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on Health Economics |
| By: | Charles F. Manski |
| Abstract: | I critique a set of entrenched methodological conventions that collectively create systemic dysfunction in statistical research for clinical decisions. These include: (1) the prevalent use of hypothesis tests to compare treatments, (2) remoteness from patient care of the methods used to evaluate the accuracy of predictions of patient outcomes, (3) poor practice of meta-analysis to combine findings across studies, and (4) widespread research with incredible certitude. It appears that the dysfunction is held in place by three factors: (i) rudimentary instruction in statistical methodology received by medical students and residents, (ii) reliance of clinical researchers on consulting biostatisticians, wo act as statistical gatekeepers in evaluation of grant proposals and paper submissions, and (iii) institutional practices of research funding agencies, medical journals, and governmental bodies that regulate medical treatment. I conjecture that systemic changes are necessary to break the existing impasse, moving statistical research to a better equilibrium. |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2607.23660 |
| By: | David E. Frisvold; Felipe Lozano Rojas |
| 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. |
| JEL: | D12 H51 H53 H75 I38 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35613 |
| By: | Meltem Daysal (Department of Economics, University of Copenhagen); Camille Fredrickson (University of Chicago); Ida Lykke Kristiansen (Department of Economics, University of Copenhagen); Mircea Trandafir (ROCKWOOL Foundation); Jonathan Zhang (Duke University) |
| Abstract: | We estimate the causal impacts of GLP 1 treatment on labor market outcomes using linked Danish administrative data and a matched stacked difference in-differences design. We compare patients who initiate GLP 1 treatment during the first two years of Semaglutide availability to observably similar patients who initiate four years later. We find that GLP 1 treatment reduces long term sickness leave by 17.3%. We estimate total fiscal benefits of GLP 1 initiation of approximately 1.3 1.5% of annual labor income per employed individual. We do not detect statistically significant or economically meaningfulimpacts on income, labor force participation, or employment over four years. |
| Keywords: | Health, Public Economics, GLP 1 |
| JEL: | H20 I10 |
| Date: | 2026–08–07 |
| URL: | https://d.repec.org/n?u=RePEc:kud:kucebi:2617 |
| By: | Janet Currie; N. Meltem Daysal; Mette Gørtz; Jonas Hirani |
| Abstract: | We ask how a younger sibling's physical disability affects sibling mental health using Danish register data on families with three or more children. Difference-in-difference models compare first- and second-born children when the third-born does or does not have a disability. Use of mental health services increases 13% among second-born children, with a 23% increase in psychiatric visits and an 18% increase in use of psychiatric medications. Effects are concentrated in households where the mother has less than high school and persist after conditioning on child test scores. Parental responses suggest that caregiving demands, stress, and strained resources are potential mechanisms. |
| Keywords: | Disability, Mental Health, Siblings, Children |
| JEL: | I14 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26186 |
| By: | Peter Nilsson; Evelina Linnros |
| Abstract: | We estimate the long-term mental health impact of an alcohol policy experiment on individuals exposed to the policy in utero. The policy lasted for 8.5 months and significantly expanded access to alcohol, especially for those under age 21. Armed with administrative data on healthcare visits, drug prescriptions, and psychological assessments and applying a triple-differences strategy, we show that prenatal policy exposure had a substantial, early, and persistent impact on the mental health of the children of young mothers. The exposed cohorts conceived just before the policy started are 16% more likely to be diagnosed with a mental condition in midlife. We find effects on common midlife conditions such as depression and anxiety, on the ability to cope with psychologically stressful situations at age 18, and on neurodevelopmental disorders that manifest in early childhood. Among individuals with predicted mental health care needs, the impact of the policy on midlife earnings is significantly lower when they reside in areas with lower barriers to accessing mental health care, with a one-standard-deviation increase in local treatment intensity reducing the negative earnings effect by about one-third. Our findings indicate that policies increasing access to mental health treatments could substantially improve labor market outcomes, even for conditions with early-life origins. |
| Keywords: | FASD, ADHD, depression, earnings, treatment barriers, prenatal alcohol, boys |
| JEL: | I12 J13 J18 J30 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26220 |
| By: | Benjamin Hansen; Niketana Kannan; Jonathan Zhang |
