|
on Health Economics |
| By: | David M. Cutler |
| Abstract: | Forecasts of the federal budget depend greatly on trends in medical spending. Since 1970, medical spending has nearly tripled as a share of gross domestic product (GDP). However, spending growth has barely exceeded GDP growth since 2010. This difference in growth rates makes forecasting spending difficult. I present scenarios for future spending derived from considering the sources of spending increase, ranging from rapid increases in new, expensive treatments to a reduction in spending due to cost-reducing technology. Even modest increases in spending relative to GDP are likely to overwhelm the federal government’s ability to pay for medical care using current tax instruments. |
| JEL: | H69 I1 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35922 |
| By: | Daniel J. Benjamin; Kristen B. Cooper; Ori Heffetz; Miles S. Kimball; Jiannan Zhou |
| Abstract: | Analyses of survey data may be confounded if people use response scales differently. We formalize and generalize the theory behind using “calibration questions, ” such as vignettes, to correct for scale-use heterogeneity. Finding, in our (N ≈ 10, 000) and existing data, that the mapping between respondents’ scales is approximately linear, we develop a simple estimator for scale-use-corrected regressions. We validate it using subjective-scale ratings of height and weight and illustrate it with life satisfaction regressions, where correction leaves the main qualitative findings intact but can substantially change coefficient ratios, for example tripling the estimated cost of unemployment relative to income. |
| JEL: | C83 D63 D90 I14 I31 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35925 |
| By: | Amy Finkelstein; Matthew J. Notowidigdo; Enzo Profili |
| Abstract: | We use a dynamic factor time series model to estimate the national mortality impact of the Great Recession. In aggregate, the Great Recession reduced the average annual, age-adjusted mortality rate by about 2 percent, with effects persisting for at least a decade. In a calibrated model of the welfare effects of the estimated impacts of the Great Recession on consumption and mortality, we find that the welfare gain from the estimated mortality decline is quantitatively significant relative to the welfare loss from the estimated consumption decline. The estimated mortality decline is also quantitatively close to prior mortality estimates using cross-sectional variation in the severity of the Great Recession, implying limited general equilibrium effects of the Great Recession on mortality. More broadly, our findings suggest that prior evidence from local labor markets that recessions are good for health can be extrapolated to the likely mortality consequences of nationwide recessions. |
| JEL: | C32 E3 I1 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35914 |
| By: | Brito Rebolledo, Emilia Javiera; Contreras, Dante; Libuy, Nicolás |
| Abstract: | Severe health events are among the most common shocks households face, and in low- and middle-income countries their consequences are absorbed largely within the family. We study how a parents severe illness affects adolescents' education in Chile. Using linked administrative records for the universe of school-age children and quasi-random variation in the occurrence and timing of parents first cancer hospitalizations, we compare exposed students with untreated classmates in a stacked difference-in-differences design. The shock reduces school enrollment and attendance and raises chronic absenteeism, with effects that persist for up to four years and roughly double for high-severity cancers. Disruptions are substantially larger for girls, consistent with caregiving and household responsibilities falling disproportionately on them. The educational response varies little with households' pre-shock labor market position, and children's hospitalizations do not rise. These findings point to an intergenerational cost of parental illness and a role for social protection in mitigating it. |
| Keywords: | Parental health shocks;School engagement;School absenteeism;human capital;Cancer;Chile |
| JEL: | I14 I21 J13 O15 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:idb:brikps:14777 |
| By: | Jonas Maibom; Trine Schack; Rune Vejlin |
| Abstract: | Using Danish administrative data from 1980–2023, we analyze lifetime income (both earnings and net-income) inequality and its evolution across cohorts. Earnings inequality rises with age from midlife onward and is highest among the low educated and lowest among those with medium education. Differences in employment attachment — such as non-employment and part-time work — account for 30–60 percent of lifetime earnings dispersion, and are particularly important among the low educated. Weak employment attachment is a key driver of lifetime earnings inequality and is closely linked to exposure to adverse shocks such as unemployment and health-related events. Lifetime earnings inequality has risen across cohorts among the low educated, partly through growing dispersion in employment attachment. In moving from earnings to net-income, transfers account for roughly five times as much of the inequality reduction as taxes, but this equalizing effect has weakened over time. Our results highlight the role of employment dynamics and social insurance for lifetime inequality. |
