jens |
| Abstract: | Using survey experiments in the United States and Germany with about 12, 000 participants, we study perceptions of socioeconomic inequality in life expectancy and policy demand. Respondents overestimate the rich-poor gap in both countries, judging the life expectancy of the rich roughly accurately but placing that of the poor well below its true level. These misperceptions vary little with political orientation or other characteristics. Correcting them shifts concern but leaves policy demand largely unchanged across general, specific, and real-stakes measures. Instead, demand divides politically, sharply in the United States and much less in Germany, consistent with views about the role of government rather than the inequality itself shaping policy demand. |
| Keywords: | health care, information treatment, socioeconomic inequality in life expectancy, survey experiment |
| JEL: | D72 D83 H53 I14 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:iwhdps:343096 |
| By: | Gradstein, Mark; Ishak, Phoebe W. |
| Abstract: | We explore the effects of early life income shocks on human capital using oil price fluctuations in a large sample of relevant African countries and employing micro data from multiple waves of the Demographic and Health Survey (DHS). Such shocks enable human capital investment via the standard income effect; but also crowd it out because of substitutability between natural resource and human capital income sources. The relative strength of the two effects depends on the age at which the shock is experienced. Consistent with these insights, we find that income shocks in early life are associated with enhanced educational attainment and wealth but are sometimes linked to reduced levels of such outcomes if experienced in adolescence. These results survive multiple robustness checks, and their broader implications are discussed. |
| Keywords: | Human capital |
| JEL: | O12 I2 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19305 |
| By: | A. Patrick Behrer; Joshua S. Goodman; J. Parker Goyer; R. Jisung Park |
| Abstract: | Nearly the entire world’s population breathes air exceeding WHO pollution guidelines, but the extent to which that exposure impairs the accumulation of human capital is not well understood. We study this using longitudinal PSAT data on nearly 10 million U.S. high school students, comparing the same student’s scores across attempts preceded by differing air quality and instrumenting for local PM2.5 with smoke from distant wildfires. A year of observed pollution exposure reduces learning by 0.04-0.06 standard deviations, or 14-19% of typical annual score growth. The damage comes almost entirely from moderate pollution days (8–12 μg/m3), below the EPA’s historical standard, and from exposure during the school year rather than summer, pointing to instructional disruption as a mechanism. Effects are three times larger in disadvantaged schools and among Black and Hispanic students, who are harmed more by the same exposure. Exposure to air pollution widens achievement gaps. |
| Keywords: | air pollution, test scores, achievement gaps, PM2.5, wildfire smoke |
| JEL: | I2 I24 Q5 Q53 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12936 |
| By: | Kelsey Moran; Gail M. Rosenbaum; Amir Goren; Michelle N. Meyer; Christopher F. Chabris; Joseph J. Doyle Jr. |
| Abstract: | Financial incentives may encourage vaccination, but their cost-effectiveness depends on targeting patients who are most responsive. We conducted a randomized controlled trial with 57, 579 adult patients in an integrated health system during the 2021–2022 influenza season. Patients with an upcoming appointment were randomized to a no-contact control, a simple reminder, a $1 cash incentive, or a scratch-off lottery ticket incentive worth up to $5, 000. Any active intervention increased vaccination at the scheduled appointment by 2 percentage points (an 8% increase over the control mean) and by 1.5 percentage points over the full influenza season. The three active arms did not differ significantly, indicating that small financial incentives provided no additional benefit beyond a reminder. Using electronic health records and area-level characteristics, we used causal forests to estimate conditional average treatment effects. Predicted responsiveness varied substantially: patients in the top quartile were 3–4 times more likely to respond to incentives than those in the bottom quartile, whereas reminder effects were relatively homogeneous. These findings suggest that low-cost reminders can increase influenza vaccination, while machine-learning methods can help identify patients most responsive to small financial incentives. |
| JEL: | I12 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35537 |