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on Health Economics |
| By: | Annica Gehlen; Sebastian Becker; Johannes Geyer; Peter Haan |
| Abstract: | We provide novel evidence on the trade-off between insurance and incentives when adjusting disability insurance (DI) benefit generosity using a comprehensive measure that encompasses not only the effect on take-up but also behavioral responses of DI recipients with respect to employment and exit from DI. Based on administrative data from the German pension insurance and exogenous policy variation, we identify the relevant behavioral margins induced by a change in benefit generosity. Using a theoretical framework, we show that our comprehensive measure of incentive effects implies a fiscal multiplier of 1.83. Incorporating elasticities with respect to exit from DI increases the fiscal multiplier compared to estimates that only account for take-up elasticities. In the context of the model, we estimate that increasing benefits is welfare improving, given the insurance effects of DI benefits estimated in previous literature. |
| Keywords: | disability insurance, pension reform, wealth effect, labor supply, mortality, RDD |
| JEL: | H55 I12 J22 J26 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25148 |
| By: | Bloom, Nicholas (Stanford University); Dahl, Gordon (University of California, San Diego); Rooth, Dan-Olof (Stockholm University) |
| 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, disability employment |
| JEL: | J14 J42 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18555 |
| By: | Sonia Bhalotra; Damian Clarke; Angelina Nazarova |
| Abstract: | Looking at the earnings profiles of men and women after their first child is born, a number of studies establish that women suffer a larger penalty in earnings than men-a child penalty. Leveraging randomness in the sex of the first birth, we show that the child penalty in the UK is larger when the first born child is a girl. We label this the daughter penalty. Exploiting rich longitudinal survey data, we examine behavioural responses to the birth of a daughter vs. a son to illuminate the underpinnings of the daughter penalty. We find that the birth of a daughter triggers more household specialisation than the birth of a son, with mothers taking on a larger share of household chores and childcare. Mothers suffer a daughter penalty in mental health, while fathers report more satisfaction with their relationship. Our findings imply that girls and boys in the UK are, on average, growing up in different home environments, with girls growing up in households that, by multiple markers, are more gender-regressive. This is potentially a mechanism for the inter-generational transmission of gendered norms. |
| Keywords: | Gender, child penalty, gender wage gap, mental health, parental involvement |
| JEL: | J2 J7 I3 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25110 |
| By: | Sonia Bhalotra; N. Meltem Daysal; Louis Fréget; Jonas Hirani; Priyama Majumdar; Mircea Trandafir; Miriam Wüst; Tom Zohar |
| Abstract: | Using Danish administrative data linked to two independent, validated postpartum depression screenings, we study how postpartum mental health shocks shape women's labor market trajectories. Event-study estimates show no pre-birth differences in trends between depressed and non-depressed mothers, but persistent employment gaps that widen immediately after birth. Health-care utilization patterns indicate that these differences reflect acute mental health shocks rather than pre-existing trends. The penalties are concentrated among less educated mothers and those in less family-friendly jobs. Our results highlight postpartum depression as a meaningful and unequal contributor to the motherhood penalty. |
| Keywords: | Postpartum depression, motherhood penalty, labor market inequality |
| JEL: | I12 J13 J16 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26015 |
| By: | Dominique Goux; Eric Maurin |
| Abstract: | This article assesses the impact of parents working from home on children's academic performance in high school. Using French data, we draw on the fact that, within each major social group, not all families have been equally exposed to the recent rise in work from home (WFH), depending on the specific occupations of the parents. Among lower-SES groups, we detect a significant deterioration in educational outcomes of adolescents whose parents are particularly exposed to the rise in WFH. Among higher-SES groups, we find no significant variation. The rise in WFH exposes parents and adolescents to more interaction, at an age when conflicts are frequent, and our findings suggest that this can contribute to worsening school problems in the least advantaged social environments. |
| Keywords: | work from home; grade repetition; general education track; high school; adolescence |
| JEL: | I20 J13 J22 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26016 |
| By: | Gabriella Conti; Rita Ginja; Petra Persson; Barton Willage |
| Abstract: | The motherhood penalty is well-documented, but what happens at the other end of the reproductive spectrum? Menopause-a transition often marked by debilitating physical and psychological symptoms-also entails substantial costs. Using population-wide Norwegian and Swedish data and quasi-experimental methods, we show that a menopause diagnosis leads to lasting drops in earnings and employment, alongside greater reliance on social transfers. Increasing access to menopause-related health care can help offset these losses. Our findings reveal the hidden economic toll of menopause and the potential gains from better support policies. |
| Keywords: | Menopause, Health, Labor Market |
| JEL: | I10 J01 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25141 |
| By: | Sonia Bhalotra; N. Meltem Daysal; Mircea Trandafir |
