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on Health Economics |
| By: | Orazio Attanasio (Yale University) |
| Abstract: | This paper reviews recent developments in the economics of human development, focusing on the early years of life as a critical period for shaping long-term outcomes. Early childhood development is inherently multidimensional: cognitive and socioemotional skills evolve dynamically and interact with health, nutrition, and environmental influences. Economists have contributed to this field by providing a conceptual unifying framework that highlights how key drivers of development reflect the choices of individuals operating under incentives and constraints. Within this framework, the paper emphasizes two central challenges: understanding the interactions among multiple dimensions of development and identifying causal linksÑparticularly the effects of different inputs at different ages. Measurement issues are a recurring theme, given the difficulty of assessing young children and the need for comparability across contexts. The paper also stresses these issuesÕ policy relevance for poverty reduction and social mobility by discussing early childhood interventions in both developed and developing countries. |
| Date: | 2026–01–01 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2491 |
| By: | Janet Currie (Yale University and NBER); Bahadõr Dursun (Newcastle University and IZA); Michael Hatch (American University); Erdal Tekin (American University, IZA, and NBER) |
| Abstract: | We examine the impact of firearm violence on newborn health in the U.S. using two approaches. First, we analyze the "beltway sniper" attacks in 2002, leveraging both temporal and spatial variation to compare birth outcomes of exposed children to those unexposed. Second, we investigate in-utero exposure to mass shootings using national data. We find that exposure to these incidents during pregnancy increases the likelihood of very low-birthweight and very premature birth. These events carry a significant economic burden, with the beltway sniper attacks costing at least $155 million and mass shootings resulting in annual costs exceeding $75 million. |
| Date: | 2025–11–01 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2487 |
| By: | Adriana Corredor-Waldron (North Carolina State); Janet Currie (Yale and NBER); Molly Schnell (Northwestern and NBER) |
| Abstract: | Black mothers with a trial of labor are 25 percent more likely to deliver by C-section than non-Hispanic White mothers. The gap is largest among mothers with the lowest risk and is reduced by only one-fifth when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and physician or medical practice group. Remarkably, the gap disappears when performing a C-section is more costly due to a concurrent pre-labor C-section limiting surgical resources. This finding is consistent with provider discretion rather than differences in unobserved medical risk accounting for persistent racial disparities in delivery method. The additional intrapartum C-sections that occur among low-risk women when hospitals are unconstrained negatively impact infant health. |
| Date: | 2025–12–29 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2489 |
| By: | Daniel R. Arnold; Michael R. Richards; Christopher M. Whaley |
| Abstract: | Mental illness exacts a heavy toll on the US healthcare system and strains general hospitals and their emergency departments. We study how psychiatric inpatient facility entry impacts the local hospital industry. We find that referrals, including from the legal system, are redirected to the specialized facilities––leaving general hospitals with approximately 60% fewer psychiatric admissions. General hospitals also discharge 50% more patients to psychiatric facilities and substitute away from high-skill psychiatric labor––consistent with specialization and market segmentation. Emergency department volumes do not change but care does. However, community-based crime, overdose deaths, and suicides do not decline in the short-run. |
| JEL: | I11 I18 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34772 |
| By: | Cavit Baran (Sabancõ University); Janet Currie (Yale University and NBER); Bahadõr Dursun (Newcastle University and IZA); Erdal Tekin (American University, IZA, and NBER) |
| Abstract: | This paper provides the first nationwide U.S. evidence on the effects of electric vehicle (EV) adoption on air quality and child health. Using county-level data from 2010-2021, we link EV registrations to air pollution, birth outcomes, and emergency department visits. Endogenous adoption is addressed using two-way fixed effects and an instrumental variables strategy exploiting the rollout of federally designated Alternative Fuel Corridors. Greater EV adoption significantly lowers nitrogen dioxide and improves infant and child health, reducing very low birth weight, prematurity, and asthma-related emergency visits. The largest health gains occur in high-pollution areas and exceed $1.2-$4.0 billion annually. |
| Date: | 2026–01–01 |
| URL: | https://d.repec.org/n?u=RePEc:cwl:cwldpp:2486 |
| By: | Abaluck, Jason; Pless, Robert; Ravi, Nirmal; Sautmann, Anja; Schwartz, Aaron |
