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on Health Economics |
| By: | Amy Finkelstein; Jonathan S. Skinner |
| Abstract: | Health care utilization per capita varies widely across the United States, yet higher utilization areas have no better patient health. In the late 2000s, this pattern was widely interpreted as evidence that health care costs could be cut substantially without harming patients, which in turn shaped the 2010 Affordable Care Act. We describe how our understanding has since evolved, emphasizing three points. First, new evidence indicates quantitatively meaningful roles for both supply-side and demand-side factors in driving regional variation in health care and in health outcomes. Second, health care productivity varies substantially across providers; improving it requires better understanding of why productivity differs. Third, we know even less about the sources of area-level productivity differences. We suggest several ways in which greater engagement with the productivity literature outside of health care could yield valuable insights. |
| JEL: | D24 I11 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35937 |
| By: | Jennifer L. Kao; Tamar Oostrom |
| Abstract: | During research and development, firms must decide which types of individuals to engage in developing and testing their products. We investigate how lowering the cost of including one group shapes its representation, subsequent innovation, and product adoption. In 2000, Medicare expanded coverage of clinical trial costs for elderly trial participants, a historically underrepresented group in drug development. This policy increases representation: trial sponsors expand trial eligibility to include elderly participants and increase the share of elderly participants. We find an immediate and large increase in the number of clinical trials for diseases common among the elderly, with the largest increase in drugs not yet approved and in approved drugs tested in new diseases. We document an increase in drug utilization of newly tested drugs among elderly individuals and analyze trial results, adverse events, and drug approvals. Our findings show how financial incentives can increase representation in product development and shift the rate, direction, and adoption of innovation to potentially benefit underserved groups. |
| JEL: | I14 I18 J14 O31 O38 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35936 |
| By: | Isaiah Andrews; Simon C. Essig Aberg; Jesse M. Shapiro |
| Abstract: | We introduce an LLM workflow for functional form sensitivity analysis. A researcher estimates the value of an object of interest by maximizing the fit of a working model to some data. The working model assumes an arbitrary form for some function. We define sensitivity by how much it is possible to change the estimate of the object of interest, without compromising fit, by selecting a different functional form. The workflow first looks for an analytic solution. If it fails to find one, it approximates the solution via numerical methods that respect the fit constraint at each step of a solver path. The workflow yields a verifiable lower bound on the in-sample sensitivity of the researcher’s estimate, and is fast in many practical situations. We illustrate with an application to the welfare cost of adverse selection in health insurance. |
| JEL: | C52 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35947 |
| By: | Liran Einav; Amy Finkelstein; Sehyun Hong |
| Abstract: | We examine how physical health, health behaviors, and mortality vary with income for prime-age adults. To do so, we leverage population-wide, individual-level cardiovascular health exams linked to income tax records and subsequent mortality for a representative sample of about 350, 000 Koreans aged 47--57. For both men and women, there is a negative disease-income gradient for high blood pressure, high blood glucose, and high body mass index, but not for high cholesterol. Disease-income gradients are steeper for women than men, and tend to be concentrated in the top half of the income distribution; similar patterns hold for health behavior-income gradients. Subsequent mortality-income gradients are also concentrated in the top half of the income distribution, but are steeper for men than women. Although physical health and behavior measures are highly predictive of subsequent mortality, differences in these measures by income explain very little of the income-mortality gradient, even for cardiovascular mortality. Our findings suggest that something other than differences in disease burden at prime age drives most of the income-mortality gradient at older ages. |
| JEL: | I12 I14 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35880 |
| By: | Youngsoo Jang (Yonsei University); Minchul Yum (Virginia Commonwealth University and CEPR) |