| Abstract: | Mental health disorders tend to emerge in childhood, with half starting by age 14. This makes early intervention important, but treatment rates are low, and antidepressant treatment for children remains controversial since an FDA warning in 2004 that highlighted adverse effects. Linking individuals across Danish administrative registers, we provide some of the first evidence of impacts of antidepressant treatment in childhood on objectively measured mental health indicators and economic outcomes over time, and the first attempt to investigate under- vs overtreatment. Leveraging conditional random assignment of patients to psychiatrists with different prescribing tendencies, we find that treatment during ages 8-15 improves test scores at age 16, particularly in Math, increases enrollment in post-compulsory education at age 18, and that it leads to higher employment and earnings and lower welfare dependence at ages 25-30. We demonstrate, on average, a reduction in suicide attempts, self-harm, and hospital visits following AD initiation. The gains to treatment are, in general, larger for low SES children, but they are less likely to be treated. Using a marginal treatment effects framework and Math scores as the focal outcome, we show positive returns to treatment among the untreated. Policy simulations confirm that expanding treatment among low SES children (and boys) generates substantial net benefits, consistent with under-treatment in these groups. Our findings underscore the potential of early mental health treatment to improve longer term economic outcomes and reducing inequality. |
| Keywords: | Antidepressants, mental health, education, test scores, human capital, Denmark, physician leniency, marginal treatment effects |
| JEL: | I11 I12 I18 J13 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:2590 |
| By: | Jim Albrecht; Per-Anders Edin; Raquel Fernandez; Jiwon Lee; Peter Skogman Thoursie; Susan Vroman |
| Abstract: | In 2002, Sweden reformed its parental leave system by adding a second "daddy month, " i.e., a second month of pay-related parental leave reserved exclusively for each parent. In addition to giving fathers an economic incentive to take more leave, this change had an effect on cultural norms. We develop and estimate a model of the household in which preferences towards leave depend on the behavior of one's peers and use it to quantify the magnitudes of the economic-incentive effects as well as the evolving norms. We find that endogenously evolving cultural norms play a major role. We use our model to evaluate the effects of several potential policy changes including decreasing the cost of child care and giving each parent a substantially larger non-transferable endowment of parental leave and conclude that only the latter would have a significant effect on the share of parental leave taken by men. |
| Keywords: | Parental Leave, Gender Equality, Childcare, Culture |
| JEL: | D10 J16 Z10 Z18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26038 |
| By: | Bargain, Olivier (University of Bordeaux); Le Vot, Julie (Bordeaux University); Herault, Nicolas (University of Bordeaux) |
| Abstract: | This paper examines whether family policy can shape gender attitudes. We exploit the introduction of a paid parental leave (PPL) scheme in Australia in 2011 and use panel data to study changes in women's gender attitudes around childbirth. Prior to the reform, childbirth is associated with a shift toward more traditional attitudes. This pattern is reversed following the introduction of PPL, with exposed mothers becoming more egalitarian. These attitudinal changes are accompanied by increased post-birth employment and hours worked. Heterogeneity analyses are consistent with mechanisms whereby the policy both legitimizes women's dual role as workers and caregivers and supports continued labor market attachment. The findings highlight how family policies can influence both gender role attitudes and labor market behavior. |
| Keywords: | gender role attitudes, paid parental leave, labor market attachment, Australia |
| JEL: | J13 J16 J18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18552 |
| By: | Alessandra Casarico; Edoardo Di Porto; Joanna Kopinska; Salvatore Lattanzio |
| Abstract: | Using a reform that increased parental leave generosity, we estimate workplace peer effects in leave-taking, focusing on fathers. Coworker fathers are more likely to take leave when exposed to more peer fathers affected by the reform. Effects are stronger in establishments with higher social capital and pre-reform leave use. We explain our findings showing that incumbent coworkers drive the effects, same-gender peer influences exceed cross-gender ones, the strongest peer effects run from higher- to lower-ranked occupations, and career penalties are absent for peer fathers. Peer effects extend to coworker fathers' partners, less so to coworker mothers' partners. |
| Keywords: | Parental leave, peer effects, career costs, female labor market participation |
| JEL: | J13 J16 J18 K31 M52 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25126 |
| By: | Miika Päällysaho |
| Abstract: | Unemployment can worsen health and increase healthcare use, creating fiscal externalities in publicly financed systems. Using Swedish register data on inpatient and outpatient care visits and drug purchases, measured as total costs rather than out-of-pocket payments, this paper estimates the effect of unemployment insurance (UI) generosity on healthcare use. Exploiting benefit caps in a regression kink design, I find no evidence that more generous UI affects healthcare use. Estimates rule out cost effects greater than 0.08 SEK per 1 SEK increase in benefits during the first 40 weeks after spell start. In Sweden's generous welfare state, modest benefit increases do not meaningfully alter the public healthcare costs of unemployment. |
| Keywords: | administrative data, healthcare, regression kink design, social insurance |
| JEL: | H51 I18 I38 J65 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26059 |
| By: | N. Meltem Daysal; Dan Anderberg; Line Hjorth Andersen; Mette Ejrnæs |
| Abstract: | We examine the impact of a 2002 Danish parental leave reform on intimate partner violence (IPV) using administrative data on assault-related hospital contacts. Using a regression discontinuity design, we show that extending fully paid leave increased mothers' leave-taking and substantially reduced IPV, with effects concentrated among less-educated women. The reform also lengthened birth spacing, while separations remained unchanged and earnings effects were modest. The timing and heterogeneity of impacts point to fertility adjustments-rather than exit options or financial relief-as the key mechanism. Parental leave policy thus emerges as an underexplored lever for reducing IPV. |
