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on Health Economics |
| By: | Liran Einav; Amy Finkelstein |
| Abstract: | Rising elderly life expectancy is a well-known source of fiscal pressure on Social Security and Medicare – but how have declining mortality and morbidity affected the two programs’ relative finances? Using nearly three decades of Medicare Current Beneficiary Survey data (1992-2019), we estimate that these demographic changes raised expected lifetime Social Security spending by over twice as much as expected lifetime Medicare spending: 14% compared to 6%. The slower growth of elderly lifetime health care spending than annuity spending reflects two features of how longevity has increased: the additional 2.4 years of remaining life expectancy were entirely healthy – free of physical or cognitive limitations – while the expected amount of time spent with severe health limitations fell by about 30%, reducing expected lifetime nursing-home and home-health use. We then write down a stylized life-cycle model of a risk-averse retiree facing stochastic mortality and health to illuminate the key forces that affect the optimal allocation of a fixed amount of public funds across Medicare and Social Security. |
| JEL: | H51 H55 I1 J14 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35346 |
| By: | Alex Chan |
| Abstract: | Risk adjustment is a payment mechanism, not only a prediction problem. I extend optimal risk adjustment to dynamic insurance markets in which plans capture future residuals from persistent risk. Under an efficiency criterion, payments should reflect expected profits and losses over the enrollee relationship on margins plans control, not only one-year spending predictions. A finite-cell model separates selection, health production, and manipulable measurement. The framework implies that annual recalculation can tax prevention, high-R² prediction can reduce welfare, and lagged claims anchors are useful only with gaming safeguards. |
| JEL: | C61 D47 D80 D82 I1 I11 I13 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35325 |
| By: | Naoki Aizawa; Hanming Fang; Katsuhiro Komatsu |
| Abstract: | We study the labor market impacts of unions by accounting for their effects on employers' insurance provision and examine how social insurance policies, in turn, affect unionization and labor market outcomes. We document that unions increase employer-sponsored insurance provision and that expansions in social insurance reduce unionization in the United States. We then develop and estimate an equilibrium labor search model where unionization, wages, and non-wage benefits are endogenously determined. We demonstrate that unionization, as well as the threat of unionization, increases employer-sponsored insurance provision in both unionized and nonunionized firms. We find that social insurance policies can affect labor market inequality through (de)unionization, and inequality may increase or decrease depending on how social insurance is targeted. Social insurance expansions, along with technological changes, contribute to the long-term decline of unions in the U.S. in the last fifty years. Although historical deunionization driven by these forces increased overall welfare, we find that subsidizing unions in the current economy can improve welfare. |
| Keywords: | Labor unions; Non-wage benefits; Employer-provided insurance; Social insurance; Technological change |
| JEL: | J42 J51 J52 I13 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26167 |
| By: | Taiyo FUKAI; Hiromi HARA |
| Abstract: | This paper provides causal evidence that firms act as important intermediaries in the implementation of social policy. In 2005, Japan introduced a policy requiring large firms to develop action plans to establish or expand their company-specific childcare programs. Using pooled repeated cross-sectional survey data with retrospective fertility and employment histories and a Difference-in-Differences (DD) framework, we estimate the policy's impact on working mothers. The results show significant increases in the uptake of maternity and parental leave and improvements in post-birth employment outcomes, with mothers more likely to remain employed and to return as regular employees after the birth of their first child. However, we do not find robust evidence that the policy affected higher-order fertility. These results highlight the importance of firms as institutional channels for implementing family-friendly policies, while also suggesting that workplace-based measures alone may be insufficient to influence fertility behavior and address Japan’s broader demographic challenges. |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:eti:dpaper:26050 |
| By: | Shan Huang; Renke Schmacker; Hannes Ullrich |