| Abstract: | We study how fertility and parental investment shape the value of mortality improvements in a quantitative dynastic life-cycle model. Households choose fertility, saving, education spending, and inter-vivos transfers under earnings risk and borrowing constraints. We distinguish the own-life component of survival valuation from the dynastic value of a statistical life, which also incorporates the value parents assign to survival benefits received by their descendants. Calibrating the model to the prebaby-boom United States, we find that the dynastic premium accounts for a substantial share of young households' valuation of a common survival improvement. Most of this premium arises from dynastic continuation, while education and financial transfers increase it further. Historical declines in maternal mortality and improvements in old-age survival both raise fertility. Lower maternal mortality reduces average investment per child, whereas improved old-age survival leaves it nearly unchanged. Investment rises in both cases among households whose fertility remains unchanged. The dynastic premium responds more strongly to improved old-age survival, while endogenous fertility materially changes both total dynastic valuation and its division between own-life and dynastic components. These findings connect the valuation of mortality improvements to the quantity-quality trade-off and show why the scope of a mortality change across generations matters for willingness to pay. |
| Keywords: | Value of a Statistical Life, Mortality Risk, Fertility, Intergenerational Transmission, Education Investments |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:yon:wpaper:2026rwp-297 |
| By: | Coleman Drake; David Anderson; Dylan Nagy; Mark Shepard |
| Abstract: | In 2017, the federal government ended payments for cost-sharing reduction (CSR) subsidies for the Health Insurance Marketplaces created by the Affordable Care Act. Rather than uniformly increase Marketplace plans’ premiums to offset the loss of these payments, over 40 states responded by silver loading—only increasing the premiums of silver plans to which CSR subsidies apply and premium tax credits are tied. Silver loading was intended to increase the affordability of Marketplace coverage by increasing premium tax credits and thereby enrollment, though the literature lacks causal estimates. Furthermore, Congress is considering reinstating CSR subsidy funding, effectively undoing silver loading. We use panel data on 2015-2021 Marketplace health plan premiums and enrollment in 12 states from the Centers for Medicare and Medicaid Services to estimate silver loading’s effects using contiguous county-pair models. We find that silver loading functioned as intended, lowering the cost of Marketplace coverage and increasing enrollment by 8-14% among subsidized Marketplace enrollees with incomes between 250% and 400% of the poverty level. We project that Congress ending silver loading would decrease Marketplace enrollment by at least 330, 000 enrollees in 2027. |
| JEL: | I0 I11 I13 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35955 |
| By: | Liran Einav; Amy Finkelstein; Jesse Gubb; Neale Mahoney; James Okun |
| Abstract: | It has been widely documented that patients in the US who are associated with disadvantaged demographics receive care at lower quality nursing homes. To understand the role that selective admissions may play in contributing to this pattern, we conducted a nationwide audit study of the impact of patient race, payer, and medical condition on responses to about 5, 500 availability inquiries sent to about 3, 000 nursing homes. We find 10-15% lower availability for Medicaid patients compared to private-pay patients and for patients with Alzheimer’s disease compared to those without; these availability gaps generally increase with nursing home quality. We find no statistically significant evidence of differential availability by race. To quantify the implications of these selective admissions practices, we embed the audit study results in a model of constrained nursing home choice. We estimate that if, counterfactually, Medicaid patients had the same choice sets as their private-pay counterparts, they would attend higher quality nursing homes on average, but the private-Medicaid gap in quality would be reduced by only 5-10%. Our results suggest that supply-side availability differences by payer are widespread, but that they are unlikely to be the primary factor behind the observed gap in quality of nursing homes attended. |
| JEL: | H44 I1 I14 L0 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35944 |
| By: | René Karadakic; David C. Chan Jr; 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. |
| JEL: | I1 J24 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35946 |
| By: | Marco Francesconi; Xiaoyu Xia |
| Abstract: | Artificial intelligence (AI) may transform labor markets not only by changing workers' tasks but also by reorganizing production. We study radiology, where AI has spread rapidly without increasing interpretations per radiologist. In our model, AI facilitates outsourcing by letting hospitals verify the quality of remotely supplied interpretations. Using US Medicare data for 2013-2024, we document declining local radiology activity in smaller markets despite stable imaging demand. Interpretations shift toward larger markets, and radiologists at documented AI-adopting platforms end up serving more markets. AI can thus reshape firm boundaries and the geographic organization of professional work without replacing workers' tasks. |
| Keywords: | artificial intelligence, labor demand, technology adoption, task substitution, firm boundaries, outsourcing, radiology, health care |
| JEL: | J23 L22 L24 O33 I11 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13086 |
| By: | Ian M. McCarthy; Katie Leinenbach |