| Keywords: | Intimate partner violence; parental leave |
| JEL: | J12 I38 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25132 |
| By: | Sascha O. Becker; Jeanet Sinding Bentzen; Chun Chee Kok |
| Abstract: | This paper provides a survey of the literature on gender differences in religiosity and the influence of religion on gender-related economic and social outcomes. Part I examines why women tend to be more religious than men, discussing central explanations. Part II explores how religion impacts various gender-related outcomes, such as gender norms and attitudes, education, labor market participation, fertility, health, legal institutions and reforms, and discrimination. Within each domain, we distinguish between effects driven by individual religiosity (intensity of religious practice or belief) and those driven by their religious denomination. We synthesize findings from numerous studies, highlighting data sources, measures of religion and gender outcomes, and empirical strategies. We focus on studies with credible causal identification-such as natural experiments, instrumental variable approaches, and policy changes-to uncover the impact of religion on outcomes. Correlational studies are also reviewed to provide context. Across studies, the evidence suggests that religious teachings and participation often reinforce traditional gender roles, affecting women's education, labor force participation, and fertility choices, although there are important nuances and exceptions. We also document instances where secular reforms or religious movements have altered these outcomes. The survey concludes by identifying gaps in the literature and suggesting directions for future research. An important take-away from our review is that rigorous empirical studies are scarce, leaving room for novel causal studies in this field. |
| Keywords: | Gender gap; Religion; Religiosity; Gender norms; Education; Fertility; Labor markets; Cultural transmission |
| JEL: | Z12 J16 J24 I21 J13 Z13 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25111 |
| By: | Alexander Ahammer; Martin Halla; Pia Heckl; Rudolf Winter-Ebmer |
| Abstract: | Long-term unemployment among older workers is particularly difficult to overcome. We study the impacts of a large-scale job guarantee program that offered up to two years of fully subsidized employment to long-term unemployed individuals aged 50 and above. Using a sharp age-based discontinuity in eligibility, we find that participation increased regular, unsubsidized employment by 43 percentage points two years after the program ended. The gains are driven by transitions into new firms and industries, rather than continued subsidized employment, and we find no evidence of displacement effects for non-participants or spillovers to family members. The program had no measurable short-run health effects. |
| Keywords: | Long-term unemployment, temporary job guarantee, subsidized employment, health status. |
| JEL: | J64 J08 J78 I14 H51 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25160 |
| By: | Todd Morris; Stefan Staubli; Benoit Dostie |
| Abstract: | We evaluate the welfare effects of five provincial mandatory retirement bans in Canada from 2005 to 2009 using linked employer-employee tax data. The bans sharply reduce retirements at age 65, with sizable announcement effects and heterogeneity across industries. Post-65 employment and earnings rise at least 14%, with gains comparable to a two-year increase in pension-eligibility ages. Older workers save more and spouses postpone retirement, benefiting public finances, with no observable effects on mortality or younger workers. Highly exposed firms reduce payroll costs via hiring adjustments while maintaining worker productivity and profitability. Our results suggest that protecting older workers was welfare-improving. |
| JEL: | H55 J26 J78 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35111 |
| By: | Hae-young Hong; Jisoo Hwang; Jongwon Kim; Jungmin Lee |
| Abstract: | This paper provides the first causal evidence on how developmental health screenings for young children affect parental behavior, leveraging a quasi-experimental change in South Korea's National Health Screening Program. Using a difference-in-discontinuities design and administrative data covering 1.3 million screening records, we find that "high-risk" screening results influence a wide range of parental behaviors, with responses varying significantly by household income. Among lower-income families, adverse results lead to greater use of publicly insured medical care, increased disability registration, and delays in subsequent childbirth. In contrast, higher-income families reduce maternal labor supply and are more likely to relocate, suggesting costly private adjustments to secure additional caregiving time and access to private developmental rehabilitation facilities. These findings highlight how household resources shape both the capacity and nature of parental responses to early health information. |
| Keywords: | developmental disorder, health screening |
| JEL: | I18 I14 D13 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:2572 |
| By: | Anne Ardila Brenøe; Jenna Stearns; Richard M. Martin |
| Abstract: | Using data from the only large-scale randomized controlled trial promoting prolonged exclusive breastfeeding, we study how the intervention affected child health and why. The intervention increased weight-for-age in infancy, with effects persisting through adolescence. We show that treated infants were breastfed more and received less water, juice, and other liquids, resulting in a more calorie-dense diet. A mediation analysis indicates that increased caloric intake explains a large share of the early weight gain, while reduced illness explains little. These findings suggest that, in this setting, the main benefits of breastfeeding promotion for physical growth came from improved nutrition. More broadly, the results highlight that the effects of breastfeeding promotion depend on the local alternatives to breast milk and may differ in settings where infant formula or other more nutritious substitutes are the main alternative. |