| Abstract: | AI can raise productivity by extracting information from rich data, yet little is known about how experts weigh AI-generated signals against established decision-support tools. We conduct a nationwide survey experiment with 372 Danish primary care physicians (21.5% of all clinics), who make diagnostic and treatment decisions on urinary tract infection vignettes before and after receiving a diagnostic signal. Holding accuracy constant, we randomize between-subjects whether the signal appears as an AI prediction or a commonly used dipstick test result. Physicians update beliefs 41% less in response to AI than to dipstick signals, consistent with AI skepticism. Roughly one-third of physicians ignore the AI tool; linked administrative data show that these non-adopters resemble adopters on a range of observables, including clinical practice and prescribing measures, except for lower baseline technology use at their clinics. When physicians use the AI tool, they ignore asymmetry in informativeness between positive and negative signals and, when shown both the AI and a redundant signal, exhibit correlation neglect. These frictions in information processing lead to increased antibiotic prescribing with the AI signal. Our findings highlight the importance of training and information design for AI implementation. |
| Keywords: | expert decision-making, artificial intelligence, healthcare, mental models |
| JEL: | I11 D81 D83 J24 O33 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:diw:diwwpp:dp2168 |
| By: | Carolina Arteaga; Victoria Barone; Stephen Claassen |
| Abstract: | We study how the opioid epidemic shaped local population dynamics in the United States. Exploiting variation in exposure that stems from Purdue Pharma's targeted marketing of OxyContin to high-cancer-mortality areas, we find that more exposed commuting zones experienced lower population growth. By 2020, a one-standard-deviation increase in exposure reduced population growth among individuals aged 18 to 64 by 2.4 percentage points. Direct mortality from drug-induced deaths made only a limited contribution to these changes. Instead, population losses were primarily driven by migratory responses: exposure increased out-migration rates, especially among college-educated individuals. These responses are consistent with the opioid epidemic operating as a disamenity shock, deteriorating local quality of life. Working in the opposite direction, we also document a rise in fertility rates that, by 2020, partially counteracts these population losses. Our findings show that the opioid epidemic reshaped local demographic composition and contributed to the long-run divergence in population dynamics across U.S. commuting zones. |
| JEL: | I1 I3 J13 R23 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35340 |
| By: | Sinara Gharibyan (IOS - Ost- und Südosteuropa verstehen); David Gomtsyan (CREI - Centre de Recerca en Economia Internacional - UPF - Universitat Pompeu Fabra [Barcelona]); Èric Roca Fernández (CERDI - Centre d'Études et de Recherches sur le Développement International - IRD - Institut de Recherche pour le Développement - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne) |
| Abstract: | This paper explores the relationship between geographic mortality differentials and human capital investment patterns in the Malthusian setup of 19th-century Armenia. We examine how variations in altitude are associated with mortality rates, human capital accumulation, and fertility decisions. Using detailed historical census and parish records, we document that higher-altitude areas tend to have lower population density, lower respiratory disease mortality, and lower overall mortality. Our empirical analysis also shows that individuals in these environments tend to display better numeracy skills and lower fertility rates. These findings align with the Ben-Porath hypothesis, suggesting that longer life horizons encourage shifting from child quantity to quality. Furthermore, these patterns are not driven by income differences or increased female autonomy arising from pastoral agriculture |
| Keywords: | Human capital formation, Mortality, Disease environment, Geography, Armenia |
| Date: | 2026–05–29 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05654079 |
| By: | James M. Flynn; David R. Munro; Caitlin K. Myers |
| Abstract: | We estimate the effect of total abortion bans enacted after Dobbs v. Jackson Women's Health on sexual behavior. Using synthetic and standard difference-in-differences designs, we analyze gonorrhea rates and over-the-counter contraceptive purchases as indicators of sexual activity and contraceptive use. We find that total abortion bans reduced gonorrhea rates by 21% among the population aged 15–44 and increased condom purchases by 5.4%. County-level analyses suggest the response reflects awareness of state policy rather than changes in travel distance to providers. These findings are consistent with a framework in which abortion restrictions increase the perceived cost of unprotected sex, inducing more cautious behavior. |
| JEL: | I11 I12 J13 K23 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35333 |
| By: | Nicolini, Marcella (University of Pavia); Sabatini, Fabio (Sapienza University of Rome) |
| Abstract: | On 28 January 2025 the second Trump administration issued a blanket stop-work order on the United States Agency for International Development (USAID), terminating the largest national bilateral aid programme worldwide. We use this natural experiment to estimate the impact of the aid cut on two outcomes in Africa: local economic activity, measured through nighttime light radiance around USAID project sites; and acute food insecurity, measured through the Integrated Food Security Phase Classification (IPC) at the subnational level. First, the cessation of USAID activities produced a sharp and significant decline in nighttime light radiance within 500 m to 10 km of project sites, attenuating monotonically and undetectable at 25 km. Second, areas more exposed to USAID humanitarian assistance saw relative increases in population in IPC Phase 3 (Crisis) or worse and Phase 4 (Emergency), with effects building over the first post-shock year, amplified in higher-vulnerability regions and approximately fourteen times larger in less democratic countries. Third, both effects are driven by humanitarian-aid cuts; the nightlight effect is also driven by productive-sector cuts. |