| Abstract: | This study tests the effects of large language model (LLM) decision support on patient care at two outpatient clinics in Nigeria. Health workers were given the option to make revisions to their initial care plan based on LLM feedback. The unassisted and assisted plans are evaluated using (1) comparisons with independent care plans created by on-site physicians, (2) laboratory tests for malaria, anemia, and urinary tract infections, and (3) a blinded randomized assessment by the on-site physician who saw the same patient. In response to LLM feedback, health workers changed their prescribing for more than half of the patients and reported high satisfaction with the recommendations. In a selected sample, retrospective review by academic physicians also suggested improvements in care related to long-term risk management. However, the three metrics show mixed effects of LLM-assistance, with on average no significant improvement in diagnostic alignment with physicians, detection rates for the tested conditions, or physician subjective assessments. Health workers follow LLM recommendations that agree with the physician's decisions only slightly more often than those that do not. These results suggest that, despite some benefits, LLM-based frontline health worker support is not yet a public health priority in low- and middle-income countries. |
| Date: | 2026–01–15 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11298 |
| By: | Guthmuller, Sophie; Carrieri, Vincenzo; Wübker, Ansgar |
| Abstract: | Organized cancer screening programs (OSPs) in Europe for breast, cervical, and colorectal cancers aim to improve early detection and reduce mortality. This study measures the effects of OSPs on participation and examines cross-program spillovers, as women are often invited to multiple screenings. We construct a regional-level dataset on OSP availability, merged with individuallevel data from the European Health Interview Survey (EHIS) covering 122, 000 women in 27 countries. We exploit cross-region and age-based variations in eligibility and employ a quasiexperimental difference-in-differences model to measure the causal effect of OSPs. OSPs substantially increase screening participation: mammography rises by 33.20 percentage points (pp) (95% CI: 24.56-41.85), fecal occult blood test (FOBT) by 19.41 pp (95% CI: 13.95-24.88), and pap test by 9.33 pp (95% CI: 5.26-13.41). Positive spillover effects occur when women are invited to two screenings (10 pp (95% CI: 4.81-15.20) for mammography, 3.35 pp (95% CI: 0.56-6.15) for pap test, 7.44 pp (95% CI:2.34-12.55) for FOBT) but targeting three cancers does not yield additional statistically significant gains. These findings highlight the strong impact of OSPs on participation and the value of coordinated screening and communication strategies as Europe expands organized screening to new cancer sites. |
| Abstract: | Organisierte Krebsvorsorgeprogramme (OSP) in Europa für Brust-, Gebärmutterhals- und Darmkrebs zielen darauf ab, die Früherkennung zu verbessern und die Sterblichkeit zu senken. Diese Studie misst die Auswirkungen von OSPs auf die Teilnahme und untersucht programmübergreifende Spillover-Effekte, da Frauen häufig zu mehreren Vorsorgeuntersuchungen eingeladen werden. Wir erstellen einen Datensatz auf regionaler Ebene zur Verfügbarkeit von OSPs und führen diesen mit Daten auf individueller Ebene aus der Europäischen Gesundheitsbefragung (EHIS) zusammen, die 122.000 Frauen in 27 Ländern umfasst. Wir nutzen regionenübergreifende und altersbedingte Unterschiede in der Teilnahmeberechtigung und verwenden ein quasi-experimentelles Differenz-in-Differenzen-Modell, um die kausalen Auswirkungen von OSPs zu messen. OSPs erhöhen die Teilnahme an Vorsorgeuntersuchungen erheblich: Die Mammographie steigt um 33, 20 Prozentpunkte (pp) (95 % KI: 24, 56-41, 85), die Fäkalbluttests (FOBT) um 19, 41 pp (95 % KI: 13, 95-24, 88) und die Pap-Tests um 9, 33 pp (95 % KI: 5, 26-13, 41). Positive Spillover-Effekte treten auf, wenn Frauen zu zwei Vorsorgeuntersuchungen eingeladen werden (10 pp (95 % KI: 4, 81-15, 20) für Mammographien, 3, 35 pp (95 % KI: 0, 56-6, 15) für Pap-Tests, 7, 44 pp (95 % KI: 2, 34-12, 55) für den FOBT). Eine gleichzeitige Einladung zu drei Krebsfrüherkennungsprogrammen führt hingegen zu keinen zusätzlichen statistisch signifikanten Effekten. Diese Ergebnisse unterstreichen den starken Einfluss von OSPs auf die Teilnahme und den Wert koordinierter Screening- und Kommunikationsstrategien, während Europa das organisierte Screening auf neue Krebsarten ausweitet. |
| Keywords: | Organized Screening Programs, screening participation, cancer screening, cross-program spillovers, Europe |
| JEL: | D90 H51 I12 I18 J18 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:rwirep:335896 |
| By: | Na'ama Shenhav; Danielle H. Sandler |
| Abstract: | We study the causal effect of women's education on their wages, non-wage job amenities, and spillovers to children. Using a regression discontinuity at the school entry birthdate cutoff, we find that women born just before the cutoff are more likely to complete some college, and experience multi-dimensional career gains that grow over the life cycle: greater employment and earnings, as well as more professional and higher-status jobs, more socially meaningful work, and better working conditions. Children’s early-life health and prenatal inputs improve in tandem with career improvements, consistent with professional advances spurring—not hindering—infant investments. Career gains are concentrated in jobs that require exactly some college, the same schooling margin shifted by the cutoff, which indicates that increased post-secondary education is the primary channel for these effects. Together, the results show that women's college attendance generates large career returns—from both wages and amenities—that strengthen over time and produce meaningful benefits for children. |
| JEL: | I12 I26 J13 J16 J32 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34767 |
| By: | Laura Montenovo; Kosali I. Simon; Coady Wing |