| Keywords: | Breastfeeding, infant feeding, child health, the Promotion of Breastfeeding Intervention Trial (PROBIT) |
| JEL: | I10 J13 J24 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26093 |
| By: | Rune Vejlin; Hans Sigaard; Michael Svarer; Anne Katrine Borgbjerg |
| Abstract: | This paper estimates the effect of a reform-induced increase in the early retirement age (ERA) on labor supply, health, and healthcare utilization using detailed Danish administrative data and a regression discontinuity design. We show that while raising the ERA successfully increased employment, it also led to spillovers into other public transfers and increased the number of self-supporting individuals. We find that the increased ERA led to small and insignificant effects on GP visits and the use of painkillers, as well as borderline significant, small positive effects on the use of antidepressants and CVD medicine. Further analysis shows that individuals who were employed due to the reform had lower pre-reform income and wealth, while the individuals who were not employed despite being affected by the reform were characterized by worse health before the reform announcement. We argue that possibilities for exiting employment serve as a potentially important mitigating mechanism for health and healthcare utilization effects by sorting vulnerable individuals out of employment. |
| Keywords: | retirement reforms, health, healthcare utilization |
| JEL: | I18 J18 J26 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26046 |
| By: | Noah Arman Kouchekinia; David Neumark; Tim A. Bruckner |
| Abstract: | With large gains in life expectancy, the population share of disability due to cognitive decline and dementia has substantially increased. Many older adults in the United States leave the workforce well before age 65. Correlational evidence suggests that leaving the workforce before retirement age could accelerate the pace of cognitive decline. We offer causal evidence, using HRS data for the United States, exploiting plausibly exogenous shifts in labor demand in local labor markets as a Bartik instrument for employment variation across these markets. We find substantial declines over time in cognitive scores stemming from negative labor demand shocks. These findings are concentrated among men aged 51 to 64, whose employment decisions and outcomes may be more sensitive to local labor market conditions than are these decisions or outcomes for women or for older men. Our evidence extends past work focusing narrowly on the retirement age window and provides further support to the notion that working to older ages may delay age-related cognitive decline. |
| JEL: | I1 J14 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35117 |
| By: | Suphanit Piyapromdee; Lindsay Jacobs |
| Abstract: | Partial and reverse retirement are two key behaviors characterizing labor force dynamics for individuals at older ages, with half working part-time and over a third leaving and later re-entering the labor force at some point. The high rate of exit and re-entry is especially puzzling when considering the flat and declining wage profiles observed at older ages and uncertainty about future re-employment. Using Health and Retirement Study (HRS) data, we document the timing and prevalence of these behaviors and show that reverse retirees resemble permanent retirees across many observables, but differ notably in reported job stress and polygenic scores linked to stress sensitivity. To understand what drives these behaviors, we develop and estimate a dynamic model of retirement that incorporates uncertainty in wages and health, along with a novel ``burnout-recovery'' process representing the accumulation and dissipation of work-related stress. The model replicates key patterns in the data, accounting for over two-thirds of reverse retirement and 40 percent of transitions to part-time work---patterns that cannot be explained by health or wealth shocks alone. Our findings suggest that reverse retirement is largely a predictable response to recoverable stress rather than a reaction to shocks. Policy simulations show that part-time subsidies and sabbaticals enhance labor force attachment and welfare by reducing burnout, while eliminating the Retirement Earnings Test raises re-entry but also increases stress exposure. Together, these findings highlight the central role of stress dynamics in shaping retirement behavior and inform the design of policies to support work at older ages. |
| Keywords: | Retirement, Mental Health, Burnout |
| JEL: | J26 I12 |
| Date: | 2025–09 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:2564 |
| By: | Jessica H. Kiser; Analisa Packham; Janelle Anthony; Evelyn Escobar; Emily Yeatts |
| Abstract: | In 2018, the Virginia Department of Health implemented the Contraceptive Access Initiative (CAI) to increase access to long-acting reversible contraceptives (LARCs). We use encounter-level data on contraceptive choice in participating CAI clinics and county-level natality data from 2014--2021 to estimate relative changes in LARC take-up and childbearing rates before and after the CAI. Difference-in-differences estimates indicate that the CAI reduced birth rates in participating counties by approximately 3 percent, or less than half of the effect size of other similar, state-level programs. We show that this smaller effect is likely due to existing high LARC take-up and contraceptive substitution. |
| JEL: | I18 I38 J18 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35108 |
| By: | Moritz Lubczyk; Maria Waldinger |
| Abstract: | What are the long-run effects of sustained exposure to air pollution? A unique natural experiment allows us to examine this question. In 1982, a sudden cut in Soviet oil forced Socialist East Germany to switch to highly polluting lignite coal. While the shock sharply increased air pollution near mining regions, authoritarian restrictions on mobility, housing, and jobs prevented sorting responses. We document persistent labor market impacts over three decades. Exposed individuals work less, earn lower wages, and retire earlier. Health is a key mechanism: infant mortality rises by 9% and the long-run incidence of asthma and cardiopathy increases significantly. |