| Abstract: | This paper examines the impact of the National Suicide Hotline Designation Act, which introduced the universal 988 calling code and earmarked federal funding to suicide crisis call centers in July 2022. We use a difference-in-differences design that leverages pre-existing cross-state variation in crisis line capacity gaps, measured by the number of pre-988 calls routed to a state but not answered in-state. The rollout substantially improved crisis line operations in states with larger baseline capacity gaps: these states answered more calls in-state and increased their in-state answer rates. However, these operational gains did not translate into detectable reductions in suicide mortality. The mortality estimates are precise enough to rule out even modest short-run reductions. We also find no statistically significant improvements in broader population mental health outcomes. These findings suggest that expanding crisis line capacity alone may be insufficient to reduce suicide deaths. |
| JEL: | H51 I12 I18 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35601 |
| By: | Conti, Gabriella; Kliem, Soeren; Sandner, Malte |
| Abstract: | We study the impacts of a prenatal and infancy home visiting program targeting disadvantaged families on mental health outcomes, assessed through diagnostic interviews. The program significantly reduced the prevalence of mental health conditions for both mothers and children, measured at primary-school age, and broke the intergenerational association of these conditions. The impacts are predominantly associated with a particular delivery model, wherein a single home visitor interacts with the family, as opposed to a model involving two home visitors. |
| JEL: | I12 J21 J13 J16 |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19327 |
| By: | Cremer, Helmuth; Lozachmeur, Jean-Marie |
| Abstract: | We study the design of nonlinear reimbursement rules for expenses on secondary preventive and on therapeutic care. With some probability individuals are healthy and do not need any therapeutic health care. Otherwise they become ill and the severity of their disease is realized and identifies their ex post type. Preventive care is determined ex ante, that is before the health status is determined while curative care is chosen ex post. Insurance benefits depend on preventive and curative care in a possibly nonlinear way, and marginal benefits can be positive or negative. In the first best, achieved when health status is ex post publicly observable, insurance benefits are flat (lump sum payments) and do not depend on expenditures. When the severity of the disease is not observable, so that there is ex post moral hazard, this solution is not incentive compatible (for more healthy individuals). The optimal insurance then implies benefits that increase with both types of care. This is because health expenditures reduce informational rents and they are upward distorted. This relaxes the incentive constraint because less healthy individuals value care more than healthy individuals. Even though preventive care is chosen ex ante, when there is no asymmetry of information, it does have an impact on the incentive constraint and thus on informational rents. This is due to two concurring effects. First, prevention is more effective for the more severely ill. Second, these individuals also have a lower marginal utility of income so that a given level of expenditure on preventive care has less impact on their utility. Finally, when individuals misperceive the benefits of preventive care, our results remain valid, but there is now an extra corrective (Pigouvian) term in the expression for the marginal reimbursement of preventive care. |
| JEL: | I11 I13 I18 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19200 |
| By: | Peter Haan; Julia Schmieder; Izabela Wnuk-Soares |
| Abstract: | We study how immigration affects prices through changes in labor supply. Using policy-driven increases in immigration to Germany and administrative data covering the universe of nursing homes, we find that one additional foreign-born woman per 100 residents reduces nursing-home care prices by 2.6 percent. The price effects are concentrated in more competitive markets. Examining potential mechanisms, we find that immigration lowers labor costs as nursing homes shift toward lower-paid foreign-born workers. We find no evidence of declines in inspection-based measures of quality or of scale effects. Finally, immigration increases the use of informal care, potentially strengthening competitive pressure from the broader care market. |
| Keywords: | Immigration, labor supply, prices, nursing homes |
| JEL: | J61 F22 J30 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:diw:diwwpp:dp2177 |
| By: | Melissa McInerney; Lorena Moreno; Jennifer M. Mellor |
| Abstract: | In this paper, we compare supplemental Medicare insurance coverage among people with probable dementia (PWPD) and matched controls, before and after onset. This retrospective secondary data analysis of insurance coverage changes using propensity score weights and the 2000-2016 Health and Retirement Study (HRS). The sample consists of 3, 001 Medicare-enrolled adults age 65 and older with PWPD, and 14, 055 controls. Probable dementia is assessed with the Langa-Weir approach and interviewer assessments for proxy interviews. Four years before onset, PWPD become more likely to have Medicare without supplemental coverage (2.97 percentage points; p=0.0016) than matched controls. This reflects the net effect of PWPD being less likely to have Medicare Advantage or traditional Medicare with supplemental coverage, and more likely to have Medicaid. Two years before onset, PWPD were more likely to be Medicaid-eligible (4.95 percentage points, p |