| Abstract: | We examine how Medicaid expansion under the Affordable Care Act reshaped federal transfer inflows to counties using state Medicaid expansions between 2014 and 2017. We show that the ACA expansion increased federal Medicaid transfers by $361 per capita in expansion counties. Using our estimates, we forecast that non-expansion counties would gain $554 per capita if they expanded Medicaid. These transfers flow to counties with lower tax capacity and lower gross income. Our findings suggest that Medicaid expansion was a health policy intervention that also functioned as a budgetary mechanism reshaping federal to local transfers and fiscal smoothing across U.S. counties. |
| JEL: | H10 H20 H27 I13 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34758 |
| By: | Soria, Chris; Feehan, Dennis |
| Abstract: | Personal networks influence health and mortality at the individual level, but less is known about how population-scale social network structure relates to mortality. This study examines how US county-level social network structure relates to mortality disparities. Using measures from 21 billion Facebook friendships, we investigate how two structural features of population social networks – cohesiveness and diversity – are associated with age-standardized and age-specific mortality rates. Bivariate results show that measures of social network structure rival smoking rates, median income, and educational attainment in their association with mortality rates. Social network structure remains predictive of mortality even after controlling for traditional measures like socioeconomic status and rural/urban classification. Network diversity is associated with lower mortality in both bivariate and multivariate analyses. Network clustering is associated with higher mortality bivariately, but this association reverses after controlling for county-level demographic and socioeconomic factors, revealing a protective effect masked by confounding. Age-stratified analyses further complicate this picture, showing that clustering predicts lower mortality among adults aged 15-64 but higher mortality among those 70 and older. These findings highlight social network structure as an important dimension of place-based health disparities, one not fully captured by conventional measures of socioeconomic composition or spatial segregation. |
| Date: | 2026–01–21 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:kvmx6_v3 |
| By: | Asena Caner (TOBB University of Economics and Technology (TOBB ETÜ)); Belgi Turan (TOBB University of Economics and Technology (TOBB ETÜ)); Berna Tari Kasnakoglu (TOBB University of Economics and Technology (TOBB ETÜ)); Yenal Can Yigit (TOBB University of Economics and Technology (TOBB ETÜ)); Donald S. Kenkel (TOBB University of Economics and Technology (TOBB ETÜ)); Donald S. Kenkel (TOBB University of Economics and Technology (TOBB ETÜ)); Alan D. Mathios (TOBB University of Economics and Technology (TOBB ETÜ)) |
| Abstract: | This study examines consumer preferences for manufactured cigarettes, roll-your-own cigarettes, and e-cigarettes in Türkiye, focusing on the impact of product attributes—such as price, legal status of e-cigarettes, and flavor availability—on consumer choices. Using a discrete choice experiment (DCE) embedded in an online survey, the research analyzes how these attributes influence decisions among Turkish adults, with a particular emphasis on the implications of regulations like e-cigarette bans. The findings reveal significant price sensitivity, both regarding the own price of products and the prices of substitute products. Additionally, the results suggest that regulatory measures, especially those targeting legal status, play a crucial role in shaping public health outcomes and consumer behavior. |
| Date: | 2025–08–20 |
| URL: | https://d.repec.org/n?u=RePEc:erg:wpaper:1791 |
| By: | Licker, Luisa V.; Guthmuller, Sophie; Wübker, Ansgar |
| Abstract: | Dementia is associated with an increasing need for care, which is often provided by informal carers. This may have an impact on their behaviour in the labour market. This study analyses the impact of dementia severity on informal care, labour market participation and working hours of informal carers. We use data from the multinational RightTimePlaceCare (RTPC) study, which covers eight European countries and uniquely links detailed information on people with dementia and their primary informal carers. Using descriptive statistics and multivariate regression models, we analyse the relationships between the severity of dementia, the intensity of care and labour market outcomes, taking into account the endogeneity of care intensity through an instrumental variable approach. Our results show that higher dementia severity significantly increases the intensity of informal care and substantially reduces both labour market participation and working hours of informal carers. These findings highlight the economic consequences of dementia care and underscore the importance of considering labour market impacts when assessing informal dementia care. |
| Abstract: | Demenz geht mit einem steigenden Pflegebedarf einher, der häufig von informellen Pflegekräften gedeckt wird. Dies kann sich auf ihr Verhalten auf dem Arbeitsmarkt auswirken. Diese Studie analysiert die Auswirkungen des Schweregrads der Demenz auf die informelle Pflege, die Erwerbsbeteiligung und die Arbeitszeiten informeller Pflegekräfte. Wir verwenden Daten aus der multinationalen RightTimePlaceCare (RTPC)-Studie, die acht europäische Länder umfasst und detaillierte Informationen über Menschen mit Demenz und ihre primären informellen Pflegekräfte auf einzigartige Weise miteinander verknüpft. Mithilfe deskriptiver Statistiken und multivariater Regressionsmodelle analysieren wir die Zusammenhänge zwischen dem Schweregrad der Demenz, der Intensität der Pflege und den Arbeitsmarktergebnissen, wobei wir die Endogenität der Pflegeintensität durch einen Instrumentvariablenansatz berücksichtigen. Unsere Ergebnisse zeigen, dass ein höherer Schweregrad der Demenz die Intensität der informellen Pflege deutlich erhöht und sowohl die Erwerbsbeteiligung als auch die Arbeitszeit der informellen Pflegepersonen erheblich verringert. Diese Ergebnisse verdeutlichen die wirtschaftlichen Folgen der Demenzpflege und unterstreichen, wie wichtig es ist, bei der Bewertung der informellen Demenzpflege die Auswirkungen auf den Arbeitsmarkt zu berücksichtigen. |