| Keywords: | foreign aid, USAID, natural experiment, nighttime lights, food security, IPC, difference-in-differences, Africa |
| JEL: | F35 O12 O19 Q18 R11 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18698 |
| By: | Lucie Schmidt; Lara Shore-Sheppard; Tara Watson |
| Abstract: | We examine spillover effects from the ACA Medicaid expansion to public programs providing cash and food assistance. We consider program participation in contiguous county pairs crossing state borders, where one state took up the Medicaid expansion and the other did not, allowing us to better control for local economic trends that could affect program participation. We find that the Medicaid expansion increased participation in food assistance and one of the cash programs, with impacts mainly due to participation conditional on eligibility, rather than from labor supply responses. Our results demonstrate the potential for spillovers across safety net programs. |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:cen:wpaper:26-32 |
| By: | Samantha Horn; Peter Schwardmann; Egon Tripodi |
| Abstract: | Evaluative social interactions are pervasive in labor markets. Inequality in these settings can arise not only from how individuals are treated or perform when evaluated, but from whether they enter evaluation at all. We study these margins in the context of social anxiety. In a controlled online experiment (N = 922), applicants decide whether to complete a live video interview that determines a monetary hiring bonus. We find that inequities associated with social anxiety are concentrated in participation rather than in performance or treatment. Socially anxious applicants are substantially less willing to interview, hold more pessimistic beliefs about being hired, and correctly anticipate a worse experience. Yet they perform no worse and are evaluated no differently. Interview experience does not attenuate the relative pessimism of socially anxious individuals, a pattern that is inconsistent with Bayesian updating under comparable signals. We use our rich audio-visual data and open-ended reflection texts to show that, instead, socially anxious applicants interpret similar interactions more negatively. We then provide evidence on organizational interventions aimed at closing social anxiety gaps. Finally, we show that social anxiety explains a meaningful share of inequalities commonly attributed to gender and social skill differences and is associated with significant earnings gaps in national data. |
| Keywords: | social anxiety, job interviews, beliefs, mental health, discrimination, learning |
| JEL: | D83 J71 I10 C90 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12722 |
| By: | Alice Chong (Graduate School of Economics, Waseda University, and Waseda Institute of Social & Human Capital Studies(WISH)); Hiroyuki Motegi (National Institute of Population and Social Security Research); Masato Oikawa (Faculty of Education and Integrated Arts and Sciences, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH)); Takumi Toyono (Waseda Institute of Social & Human Capital Studies (WISH)); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH)) |
| Abstract: | We provide causal evidence on whether working from home (WFH) enables workers to balance employment and eldercare, and how formal care infrastructure and gender norms shape this relationship. Exploiting Japan’s COVID-19-induced remote work expansion, we find striking heterogeneity: WFH increases caregiving among part-time workers with positive health effects, but among full-time employees, only women increase caregiving — and their health deteriorates. Greater formal care availability and progressive gender norms substantially attenuate these effects. Realizing the work-care balance benefits of workplace flexibility requires complementary investments in care infrastructure and progress toward gender equality. |
| Keywords: | working from home, informal caregiving, work-care balance, gender norms, long-term care, double burden, difference-in-differences (DID) |
| JEL: | I10 J14 J20 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2601 |
| By: | Matthew Brown; Emily J. Davis; Devin G. Pope |
| Abstract: | The consequences of online regulations depend on the extent to which users can circumvent restrictions or substitute toward noncompliant platforms. Since 2023, 25 U.S. states have implemented age verification laws that caused prominent adult websites (including Pornhub) to restrict local access for all users. We study how these restrictions affected browsing activity using individual-level panel data. Access restrictions reduced overall time spent on adult sites by roughly 10%. Specifically, for every 100 hours spent on top adult sites before restrictions, about 50 hours remained accessible at noncompliant sites that never restricted access, 30 hours persisted through VPN-based circumvention, 10 hours were substituted from compliant sites to noncompliant sites, and 10 hours were no longer spent on adult sites. |