| Keywords: | Air pollution, labor supply, migration, place effects |
| JEL: | I15 J24 J60 N54 Q53 |
| Date: | 2025–10 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:2585 |
| By: | Cristina Bellés-Obrero; Manuel Flores Mallo; Pilar García-Gómez; Sergi Jimenez-Martin; Judit Vall Castelló |
| Abstract: | Spain, with one of the highest life expectancies globally and a rapidly ageing population, faces growing challenges in sustaining its pension, healthcare, and long-term care systems. This study examines trends in health inequalities among retired Spaniards from 2004 to 2022, using eight waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). We analyse five health outcomes—limitations in daily and instrumental activities, number of chronic conditions, a composite health deficiency index, mental health (EURO-D scale), and cognitive performance—and use linear regression to assess income-related gradients, adjusted for age and sex. We also compute a catch-up time measure—the number of years a poorer individual would need to reach the same level of health as a richer individual—and concentration indices of bad health. We then examine how these inequalities change over time, allowing us to explore the potential influence of pension reforms within the context of Spain’s Beveridge-style healthcare system and tax-funded long-term care provision. Our results show no clear evidence that health inequality has increased from 2004 to 2022. These findings contribute to understanding how income disparities interact with social protection systems in ageing societies and inform the design of equitable health, long-term care, and pension policies. |
| JEL: | D31 H55 I14 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35105 |
| By: | Qian, Yuting (Yale University); Gettel, Cameron (Yale University); Su, Jasmine (New York University); Grogan, Elyssa (New York University); Cohen, Inessa (Yale University); Rothenberg, Craig (Yale University); Chen, Xi (Yale University); Hwang, Ula (New York University and James J. Peters VA Medical Center) |
| Abstract: | Geriatric Emergency Departments (GEDs) -- accredited units that integrate geriatric-trained staff, age-friendly protocols, and post-visit care coordination -- have expanded rapidly across the United States. This paper provides the first nationally representative estimates of GED effects on hospitalization and mortality among Medicare beneficiaries. Linking data from the Health and Retirement Study to Medicare claims, we find that older adults treated at a GED were 9.7 percentage points less likely to be hospitalized and 6.1 percentage points less likely to die within 30 days, compared to those treated at a non-GED emergency department. Placebo tests and sensitivity analyses support causal interpretation. However, treatment effect heterogeneity analysis reveals that gains are concentrated among non-Hispanic white patients and adults under age 80; Black and Hispanic older adults exhibit no statistically significant benefit, consistent with persistent disparities in post-discharge care access and social support. These findings suggest that GED accreditation improves downstream health outcomes at scale, but that structural inequities outside the emergency department attenuate benefits for minority patients. |
| Keywords: | geriatric emergency department, Medicare, hospitalization, 30-day mortality, racial disparities, health and retirement study, accreditation, aging |
| JEL: | I11 I14 I18 J14 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18556 |
| By: | Hitoshi Shigeoka; Mika Akesaka |
| Abstract: | Seasonal allergies affect over 400 million people globally, yet the broader economic consequences of pollen exposure remain understudied. Evidence from Japan's ambulance records suggests that high-pollen days are associated with increases in accidents, including traffic accidents and work-related injuries, which may reflect impaired cognitive performance. Retail scanner data and cellphone mobility records indicate that individuals already engage in avoidance behaviors, such as purchasing allergy products and limiting outdoor activities on weekends. This suggests that relying on individual self-protection may be insufficient to offset these risks, and thus greater government intervention may be warranted to mitigate pollen-related harm. |
| Keywords: | Seasonal allergies, pollen, accidents, cognition, avoidance behaviors, climate change |
| JEL: | I12 J24 Q51 Q53 Q54 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26007 |
| By: | Abioye, Ruth; Oladapo, Rasaq Kayode; Olaoyo, Michael Olawale; Akpan, Usoro; Afolabi, Oluwatosin Rachael |
| Abstract: | Neglected tropical diseases (NTDs) affect over one billion people globally, disproportionately impacting populations in low-resource settings such as Nigeria. While the physical consequences of NTDs are well documented, their mental health burden remains under-recognised and insufficiently integrated into policy and practice. Individuals affected by NTDs frequently experience depression, anxiety, stigma, and reduced quality of life, driven by interconnected pathways including disability, social exclusion, poverty, and cultural interpretations of disease. Current burden estimation frameworks often fail to capture these psychosocial dimensions, leading to underestimation of disease impact and misaligned health priorities. This Viewpoint argues for greater recognition of the mental health burden associated with NTDs and highlights the need for integrated, person-centred approaches to care. Addressing these gaps is essential for improving quality of life and strengthening progress toward NTD control and elimination. |
| Date: | 2026–04–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:esdjx_v1 |
| By: | Manuela Angelucci; Raissa Fábregas; Antonia Vazquez |