| Abstract: | The Critical Access Hospital (CAH) program, established under the Balanced Budget Act of 1997, provides cost-based Medicare reimbursement to small rural hospitals in exchange for limits on inpatient capacity and service scope. We estimate the effects of CAH designation on hospital finances, capacity, and organizational outcomes using a synthetic difference-in-differences design that exploits the staggered 1999– 2002 rollout of state-level CAH availability. We find that CAH designation raises operating margins by three to four percentage points, with no change in liquidity or capital investment, as cost-based reimbursement sustains revenue while expenses fall with scale. Designation also reduces inpatient scale, with significant declines in total beds, obstetric capacity, and nursing staff. Emergency department visits also decline meaningfully, while outpatient volume is largely unchanged. At the same time, CAH designation reduces hospital closures, with no meaningful effect on mergers. These results point to a “survival versus scale” tradeoff across hospitals within a state, wherein designation-based subsidies avert closure for a small number of hospitals while inducing widespread inpatient downsizing among the many more hospitals that convert. Because converting hospitals shed more inpatient capacity than averted closures preserve, the program may reduce aggregate rural inpatient capacity even as it keeps hospitals open. |
| JEL: | H51 I11 I18 L51 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35876 |
| By: | Samar Benina (CY - CY Cergy Paris Université); Inès Chouk (CY - CY Cergy Paris Université); Aïda Mimouni (CY - CY Cergy Paris Université) |
| Abstract: | 2025). The democratization of the use of tools such as ChatGPT, Claude, or Mistral by patients is progressively reshaping how they access information, interpret symptoms, prepare for consultations, manage uncertainty and navigate their healthcare journey (Cao et al., 2026; Dullabh et al., 2026; Traylor et al., 2025). Despite the rapid diffusion of these practices, relatively little research has focused on these new behaviors. In this context, the aim of this research is to better understand how the patients use GenAI throughout their healthcare journey and how this use reshapes the patient-physician relationship. To this e discourses on the web. 745 contributions from three online communities (Reddit, Facebook, Doctissimo) were analyzed. The findings highlight that (1) GenAI plays a pervasive role across the stages of the healthcare journey and enhances patient empowerment, (2) reconfigures the patient-physician relationship by introducing a new form of intermediation and (3) generates risks associated with overtrust, overreliance and privacy issues. |
| Keywords: | discours de patients en ligne, empowerment du patient, parcours de santé, patient empowerment IA générative, patients online discourses, healthcare journey, Generative AI, patient empowerment IA générative parcours de santé discours de patients en ligne empowerment du patient, Generative AI healthcare journey patients online discourses |
| Date: | 2026–09–03 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05775345 |
| By: | David Bardey; Philippe De Donder |
| Abstract: | We study how behavioral heterogeneity in preferences for information acquisition affects equilibrium outcomes in health insurance markets. Individuals differ in the psychological utility they derive from learning information about their health risks, generating heterogeneous demand for genetic testing even when tests are inexpensive. The value of becoming informed depends on the insurance contracts available, while these contracts themselves depend on the fraction of individuals who acquire information. Information acquisition and insurance-market outcomes are therefore jointly determined. We show that these behavioral differences shape both the extent of adverse selection and whether the equilibrium is pooling or separating. Within a given contractual regime, stronger attraction to chance reduces information acquisition and mitigates adverse selection; in turn, it expands the range of testing costs for which the Wilson-type criterion selects pooling. Moreover, cheaper access to genetic information need not be associated with greater equilibrium information acquisition. At the testing-cost threshold at which the equilibrium switches from pooling to separation, the separating equilibrium prevailing at lower testing costs can exhibit a lower testing rate than the pooling equilibrium prevailing at slightly higher costs. Thus, the effect of technological progress on information acquisition depends on its endogenous impact on insurance contracts and equilibrium selection. |
| Keywords: | genetic testing, information acquisition, information avoidance, adverse selection, pooling and separating equilibria, attraction to/repulsion from chance, Wilson-type regime selection |
| JEL: | D81 D82 I13 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13088 |
| By: | Jorge M. Agüero; Ursula T. Aldana; Erica M. Field; Veronica Frisancho; Ignacio Rodriguez Hurtado; Javier Romero |