| Keywords: | lifetime earnings inequality, employment attachment, income redistribution, tax and transfer system |
| JEL: | D31 J31 J64 H24 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13072 |
| By: | Chenhao Liang (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Jongsay Yong (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Yuting Zhang (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia) |
| Abstract: | Specialist physician fees in Australia are set at the discretion of the treating physician, guided only by a non-binding government schedule fee. Using administrative data on 5.8 million initial specialist consultations in 2023/24, we risk-adjust fees for patient characteristics and decompose the residual variance into physician, specialty, and regional components using a four-level random effects model. Accounting for patient risk factors reduce the fee variance by at most 5.3%. Physician-level variation accounts for 44.6%, specialty for 22.1%, and region for 3.8%; the ranking is broadly stable across six major specialties estimated separately. These results indicate that the fee dispersion of initial consultations, which is a schedule-priced, largely homogeneous service, is driven predominantly by physician-specific pricing discretion rather than by patient need, specialty norms, or geographic market conditions. We discuss implications for fee regulation and price transparency policy. |
| Keywords: | physician pricing, fee variation, variance decomposition, out-of-pocket costs, price transparency, Medicare |
| JEL: | I11 I18 D40 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:iae:iaewps:wp2026n18 |
| By: | Beata Smarzynska Javorcik; Alessia Lo Turco; Daniela Maggioni; Gianluca Santoni |
| Abstract: | This paper examines whether and how foreign acquisitions improve occupational safety. Using linked administrative data on French manufacturing plants over 2003-2017 and event studies on a matched sample, we find that foreign acquisitions reduce accident rates and workdays lost. Safety gains coincide with expanded managerial hierarchies, greater technical-manager presence, foreign manager hiring, and worker training. We find little evidence supporting automation, task reallocation, or outsourcing as alternative explanations. Moreover, domestic acquisitions do not generate comparable improvements. Our findings are consistent with foreign acquisitions improving workplace safety through the transfer of managerial and organisational practices, highlighting a benefit of multinational activity beyond conventional measures of firm performance. |
| Keywords: | multinationals, workplace safety, work accidents, organisational changes |
| JEL: | F23 F61 I10 J21 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_13071 |
| By: | Lucas Braga de Melo; Valdemar Pinho Neto |
| Abstract: | Non-fatal strangulation (NFS) is a form of intimate partner violence (IPV) and a strong predictor of intimate partner homicide (IPH). We compile NFS statute data, link them to homicide reports, 1990–2019, and estimate effects on IPH using a two-stage difference-in-differences estimator for staggered adoption and heterogeneous effects. NFS laws reduce IPH for ages 18–49, by 0.169 female-victim homicides per 100, 000 women and 0.090 male-victim homicides per 100, 000 men. We find no effects on IPH for ages 50–70 or on stranger-perpetrated homicides. Evidence from reported IPV incidents is suggestive of changes in reported incident classification and arrest patterns. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:not:notnic:2026-02 |
| By: | Ferdi Botha (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Steeve Marchand (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Derek Tong (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia) |
| Abstract: | This paper examines how high school bullying and discrimination are associated with mental distress, both during high school and later in life. Using retrospective data from adults in Australia, we document the reported frequency of past bullying and whether, during their time in high school, respondents experienced discrimination based on characteristics such as ethnicity, religion, disability, sexual orientation, gender, or physical appearance. Frequent bullying is particularly prevalent among certain groups and is most common among those targeted due to a disability. We find that bullying is strongly associated with greater mental distress during high school, which persists into adulthood, even after accounting for experiences of discrimination. These associations are strongest for frequent bullying and are observed for both men and women. Discrimination based on disability and sexual orientation is also independently associated with greater mental distress. The findings underscore the significant challenges faced by those who experience frequent bullying during their teenage years, particularly among groups already experiencing discrimination. |