| JEL: | I18 K42 L51 L86 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35322 |
| By: | Nguyen, Thao Le; Schmitz, Hendrik |
| Abstract: | In this paper we examine whether additional schooling can offset genetic disadvantages in longevity. Using data from the English Longitudinal Study of Ageing (ELSA) and polygenic scores for longevity, we study heterogeneity in the effects of education on panel attrition - a proxy that closely follows mortality for older individuals. Identification comes from the 1947 UK schooling reform, which raised the minimum school-leaving age from 14 to 15 and provides quasi-experimental variation in educational attainment. The results indicate that the reform effect varies by genetic mortality risk. There are no significant effects of an additional year of compulsory schooling on panel attrition among individuals in the group with lowest genetic mortality risk. In contrast, for the group with highest genetic mortality risk an additional year of compulsory schooling increases the probability of survival in the sample up to age 84. This suggests that the reform mitigated the genetic inequalities in longevity. |
| Abstract: | In diesem Beitrag untersuchen wir, ob eine längere Schulbildung genetisch bedingte Nachteile hinsichtlich der Lebenserwartung ausgleichen kann. Anhand von Daten aus der "English Longitudinal Study of Ageing" (ELSA) und polygenen Scores für die Lebenserwartung untersuchen wir die Heterogenität der Auswirkungen von Bildung auf den Panel-Austritt -ein Indikator, der die Sterblichkeit älterer Menschen eng widerspiegelt. Die Identifikation erfolgt anhand der britischen Schulreform von 1947, die das Mindestalter für den Schulabschluss von 14 auf 15 Jahre anhob und eine quasi-experimentelle Variation im Bildungsniveau ermöglicht. Die Ergebnisse deuten darauf hin, dass der Reformeffekt je nach genetischem Mortalitätsrisiko variiert. Bei Personen in der Gruppe mit dem niedrigsten genetischen Mortalitätsrisiko hat ein zusätzliches Jahr Pflichtschulzeit keine signifikanten Auswirkungen auf die Panel-Abwanderung. Im Gegensatz dazu erhöht bei der Gruppe mit dem höchsten genetischen Sterblichkeitsrisiko ein zusätzliches Jahr Schulpflicht die Überlebenswahrscheinlichkeit in der Stichprobe bis zum Alter von 84 Jahren. Dies deutet darauf hin, dass die Reform die genetisch bedingten Ungleichheiten in der Lebenserwartung gemildert hat. |
| Keywords: | Education, Mortality, Attrition, Gene-Environment Interactions |
| JEL: | C31 J14 J24 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:rwirep:341404 |
| By: | Pol Campos-Mercade; Armando Meier; Stephan Meier; Devin Pope; Florian H. Schneider; Erik Wengström |
| Abstract: | Can monetary incentives improve health behaviors in the long run, and do commonly used surrogate outcomes capture these effects? We study these questions in the context of vaccination using a large-scale field experiment. The experiment combines commonly used surrogates—vaccination intentions, intermediate behavioral proxies, and short-run vaccination—with long-run administrative vaccination records. We first document that incentives increase vaccination rates in the long run: guaranteed $20 incentives raise COVID-19 booster uptake by 9 percentage points. Lottery-based incentives also increase long-run uptake, while prosocial incentives primarily accelerate vaccination. Second, using surrogacy methods, we study whether surrogates can predict long-run impacts. Although the surrogates are strongly correlated with eventual vaccination, the assumptions required for surrogacy methods are often violated, and they do not accurately predict long-run impacts. Our findings highlight both the ability of incentives to change behavior and the importance of measuring long-run outcomes rather than relying solely on surrogates. |
| Keywords: | incentives, health behavior, vaccination, surrogates |
| JEL: | C93 D01 D62 I12 I18 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12730 |
| By: | Dills, Angela; Raghav, Manu |
| Abstract: | The use of various controlled and illegal substances, especially by young adults, has been a cause of much concern among policymakers, law enforcement officials, educators, and parents. State-level legalization of recreational marijuana in the United States raised concerns about potential adverse impacts on campus drug use and drug law violations. This paper combines data from three sources for 2001-02 to 2023-24, including college campus drug law violations that are collected under the Clery Act of 1990. We find that state legalization of recreational marijuana substantially reduced the arrests and disciplinary incidents for drug law violations. |
| Keywords: | Marijuana Legalization, Adolescent Risky Behavior, Higher Education, Campus Law Enforcement |
| JEL: | I21 I23 K42 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1775 |
| By: | Sun, Meiping (Shandong University of Finance and Economics); Yang, Yiying (Fordham University) |