| Abstract: | AI-powered mental health apps have attracted growing interest as a low-cost way to expand care. Yet questions remain about their effectiveness, safety, and whether they may crowd out psychotherapy. We evaluate one such app in a randomized controlled trial among 1, 964 Mexican women with mild to severe psychological distress. Over six months, app access improved mental health by 0.3 standard deviations with no evidence of harm, improved sleep quality, increased healthful behaviors, and reduced missed work, yielding considerably larger benefits than costs. Treated participants were also more likely to seek traditional psychotherapy, but this increase does not explain most of the mental health gains. App use was high in the first month but then declined, as is common in digital interventions. Despite this drop in use, treatment effects persisted. Participants continued to implement practices promoted by the app, suggesting that even short-term engagement can produce durable improvements through sustained behavioral change. |
| Keywords: | Mental Health, AI |
| JEL: | I12 I15 O33 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26107 |
| By: | Linea Hasager; Mia Jørgensen |
| Abstract: | Does living in a low-income neighborhood have negative health consequences? We document causal neighborhood effects on health by exploiting a Spatial Dispersal Policy that quasi-randomly resettled refugees across neighborhoods and apartment buildings from 1986 to 1998. Refugees allocated to low-income neighborhoods had a 12 percent higher risk of having developed a lifestyle related disease 8 to 15 years after immigration compared with those allocated to high-income neighborhoods. Our results suggest that interaction with neighbors and the characteristics of the immediate environment are important determinants for health outcomes. Our results further suggest that differences in health care access, ethnic networks, and individual labor market outcomes are not the main drivers behind the neighborhood effects on health. |
| Keywords: | Health inequality, Refugee Dispersal Policy, lifestyle related diseases, neighborhood effects |
| JEL: | J15 I12 I14 I31 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26032 |
| By: | Maria Hofmarcher (HS&I Health System Intelligence e.U.); Robert Holzmann; Reinhard Koman (Oesterreichische Nationalbank) |
| Abstract: | Estimates of social insurance pension wealth are available for a number of Western economies, including Austria for the year 2017. Such wealth may be compared with conventional wealth in terms of size and distribution and when we add such estimates to measures of wealth in the conventional sense, we arrive at measures of augmented wealth. In this paper, we estimate health and long-term care insurance wealth in Austria and add that to conventional wealth estimates for Austria to achieve a further measure of augmented wealth. To our knowledge, this is the first attempt worldwide to do this. The resulting magnitude of health and long-term care insurance wealth is substantial, namely EUR 238, 000 at the household level. It is comparable in scale to both pension insurance wealth (EUR 245, 000) and net wealth in the conventional sense, i.e. property plus financial wealth minus debt (EUR 250, 000). As regards distributive characteristics, health and longterm care insurance wealth is rather equally distributed (Gini coefficient of 0.31), compared to pension insurance wealth (0.45) and conventional wealth in Austria (0.73). The Gini coefficient for the new augmented wealth distribution (conventional wealth plus health and long-term care insurance wealth) is 0.47. |
| Keywords: | net wealth, health insurance, long-term care, augmented wealth, HFCS |
| JEL: | D31 H51 I13 |
| Date: | 2025–05–06 |
| URL: | https://d.repec.org/n?u=RePEc:onb:oenbwp:266 |
| By: | Krzysztof Karbownik; Helena Svaleryd; Jonas Vlachos; Xuemeng Wang |
| Abstract: | Work-related burnout and stress-related sickness absence have become increasingly prevalent, but evidence on which workplace features shape workers' mental health remains limited. Using population-level Swedish register data covering all lower- and upper-secondary teachers from 2006-2024, we show that schools serving more disadvantaged students exhibit substantially higher rates of sickness absence, particularly for stress-related diagnoses. Exploiting within teacher variation across student cohorts, we separate sorting from exposure and find that a one standard deviation increase in student disadvantage raises overall and stress-related sick leave by 3.6% and 8.7%, respectively. Survey evidence indicates that these effects operate through classroom conditions rather than workload or organizational differences. The findings establish client composition as a distinct and policy-relevant determinant of worker health in contact intensive occupations. |
| Keywords: | student composition, teachers' health, mental health, contact-intensive occupations |
| JEL: | I10 I21 J63 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26050 |
| By: | Ramiro de Elejalde; Eugenio Giolito |
| Abstract: | We study the causal effect of delivering in a private rather than a public hospital on maternal outcomes in Chile. We exploit a 2003 copayment reduction that expanded access to private hospitals for women insured by the public system as an instrument for private delivery. Combining administrative birth records with hospital discharge data, we estimate an IV difference-in-differences model that follows mothers for up to fifteen years after the first birth. Private hospital delivery improves short-term outcomes, reducing prolonged hospitalizations and 30-day readmissions. These gains are offset by worse long-term outcomes: women induced to deliver in private hospitals face higher risks of repeat C-sections, cesarean-scar complications, and hysterectomy, with no effects on subsequent fertility. The results highlight a trade-off between short-run improvements in observable outcomes and long-run maternal health risks generated by organizational practices that encourage planned cesarean delivery. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:chb:bcchwp:1079 |
| By: | Bargain, Olivier (University of Bordeaux); Herault, Nicolas (University of Bordeaux); Nettle, Daniel (Institut Jean Nicod, CNRS UMR 8129, ENS-PSL, EHESS) |