| Keywords: | Dementia, Informal caregiving, Labour market participation, Labour market hours |
| JEL: | J14 J22 I11 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:rwirep:335897 |
| By: | Hiroyuki Yamada (Keio University); Anh Tuyet Nguyen (Independent Researcher); Yasuharu Shimamura (Aoyama Gakuin University); Midori Matsushima (University of Tsukuba) |
| Abstract: | This study investigates whether asymmetric information in the public health insurance market remains empirically relevant as coverage approaches universal levels. Focusing on Vietnam’s public health insurance system – characterized by a uniform benefit package and a gradual transition toward universal health coverage – we analyze five waves of nationally representative survey data spanning 2004 to 2020. Following the methodology of Chiappori and Salanié (2000), we test for a conditional correlation between insurance enrollment and realized health risks. Our results consistently demonstrate the persistence of asymmetric information throughout the study period, even as aggregate coverage among working-age adults exceeded 80% by 2020. Subgroup analyses reveal that while selection effects weaken in groups subject to near-automatic enrollment, such as government employees and students, they remain deeply entrenched among private-sector workers, the self-employed, and dependents who retain greater discretion in participation. These findings underscore that high aggregate coverage does not mechanically eliminate informational frictions. Consequently, the study highlights the critical importance of enrollment design and effective enforcement mechanisms in sustaining robust risk pooling and financial viability during the final stages of the transition to Universal Health Coverage. |
| Keywords: | Asymmetric Information; Public Health Insurance; Universal Health Insurance Coverage; Vietnam |
| JEL: | I13 I15 I18 O17 |
| Date: | 2025–02–04 |
| URL: | https://d.repec.org/n?u=RePEc:keo:dpaper:dp2026-001 |
| By: | Kang, Hyein; Geoghegan, Rose; Heflin, Colleen; Rothwell, David W. (Oregon State University) |
| Abstract: | Being a first-time mother carries substantial consequences, including financial strain, mental and physical health adjustments, and impacts on job stability and time use. Dynamics of safety net usage among first-time mothers are well-documented, but little is known about how new mothers coordinate work and public benefits together. In this research, we study population-level employment and social safety net program participation among new mothers by linking birth records in Oregon between 2016 and 2017 to wage and program enrollment data from 2014 through 2019. Following new mothers for two years before and after their childbirth, we find a significant decrease in mothers’ employment in the quarters surrounding childbirth with a corresponding surge in reliance on safety net benefits. We also find that education, marital status, and income level were key determinants of shaping work and safety net usage patterns among first-time mothers. These shifts were especially pronounced among low socioeconomic status women, who demonstrate greater responsiveness in employment and safety net utilization around the time of birth. Our findings point to the importance of integrating both work and safety net program participation and demonstrate gaps where additional work-supports and safety net engagement would promote economic security. |
| Date: | 2026–01–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:85dmb_v1 |
| By: | Diego Ascarza-Mendoza (School of Government and Public Transformation, Tecnológico de Monterrey); Alex Carrasco (Massachusetts Institute of Technology) |
| Abstract: | Why do two out of three Americans claim Social Security benefits before reaching their Full Retirement Age? Why do even sufficiently rich people claim early very often? This paper resolves this puzzling phenomenon by extending a standard incomplete markets life-cycle model to incorporate health dynamics and bequest motives. Relative to the existing literature, health plays a broader role, affecting not only medical expenses and mortality but also directly the marginal utility of consumption. This role of health is disciplined using microdata on consumption, assets, income, and health from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS). The calibrated model successfully replicates the fraction of early claimers. Counterfactual exercises show that health-dependent preferences and bequest motives are crucial for this result. The model’s success is explained by a novel channel that comes from the interaction between the negative effect of worsening health on the marginal utility of consumption, the downward health trend because of aging, and bequest motives. These two elements reduce the gains from delaying by (1) making individuals more impatient and (2) increasing the strength of bequest motives relative to future consumption. The results suggest that governments aiming to insure against longevity must consider the complementary interaction between individual incentives to insure against longevity and health risks. |