| Abstract: | This paper examines the long-term and multi-generational benefits of skilled birth attendance (SBA), which involves having a trained midwife or doctor present at delivery to safely perform normal deliveries using aseptic techniques and provide first-line emergency obstetric care. Using data on the county-by-county rollout of SBA in China from the 1930s to the 1970s, our research first demonstrates that the SBA reform substantially reduced neonatal mortality. We then show that exposure to skilled delivery during birth leads to a 1.5% increase in adult income. Moreover, we discovered that the benefits of exposure to SBA in previous generations extend to subsequent offspring. Children with at least one parent who experienced SBA have a 2.6% higher monthly income in adulthood than those whose parents did not have access to SBA. We also present evidence of several underlying mechanisms, including improved physical and mental health, better educational outcomes, and enhanced cognitive abilities. Our findings indicate that having skilled health professionals attend childbirths can result in significant long-term and multi-generational benefits. |
| Keywords: | skilled birth attendance, adult earnings, human capital, health, public goods |
| JEL: | H51 H75 I15 I18 J24 N35 O12 O15 |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18719 |
| By: | Amie Bostic |
| Abstract: | Single mothers often face worse health than their married counterparts. This disparity has been connected to single mothers’ economic disadvantage and lower societal position. As a result of this disadvantage, accessing healthcare and maintaining good health can be challenging. Publicly provided health insurance, such as Medicaid, however, may serve as an important buffer, helping to overcome the financial and social pressures of single motherhood and improving single mother health. Medicaid generosity may also narrow the health divide between white and nonwhite single mothers. This article considers the role of place and policy in alleviating or exacerbating health differences among poor single mothers. I find greater Medicaid spending corresponds with better self-rated health for poor single mothers and find an especially strong positive association between Medicaid spending and health for poor, Black single mothers. Specifically, poor single mothers in states with higher average spending on Medicaid between 1995-2019 are predicted to have higher self-rated health than single mothers in states with lower average Medicaid spending. This variation is associated with considerable spatial inequalities in health, as states that spend the least on Medicaid, per enrollee, also tend to have larger Black populations, further compounding patterns of place-based racial inequalities in health. |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:lis:liswps:915 |
| By: | Masato Oikawa (Faculty of Education and Integrated Arts and Sciences, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH)); Rong Fu (Faculty of Commerce, Waseda University, and WISH); Akira Kawamura (Faculty of Human Sciences, Waseda University, and WISH); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University, and WISH) |
| Abstract: | When patients anticipate a reduction in their healthcare copayment, do they wait for the lower price before seeking care—and if so, at what cost? We answer this question by exploiting Japan's age-70 copayment threshold—a sharp and fully anticipated price reduction determined solely by date of birth—using administrative claims from Japan's National Database of Health Insurance Claims tracking over 5.7 million individuals. We document significant wait-for-discount behavior within universal health insurance. Using a dynamic difference-in-differences event study design, we show that standard regression discontinuity estimates overstate long-run price elasticity by conflating intertemporal substitution with structural demand: the immediate elasticity of −0.200 reflects a transitory spike driven by pent-up demand, while the steady-state elasticity stabilizes at −0.088 once deferred demand is absorbed. The welfare consequences are severe and concentrated among the relatively healthy: heterogeneity analysis reveals a behavioral decoupling in which healthy individuals strategically time elective procedures, exhibiting a 5% drop in admissions pre-threshold and an 8.5% spike post-threshold. Crucially, deferral triggers a deterioration mechanism: inpatient expenditures escalate steadily in subsequent months, peaking at a 4.3% surge in months seven through nine—reflecting the progression of conditions left unmanaged during deferral rather than a simple release of pent-up demand. Cost-benefit analysis reveals a severe targeting inefficiency: for every 1 yen saved by a patient through deferral, the social insurance system incurs approximately 47 yen in downstream social costs—a ratio that represents a strict lower bound on the true social cost and that standard static policy evaluations miss entirely. |
| Keywords: | Strategic Care Deferral, Wait-for-discount, Intertemporal Substitution, Offset Effect, Price Elasticity, Targeting Inefficiency, Dynamic Inefficiency, Administrative Claims Data (NDB) |
| JEL: | I11 I13 I18 D12 H51 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2604 |
| By: | Dominik Jockers; Sarah Langlotz; Sebastian Vollmer; Frank Tanser; Till Bärnighausen |