| Abstract: | Job loss is known to adversely affect mental health, but the time course of recovery and the role of anticipation remain unclear. Using 22 annual waves (2001-2022) of the Household, Income and Labour Dynamics in Australia (HILDA) survey, we estimate fixed-effects models to examine the relationship between redundancy and mental health (SF-36), incorporating subjective probability of job loss to refine anticipation measures. The final sample consists of 14, 195 individuals and 4, 251 redundancy events. Three key findings emerge. First, we document a generalized decline in mental health prior to job loss that is not confined to individuals who anticipate redundancy, suggesting psychological costs of impending job loss due to factors other than anticipation. Second, we document complete recovery among those who are re-employed, revealing that psychological restoration can occur relatively quickly upon securing new employment. Third, perceived anticipation of job loss does not appear to meaningfully alter these post-redundancy recovery trajectories. These findings call for greater emphasis on employment trajectories in both research and policy aimed at understanding and mitigating the mental health impacts of job loss. |
| Keywords: | job loss, mental health, anticipation, unemployment, panel data |
| JEL: | J63 J64 I31 I12 C23 D91 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18549 |
| By: | Randi Hjalmarsson; Matthew J. Lindquist |
| Abstract: | Attention Deficit and Hyperactivity Disorder (ADHD) is highly prevalent amongst criminal justice populations: ADHD diagnoses and medication are upwards of five times more likely for individuals who have a Swedish prison record than those without. We merge Swedish prison registers (with detailed healthcare data) to out-of-prison healthcare, crime, and employment data to study the effect of in-prison ADHD diagnoses. For individuals with no ADHD history, this new diagnosis treatment can include an information shock, medication and/or therapy. We compare the pre- and post-prison dynamics for treated inmates to alternative undiagnosed comparison groups: all untreated individuals, untreated early spells for repeat offenders treated in later spells, or a matched and reweighted control group. A robust set of findings emerge. New in-prison ADHD diagnoses significantly and persistently increase post-prison ADHD and substance abuse related healthcare. Crime and labor market outcomes, however, do not improve. There are also significant family spill-over effects: both children and siblings with no previous history of ADHD are more likely to be treated for ADHD after a newly diagnosed family member's prison spell. Though prison appears to serve as an institution to bring high-risk, vulnerable populations into the public healthcare system, our results suggest that ADHD related care may not be as effective at lowering crime as many policy makers argue. |
| Keywords: | Prison, Health, ADHD, Medication, Crime, Recidivism |
| JEL: | K42 I14 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26030 |
| By: | Sarah Cattan (Institute for Fiscal Studies, HCEO, IZA, CESifo); Gabriella Conti (University College London, Institute for Fiscal Studies, CEPR, CESifo, CSEF, IZA, RFBerlin); Christine Farquharson (Institute for Fiscal Studies) |
| Abstract: | Early childhood programmes frequently lose effectiveness at scale, yet the role of the workforce remains poorly understood. We document substantial heterogeneity in workforce effectiveness in England’s national home-visiting programme for first-time teenage mothers, despite a highly-structured curriculum and well-qualified staff. Exploiting quasi-random assignment of mothers to family nurses, we estimate that a one standard deviation increase in workforce effectiveness raises children’s cognitive and socio-emotional development by 0.20-0.23 SD. Structural quality—observable worker characteristics —does not predict effectiveness, but process quality —how visits are delivered— does. Greater effectiveness is linked with improvements in maternal mental health and risk behaviours. |
| Keywords: | Early Childhood Development, Home Visiting, Workforce Quality, Process Quality, Scaling, Family Nurse Partnership |
| JEL: | I18 I38 J13 J24 |
| Date: | 2026–04–20 |
| URL: | https://d.repec.org/n?u=RePEc:sef:csefwp:777 |
| By: | Mette Foged; Karen-Inge Karstoft; Edith Zink |
| Abstract: | Employment gaps between refugees and natives are well documented, yet the role of trauma-related mental health in shaping these gaps remains underexplored, partly because most data sources lack measures of symptoms early after arrival. We assess probable PTSD shortly after displacement in an entire refugee arrival cohort and link these data to administrative tax records. We find that PTSD symptoms are associated with lower employment probabilities, explaining roughly one-quarter of the refugee-native employment gap one to two years after arrival. This difference is nearly twice as large as the difference attributable to English proficiency and comparable to the difference linked to pre-displacement employment. Among employed refugees, probable PTSD is associated with fewer hours worked per month, though not with lower hourly wages. Our findings underscore the potential of early psychological screening and support as complements to existing labor market integration policies. |
| Keywords: | Refugees, labor market assimilation, mental health |
| JEL: | J15 J61 I18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26019 |
| By: | Giovanna D'Adda; Simone Ferro; Tommaso Frattini; Alessio Romarri |
| Abstract: | Using large-scale high-granularity data from a food delivery platform and granular pollution and weather information, we study how PM2.5 fluctuations affect riders' absenteeism, productivity, and accidents. Exploiting exogenous pollution variation from inverse boundary layer height, we find that higher pollution increases absenteeism for all workers and raises delivery times and accident rates only among (e-)bike riders, who must exert physical effort while working. Affected workers compensate productivity losses by working longer hours. Monetary incentives mitigate the effects on absenteeism but do not offset the decline in productivity and appear to exacerbate accident risk. |