| JEL: | I1 I13 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35606 |
| By: | Diane E. Alexander; Molly Schnell |
| Abstract: | This paper examines how selection into medicine in the United States influences physician practice styles. We exploit macroeconomic conditions at the time of medical school application as an exogenous shock to the applicant pool and find that labor market downturns in other prestigious fields increase applications to medical school and shift the composition of matriculating cohorts toward students from non–pre-medical backgrounds. Strikingly, these low–outside-option cohorts practice medicine differently decades later. Conditional on experience, specialty, and outcome year, recession-cohort physicians bill Medicare more per beneficiary despite seeing healthier patients—particularly on discretionary, revenue-generating services—and sort into practice settings with higher-powered financial incentives. The additional spending does not produce detectable improvements in patient health. Taken together, our findings point to stronger financial motivation among those drawn into medicine when outside options are weak and suggest that medical school admissions screen imperfectly on the attributes that ultimately shape how physicians practice. |
| JEL: | E32 I11 I23 J24 J44 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35631 |
| By: | Xin Zhang; Yixuan Wang; Xingyi Hu; Xi Chen |
| 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. |
| JEL: | D13 I14 I24 J13 J16 Q53 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35591 |
| By: | Fella, Giulio; Holm, Martin Blomhoff; Pugh, Thomas M. |
| Abstract: | We use administrative data for Norway to estimate an incomplete-market life-cycle model of retired singles and couples with a bequest motive, health-dependent utility, and uncertain longevity and health. We allow the parameters of the bequest utility to differ between households with and without offspring. Our estimates imply a very strong utility of residual wealth (bequest motive), in line with the estimates by Lockwood (2018). The bequest motive accounts for approximately three-quarters of aggregate wealth at age 85. More surprisingly, we estimate similar utility of residual wealth for households with and without offspring. We interpret this as, prima facie, evidence that the utility of residual wealth represents forces beyond an altruistic bequest motive. |
| Keywords: | Retirement; Savings |
| JEL: | D11 D12 D14 E21 |
| Date: | 2024–07 |
| URL: | https://d.repec.org/n?u=RePEc:cpr:ceprdp:19233 |
| By: | David G. Blanchflower; Alex Bryson; Anthony Lepinteur; Alan Piper |
| Abstract: | A substantial literature finds poor mental health is hump-shaped with respect to age, whilst subjective wellbeing is U-shaped. Recent cross-sectional studies indicate a change in this relationship driven by the declining mental health of the young. We contribute to this literature by re-examining the age patterns in subjective wellbeing and illbeing for individuals in five European countries (France, Germany, Italy, Spain and Sweden). We do so with fifteen waves of the COME-HERE (CH) panel survey for 2020-2025 plus data from the Global Minds (GM) surveys of 2020-2026 for the same countries. We show that wellbeing rises and illbeing declines in a roughly monotonic fashion with age. This is found both with cross-section data from the CH and GM data, and from longitudinal plots of person fixed effects by age in the CH data. |
| Keywords: | subjective wellbeing; mental health; age; despair; panel data |
| JEL: | I31 I38 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:crm:wpaper:26200 |
| By: | Caroline Namubiru; Jörg Baten; Alberto Batinti; Joan Costa-i-Font |
| Abstract: | Although compulsory education (CE) laws have widened access to schooling and shaped economic, social, and health outcomes, it remains unclear whether they reduce long-run health inequalities. We study the effect of CE policies on health inequality using height Gini indices for 66 countries between 1810 and 2000, estimating intent-to-treat effects through a staggered difference-in-differences design. Our results indicate that CE exposure reduces the height Gini. The inequality-reducing effect appears to operate mainly through increased years of schooling and reduced fertility. The effect is not uniform across regions, being largest in Europe, and it is driven largely by later extensions of CE duration rather than initial adoption alone. Overall, the findings indicate that education policy can meaningfully narrow health disparities over time, but its effectiveness depends on the scale of the mandate and the timing of adoption. |
| Keywords: | compulsory education, height, height inequality, health inequality, Gini index, economic development, human capital, education policy, anthropometric history, difference-in-differences |
