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on Health Economics |
| By: | Helmut Farbmacher; Rebecca Groh |
| Abstract: | This study examines long-term mortality effects of combat exposure using the Vietnam War draft lottery as a quasi-experiment. We validate the lottery by analyzing combat fatalities, revealing that 1951-1952 cohorts had notably fewer lottery-induced deployments than 1950, limiting detectable long-term mortality impacts at the cohort level. Using deceased-only datasets, we invert standard identification by modeling draft eligibility as the outcome. We find significant excess mortality among Black men in the 1950 cohort (1.09\%, approximately 2, 700 additional deaths), and null effects in later cohorts. Findings suggest that pooling cohorts with limited combat exposure may prevent detection of true treatment effects at cohort levels. |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2511.22776 |
| By: | Arapakis, K.; French, E.; Jones, J. B.; McCauley, J. |
| Abstract: | We document racial differences in total and out-of-pocket medical expenditures, using data from the Health and Retirement Study linked to Medicare and Medicaid records. While White, Black, and Hispanic households have similar total annual medical expenditures, minorities, who have fewer financial resources, benefit from higher Medicaid recipiency and face lower out-of-pocket spending. At age 65, White, Black, and Hispanic households incur on average $136, 000, $59, 000, and $68, 000, respectively, in out-of-pocket medical spending over the remainders of their lives. We use our model to evaluate a policy reform that expands public nursing home insurance. Given that White households currently pay the most out-ofpocket, they have the most to gain from the reform. In the absence of a highly redistributive funding scheme, this reform will on average redistribute financial resources from minorities to White households, illustrating how expanding public insurance can have unintended distributional consequences. |
| Keywords: | Medical Spending, Medicaid, Medicare, Long-Term Care, Race |
| JEL: | G52 I13 I14 |
| Date: | 2025–02–02 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2579 |
| By: | Blundell, R.; Britton, J.; Dias, M. C.; French, E.; Zou, W. |
| Abstract: | Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimate the impact of health on employment for individuals close to retirement age. Estimating the model separately by race and gender, we find that racial differences in employment can be partly explained by the worse health of minorities as well as the larger impact of health on employment for minorities. |
| Date: | 2025–12–05 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2580 |
| By: | Moustapha Sarr |
| Abstract: | This paper analyzes the impact of the public decision-maker on the intergenerational transmission of food preferences. We develop a theoretical model of food preferences inter-generational transmission in which parents transmit their own food preferences to their children through their food practices but also have a concern for the future public health conditions influenced by their feeding efforts. We find that, even if people fully care about future public health, the mechanism of food preferences transmission leads to a heterogeneous population where unhealthy food preferences persist. In this setup, we show that public interventions (public good provision and nutritional education program) induce a distribution of food preferences which converge to an homogeneous population with healthy food preferences. |
| Keywords: | socialization effort, food preferences, inter-generational transmission, public health, public good provision, nutritional education program |
| JEL: | D10 H41 I18 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:drm:wpaper:2025-45 |
| By: | Aapo Hiilamo (Max Planck Institute for Demographic Research, Rostock, Germany); Moritz Oberndorfer |
| Abstract: | A randomized trial of a partial basic income scheme for the population in unemployment in Finland was conducted in 2017–2018. No studies to date that we are aware of have investigated to what extent the effects of the trial on self-reported mental health were heterogeneous. This is an important question for understanding the implications of basic income schemes for the distribution of mental health in a population. We studied effect heterogeneity using data from a survey conducted at the end of the two-year experiment with a response rate of 20% (intervention n=569, control n=1028). Mental health was measured by the MHI-5 five-item instrument. We considered effect heterogeneity across potential indicators of labor market disadvantages, including age, gender, education, prior employment status, household size, and family type. Participants in the intervention group had moderately better mental health compared with those in the control group (adjusted risk difference for poor mental health -0.08 [95%CI: -0.12; -0.03]). Multilevel modelling and causal forest showed no evidence for heterogenous effects on mental health. Our results suggest that basic incomes schemes have no harmful effects on mental health across multiple potential axes of labor market disadvantage, and are unlikely to increase mental health inequalities among people in unemployment. |
| JEL: | J1 Z0 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:dem:wpaper:wp-2025-035 |
| By: | Bietenbeck, Jan (Lund University); Maschmann, Lukas (Lund University); Nilsson, Therese (Lund University); Spika, Devon (University of Zurich) |