| Keywords: | Health, MarginalUtility, Frailty Index, Social Security, Annuities |
| JEL: | F13 D72 D83 C91 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:gnt:wpaper:22 |
| By: | Chun Yee Wong (IUJ Research Institute, International University of Japan); Shugo Shinohara (Keio University) |
| Abstract: | Increasing the cost share for older people can be a policy solution for sustaining healthcare schemes in aging societies. However, its effects on health behaviours remain elusive. This study investigates the Japanese health insurance reform, which increased the copayment rate from 10% to 20% for people aged 70-74 years in 2014. Using data from the Japanese Ministry of Health, Labor and Welfare between 2013 and 2016, our analysis examined the impacts of increased copayment on positive and negative health behaviours among older people, including having regular meals, doing moderate exercise, having regular sleep, smoking, and drinking alcohol. The study found that while augmented cost sharing is associated with increased positive health behaviours, its impact on negative behaviours is complex, with no significant impact on smoking rates but mild upward alcohol consumption. The subsample analyses further reveal heterogeneous effects of increased copayment, in which individuals with higher education levels or those living in big cities are more likely to respond to the policy change by increasing positive health behaivours. This research contributes to the understanding of the complex interplay between health insurance coverage and health behaviours among older adults, highlighting the importance of considering socio-demographic factors in promoting healthy aging. |
| Keywords: | Copayment, Health Insurance, Health Behaviours, Older Adults, Japan |
| JEL: | I12 I15 I18 |
| Date: | 2026–02 |
| URL: | https://d.repec.org/n?u=RePEc:iuj:wpaper:ems_2026_02 |
| By: | Daniel Ershov; Jessica Fong; Pinar Yildirim |
| Abstract: | This paper studies how online dating platforms have impacted marital outcomes, assortative matching, and sexually transmitted disease (STD) rates in the United States. We construct county-level measures of online dating usage using data from website-based platforms (2002–2013) and mobile app-based platforms (2017–2023). Leveraging county-level variation and an instrumental variable strategy, we show in the desktop era, a 1% increase in online dating sessions raises divorce rates by 0.50%, while in the mobile era, a 1% increase in online dating activity lowers marriage and divorce rates by 0.40% and 0.33%, respectively. We also document shifts in assortative matching. Desktop sites reduce sorting along education and employment dimensions, whereas mobile sites reduce sorting by employment, but increase sorting by race. Across both eras, we find no evidence that greater online dating usage increases average STD rates. Average effects are negative or statistically insignificant, but are positive for some subpopulations. We develop a search and matching model where technological changes that impact search costs, market size, and market noise can explain our empirical findings. |
| JEL: | L12 L16 M0 M1 M10 M13 M15 M20 M3 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34757 |
| By: | Mevlude Akbulut-Yuksel (Dalhousie University); Dozie Okoye (Dalhousie University); Belgi Turan (TOBB University of Economics and Technology) |
| Abstract: | This study examines the long-term effects of the PKK conflict in Turkiye, using a difference-in-differences approach to exploit variations in conflict intensity across regions and cohorts. Our findings indicate that exposure to conflict during childhood significantly reduces educational attainment and adversely affects labor market outcomes in adulthood. Specifically, affected individuals are less likely to complete primary and secondary school and are more likely to be informally employed or engaged in low-skill jobs. In addition, exposure to conflict is associated with lower skill levels and a decreased likelihood of employment in the formal and manufacturing sectors, especially for males. Furthermore, we find that parental exposure to conflict negatively impacts the health outcomes of their children, particularly their height and weight for age, although the educational impacts generally do not persist into the second generation. These results are robust to the use of alternative samples and specifications, including controlling for migration and excluding the less affected regions and the major urban centers. Our findings highlight the profound and lasting impact of conflict on human capital development, emphasizing the importance of targeted policies to support affected children. |
| Date: | 2025–12–20 |
| URL: | https://d.repec.org/n?u=RePEc:erg:wpaper:1818 |
| By: | Wilson King; Edward Miguel; Michael W. Walker |
| Abstract: | Taller people earn more, especially in low- and middle-income countries. We present among the first evidence of this phenomenon in Africa, using longitudinal microdata on a cohort of middle-aged Kenyan adults. We document a substantial height/earnings premium: controlling for gender, age, and other socio-demographics, monthly earnings increase by 1.07% per centimeter (or 2.72% per inch). Nearly half this effect can be explained by differences in cognition, measured from an unusually rich battery containing 27 modules. Additional shares of the premium can be attributed to measures of physical strength and non-cognitive ability. In contrast to prior work, we find little role for occupational sorting: conditional on cognitive and non-cognitive ability, taller people do not appear more likely to work in higher paid sectors. Leveraging repeated measures of height and an instrumental variables specification, we find suggestive evidence that measurement error may be attenuating the estimated relationship. |