| Keywords: | Bullying, discrimination, high school, adulthood, mental distress |
| JEL: | I10 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:iae:iaewps:wp2026n17 |
| By: | Hiller, Tatiana; Peñaloza-Pacheco, Leonardo; Rozo, Sandra |
| Abstract: | Does extending full health coverage to an excluded group induce health externalities for the population already insured? In 2022 Colombia expanded health services from emergency only to full access to approximately two million Venezuelan migrants. Comparing municipalities more and less exposed to program take-up before and after its onset, this paper finds that the program reduced mortality rates for Colombians, saving one Colombian life for each 300 migrants covered. The effects are explained by a more efficient use of the health services by beneficiaries and regular and timely payments for the newly insured patients. The Colombian deaths saved are those that timely health treatment prevents. The net fiscal cost of the program is USD 93, 000 per Colombian life saved, well below the value of a statistical life. |
| Date: | 2026–10–15 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11486 |
| By: | Costa-Font, Joan; Jimenez-Martin, Sergi; Vilaplana-Prieto, Cristina |
| Abstract: | We estimate the health and wellbeing effects of subsidized access to long-term care (LTC). Our analysis exploits the staggered implementation of Spain’s 2007 System of Autonomy and Care for Dependent People (SAAD), which expanded publicly funded and universal LTC subsidies and supports, as well as its subsequent reform. Using two decades worth of administrative and survey data and leveraging exogenous regional and individual-level variation in program exposure, we find that access to SAAD benefits reduces the care receiver’s depressive symptoms by about 1 percentage point, increases its survival probability by 2.6–3 percentage points, and raises its life satisfaction by 0.24–0.50 scale points. Cost-effectiveness estimates indicate that the implied cost per quality-adjusted life year (QALY) gained lies below commonly accepted efficiency thresholds for public health spending in Europe. These findings document sizeable health returns and efficiency gains from publicly subsidized LTC provision. |
| Keywords: | lomg-term care subsidies;long-term care supports;old age care;Spain;mortality;cost per QALY;survival;mental health;life satisfaction |
| JEL: | I18 J14 J16 |
| Date: | 2026–10–14 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140775 |
| By: | Chenhao Liang (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Susan J. Méndez (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Ou Yang (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia); Yuting Zhang (Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia) |
| Abstract: | In referral-based systems, general practitioners (GPs) act as gatekeepers to specialist care and usually choose which specialist a patient sees. We examine whether GP–specialist referral relationships are associated with specialist fees, out-of-pocket costs, waiting times and bulk billing (zero patient payment) in Australia, where specialists set their own fees. Using linked whole-of-population administrative data on 6.3 million initial specialist consultations in orthopaedic surgery, dermatology and cardiology between July 2021 and June 2025, we estimate models with GP, specialist and patient-area fixed effects. We measure relationships by their length, the number of consecutive years a GP has referred to the same specialist, and by the concentration of a GP’s referrals, using the Herfindahl–Hirschman Index. In all three specialties, each additional year of collaboration is associated with 0.3–0.8\% higher fees, 3.9–4.5\% higher out-of-pocket costs, 1.9–4.7 days longer waits and a lower probability of bulk billing. Most of the waiting-time difference arises when a pair becomes established. Associations with referral concentration are smaller and largely attenuate once relationship length is accounted for. Providing GPs with information on fees, out-of-pocket costs and waiting times at the point of referral, and prompting periodic review of established referral pathways, could improve affordability and access while preserving continuity of care. |
| Keywords: | Referral relationships, referral concentration, specialists, general practitioners, physician fees, out-of-pocket costs, waiting times, Australia |