| Abstract: | Error in the measurement of key development outcomes affects our understanding of socioeconomic phenomena and their policy implications. This paper focuses on measuring intimate partner violence (IPV), a public health issue affecting women globally. We introduce a novel, privacy-enhancing data collection method using a ballot, comparing it to standard survey techniques in which responses are not kept private from enumerators, and list experiments, an approach ensuring complete anonymity. Our findings show that improved privacy yields higher and more accurate IPV reports than both, especially among women with low education. By linking our data with two natural experiments, we demonstrate that the non-random nature of underreporting with standard methods can lead to biased estimates of IPV determinants. |
| JEL: | C81 C83 J12 J16 O12 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35891 |
| By: | Armantier, Olivier; Treich, Nicolas |
| Abstract: | Despite its rapid global growth, pet insurance remains poorly understood. This paper provides the first theoretical and empirical analysis of pet insurance demand in economics. Our model predicts that, unlike standard property insurance, pet insurance demand increases with a non-financial factor, the pet’s companionship value, and is inverse U-shaped with wealth. These predictions are supported empirically by our survey evidence. We also identify determinants and frictions of pet insurance demand, including risk attitudes, education, financial literacy, and liquidity constraints. Finally, we find that pet insurance decisions are more closely associated with health insurance, a non-property insurance, than with car insurance. |
| JEL: | D12 D64 G22 H3 Q18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:132305 |
| By: | Prati, Alberto; Senik, Claudia |
| Abstract: | We revisit the famous Easterlin paradox by considering that life evaluation scales refer to a changing context, hence they are regularly reinterpreted. We propose a simple model of rescaling based on both retrospective and current life evaluations, and apply it to unexploited archival data from the USA. When correcting for rescaling, we find that the well-being of Americans has substantially increased, on par with GDP, health, education, and liberal democracy, from the 1950s to the early 2000s. Using several datasets, we shed light on other happiness puzzles, including the apparent stability of life evaluations during COVID-19, why Ukrainians report similar levels of life satisfaction today as before the war, and the absence of parental happiness. |
| Keywords: | happiness;life satisfaction;subjective well-being;easterlin paradox;cantril ladder;rescaling;gallup;SOEP |
| JEL: | N0 |
| Date: | 2025–01–20 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:141745 |
| By: | Sonia Akter (Australian National University); Madhavi Pundit (Asian Development Bank) |
| Abstract: | This paper identifies the range of well-being losses caused by climatic hazards in coastal regions of Asia and the Pacific and reviews how these losses are measured for policy and practice. It draws on a targeted review of selected studies. The review identifies nine domains of well-being loss: food security, water and sanitation, livelihoods and employment, unpaid work, mobility and displacement, health and psychosocial well-being, safety and gender-based violence, cultural and social well-being, and ecosystem loss. Existing measurement approaches are not equipped to capture these well-being losses in a comprehensive, time-effective, and cost-effective manner. A case study on Cyclone Remal in Bangladesh highlights the importance of timely, sex-disaggregated data collection using customized rapid survey tools for effective and equitable disaster response, recovery, and resilience. The paper proposes a framework for data collection and recommends key well-being indicators. It emphasizes the need to institutionalize tailored rapid survey tools within national systems and strengthen data capacity and coordination to support gender-inclusive disaster response. |
| Keywords: | climate change adaptation;natural hazards;sex-disaggregated data;disaster risk reduction |
| JEL: | I31 Q54 Q56 |
| Date: | 2026–10–22 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:023850 |
| By: | Philippe De Donder; Mathieu Lefebvre; Marie-Louise Leroux; Quitterie Roquebert |
| Abstract: | This paper investigates how marginal utility varies with health status (i.e. 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 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13096 |
| By: | Brown, Jessica (University of South Carolina); Herbst, Chris (Arizona State University) |
| Abstract: | Anecdotal evidence suggests that private equity (PE) has become increasingly prominent in the U.S. child care market. Combining multiple proprietary datasets, we provide the first systematic analysis of PE ownership trends, characteristics, and locational preferences. The fraction of center-based child care teachers working at PE-owned providers has grown nationally from less than 1% in 1997 to 10% today, with considerable between- and within-state variation. PE-backed providers are larger and higher-revenue than non-PE providers. While PE-owned businesses charge higher prices than sole proprietors, they are slightly less expensive than other national chains. They are also more likely to be accredited by the National Association for the Education of Young Children, and to be in the top tier of states' quality rating systems. Geographically, we find that PE providers are more likely to operate in higher-income communities, in markets with excess demand, and in states with less stringent regulations on staffing levels and education requirements. Together, our findings suggest that PE providers tend to be located in areas where they can more easily extract rents and pursue observable signs of quality in order to attract consumers. |