| JEL: | I15 J1 O11 |
| Date: | 2026–01 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34769 |
| By: | Salamatu Nanna Adam |
| Abstract: | Understanding what drives people to get tested for HIV is essential for designing effective communication strategies that promote test uptake. In this study, I use a randomized experiment to examine whether and how the format of information affects HIV testing behavior among university students in Ghana. Providing factual information on HIV incidence and the availability of nearby testing services increased actual testing rates by about 1 percentage point from a near-zero baseline. In contrast, adding a story about the testing experience to this statistical information did not generate any additional effect. Financial incentives, introduced non-randomly, raised testing rates to 11 percent. Interestingly, the impact of the original information treatments diminished when a financial incentive became available. Analysis of belief outcomes indicates that the information treatment primarily worked by increasing awareness of local testing services and correcting misperceptions about peer testing behavior, rather than by heightening perceived risk. However, stories did not enhance the treatment effect on beliefs or information recall beyond the impact of simple statistical facts. These results suggest that factual information can effectively address informational barriers to HIV testing in this context, while narrative elements offer no measurable added benefit for influencing this high stakes health behavior. |
| Keywords: | Beliefs, Recall, Stories/Narratives, Statistics, Information, Incentives |
| JEL: | D83 D91 I12 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:cer:papers:wp805 |
| By: | Ambel, Alemayehu A.; Belete, Getachew Yirga |
| Abstract: | This study investigates the distribution of benefits from public health care spending in Ethiopia by combining individual health care utilization data from the 2018/19 and 2021/22 waves of the Ethiopia Socioeconomic Panel Survey with regional budget information. It analyzes how health care subsidies and out-of-pocket expenditures are distributed across income groups and rural-urban settings. The results show that, although public health care use and subsidies are generally progressive, they tend to favor wealthier individuals. Further disaggregation by facility type and location over time provides deeper insight into these distributions. Hospital care subsidies are largely pro-rich, while benefits from health centers and posts are strongly pro-poor. Furthermore, rural residents face regressive out-of-pocket costs. However, the longitudinal nature of the data allowed an assessment of temporal changes, showing recent improvement in pro-poorness at primary facilities. Subsidies at health centers and health posts demonstrated an increased pro-poor orientation between 2019 and 2022, which was particularly strong for outpatient and inpatient services in urban areas. The observed trends over time suggest potential to reduce disparities across all service types, including hospital care, through targeted approaches aimed at improving community access to these facilities. These fin dings have significant implications for equity in health care financing and inform policy priorities aimed at achieving universal health coverage in Ethiopia. |
| Date: | 2026–01–12 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11293 |
| By: | Leon Iusitini (Auckland University of Technology); Gail Pacheco (Auckland University of Technology); Thomas Schober (Auckland University of Technology) |
| Abstract: | Childhood immunisation coverage in New Zealand has fallen since 2016, with the decline accelerating during the COVID-19 pandemic. Using administrative data from Stats NZ's Integrated Data Infrastructure, we examine determinants of immunisation uptake and how these have changed over time. We find that the likelihood of being fully immunised is lower among Māori children, later-born children, and children in lower-income households. We also identify weaker connection to primary care, particularly non-enrolment with a Primary Health Organisation, as an important factor associated with lower uptake. Although observed characteristics changed over time, these changes explain only a small share of the overall decline in uptake, suggesting an important role for unobserved factors. Finally, we find that parental COVID-19 vaccination and maternal vaccinations during pregnancy are strongly associated with children's uptake. |
| Keywords: | Childhood immunisation, vaccine uptake, New Zealand, Integrated Data Infrastructure (IDI) |
| JEL: | I12 I18 I14 C21 |
| Date: | 2026–02–05 |
| URL: | https://d.repec.org/n?u=RePEc:aut:wpaper:2026-02 |
| By: | Ogurcova, Ilona |
