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on Health Economics |
| By: | Evelina Björkegren; Aline Bütikofer; Gabriella Conti; Marten Palme; Kjell G. Salvanes; Mårten, Palme; Daniel Björkegren |
| Abstract: | This study examines the long-term consequences of neonatal health using three birth anthropometric measures — weight, length, and head circumference — and analyzes their differential associations with outcomes across the life course. Using linked Swedish and Norwegian population registers with follow-up into adulthood, we compare birth measures of singletons and twins and further estimate within-twin-pair fixed-effects models that control for shared genetic and family environmental factors. Our samples comprise up to approximately 679, 000 singletons and 10, 400 twins in Sweden, and 347, 841 singletons and 6, 762 twins in Norway, followed into adulthood. We find that different birth measures capture distinct aspects of fetal development with varying predictive validity across outcome domains. Birth length emerges as the strongest predictor of health outcomes (infant mortality, adult height), consistent with its role as a cumulative indicator of skeletal growth throughout gestation. Birth weight retains stronger associations with cognitive and educational outcomes (grade point average [GPA], years of schooling) in conditional models. Head circumference shows weak and inconsistent associations across specifications. Using within-pair head circumference differences to classify twins as symmetrically versus asymmetrically growth restricted, we find that symmetric intrauterine growth restriction is associated with substantially worse long-term outcomes than asymmetric restriction. In Norwegian twin pairs, growth restriction is associated with lower general cognitive ability (measured at military enlistment) relative to the unaffected co-twin; this within-pair deficit is more than twice as large for symmetric as for asymmetric restriction. We also document significant intergenerational transmission of birth anthropometrics, suggesting both environmental and genetic contributions. Finally, our register-based design with near-complete population coverage minimizes selection bias and attrition while providing statistical power for within-pair analyses across multiple outcomes. Exclusive reliance on birth weight may obscure important information about early-gestation developmental insults. |
| Keywords: | birth weight, birth length, head circumference, twin studies, fetal origins, intrauterine growth restriction, linkage to administrative data |
| JEL: | I14 I12 J13 J24 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12958 |
| By: | Mukhopadhyay, Sankar (University of Nevada, Reno) |
| Abstract: | This paper studies how reducing the risk of income-related Medicaid disenrollment affects labor supply. The Families First Coronavirus Response Act of 2020 conditioned enhanced federal Medicaid funding on states maintaining continuous coverage, prohibiting most disenrollments regardless of income changes during the COVID-19 public health emergency. Using PSID data, we estimate event-study models with individual fixed effects. Treatment status is held fixed throughout the panel to avoid conditioning on post-policy Medicaid enrollment. The baseline Medicaid group experienced a 4.6-hour (or about 14%) larger change in weekly hours worked than the comparison group (p = 0.006), robust across alternative specifications. Employment responses are concentrated among married spouses and partners (17.2 percentage points, p = 0.015), consistent with a household-level channel in which secondary-earner employment is discouraged under ordinary Medicaid rules because additional household earnings can trigger coverage loss. Among expansion-state enrollees, the probability of having taxable family income above 138 percent of the federal poverty threshold rises by 14.8 percentage points (p = 0.015), supporting the coverage-loss-risk interpretation. |
| Keywords: | Medicaid, continuous coverage, labor supply, income |
| JEL: | I13 I18 J22 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18887 |
| By: | Pietro Tebaldi; Andrea Scalenghe; Joseph Orsini |
| Abstract: | The Affordable Care Act, the largest US welfare reform since 1965, banned health insurance underwriting and rejections based on pre-existing conditions and introduced large premium subsidies for low- to middle-income individuals. Yet how many people the ban made better off, and how its effects varied by health risk, remain unknown—because data on who was rejected before the reform have been lacking. Using a proprietary dataset of pre-ACA insurance applications and underwriting decisions, we document, model, and estimate the reform's heterogeneous effects by age, income, and health risk. We find its benefits were concentrated among low-income, high-risk, or over-50 individuals. |
| JEL: | I11 I13 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35692 |
| By: | Jason Paul Bonham (Max Planck Institute for Demographic Research, Rostock, Germany); Ken Smith; Tim A. Bruckner |