| Keywords: | child care, child care quality, private equity |
| JEL: | J13 G24 L22 L11 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18990 |
| By: | Morteza Meybodi (Leuven Economics of Education Research Centre (LEER), FEB, KULeuven); Vincent Vandenberghe (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES)) |
| Abstract: | This paper examines how career-long emotional/interpersonal work demands are associated with mental health among adults aged 50 and older. Using retrospective work histories from SHARE combined with ISCO-4-level occupational characteristics from O*NET, we construct employment trajectories capturing cumulative exposure to emotionally/interpersonally demanding work and examine its association with later-life depressive symptoms, measured by the EURO-D scale. Our findings show that careerlong emotional/interpersonal demands are associated with a higher risk of depression after age 50, although their relative importance is modest. Career instability, such as employment gaps, redundancies, and part-time work, emerges as a stronger predictor. Pre-labour-market factors, including childhood health and educational attainment, also play a substantial role, highlighting the lasting importance of early-life circumstances for later-life mental health. |
| Keywords: | mental health, depressive symptoms, working conditions, emotional/interpersonal demands, career arduousness |
| JEL: | J14 I1 J26 |
| Date: | 2026–10–28 |
| URL: | https://d.repec.org/n?u=RePEc:ctl:louvir:2026021 |
| By: | Kelly M. Jones; Mayra Pineda-Torres |
| Abstract: | Many public policies aim to support (or change the behavior of) a specific, targeted sub-group of the population. To measure the causal impacts of such policies, social scientists use quasi-experimental methods of policy evaluation, but are often hampered by data availability issues, especially regarding targeted populations, who are often disadvantaged and/or vulnerable. We use power calculations to quantify the challenge of detecting a policy’s impact on a small minority population based on population level data, using the impact of abortion bans on economic welfare as an example. We provide insight into this challenge and a roadmap for how researchers can calculate, ex-ante, whether their study is sufficiently powered to detect reasonably meaningful effect sizes. |
| JEL: | C12 C18 I18 J13 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35894 |
| By: | Delarmente, Benjo A. |
| Abstract: | The Universal Health Care Act of 2019 made PhilHealth membership universal and automatic for all Filipinos, but whether that membership translates into actual care for adolescents is not well understood. Adolescents are an understudied group in health financing, and their needs are largely for outpatient and preventive care rather than for hospital care. This paper uses seven rounds of the Longitudinal Cohort Study of the Filipino Child together with a within-child research design, and it estimates the effect of household PhilHealth coverage and of barangay supply-side readiness on adolescent utilization, hospitalization, and self-rated health. It also tests whether coverage and supply are complementary, which was the study’s main hypothesis. The results show that coverage, supply-side readiness, and their interaction are not associated with reported illness, outpatient consultation, or self-rated health. The clear exception is hospitalization conditional on illness, which is significantly higher for adolescents with coverage and for those in better-supplied areas, although the interaction remains statistically insignificant for every outcome. The cross-sectional association between coverage and use disappears once the design accounts for the kinds of families that select into coverage. This pattern is consistent with PhilHealth’s historical focus on inpatient care and with its thin outpatient coverage during the study period. Coverage moved the inpatient margin that PhilHealth financed, but it did not move outpatient use or general health, which is what adolescents mostly need. The paper offers several explanations for the absence of complementarity, and it draws implications for the design of adolescent outpatient benefits and for the measurement of effective coverage under universal health care. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | PhilHealth, universal health care, adolescent health, supply-side readiness, healthcare utilization, panel data, HEFP |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:phd:dpaper:dp_2026-18 |
| By: | Mikula, Stepan (Masaryk University); Nicolini, Marcella (University of Pavia); Sabatini, Fabio (Sapienza University of Rome) |
