|
on Health Economics |
| By: | Orazio Attanasio; Gabriella Conti; Pamela Jervis; Costas Meghir; Aysu Okbay |
| Abstract: | We evaluate impacts heterogeneity of an Early Childhood Intervention, with respect to the Educational Attainment Polygenic Score (EA4 PGS) constructed from DNA data based on GWAS weights from a European population. We find that the EA4 PGS is predictive of several measures of child development, mother’s IQ and, to some extent, educational attainment. We also show that the impacts of the intervention are significantly greater in children with low PGS, to the point that the intervention eliminates the initial genetic disadvantage. Lastly, we find that children with high PGS attract more parental stimulation; however, the latter increases more strongly in children with low PGS. |
| JEL: | I24 I26 I3 I38 O15 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33781 |
| By: | Samuel Antill; Jessica Bai; Ashvin Gandhi; Adrienne Sabety |
| Abstract: | Healthcare firms are filing for Chapter 11 bankruptcy at record rates. We find that bankruptcies increase healthcare staff turnover, worsen care, and harm patients. Using a difference-in- differences design, we estimate that a bankruptcy filing immediately increases staff turnover and worsens the firm’s performance on unannounced inspections. Next, using a patient- distance-to-facility instrument, we document that bankruptcies harm patients through increases in hospitalizations, physical restraints, and bedsores. Finally, we employ a randomized survey experiment of nursing home staff to confirm that bankruptcy filings increase voluntary departures and that replacement workers harm patients. |
| JEL: | I11 |
| Date: | 2025–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33763 |
| By: | Clemens, Jeffrey; Detering, Helena; Mahajan, Anwita |
| Abstract: | Due to the implementation and unwinding of a ``continuous coverage requirement'', the COVID-19 pandemic gave rise to the most dramatic changes in Medicaid enrollments in the program's history. Nationwide, enrollments rose by 23 million individuals from February 2020 through March 2023, then declined by roughly 15 million by late 2024. Notably, changes in per capita enrollments varied dramatically across the country, with several states experiencing net declines and several states seeing their enrollments rise, on net, by more than 5 percent of their populations. Through a mix of descriptive and causal analyses, we explore several hypotheses regarding the possible causes of these variations. We find that a wide range of provisions designed to ease the frictions of the continuous coverage provision's winding down have surprisingly little predictive power. Similarly, we find that variations in federal aid to state and local governments has no predictive power, suggesting that liquidity constraints had little influence on states' management of Medicaid enrollments during this period. Variations in political preferences, as proxied by Trump's 2016 vote share, have modest predictive power within the unwinding episode. Finally, states that enacted Medicaid expansions during the pandemic experienced relatively large net gains in enrollments. The baseline generosity of states' eligibility thresholds also predicts relatively large run-ups and net increases in enrollments. |
| Keywords: | continuous coverage, Medicaid, COVID-19, unwinding |
| JEL: | H5 H51 H75 I18 |
| Date: | 2025–04 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:125044 |
| By: | Emmanuel, Zachariah; Emmanuel, Maria; Aipoh, Godwin; Dickson, Vonke; Collins, Emma |
| Abstract: | This paper examines the effects of tobacco restrictions policy on respiratory health. We leverage the heterogeneous timing across states in the adoption of the policy from a sample of 8, 175 individuals between the ages of 18 and 21. Using the 2011 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), we estimate the impact of the Tobacco 21 MLSA policy on the prevalence of chronic obstructive pulmonary disease (COPD), a progressive lung condition marked by airflow obstruction due to prolonged exposure to irritants like cigarette smoke and air pollution. We find that the T21 MLSA policy lowered the risk of COPD by 11.4 percentage points, or approximately 6.7%, among young adults between the ages of 18 and 21. In addition, we find that the policy had a greater effect on male, black, and Hispanic populations. We also find the policy to be more effective among 20-year-old unemployed young adults with some college education. These findings suggest that the T21 MLSA policy has effectively reduced respiratory health problems among teenagers and young adults, supporting its public health benefits to society. Therefore, states that are yet to adopt the T21 MLSA policy should consider its potential to decrease the risk of COPD and, ultimately, tobacco-related mortality as a valuable component of their health policy. |
| Keywords: | Tobacco 21 MLSA policy, respiratory health, copd, |
| JEL: | I1 I12 I18 |
| Date: | 2025–03–26 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:124996 |
| By: | Massimo Anelli; Felix Koenig |
| Abstract: | We develop a revealed preference approach to measure the value of workplace amenities by analyzing how variation in non-wage job attributes affects excess mass in the earnings distribution at budget discontinuities. The approach formalizes the idea that workers are less responsive to monetary incentives when amenities constitute a larger share of total compensation. Applying this method to workplace safety during COVID-19 waves, we find that workers are willing to sacrifice 9% of their earnings to reduce weekly fatality risks by one in 100, 000. The findings suggest that conventional hedonic regressions substantially under-estimate the value of workplace safety. |