| Abstract: | This study considers the relation between institutional adaptation and long-term behavioral change. Often, behavioral interventions weaken over time as prior norms reemerge. As a contradictory case, we focus on the practice of tobacco abstention within the Church of Jesus Christ of Latter-day Saints. Although originally taught in 1833, tobacco abstention was not standardized until a 1921 requirement of tobacco abstention for Latter-day Saint temple participation, a powerful symbol of collective attachment. Drawing from this narrative, we offer an analytic framework called symbolic resonance (SR) that accounts for how behaviors embedded within symbolically resonant institutions can promote durable normative change. We then compare this case to broader U.S. tobacco trends to illustrate SR's diagnostic value. As an empirical demonstration, we compare changes in tobacco-related health outcomes both before and after the 1921 ban by temple participation utilizing the Utah Population Database. We find that tobacco-related health advantages were confined to later cohorts who engaged in temple rituals. These results suggest that institutions may influence behavior durability when expectations are paired with symbols. SR provides analytic leverage for understanding connections between organization, individual behavior, and health beyond the Latter-day Saint case. |
| Keywords: | Utah, mortality, religious institutions, smoking |
| JEL: | J1 Z0 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:dem:wpaper:wp-2026-037 |
| By: | Frisvold, David (University of Iowa); Lozano-Rojas, Felipe (University of Georgia) |
| Abstract: | Ten states implemented Supplemental Nutrition Assistance Program (SNAP) Food Restriction Waivers to restrict purchases of sugary beverages with SNAP funds for the first time in program history in 2026. We estimate the short-run impact of these waivers using a new panel dataset of household beverage purchases. For the average SNAP household, these waivers decrease soda purchases by 13 percent with persistent effects for up to two months after implementation. For inframarginal SNAP households, these waivers decrease soda purchases by 18.5 percent. These findings are inconsistent with the predictions of traditional demand theory and suggest that behavioral models incorporating mental accounting and labeling better characterize consumer responses to SNAP purchase restrictions. |
| Keywords: | SNAP, consumption, mental accounting, labeling, fungibility |
| JEL: | D12 H53 H51 H75 I38 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18883 |
| By: | Joan Costa-i-Font; Juan David Garcia Corchero |
| Abstract: | We examine the effect of the expansion of patient choice of health care provider on measures of process delivery and clinical outcomes central to the functioning of a health system, using a quasi-natural experiment in Spain over 2002–2019. We draw on a staggered adoption of provider choice reforms across Spanish regional health services and a heterogeneity-robust difference-in-differences estimator applied to regionyear panel data alongside individual-level survey data. We estimate that the availability of provider choice reduced specialist waiting times by approximately 17 days (19% of the pre-reform mean) and the use of private specialist visits, without increasing public health spending. The waiting-time and private-utilisation results are robust to excluding the region where the 2009 reform bundled choice with new hospitals, public–private partnerships, and a budget increase. Although we cannot reject zero effects on some clinical outcomes, the evidence is consistent with the thesis that provider choice improves the “quality needle”, namely it improves observable process quality without affecting less-visible clinical dimensions. |
| Keywords: | provider choice, difference-in-differences, waiting times, health outcomes, Spain, public–private substitution |
| JEL: | I11 I18 D82 H75 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12966 |
| By: | Zhang, Xin; Wang, Yixuan; Hu, Xingyi; Chen, Xi |
| Abstract: | We examine how prenatal exposure to air pollution interacts with gender-biased parental investments to shape long-run cognitive performance. Using nationally representative survey data from China, we show that fetal PM2.5 exposure significantly reduces cognitive ability for women, particularly among those with brothers. Our evidence suggests that the family investment channel operates primarily through education rather than health, with gender-biased educational resource allocation compounding negative outcomes for females. Specifically, conditional on the same level of fetal PM2.5 exposure, females receive less homework assistance from their families and attain lower levels of education. |
| Keywords: | fetal pollution exposure, cognitive ability, parental investment, gender disparities |
| JEL: | D13 Q53 J16 I24 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1814 |
| By: | de Elejalde, Ramiro (Banco Central de Chile); Giolito, Eugenio (Universidad del CEMA) |
| 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 instrumented 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. The offsetting risks come with later pregnancies: women induced to deliver in private hospitals face higher rates of repeat C-sections, cesarean-scar complications, and hysterectomy. Subsequent fertility is unaffected. The results point to a trade-off between short-run improvements and long-run maternal health risks from hospital practices that favor planned cesarean delivery. |
| Keywords: | cesarean section, maternal health, private hospitals, provider incentives |
| JEL: | I11 I12 I13 I18 J13 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18877 |