| Keywords: | Air Pollution; Food Delivery Riders; Absenteeism; Labor Productivity; Workplace Safety. |
| JEL: | H4 J28 Q52 |
| Date: | 2025–11 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25123 |
| By: | Kucera, Alexander (Michigan State University); Scavette, Adam (Federal Reserve Bank of Philadelphia); Porreca, Zachary (Magna Graecia University) |
| Abstract: | The geography of the U.S. opioid epidemic has shifted across successive waves. After a period in which overdose mortality increasingly burdened rural and suburban communities, the fentanyl era appears to have redirected harm toward dense urban cores. We document this post-2015 urbanization using national mortality microdata from CDC WONDER and inpatient discharge records from Pennsylvania. We show three patterns. First, urban overdose mortality rises sharply after fentanyl becomes the dominant illicit opioid. Second, within large metropolitan areas, overdose rates diverge between core counties and suburban peripheries, with especially large gaps in eastern metros, where fentanyl diffused earlier and more intensely. Third, within the Philadelphia region, overdose-related inpatient admissions become increasingly concentrated in a small number of central-city ZIP codes, especially near longstanding drug-market hotspots. We argue that this shift reflects both supply- and demand-side changes associated with fentanyl. If overdose risk is becoming more spatially concentrated, then naloxone distribution, outreach, enforcement, and emergency response may be more effective when targeted to a narrower set of urban locations. |
| Keywords: | fentanyl, overdose, opioid, drug epidemic |
| JEL: | I18 K42 I10 R11 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18562 |
| By: | Austin, Maura (University of Virginia); Timbs, Nathan; Potter, Philip |
| Abstract: | After more than a decade and billions of dollars spent combatting the worst opioid crisis in US history, the CDC documented a striking decline in fentanyl- related mortality beginning in May 2023. What drove this decline? We synthesize three sources of data – global shipping records, fentanyl seizures, and overdose deaths – to serve as empirical signals through which we gain visibility into critical links in the supply chain. This framework allows us to triangulate where in the supply chain the disruption originated. Our analysis indicates that the decline in overdose deaths stemmed in substantial part from enforcement operations that destabilized Mexican cartels’ production and trafficking networks, alongside any effects of precursor controls, domestic enforcement, and harm-reduction efforts. |
| Date: | 2026–04–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:kzw6q_v1 |
| By: | Joseph S. Briggs; Ciaran Rogers; Christopher Tonetti |
| Abstract: | We study consumer demand for savings, life insurance, annuities, and long-term care insurance using novel survey data and a structural life-cycle model. We document that individuals perceive substantial insurance nonpayment risk, and these beliefs predict ownership. Embedding elicited beliefs into an incomplete-markets model alongside additional real-world insurance features, we match empirical patterns of low participation. Relative to a no-insurance benchmark, access to existing imperfect insurance reduces median wealth by 16% and generates a modest 0.6% welfare gain. Eliminating nonpayment risk would substantially increase insurance ownership, yield a further 11% decline in median savings, and generate an additional 1.7% welfare gain. |
| JEL: | D14 E21 G22 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35122 |
| By: | Arnab K. Basu; Tsenguunjav Byambasuren; Nancy H. Chau |
| Abstract: | We trace the impact of a partial liquor ban - from launch to reversal - on alcohol consumption and women's experience with intimate partner violence (IPV) in Kerala, India. Decomposing the policy-induced and reversal effects by employing difference-in-differences and event-study approaches, we identify a significant reduction in alcohol consumption (but only in liquor-serving bars) with an accompanying reduction in IPV during the policy period. However, both alcohol consumption and IPV rebounded to pre-ban levels after the policy removal. Heterogeneity analysis further reveals these effects to be confined only amongst high-wealth households. A battery of robustness tests confirms our findings. |
| Keywords: | Alcohol drinking, Domestic violence, Prohibition, Kerala, India |
| JEL: | D04 D12 J16 K42 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:25162 |
| By: | Sonia Bhalotra; Damian Clarke; Atheendar Venkataramani |
| Abstract: | We leverage the introduction of the first antibiotic therapies in 1937 to examine the long run effects of early childhood pneumonia on adult educational attainment, employment, income, and work-related disability. Using census data, we document large average gains on all outcomes, alongside substantial heterogeneity by race and gender. On average, Black men exhibit smaller schooling gains than white men but larger employment and earnings gains. Among Black men (and women), we identify a pronounced gradient in gains linked to systemic racial discrimination in the pre-Civil Rights era: individuals born in more discriminatory Jim Crow states realized much smaller gains than those born in less discriminatory states. There is no similar gradient among white Americans. Women of both races exhibit smaller education and earnings gains than men on average, consistent with cultural and institutional barriers to women's work. Our findings highlight the role of opportunities in shaping the extent to which investments in early-life health translate into longer run economic gains. |
| Keywords: | Early childhood, medical innovation, race, human capital production, education, income, disability, systemic discrimination, institutions, infectious disease, pneumonia, antibiotics, sulfa drugs |
| JEL: | I10 I14 J71 H70 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26012 |