| Keywords: | non-wage amenities, labor supply, bunching, workplace safety, value of life, job satisfaction |
| Date: | 2025–05–06 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepdps:dp2100 |
| By: | Dasgupta, Shouro; Robinson, Elizabeth J. Z.; Shayegh, Soheil; Bosello, Francesco; Park, R. Jisung; Gosling, Simon N. |
| Abstract: | Heat stress affects the health of workers through physiological and behavioural responses, in turn, affecting the labour force through impacts on labour supply, labour productivity and labour capacity. In this Review, we explore the extent to which heat stress affects the labour force and discuss the corresponding occupational health and economic impacts. The relationship between labour force outcomes and temperature is largely nonlinear, declining sharply beyond peak thresholds. Observed and projected labour losses are heterogeneous across regions, sectors and warming levels. High-exposure sectors such as agriculture and construction are projected to experience the greatest losses under future warming, with ~33%, ~25% and ~18% declines in effective labour across Africa, Asia and Oceania, respectively, under a 3 °C warming scenario. Labour losses are also expected in low-exposure sectors such as manufacturing and utilities, but Northern Europe tends to benefit in the short run. These collective heterogeneous labour impacts lead to considerable reductions in global gross domestic product (GDP) and welfare, with projected GDP losses of 5.9% in South Asia and 3.6% in Africa. Improved local-scale exposure–response functions and incorporating adaptation into economic models are required to advance understanding of heat stress impacts on labour. |
| JEL: | R14 J01 |
| Date: | 2024–12–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:126135 |
| By: | Marianne Simonsen; Lars Skipper; Jeffrey A. Smith |
| Abstract: | This paper uses register-based data to analyze the consequences of a recent major Danish welfare reform for children's academic performance and well-being. In addition to work requirements, the reform brought about considerable reductions in welfare transfers. We implement a comparative event study that contrasts outcomes for individuals on welfare at the time of reform announcement before and after the implementation of the reform with the parallel development in outcomes for an uncontaminated comparison group, namely those on welfare exactly one year prior. Our analysis documents that mothers' propensity to receive welfare decreased somewhat as a consequence of the reform, just as we observe a small increase in hours worked. At the same time, we do not detect negative effects on short-run child academic performance. We do find small negative effects on children's self-reported school well-being and document substantial upticks in reports to child protective services for children exposed to the reform. |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2506.03927 |
| By: | Omar Chisari; Antonio Estache |
| Abstract: | We rely on a simple choice model of hospital-capacity decisions to highlight the relevance of policymakers’ behavioural biases in the management of health care demand uncertainty. We show that matching ex-ante the design of the fiscal approach to financing hospitals with the policymakers’ behavioural biases could reduce care-rationing risks. However, the effectiveness of the financing choice also depends on the levels of operational and social costs the policymakers decide to work with in their assessments of needs. The model can also be used ex-post to reveal undeclared behavioural biases and use this information to improve future financing policy designs. |
| Keywords: | Uncertainty, behavioural biases, hospital capacity, health care financing, social cost valuation |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:eca:wpaper:2013/391422 |
| By: | Fedele, Alessandro (Free University of Bozen/Bolzano); Tonin, Mirco (Free University of Bozen/Bolzano); Wiesen, Daniel (University of Cologne) |
| Abstract: | The health sector requires skilled, altruistic, and motivated individuals to perform complex tasks for which ex-post incentives may prove ineffective. Understanding the determinants of self-selection into health professions is therefore critical. We investigate this issue relying on data from surveys and incentivized dictator games. We compare applicants to medical and healthcare schools in Italy and Austria with non-applicants from the same regions and age cohorts. Drawing on a wide range of individual characteristics, we employ machine learning techniques for variable selection. Our findings show that higher cognitive ability, greater altruism, and the personality trait of conscientiousness are positively associated with the likelihood of applying to medical or nursing school, while neuroticism is negatively associated. Additionally, individuals with a strong identification with societal goals and those with parents working as doctors are more likely to pursue medical education. These results provide evidence of capable, altruistic, and motivated individuals self-selecting into the health sector, a necessary condition for building a high-quality healthcare workforce. |
| Keywords: | personality traits, cognitive ability, altruism, health professions, self-selection, machine learning |
| JEL: | I1 J24 J4 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17941 |
| By: | Li, Mingjian |