| By: | Go Nakatsui (Research Center for Advanced Policy Studies, Institute of Economic Research, Kyoto University); Fumio Ohtake (Research Center for Advanced Policy Studies, Institute of Economic Research, Kyoto University, Center for Infectious Disease Education and Research, Osaka University); Reo Takaku (Graduate School of Economics, Hitotsubashi University); Naoto Tanemoto (Policy Research Institute, Ministry of Finance, Japan) |
| Abstract: | Cost-sharing reforms can shift behavior beyond the patients who pay. Using 180 million pharmacy dispensing claims, we study Japan's 2024 surcharge on brand-name drugs with generic alternatives. Generic dispensing increased in both surcharge-eligible and exempt categories, 1.92 pp more in eligible categories. Responses extended beyond own-price incentives: generic-name prescribing increased despite physicians not bearing the charge; dispensing responses showed no monotonic gradient in surcharge amounts; and generic adoption spilled over to exempt categories (+3.85 pp), concentrated among the most-exposed patients and physicians. Targeted cost-sharing can shift defaults across stakeholders beyond its formal scope, and reporting requirements can change prescribing behavior. |
| Keywords: | generic substitution, patient cost-sharing, pharmaceutical policy, behavioral economics, Japan |
| JEL: | I11 I18 D91 L51 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:kyo:wpaper:1130 |
| By: | Joan Costa-Font; Sergi Jiménez-Martín; Cristina Vilaplana Prieto |
| Abstract: | We estimate the health and wellbeing effects of subsidized access to long-term care (LTC). Our analysis exploits the staggered implementation of Spain's 2007 System of Autonomy and Care for Dependent People (SAAD), which expanded publicly funded and universal LTC subsidies and supports, as well as its subsequent reform. Using two decades worth of administrative and survey data and leveraging exogenous regional and individual-level variation in program exposure, we find that access to SAAD benefits reduces the care receiver's depressive symptoms by about 1 percentage point, increases its survival probability by 2.6–3 percentage points, and raises its life satisfaction by 0.24–0.50 scale points. Cost-effectiveness estimates indicate that the implied cost per quality-adjusted life year (QALY) gained lies below commonly accepted efficiency thresholds for public health spending in Europe. These findings document sizeable health returns and efficiency gains from publicly subsidized LTC provision. |
| Keywords: | cost per QALY, life satisfaction, long-term care, long-term care subsidies, long-term care supports, mental health, mortality, old age care, Spain, survival |
| JEL: | I18 J14 J16 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1593 |
| By: | Demireva, Neli; Reeves, Aaron; Sochas, Laura |
| Abstract: | Collective bargaining institutions play a crucial role in determining wages and working conditions, which are both important social determinants of health. We use data from the EU Labour Force Survey (2007, 2013 & 2020), which covers 900, 000 individuals across 31 countries. We examine the relationship between collective bargaining coverage and exposure to occupational health risks among migrants and citizens. We find that migrants’ occupational health outcomes exhibit less responsiveness to changes in collective bargaining coverage compared to citizens. Additionally, contrary to expectations, lower levels of coverage correlate with lower reported health risks and fewer work-related health issues. We suggest avenues for future research. |
| Date: | 2026–08–31 |
| URL: | https://d.repec.org/n?u=RePEc:ese:iserwp:2026-04 |
| By: | Chiara Canta (TBS - Toulouse Business School); Helmuth Cremer (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - Comue de Toulouse - Communauté d'universités et établissements de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | We study the optimal long-term care (LTC) policy when informal care can be provided by children in exchange for monetary transfers from their elderly parents. We consider a bargaining model with single-child families, where daughters have lower labor market wages, and bargaining power within the family varies by the child's gender. In the laissez-faire scenario, daughters always provide more informal care than sons. When their bargaining weight is smaller, they also experience lower welfare; however, this may be reversed if their bargaining weight is sufficiently high. The first-best outcome involves redistribution from families with sons to families with daughters and can be implemented through a gender-specific schedule of public LTC benefits and state-contingent transfers to adult children. Gender neutrality disadvantages families with daughters and may even leave daughters worse off than under laissez faire. It also leads to a distorted allocation of care within families with daughters and affects the distribution of transfers in all families. |
| Keywords: | informal care, Long-term care, strategic bequests, family bargaining, gender-neutrality |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05746561 |
| By: | Daniel Nettle (IJN - Institut Jean-Nicod - DEC - Département d'Etudes Cognitives - ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - CdF (institution) - Collège de France - CNRS - Centre National de la Recherche Scientifique - Département de Philosophie - ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres, Northumbria University [Newcastle]); Melissa Bateson (Newcastle University [Newcastle]) |