| Abstract: | The efficiency and quality of healthcare services increasingly depend on the application of advanced governance, risk management, and control models. Internal audit, when conducted in line with international professional standards, has the potential to act not only as a control mechanism but also as a strategic partner contributing to organizational resilience and value creation. In 2024, The Institute of Internal Auditors (IIA) introduced the Global Internal Audit Standards, strengthening the emphasis on professionalism, independence, competence, and strategic alignment of the internal audit function across all sectors, including the public healthcare system. This article examines the challenges of applying these global standards within the Lithuanian healthcare sector, focusing on a specific regulatory requirement that mandates medical or health sciences education for the head of internal audit (the so-called internal medical audit). Through a systematic analysis of the Global Internal Audit Standards, national legislation on public sector internal audit, and sector-specific regulations issued by the Ministry of Health, the study identifies a fundamental normative tension between international audit professionalism and sectoral qualification restrictions. The article argues that internal audit effectiveness derives primarily from professional audit competencies, independence, and risk-based methodologies rather than from subject-specific clinical education. Drawing on an analogy with information technology audits, the analysis demonstrates that complex, knowledge-intensive sectors can be audited effectively through professional internal auditors who engage subject matter experts without compromising objectivity. The findings suggest that the current regulatory model risks professional isolation of healthcare auditors, reduced audit value, weakened organizational resilience, and inefficient allocation of scarce healthcare resources. The article concludes that aligning national healthcare audit regulation with the Global Internal Audit Standards would strengthen governance, enhance risk management, and enable internal audit to function as an integral component of professional management and innovation within healthcare institutions. |
| Date: | 2026–01–29 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:sav3b_v1 |
| By: | Workineh Ayenew; Andreas Kotsadam; Charlotte Ringdal; Espen Villanger |
| Abstract: | Armed conflict has far-reaching effects on household well-being, including increased risk of violence. We examine whether changes in local armed conflict exposure are associated with changes in caregiver-perpetrated physical punishment of children. We link six waves (2016–2021) of panel survey data from employed women in Ethiopia (1, 065 respondents; just over 5, 000 respondent-wave observations) to geo-referenced conflict events from ACLED. Using respondent and wave fixed-effects linear probability models, we find that a one–standard–deviation increase in conflict exposure (18.8 events) increases the probability of physical punishment by any caregiver by 3.4 percentage points (pp) (≈ 5.2% relative to the mean), father punishment by 2.7 pp (≈ 6.4%), mother punishment by 3.6 pp (≈ 5.6%), and punishment by both caregivers by 2.9 pp (≈ 7.3%). A decomposition into presence versus intensity indicates a sizeable increase at conflict onset, with smaller incremental increases as events accumulate. Conflict exposure also coincides with higher caregiver distress and indicators of economic strain, including reduced labor supply and lower reported income among fathers. These findings suggest that conflict can spill over into harsher parenting, highlighting the importance of integrating child protection, caregiver mental health support, and livelihood assistance into conflict-response programming. |
| Keywords: | civil conflict, ethiopia, violence against children |
| JEL: | I1 J12 J13 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:hic:wpaper:451 |
| By: | David Bardey (UNIANDES - Universidad de los Andes [Bogota]); Philippe de Donder (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); Vera Zaporozhets (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: | This survey examines the economic literature on the incentives that shape both the use and the development of diagnostic tests, with a particular focus on companion (biomarker) tests central to precision medicine. Misdiagnosis, underdiagnosis, and overdiagnosis represent a substantial global burden, driving healthcare costs and adverse patient outcomes. The study synthesizes theoretical, empirical, and experimental evidence to assess how healthcare providers' decisions regarding diagnostic tests are influenced by payment schemes, altruism, and time constraints. Fee-for-service arrangements are shown to encourage excessive testing, while capitation and salary-based contracts help contain costs, though sometimes at the expense of quality. Physicians' non-monetary motivations, such as altruism and reputational concerns, interact with financial incentives in complex ways, occasionally leading to unintended consequences such as undertesting. From a normative perspective, the literature highlights the trade-offs inherent in reimbursement design: mandating even costless diagnostic tests is not always optimal, and greater altruism does not necessarily enhance welfare. Current practices, such as reimbursing biomarker tests separately from associated treatments in the U.S., are criticized for discouraging their adoption. At the industry level, the survey explores incentives for developing innovative tests. Pre-approval companion tests can improve drug approval prospects and justify higher prices, whereas post-approval test development faces weaker incentives due to reduced market size. Competition among firms strengthens incentives relative to monopolistic settings, but test introduction may also dampen price competition. The findings suggest that pay-for-performance schemes, procurement design, and value-based pricing can help better align private and social incentives for both test use and development. Overall, the survey underscores the importance of carefully designed reimbursement mechanisms and policy tools to promote the efficient integration of diagnostic innovations into healthcare systems. |