| JEL: | I11 I18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:iae:iaewps:wp2026n19 |
| By: | Wojciech Zawadzki (University of Warsaw, Faculty of Economic Sciences); Henrik Andersson (Swedish National Road and Transport Research Institute (VTI); University of Toulouse Capitole, Toulouse School of Economics); Mikołaj Czajkowski (University of Warsaw, Faculty of Economic Sciences); Arne Risa Hole (Universitat Jaume I) |
| Abstract: | This study investigates how the design of the cost attribute shapes stated preference estimates of the value of a statistical life (VSL). Using a discrete choice experiment (DCE) on willingness to pay (WTP) for cardiovascular mortality risk reductions, we implement a randomized design that varies the cost vector across three treatments, allowing us to compare monetary vectors that differ jointly in their range and spacing. Complementary diagnostics examine scope sensitivity and potential anchoring effects induced by information disclosure and feedback mechanisms. Point estimates of VSL differ by up to roughly 25% across treatments, but the reported between-treatment comparisons are not statistically significant. These results establish neither a detectable VSL effect nor equivalence across treatments. This contrast carries direct policy implications, since cost-benefit analyses and health regulations typically rely on point estimates of VSL rather than full distributions. Secondary diagnostics indicate less-than-proportional WTP scaling over the tested risk increments, while anchoring stimuli (revealing all attribute levels upfront, ordering cost levels from extremes, or providing feedback on comprehension questions) exert no detectable influence on choices or WTP. Taken together, the results highlight the need for clearer methodological guidance on cost attribute selection in stated preference research and underscore that seemingly modest design choices can shift welfare estimates in ways that are consequential for policy appraisal, while accounting for estimation uncertainty. |
| Keywords: | cost vector effects, value of statistical life, behavioral biases, discrete choice experiment, mortality risk reduction |
| JEL: | I12 D01 D61 Q51 C83 C93 |
| Date: | 2026–10–15 |
| URL: | https://d.repec.org/n?u=RePEc:war:wpaper:2026-40 |
| By: | Kovacs, Roxanne (Department of Economics, School of Business, Economics and Law, Göteborg University); Abuya, Timothy; Powell-Jackson, Timothy |
| Abstract: | Excess demand is pervasive in public service delivery, but its consequences depend on how providers allocate scarce capacity. We sent standardised patients – trained auditors posing as real patients – to 198 primary-care facilities in Nairobi. Across 1, 326 pre-scheduled visits, we exploit within-facility variation in workload. We find that when queue length exceeds the typical daily workload per provider, waiting time is 21 minutes longer (0.4 SD). We find no reduction in consultation effort and no statistically significant deterioration in care quality or access. This suggests short-run congestion is borne primarily through users’ time and need not reduce service quality. |
| Keywords: | Excess demand; Non-price rationing; Queuing; Congestion; Healthcare |
| JEL: | D24 H51 I11 I18 |
| Date: | 2026–10 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:gunwpe:0864 |
| By: | Costa, Eduardo; Gonçalves, Judite; Martins, Pedro |
| Abstract: | Healthcare systems across Europe are facing increasing workforce shortages. This paper aims to estimate the impact of physicians' and nurses' retirements on hospital operations and inpatient outcomes. The analysis draws on 2006-2018 NHS records (covering all discharges from Portugal's public hospitals) merged with Social Security records (covering all public servant retirements) at the hospital-month level and panel fixed-effects models with case-mix controls. Semi-structured interviews with health professionals and hospital executives contextualize findings. Our study shows that retirements, especially of physicians, are associated with short-term shifts in hospital activity, particularly a reduction in the share of inpatient-care admissions and changes in specific admission categories, rather than a broad reduction in total admissions. However, short-term patient outcomes remain stable, as resources are reallocated to critical cases. |
| Keywords: | health professionals' retirement, physicians, nurses, hospital admissions, hospital mortality, readmission rates |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1831 |
| By: | Lucas Taulbee; Brian Redding; Thomas Carl Keene; Alison Davis; Michael Clark |