| Abstract: | We examine whether culturally transmitted time and risk preferences help explain differences in preventive health care uptake. We combine individual-level survey data from 27 European countries with country-level preference measures from the Global Preferences Survey. To isolate cultural influences from institutional and economic confounders, we focus on second-generation immigrants, who were born and currently reside in the same country -- and thus face the same institutional environment and health care system -- but whose parents originate from culturally distinct countries. We find that descendants of more patient cultures are more likely to use preventive services, while those from more risk-taking cultures are less likely to do so. These associations appear across multiple preventive care outcomes and remain robust to a wide range of socio-demographic and country-of-origin controls. The results highlight the role of culturally shaped preferences as a subtle but systematic determinant of preventive health behavior. |
| Keywords: | patience, culture, preventive care, risk-taking |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18301 |
| By: | Carlos Álvarez-Nogal (Universidad Carlos III de Madrid) |
| Abstract: | Adaptation strategies are considered important in mitigating the mortality effects of warm temperatures, but less is known about the role of public health interventions. I study how the provision of three health-enhancing services—sanitary infrastructures, scientific-based infant care and hospital care—influenced the temperature-mortality gradient in Germany during the period 1888-1913. I find that: (i) the mortality impact of warm temperatures was substantial; (ii) heat-related mortality (infant deaths) decreased by ca. 25 (30) percent; and (iii) greater access to piped water, infant care and hospital care account for 60 (25) percent of the mortality decline at high temperatures. |
| Keywords: | Germany, extreme temperatures, mortality, public health, climate |
| JEL: | I10 I30 I18 N33 Q54 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:hes:wpaper:0290 |
| By: | Costa-Font, Joan (London School of Economics); Nicinska, Anna (University of Warsaw) |
| Abstract: | Education systems serve various purposes, including the enhancement of later-life health, though its effect can differ by socio-political regime. This paper examines the effects of exposure to communist education, which exposed children to a distinct curcurriculum and ideological content on later-life health. We exploit a novel dataset that collects information on compulsory education reforms in several European countries, with different cohorts exposed and unexposed to Soviet communist education. Using a difference-in-differences (DiD) design, we show that while the extension of compulsory education improved some relevant measures of health, communist education encompassed an additional health-enhancing effect. We document that the effect remains robust when using staggered DiD approaches and various robustness tests, and that it is explained by the priority given to physical education in school curricula, together with an increased likelihood of marriage. |
| Keywords: | physical activity, later-life health, health education gradient, communist education, Europe, Soviet Communism |
| JEL: | I18 I26 P36 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18304 |
| By: | Capkun, Vedran (HEC Paris); Cianciaruso, Davide (New Economic School (NES)); Sinha, Kirti (Naveen Jindal School of Management, UT Dallas) |
| Abstract: | We study whether mandatory surveys of patient experience affects patient mortality in U.S. hospitals. We exploit two settings where healthcare regulators mandated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey: the 2003 Maryland pilot study and the 2007 nationwide adoption. Difference-indifferences analyses show increased mortality for hospitals that were subject to the mandate, relative to other comparable hospitals. We observe this effect before hospitals disclose their HCAHPS ratings, which suggests that it is attributable to measurement, rather than to disclosure. An analysis of changes in hospital expenses shows that, after the mandate, affected hospitals experienced a relative increase (decrease) in non-clinical (clinical) expenses. This finding is consistent with theories of multitasking, which predict that more incentives for one task (in this case, patient experience) cause some reallocation of resources from other tasks (clinical care). |
| Keywords: | regulation; healthcare; patient experience; HCAHPS survey; multitasking |
| JEL: | M41 |
| Date: | 2025–06–05 |
| URL: | https://d.repec.org/n?u=RePEc:ebg:heccah:1571 |
| By: | David Raitzer (Asian Development Bank); Rita Abdel Sater (Agence Française de Développement); Odbayar Batmunkh (Asian Development Bank); Julia Girard (Agence Française de Développement); Lennart Reiners (Asian Development Bank); Amir Jilani (Asian Development Bank) |