| Abstract: | This study examines whether Medicaid expansion under the Affordable Care Act (ACA) led to strategic income reductions to qualify for coverage. Using monthly data from the Survey of Income and Program Participation (2013–2019) and a regression discontinuity design, this paper finds that childless households in expansion states with earnings just above the eligibility threshold reduced their lowest monthly earnings by 39 percentage points of the Federal Poverty Level (roughly $700 for a two-person household) relative to those just below. The effect intensified as the mandate penalty increased and diminished after its repeal. Evidence suggests earnings adjustments along both intensive and extensive margins. The paper reinforces the validity of using the lowest monthly earning to identify Medicaid eligibility and provides the first evidence of a substantial labor supply response to the ACA |
| Keywords: | Medicaid; The ACA; Mandate Penalty; Labor Supply; Earning Adjustments |
| JEL: | H31 I13 I18 J22 |
| Date: | 2025–05–29 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:125043 |
| By: | Sandra Rozo; Grossman, Guy |
| Abstract: | Forced displacement has reached unprecedented levels, with more than 120 million individuals displaced globally as of 2024 due to conflict, violence, climate change, and human rights violations. These crises are increasingly protracted, characterized by low return rates, and demand a shift from hosting models solely funded through humanitarian aid to financially sustainable, medium- to long-term strategies. This VoxDevLit synthesizes quantitative research conducted between 2010 and 2024, focusing on studies that use experimental or quasi-experimental methods to examine (1) the impacts of forced displacement on host communities and (2) the effectiveness of policies designed to support both forcibly displaced populations and their hosts. Key insights from this body of work indicate that forced displacement inflows generally exert neutral effects on native employment and wages, although vulnerable native workers—particularly those in the informal sector—may initially face challenges. Investments in inclusive social protection services that benefit both displaced populations and host communities can alleviate pressures and foster social cohesion. Additionally, cash transfers enhance immediate well-being and are most effective in the medium run when paired with initiatives that promote the economic self-reliance of forcibly displaced populations. Granting refugees the right to work has demonstrated transformative impacts on economic and well-being outcomes, while also providing a financially sustainable solution for hosting refugees over the medium to long term. Finally, addressing the mental health challenges faced by forcibly displaced populations is critical to enable them to recover their lives. This review underscores the importance of transitioning from humanitarian aid to self-reliance models, closing policy implementation gaps, and tailoring interventions to local contexts. |
| Date: | 2025–05–19 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11123 |
| By: | Zhang, Xin; Chen, Xi; Sun, Hong; Yang, Yuanjian |
| Abstract: | This paper attempts to provide one of the first population-based causal estimates of the effect of air pollution on suicidal ideation-a key precursor to suicide attempt and completion-among school-age children. We use daily variations in the local wind direction as instruments to address endogeneity in pollution exposure. Matching a unique risk behavior survey of 55, 000 students from 273 schools with comprehensive data on air pollutants and weather conditions according to the exact date and location of schooling, our findings indicate that a 1% decline in daily PM2.5 is associated with a 0.36% reduction in the probability of suicidal ideation. Moreover, the dose-response relationship reveals that the marginal effects increase significantly and non-linearly with elevated concentration of PM2.5. The effect is particularly pronounced among younger, male, students from low-educated families, and students with lower grades. |
| Keywords: | suicidal ideation, air pollution, school-age children, risky behaviors, China |
| JEL: | I31 Q51 Q53 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1618 |
| By: | Krekel, Christian (London School of Economics); Goebel, Jan (DIW Berlin); Rehdanz, Katrin (Kiel University) |
| Abstract: | Most people consider parks important for their quality of life, yet systematic causal evidence is missing. We exploit exogenous variations in their use values to estimate causal effects. Using a representative household panel with precise geographical coordinates of households linked to satellite images of green spaces with a nationwide coverage, we employ a spatial difference-in-differences design, comparing within-individual changes between residents living close to a green space and those living further away. We exploit Covid-19 as exogenous shock. We find that green spaces raised overall life satisfaction while reducing symptoms of anxiety (feelings of nervousness and worry) and depression. There is also suggestive evidence for reduced loneliness. Given the number of people in their surroundings, a compensating-surplus calculation suggests that parks added substantial benefits during the period studied. |
| Keywords: | quasi-natural experiment, wellbeing, mental health, green spaces, parks, compensating surplus |
| JEL: | I10 I31 R23 H41 Q51 |
| Date: | 2025–06 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17942 |
| By: | Joan Costa-Font; Cristina Vilaplana-Prieto; Joan Costa-i-Font |
| Abstract: | We study the impact of the Brexit referendum on the quality of employment and working conditions of workers in the National Health Service (NHS). Using a difference-in-differences (DiD) design and propensity score matching to compare NHS employees with a control group referring to occupations less exposed to employees from the European Union (EU) before Brexit. We document that Brexit led to the average reduction of job satisfaction by 1.39% - largest for physicians (2.6%) and nurses (2.4%) - and an increase of both paid (1.75 hours/week) and unpaid working hours (8.3 hours/week). Nonetheless, the effect was heterogeneous despite the general rise in working time. Indeed, job satisfaction fell by 2.6% among British workers but increased by 3% among overseas workers. These changes were accompanied by a comparable reduction in leisure time and a higher likelihood of workers intending to leave their jobs, suggesting broader behavioural effects that may undermine NHS productivity. |