| Abstract: | Regional disparities in healthcare access and health outcomes are well-documented in the United States. Rural localities face worse health outcomes and greater challenges to accessing care than urban localities, particularly in the South. This study examines national and regional trends in hospital establishments (openings and closings), employment, size (employees per establishment), and regional concentration over three decades. We document an era of declining hospital counts and increasing employment within the industry, highlighting how the trends have differed across regions and rurality. Finally, we consider how these trends relate to the current policy environment in the United States. |
| Keywords: | hospitals, rural healthcare, consolidation |
| JEL: | I10 I14 R12 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:cen:wpaper:26-51 |
| By: | Olivier Arsene (EESC-GEM - Grenoble Ecole de Management); Claudio Vitari (EESC-GEM - Grenoble Ecole de Management) |
| Abstract: | This study examines trust in decentralized digital health by distinguishing two trust objects: the health information technology (HIT) artefact and the Health Software Provider (HSP) organization. Based on 25 semi-structured interviews with self-employed physicians, medical secretaries, and IT support staff in France, we conduct a theory-informed thematic analysis using system trust antecedents (functionality, helpfulness, reliability) and organizational trustworthiness dimensions (competence, benevolence, integrity). Findings show that physicians primarily ground trust in artefact performance and workflow fit, whereas provider trustworthiness is assessed more indirectly through support responsiveness, update strategies, pricing practices, and the translation of regulatory mandates into software defaults. We theorize inscription-based inference as the mechanism through which artefact evolution shapes attributions of provider trustworthiness under opacity and regulation. This explains why continued use can be misread as provider loyalty when artefact and provider trust are conflated, even as organizational trust erodes under high switching costs, informing governance and design choices. |
| Abstract: | Cette étude examine comment la confiance se construit et s'affaiblit dans la santé numérique décentralisée en distinguant deux cibles de confiance : l'artefact de technologie de l'information en santé et l'organisation éditrice. À partir de 25 entretiens semi-directifs menés en France auprès de médecins libéraux, de secrétaires médicales et de professionnels du support informatique, nous conduisons une analyse thématique informée par la théorie. Nous mobilisons des antécédents de la confiance envers les systèmes (fonctionnalité, utilité, fiabilité) et des dimensions de la confiance organisationnelle (compétence, bienveillance, intégrité). Les résultats montrent que les médecins ancrent surtout la confiance dans la performance de l'artefact et son adéquation au flux de travail, tandis que la confiance envers l'éditeur est inférée via la réactivité du support, les stratégies de mise à jour, les pratiques tarifaires et la traduction des exigences réglementaires en réglages par défaut. Nous théorisons l'inscription comme mécanisme d'enchevêtrement, expliquant pourquoi l'usage continu peut relever davantage d'une contrainte plutôt que d'une confiance stable et nous proposons des recommandations permettant aux éditeurs de logiciels de développer des stratégies de confiance pérennes. |
| Keywords: | Health Information Technology, Self-employed Medicine, Physicians, Operational Trust, Organizational Trust, Healthcare Ecosystem, Digital Health Ecosystem, Technologies de l’information en santé, Écosystème numérique de santé, Écosystème de santé, Confiance organisationnelle, Confiance opérationnelle, Médecins, Médecine libérale |
| Date: | 2026–05–20 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05789307 |
| By: | Canta, Chiara; D’Annunzio, Anna; Lefouili, Yassine |
| Abstract: | We study the impact of privacy regulation on data-driven innovation and welfare in the healthcare sector. A platform providing medical services (e.g., a hospital) collects patient data and may sell non-rival access to downstream innovators. Without data externalities, consent can induce inefficiently low data sharing because the platform cannot identify privacy-concerned patients and captures only part of the social value of innovation. Consequently, requiring consent can reduce welfare for intermediate privacy costs. When one patient’s disclosure reveals information about others, consent decisions become strategic complements. These externalities reduce the compensation required for disclosure and can instead produce excessive sharing, potentially justifying additional restrictions on compensation or data sharing. If the platform controls innovator access, consent can induce excessive restrictions without data externalities, whereas sufficiently strong externalities can lead the platform to admit too many innovators. |
| Keywords: | Data sharing; privacy; consent policy; innovation; healthcare. |
| JEL: | D83 L15 L51 |
| Date: | 2026–10–14 |
| URL: | https://d.repec.org/n?u=RePEc:tse:wpaper:132282 |