| JEL: | I14 I15 I24 I25 I28 N30 O15 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12919 |
| By: | Nicole Siegal; Sumedha Gupta; Matthew C. Aalsma; Stephen Crystal; Jennifer Miles; Hillary Samples; Allen Campbell; Kosali I. Simon; Rosalie Liccardo Pacula |
| Abstract: | Buprenorphine prescribing for opioid use disorder remains far below the scale of the overdose crisis. We estimate the causal effect of county-level synthetic opioid overdose mortality shocks on the volume of buprenorphine treatment delivered, exploiting the staggered geographic diffusion of synthetic opioids from 2013 to 2023. Linking IQVIA Longitudinal Prescription Claims to National Vital Statistics System mortality records, we implement a difference-in-differences estimator with propensity score matching under three complementary exposure measures. Treatment volume increases significantly under all three definitions, with no evidence of differential pre-trends; point estimates for buprenorphine prescribing rates range from 5 to 17 percent of pre-treatment means, emerge within one to two quarters, and grow monotonically thereafter. Our design does not separately identify changes in patient demand and provider behavior, but the increase in unique prescribers is consistent with a provider-side response. The response is concentrated among advanced practice providers, Medicaid patients, and counties with pre-existing buprenorphine infrastructure; counties with little baseline prescribing show no response. Local mortality information acts as a determinant of treatment volume, with effects comparable in magnitude to major legislative interventions aimed at expanding treatment, but appear only where prescribing capacity already exists. |
| JEL: | I10 I12 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35648 |
| By: | Abdel Ghany, Jasmin; Romell, Emma; Wilde, Joshua |
| Abstract: | A large body of research documents the harm that armed conflict inflicts on the health of populations in conflict zones. Yet if violence injures collectivities rather than only those who experience it directly, its health consequences should extend to those who identify with affected populations wherever they reside. We test this hypothesis by examining the effects of the October 7, 2023, attacks in Israel and the ensuing onset of the Gaza War on infant health in the United States among mothers born in Israel, the West Bank, and neighboring, Arab, and Muslim-majority countries. In a novel application of the event-study design, we trace month-by-month changes in preterm birth and low birthweight – outcomes that shape health and socioeconomic attainment throughout the life course. Our analyses show that the Israel-born diaspora experienced an immediate, short-lived reversal in their previously substantial infant health advantage after the October 7 attacks. Infant health also deteriorated among mothers born in neighboring, other Arab, and other Muslim-majority countries. These findings indicate that the health consequences of violence are not confined to the conflict zone but extend to geographically distant diaspora communities who are connected to the affected populations by shared national and ethnic origin and religion. |
| Date: | 2026–08–19 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:zhyr7_v1 |
| By: | Weihua An; Pablo Estrada; Juan Estrada; David Jacho-Chavez |
| Abstract: | This paper proposes a model-based empirical method to identify influential individuals in risky behaviors. To determine the most influential individuals, we estimate peer influence using observational cross-sectional data from multiple social connections. Our empirical strategy employs the observed characteristics of distant individuals across multiple social networks as instruments to address the endogeneity arising from homophily. Using Add Health data, we find positive peer effects from friends and classmates on both cigarette smoking and marijuana use. Based on the estimated peer effects, we characterize the influencers in our sample. |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2608.01415 |
| By: | Escobar Carias, Michelle (Business School, Newcastle University); Baranov, Victoria (Department of Economics, University of Melbourne); Bhalotra, Sonia (Department of Economics, University of Warwick); Biroli, Pietro (Department of Economics, University of Bologna); Maselko, Joanna (Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina) |
| Abstract: | Does past treatment for depression create resilience to future shocks? We study a randomized CBT-based intervention for prenatally depressed mothers in Pakistan and exploit variation in COVID-19 restriction stringency six years after childbirth. Treated women were protected against restriction-induced anxiety, depression, comorbidity, and functional impairment. Pro tection extended to spousal relationships, offsetting restriction-driven declines in relationship quality and increases in marital conflict. This resilience operates through psychological channels: the intervention builds locus of control and self-efficacy, strengthens family and partner support, and reduces how overwhelmed women feel when shocks arrive. The resulting psycho logical capital has returns well beyond the treated condition. |