| Abstract: | We study how learning HIV status affects sexual behavior and new HIV infections in South Africa, a high-prevalence setting with universal treatment access. Using financial incentives randomly assigned in a cluster-randomized trial, we instrument HIV status learning and follow participants for up to five years. On average, testing does not change risk behavior, but effects vary by relationship status: among individuals not in relationships, testing increases condom use regardless of the test result; among those in relationships, only HIV-positive results increase abstinence. New HIV infection estimates are large but imprecise. Overall, relationship dynamics matter, and testing alone offers limited preventive benefits. |
| Keywords: | HIV testing, sexual risk behavior, health information |
| JEL: | I12 I18 C26 D83 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12729 |
| By: | Maciej Karpinski; Christoph Schimmele; Allison Leanage; Jing Shen; Rubab Arim |
| Abstract: | This study examines socioeconomic correlates of loneliness among immigrants with disabilities, using data from the 2022 Canadian Survey on Disability. The findings show that the association between socioeconomic circumstances and severe loneliness differed between immigrants and Canadian-born persons with disabilities. Employment or school participation provided immigrants with disabilities less protection from severe loneliness than it did for Canadian born persons with disabilities. For both groups, food insecurity and core housing need were associated with a higher probability of severe loneliness; however, these associations were stronger for immigrants with disabilities. Immigrants with disabilities had a higher probability of severe loneliness than their Canadian-born counterparts, even in absence of food insecurity, core housing need and low income. Overall, the findings highlight the complex interplay between socioeconomic circumstances and emotional well being among immigrants with disabilities and point to the need for targeted supports that address the unique vulnerabilities of this population. |
| Keywords: | socioeconomic correlates, loneliness among immigrants, disabilities |
| JEL: | J23 M21 |
| Date: | 2026–04–22 |
| URL: | https://d.repec.org/n?u=RePEc:stc:stcp8e:202600400004e |
| By: | Robert D. Lieberthal (Thomas Jefferson University; Lieberthal & Associates, LLC); Sabin Ahmed (The MITRE Corporation); David M. Hechtman (The MITRE Corporation); Lauren R. Indrisano (Elevance Health); Douglas R. Amirault (The MITRE Corporation); Susan Haas (The MITRE Corporation); Varun Saraswathula (Congressional Research Service) |
| Abstract: | Helicopter emergency medical services (HEMS) provide rapid access to critical care but are costly to operate and difficult to sustain financially. A clear understanding of these costs is essential for evaluating the feasibility and design of population-based funding or policy strategies. We developed a two-part model: (1) a cost framework capturing capital and operating expenses (e.g., aircraft, equipment, labor, facilities), and (2) an actuarial revenue model using healthcare encounter data and payer reimbursement rates. The model was applied to a commercially insured Massachusetts population (3.9M lives), using provider charge data and Medicare fee schedules. We analyzed breakeven transport volumes under varying reimbursement and labor cost assumptions, including sensitivity scenarios. Under optimistic assumptions (full charge realization, minimal overhead), breakeven is reached with approximately 90 annual transports. More realistic scenarios, incorporating commercial reimbursement at 50% of charges and full 24/7 staffing, require 184 transports. If labor costs are doubled or Medicare rates are used exclusively, breakeven thresholds exceed 1, 000 transports per year. A Monte Carlo simulation (10, 000 iterations) confirmed the robustness of these thresholds: the median simulated breakeven was 190 transports under commercial reimbursement, closely matching the deterministic base case. The 90th percentile reached 304 (commercial) and 1, 066 (Medicare) annual transports. HEMS programs are highly sensitive to labor costs and payer reimbursement levels. Sustainable operation requires more transport volume than previously estimated, especially when reimbursement is constrained or staffing costs increase. This model provides a transparent, replicable tool to inform financial planning, policy evaluation, and payer negotiations for air medical services. |
| Date: | 2026–06 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2606.13981 |
| By: | Moeller, Jakob; Halla, Martin; Thomas, Tobias |
| Abstract: | We study the effect of pre-booked COVID-19 vaccination appointments using a na- tionwide campaign in Austria. Leveraging administrative microdata on more than 450, 000 initially unvaccinated adults, we exploit cross-state variation in program participation and staggered appointment timing in a difference-in-differences de- sign. Pre-booked appointments increase vaccination on the appointment day by 0.8 percentage points (8 per 1, 000), with no evidence of intertemporal substitution. Effects are larger for socio-economically disadvantaged individuals and substan- tially weaker in areas with stronger vaccine skepticism. The findings suggest that behavioral interventions are effective when low uptake reflects frictions, but have limited impact when driven by entrenched skepticism. |
| Keywords: | Behavioral public policy, behavioral frictions, vaccine hesitancy, nudges, pre-booked appointments, COVID-19, administrative data |
| JEL: | I12 D91 H51 C21 D83 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:dicedp:341426 |