| Abstract: | Childhood vaccination rates often fall over the course of the immunization schedule. We study whether local mobile internet coverage reduces this decline, using data on about 113, 000 children from India's National Family Health Survey (2019--21) matched to georeferenced maps of 3G network coverage. To address the non-random placement of 3G networks, we instrument coverage with terrain ruggedness, which raises the cost of deploying and maintaining network infrastructure. Comparing clusters within the same district, we find that 3G coverage has no detectable effect on the doses due in the first year of life but increases receipt of the doses due at 16--24 months. The effect emerges when children reach the age at which these doses become due. In a within-child design comparing earlier and later vaccinations of the same child, which removes all factors that affect both vaccinations equally, 3G coverage raises completion of the 16--24-month stage of the schedule but not of earlier stages. Taken together, the results point to information and coordination frictions as one barrier to completing vaccination in the second year of life. |
| Keywords: | mobile internet, 3G coverage, vaccination, health information, digital connectivity, India, child health |
| JEL: | I12 I18 O15 O33 L96 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp19010 |
| By: | Arcangelo Dimico (Department of Economics, Queen's University Belfast); Gaia Narciso (Department of Economics, Trinity College Dublin) |
| Abstract: | Forced sterilization represents one of several coercive population control measures enacted during the 20th century. This paper examines the short‐ and long‐run effects of coerced sterilization, drawing evidence from the experience of Native American women in the 1970s. Beyond reduced fertility, our findings indicate that, in the long run, Native American women exposed to forced sterilization experienced worse health outcomes, lower labor market participation, lower income, and decreased investment in their children's education. We also examine the intergenerational transmission of fertility choices and find suggestive evidence of a reversal: children of mothers exposed to forced sterilization have higher fertility. |
| Keywords: | Sterilization; fertility; human capital; intergenerational transmission |
| JEL: | I15 J13 J15 N32 O12 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:tcd:tcduee:tep2326 |
| By: | Natalie Bau; Corinne Low; Bryce Millett Steinberg |
| Abstract: | Whether to engage in sex and with whom are extremely consequential decisions for young women worldwide, and particularly in sub-Saharan Africa, where HIV rates are high and adolescent pregnancies are common. Yet little is known about the extent to which these decisions are financially motivated. We combine a randomized controlled trial of monthly cash assistance to female students at the University of Zambia with detailed, high-frequency data on sexual behavior and partner characteristics. We find that this temporary increase in income significantly changes women's sexual behavior. Treated participants are 5.1 percentage points less likely to have sex during the treatment period, and the rate of condomless sex falls by 30%. Among women who were not sexually active at baseline, the likelihood of having sex falls by 43%, and partner quality conditional on sex greatly improves. Financial assistance also reduces financial precarity, increasing food security, mental health, and cognitive capacity. These results can be rationalized with a dynamic model of partner search in which women can choose to search for boyfriends or high-income partners who provide financial support and bargain over both transfers and condom use. We conclude that a substantial share of sexual activity is financially motivated in this setting, even in a population not typically regarded as vulnerable. Increasing young women's income may be a useful tool for reducing the negative externalities of risky sex and improving match quality. |
| JEL: | J16 O12 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35940 |
| By: | Ulep, Valerie Gilbert T.; Casas, Lyle Daryll D.; Manuel, Aaron Carlos G.; Mojica, Winlove P. |
| Abstract: | Violence poses serious risks to adolescent health and development. However, evidence on how these experiences vary by sexual orientation, gender identity, and expression (SOGIE) remains limited in low- and middle-income countries. Using nationally representative survey data, we examined the association between SOGIE and exposure to domestic violence and bullying among Filipino adolescents. We used multivariable regression models to estimate associations across multiple dimensions of SOGIE while controlling for relevant covariates. Our results show that sexual minority adolescents (lesbian, gay, bisexual, pansexual, asexual, queer) face significantly higher odds of violence. After adjusting for individual and household factors, they have about 1.7 times higher odds of exposure to domestic violence and twice the odds of experiencing bullying compared to their heterosexual peers. Gender expression is associated with elevated risks of domestic violence among adolescents and in sex-specific ways, particularly for bullying among gender non-conforming boys and domestic violence among gender non-conforming girls. Our findings provide the first large-scale quantitative evidence of SOGIE-related violence in the Philippines and highlight the need for inclusive, evidence-based child protection and anti-bullying policies that address the vulnerabilities of LGBTQ+ adolescents. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | adolescents, SOGIE, LGBTQ+, domestic violence, bullying, Sexual Orientation, Gender Identity, and Gender Expression, Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:phd:dpaper:dp_2026-13 |