| Keywords: | Resilience, mental health, functioning, spousal conflict, restrictions JEL Classification: G18, I12, J12, J16 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:cge:wacage:819 |
| By: | Martin, Josh; Geiger, Ben Baumberg |
| Abstract: | There has been a considerable increase in the number of people in the UK reporting that they are economically inactive due to long-term sickness or disability since the coronavirus pandemic, which has attracted policy and research interest. The key data source for these trends is the UK Labour Force Survey (LFS), which has seen a sharp decline in response rates and issues associated with population weighting over recent years. It therefore remains unclear whether the rise in reported rates of sickness is a genuine phenomenon or a statistical artefact. We examine the role of proxy responses and survey mode on the LFS to test the robustness of the trends in sickness. In so doing, we shed light on the important role of proxy responses on the LFS, particularly in the domains of young people and health status. We find considerable selection effects associated with proxy response, and very high rates amongst young people. The increase in incidence of reported long-term sickness may be slightly smaller when accounting for changing survey response patterns, although other findings also suggest the reverse; either way, the increase is not simply a methodological artefact. |
| Keywords: | long-term sickness; economic inactivity; coronavirus pandemic; proxy responses; survey methodology; household surveys; survey methods |
| JEL: | C81 C83 J21 |
| Date: | 2026–07–15 |
| URL: | https://d.repec.org/n?u=RePEc:eoe:escoed:escoe-dp-2026-10 |
| By: | Elizabeth Rhodes; David E. Broockman; Eva Vivalt; Patrick K. Krause; Sarah Miller; Alexander W. Bartik |
| Abstract: | When an individual's income changes, it can affect their entire household. We study the intrahousehold effects of an unconditional cash transfer in which 1, 000 individuals were randomly selected to receive a $1, 000 per month transfer for three years, while a control group of 2, 000 participants received $50 per month over the same time period. We find no effects on aggregate measures of household stability, although there is suggestive evidence of improved relationship quality and greater trust in partners among recipients in relationships. Transfers to friends and family increase, consistent with recipients sharing some of the additional income with others. There are also spillovers on the income and employment-related outcomes of other household members: household income excluding the recipient decreases by about $1, 700 per year, and partners are less likely to be promoted or to move to a better job. Other household members are significantly more likely to participate in education or training, and recipients are also more likely to report someone in their household having to forgo healthcare, potentially reflecting greater engagement with the healthcare system and the identification of previously unmet needs. We observe limited changes in decision-making power or division of labor within the household. Some indicators of intimate partner violence decline, particularly for women, but reported incidence is low and most estimates do not remain statistically significant after adjustment for multiple hypothesis testing. Subgroup differences are generally imprecise, although point estimates suggest larger education and health spillover effects when the recipient is a woman. Household structure also appears to mediates the impacts of the transfers. |
| JEL: | C93 D13 H31 I30 J12 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35589 |
| By: | Paul Gertler; Ada Kwan |
| Abstract: | We provide evidence of fraudulent diagnostic misreporting leading to spending on unnecessary medical care and show that it is strongly associated with provider profit motivation and weak prosocial preferences. Using incognito standardized patients (SP) presenting identical acute malaria symptoms as real walk-in clients to private providers in Kenya, we observe diagnostic and treatment decisions under controlled conditions with externally verified disease status. Because the SPs were confirmed to be malaria-negative, any reported positive diagnosis is a false positive by construction. Providers ordered malaria tests in 81% of the SP encounters. Conditional on administering a malaria test, providers report false positive results in 30% of encounters, substantially exceeding the approximately 3-5% false positive rates reported for the same malaria tests in diagnostic accuracy studies. This occurs despite near-perfect knowledge of appropriate diagnostic protocols. We link this behavior to provider preferences measured using a real-stakes, modified dictator game. While ordering a test is uncorrelated with preferences, the top 25% most profit-motivated providers report 16 percentage point (pp) more false positives and sell 20 pp more antimalarial drugs than more altruistic providers, conditional on ordering a malaria test. Misreporting is accompanied by selective concealment of diagnostic evidence from patients. |
| JEL: | A13 I15 K42 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35627 |