| Keywords: | Incentives, Healthcare Systems, Diagnostic Tests |
| Date: | 2025–10–23 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05468072 |
| By: | Chia-Jung Tsai (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | Throughout history, disease outbreaks have triggered discrimination and avoidance toward groups perceived as carriers, which reflects a persistent pattern of "othering" in response to health threats. This study examines how COVID-19 threat perceptions influenced avoidance behaviors toward specific ethnic groups and investigates the mediating role of trust in different information sources. Using data from an online survey conducted via Meta Advertising Manager in Europe and the United States during the early stages of the pandemic, the research reveals three key findings. First, perceived COVID-19 threats correlated with avoidance behaviors toward restaurants, products, and human contact, with stronger associations observed toward Asians compared to Iranians and Italians. Second, higher perceived threats positively correlated with increased trust in most information channels, though the relationship varied by country. Third, the study identifies a crucial mechanism where trust in social media networks and personal acquaintances acts as a key factor in transforming perceived pandemic threats into ethnically targeted avoidance behaviors, while traditional information sources like medical professionals and newspapers showed no such effect. These findings demonstrate how global health crises can inadvertently reinforce xenophobic attitudes through information dissemination channels and offer insights for preventing racial and ethnic biases during public health emergencies. |
| Keywords: | Europe, USA |
| JEL: | J1 Z0 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:dem:wpaper:wp-2026-003 |
| By: | Attanasi, Giuseppe; Ciucani, Carlo (CNR); Morone, Andrea; Morone, Piergiuseppe; Tiranzoni, Paola |
| Abstract: | This paper refers to interview data collected in six municipalities in the Lecce province of southern Italy, across three waves: 2020, 2021, and 2022. The principal aim of the research was to determine whether compliance with four government-recommended non-pharmaceutical measures to prevent the spread of COVID-19 differed over the years and, if so, whether these differences were influenced by personal characteristics. Specifically, we focused on the psychological features of self-control, risk attitude, and fear of contracting COVID-19 and their relationships with indoor and outdoor mask use, and indoor and outdoor physical distancing. The results suggest that virus mortality, the regulations in force, and experience of the pandemic affected compliance with certain preventive measures across all waves. With regard to psychological features, the three factors of interest were found to determine preferences and substitutions across measures. |
| Date: | 2026–01–22 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:s5fa4_v1 |
| By: | Alexander Bertermann; Hannah Schildberg-Hörisch |
| Abstract: | This paper provides the first evidence that children’s economic preferences vary systematically with parental mental health. Using experimentally elicited measures of economic preferences from more than 4, 500 children in Bangladesh, we document that children of parents with indications of mental illness are less prosocial but more patient than their peers with mentally healthy parents. Attitudes toward risk remain unchanged. We discuss potential pathways through which parental mental health may influence the formation of children’s preferences, documenting that children of parents with indication of mental illness assume greater responsibilities within the family, experience less parental involvement, and are exposed to a more adverse home environment. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ifowps:_424 |
| By: | Lepe, Alexander; Kolodziej, Ingo; Zinn, Sabine |
| Abstract: | This paper examines the gaps in Germany's pandemic data infrastructure revealed during COVID-19 and argues that linking the Socio-Economic Panel (SOEP) with administrative health records would strengthen the country's ability to monitor infectious diseases and their social distribution. Drawing on evidence from the RKI-SOEP study, we illustrate the added value of combining a rich household survey with infectious disease data. We discuss why such linkages remain limited in Germany, outline practical possibilities for implementation, and show how integration could support more timely and equitable evidence during future public health crises while also enabling broader health and social research. |
| Abstract: | Dieser Beitrag untersucht die während COVID-19 zutage getretenen Lücken in der deutschen Pandemiedateninfrastruktur und argumentiert, dass eine Verknüpfung des Sozioökonomischen Panels (SOEP) mit administrativen Gesundheitsdaten die Möglichkeiten des Staates verbessern würde, Infektionskrankheiten und deren gesellschaftliche Verbreitung zu verfolgen. Anhand von Erkenntnissen aus der RKI-SOEP-Studie veranschaulichen wir den Mehrwert einer Verknüpfung von umfangreichen Haushaltsbefragungen mit Daten zu Infektionskrankheiten. Wir diskutieren, warum solche Verknüpfungen in Deutschland nach wie vor eingeschränkt sind, skizzieren praktische Möglichkeiten für die Umsetzung und zeigen, wie die Integration zeitnahere und ausgewogenere Erkenntnisse während künftiger Krisen im Bereich der öffentlichen Gesundheit liefern und gleichzeitig eine breitere Gesundheits- und Sozialforschung ermöglichen könnte. |
| JEL: | C89 I18 I19 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:rwirep:335895 |