| Abstract: | We present the findings of a pilot that randomized provision of structured electronic food vouchers to poor households in the Philippines, which was designed to inform a new national food voucher program. The study utilized a matched pair cluster-randomized controlled trial to evaluate the effectiveness of vouchers plus nutrition education sessions. It involved 4, 883 poor households across five provinces, randomly assigned to the control group or to receive nutrition education and monthly electronic food vouchers worth PHP3, 000 ($55) with pre-allocated shares for different food groups. After 6 months, statistically significant improvements are found in household food expenditure, dietary diversity, and food security, although the dietary and food security effects are modest on average. Food expenditure responses to voucher allocations are strongest for proteins and for fruits and vegetables, whereas the carbohydrate allocations are more fungible. Notably, dietary effects are more pronounced in highly urban areas, in households enrolled in an existing conditional cash transfer program, in those with better nutrition knowledge at baseline, in smaller-sized households, and in those that had more recently redeemed the voucher. This suggests that effectiveness could be enhanced by adjusting voucher allocation ratios towards underconsumed food groups, increasing the voucher amount, increasing redemption frequency, and improving nutrition education. |
| Keywords: | food assistance;electronic food vouchers;nutrition;social protection |
| JEL: | I12 I18 H23 I38 |
| Date: | 2025–12–04 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:021825 |
| By: | Carvalho, Leandro; Walque, Damien de; Lund, Crick; Schofield, Heather; Somville, Vincent; Wei, Jingyao |
| Abstract: | Mental health conditions are strongly associated with reduced labor market participation, but the underlying channels through which such conditions impact labor supply remain unclear. This paper reports on a two-phase study decomposing this relationship by examining (i) job take-up decisions; (ii) labor supply, output, and earning conditional on job take-up; and (iii) quit rates. In Phase 1, women in rural Ghana were asked whether they would be willing to take up a cash-for-work job during the lean season when alternative work is scarce. The findings show that individuals with depression and anxiety, which are common in this population, are much more likely to decline work offers outside the home but equally likely to accept work-from-home positions. In Phase 2, jobs at home were randomly offered to those who were willing to work from home, avoiding selection effects. Neither depression nor anxiety predicted work completion, income, or quit rates. These findings suggest that poor mental health may harm labor market outcomes in traditional jobs outside the home via reduced take-up, above and beyond the established negative impacts of mental health on productivity in work outside the home. The results also suggest an alternative approach to improving labor market outcomes for those in poor mental health: work-from-home opportunities, which are not associated with lower take-up or lower productivity on the job for those in poor mental health. |
| Date: | 2025–12–03 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11271 |
| By: | Akresh, Richard; Walque, Damien de; Kazianga, Harounan; Stocker, Abigail |
| Abstract: | Cash transfers are a cornerstone of social protection. This paper evaluates an integrated program in Burkina Faso that combines cash transfers with parenting interventions delivered through group meetings or home visits. In a randomized experiment across 225 villages, households received cash alone; cash plus information on child health and development; or cash, information, and home visits reinforcing the information. Fifteen months after treatment ended, households receiving all three components had fewer pregnancies, more medically assisted births, improved health behaviors, and better educational outcomes. Adding home visits is essential for enhancing child development. Cash alone or with information produces no lasting effects. |
| Date: | 2025–12–03 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11270 |
| By: | Joan Costa-i-Font; Richard Frank; Nilesh Raut |
| Abstract: | The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level variation in stock market wealth from 1996 to 2016, we document that exogenous wealth shocks significantly reduce the probability of LTCI coverage, without significantly altering Medicaid eligibility among owners of housing and financial assets. The effect of shocks to liquid wealth strongly dominates the effect of housing wealth changes. A $100K increase in housing (financial) wealth reduces the likelihood of LTCI coverage by 1.24 (3.22) percentage points. |
| Keywords: | long-term care insurance, housing assets, Medicaid, house prices, stock market price index, instrumental variables |
| JEL: | I18 J14 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12294 |
| By: | Hansen, Kristian S. (National Research Centre for the Working Environment (NFA), Copenhagen, Denmark); Moreno-Ternero, Juan D. (Department of Economics, Universidad Pablo de Olavide); Østerdal, Lars Peter (Department of Economics, Copenhagen Business School) |
| Abstract: | This paper develops a unified framework for evaluating health outcomes that jointly incorporates equity and productivity. Extending beyond traditional QALYs, PALYs, and the more recent PQALYs, we introduce a class of evaluation functions that integrate fairness- and productivity-sensitive principles. By imposing normative principles, includ-ing independence from measurement scales and Pigou-Dalton transfer properties, we ob-tain tractable power-form representations. In balancing distributive justice and efficiency, the framework provides a coherent foundation for assessing health interventions in con-texts where both equity and productive capacity are at stake. |
| Keywords: | Health; Productivity; Equity; Distribution; QALYs; PALYs; PQALYs |
| JEL: | D63 I10 J24 |
| Date: | 2025–10–07 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:cbsnow:2025_009 |