| Keywords: | job satisfaction, workforce motivation, Brexit, health care workforce, workforce composition, leisure satisfaction, NHS |
| JEL: | I12 J22 J45 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11876 |
| By: | Jon H. Fiva; Jo Thori Lind; Bjørn-Atle Reme; Henning Øien |
| Abstract: | Political office involves stress, long hours, and media scrutiny, which may harm politicians' health. However, winning prestigious positions can increase social status, income, and connections, potentially offsetting these harms. We investigate the health effects of political promotions using comprehensive Norwegian administrative data on public health care utilization. Using an event study framework, we assess health outcomes by comparing newly elected mayors to controls matched by gender, age group, and education within the same municipality. While securing full-time office results in a substantial income boost, we find no evidence of adverse health effects. On the contrary, winning office leads to a sustained modest reduction in both general doctor visits and mental health consultations. This evidence runs counter to common concerns about the toll of political careers, pointing to potential health benefits associated with political advancement. |
| Keywords: | political selection, returns from office, health consequences, event study, administrative data |
| JEL: | D72 I12 J81 M51 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11881 |
| By: | Francisca Castro; Tilman Brück; Wolfgang Stojetz; Hadi Jaafar |
| Abstract: | When refugees flee abroad, they carry the legacy of their traumatic experiences across borders. While there are over 43 million refugees worldwide, the long-term effects of conflict exposure on their well-being remain poorly understood. This paper examines how pre-displacement exposure to violent conflict and environmental stressors shapes the long-term social well-being of Syrian refugees in Jordan, focusing on life satisfaction, social trust, and social safety nets. Using representative survey data from refugees living in Jordan and conflict events, as well as remote sensing environmental data from Syria, we distinguish between exposure to conflict events and conflict fatalities, revealing distinct effects. While exposure to conflict events has no systematic impact on social outcomes, exposure to conflict fatalities significantly reduces life satisfaction and weakens social safety nets. These effects are critically mediated by mental health, with depressive symptoms significantly explaining the negative impact of conflict fatalities on life satisfaction. Our findings also highlight gendered dimensions: individuals living in female-majority households experience particularly severe declines in life satisfaction, whereas those in male-majority households show greater deterioration in social safety nets. Having experienced droughts before leaving Syria further amplifies the negative effects of conflict, particularly on social safety nets. These results highlight the importance of considering intersecting vulnerabilities due to gender, environmental stress, and conflict exposure when designing support systems for forcibly displaced populations. |
| Keywords: | climate, conflict, jordan, mental health, refugees, social well-being, syria |
| JEL: | D74 D91 F22 I12 I31 O15 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:hic:wpaper:431 |
| By: | Latonen, S.; Pussila, S.; Seeck, H.; Airaksinen, M.; Juppo, A. M. |
| Abstract: | Despite the vulnerabilities of the pharmaceutical industry and its critical role in functioning healthcare systems, no previous crisis management theory–based empirical studies focusing on this field during the COVID-19 pandemic has been published. The present study aims to fill this gap and identify areas for development to improve future crisis preparedness. Organisational crisis management process models provided a theoretical framework. A cross-sectional survey study was conducted during the second wave of the pandemic (October–November 2020). This online survey was developed based on the crisis management process models and sent to managing directors working in the pharmaceutical and wholesale companies (n = 73) in Finland. Descriptive statistics were calculated, and open-field responses were analysed qualitatively using content analysis. Nine semi-structured interviews with industry leaders and managers conducted in March–May 2021 were utilised in data triangulation. The results revealed that crisis preparedness improved concurrently during the pandemic due to increased risk perception, updated preparedness plans and operational changes. Crisis decision-making was made via teams or shared efforts between key persons. Anticipation of and responses to increased demand and stocking, coordination and collaboration among pharmaceutical supply chain stakeholders were identified as key challenges. The study extends crisis management process models to the pharmaceutical industry context and advances this research field by drawing on a novel approach for data collection utilising crisis management process models for survey development. Practical implications for improving future preparedness are suggested. |
| Keywords: | Covid-19; crisis management; Finland; pandemic preparedness; pharmaceutical industry; coronavirus |
| JEL: | J50 |
| Date: | 2025–07–31 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:128184 |