| Abstract: | Food insecurity (FI) has become a major focus of academic and policy concern. FI is prevalent even in highincome countries, and is consistently associated with poor physical and mental health outcomes. These associations are attenuated but not eliminated by controlling for more general social determinants. Though it is clear that the associations exist, it is less clear why. FI reflects social and material disadvantage, so its negative association with health is not a surprise; but there are multiple pathways by which the association could play out. We review four: (A) FI is a non-causal correlate of general disadvantage; (B) FI causes poor health, but this is not mediated by diet; (C) FI causes poor health by changing what people eat; (D) FI causes poor health by changing the temporal patterning of their eating. These pathways are not mutually exclusive, and we suggest that several play partial roles. Understanding their relative importance is nonetheless an important goal if we wish to intervene effectively to mitigate the health burden of FI. |
| Date: | 2026–12 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05735948 |
| By: | Salvi, Irene; Fu, Enqi; Geissler, Alexander |
| Abstract: | Switzerland has achieved considerable progress in HIV care, with high treatment coverage and viral suppression among diagnosed people living with HIV. However, new infections continue to occur, and the remaining gap in the HIV care cascade is primarily related to diagnosis. In view of upcoming funding cuts, updated estimates of the lifetime economic burden of new HIV infections are needed to inform prevention policy, resource allocation, and progress towards UNAIDS and Swiss National Programme (NAPS) elimination targets. This cost-of-illness study estimated the lifetime direct medical and broader societal costs associated with one new HIV infection in Switzerland. We developed an incidence-based state-transition Markov model to simulate the lifetime progress through CD4 categories-defined health states of a newly infected person living with HIV in Switzerland. The model followed individuals in annual cycles across CD4 >500 cells/µL, CD4 200-500 cells/µL, CD4 |
| Keywords: | HIV, cost of illness, Markov model, economic burden, societal costs, HIV prevention, UNAIDS targets, Switzerland |
| JEL: | I10 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:hsgmed:202603 |
| By: | Jan Berendsen (University of Hamburg); Robert Dur (Erasmus University Rotterdam); Iris Kesternich (University of Hamburg) |
| Abstract: | It has been argued that the search for meaning is among the strongest drivers of human behavior. We ran a survey on a large representative sample to assess how important it is for people to lead a meaningful life, what makes life meaningful, what differentiates meaning from happiness, and whether people who find meaning important lead different lives than people who prioritize happiness. We collect three types of data: open questions, vignettes, and self-reported meaning and happiness. We show that people care strongly about both meaning and happiness and that the drivers of a meaningful and happy life differ in important ways. Moreover, we find interesting gender differences and a substantial underestimation by women of how much children contribute to men's meaning and happiness. |
| Keywords: | Meaning; Happiness; Survey data; Vignette study; Large Language Models; Gender |
| JEL: | D00 D9 I3 |
| Date: | 2026–09–06 |
| URL: | https://d.repec.org/n?u=RePEc:tin:wpaper:20260065 |
| By: | Fazliddin Shermatov; Stephane Robin; Aldo Geuna |
| Abstract: | Whether artificial intelligence pays off for the firms that build it into their products is hard to establish, because AI innovation is itself hard to observe. The medical technology sector is a rare exception: an AI-enabled device must obtain clearance from a national health authority before it can reach a patient, leaving a dated, firm-attributable record of AI innovation output that can be observed directly rather than proxied. We exploit this setting with a three-stage recursive model estimated on a novel firm-level dataset linking FDA premarket clearances, USPTO patents, Scopus publications, and Orbis financials, tracing the full innovation chain from external collaboration through AI device introduction to firm performance. We find that external AI research collaboration is a robust driver of AI device introduction across firm sizes and estimators, with a larger effect for small firms, consistent with external knowledge ties substituting for limited internal R&D capacity. Decomposing by partner type, the effect is largest for industry and clinical collaborations and smallest for academic ties, consistent with the former being closer to the regulatory and commercialisation process. Firms that bring AI devices to market display higher labour productivity, an effect robust for small firms and the full sample that holds under both sequential and joint maximum-likelihood estimation and accumulates across successive device introductions. Effects on profit margins are present but weaker and do not survive all specifications, a pattern consistent with competitive entry eroding pricing power as AI devices diffuse through the sector. |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2609.08485 |