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on Health Economics |
| By: | Jakub Ryłow (Faculty of Economic Sciences, University of Warsaw) |
| Abstract: | This article examines the intellectual connections between the works of Kenneth Arrow, Alan Garber, and Peter Zweifel in the context of the economics of medicine, with particular emphasis on uncertainty, decision-making, and risk. It argues that health economics should be understood not merely as an applied field, but as a domain in which economic theory, mathematical economics, and actuarial science intersect. Arrow's analysis establishes uncertainty and information asymmetry as structural features of medical care markets, challenging standard welfare-theoretic assumptions. Garber extends this insight by formalizing medical decision-making through cost-effectiveness analysis and decision theory, translating clinical uncertainty into economically tractable choice problems. Zweifel's contributions to actuarial risk theory provide the mathematical foundations for health insurance systems, enabling the aggregation, pricing, and long-term management of medical risk. Taken together, these approaches demonstrate that modern health economics relies on mathematical formalization not only to model behavior, but to sustain the institutional viability of health care systems through insurance, risk pooling, and intertemporal solvency. The economics of medicine thus emerges as a field in which mathematical economics and actuarial methods are indispensable for understanding how societies manage health-related uncertainty. |
| Keywords: | health economics, cost-effectiveness analysis, QALY, willingness to pay, health insurance, decision theory, actuarial science, medical uncertainty, risk pooling |
| JEL: | D81 I11 I13 C61 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:war:wpaper:2026-6 |
| By: | Coady Wing; Wei-Lun Lo; Maddie Potter; Tarik Yuce; Alberto Ortega; John Cawley; Thuy D. Nguyen; Kosali I. Simon |
| Abstract: | We document state variation in Medicaid coverage for obesity-indicated GLP-1 medications over time, and use a stacked difference-in-differences design to estimate the effects of coverage on utilization and net-of-rebate spending. Nine quarters out, coverage increases prescriptions for obesity-indicated GLP-1 medications by 0.82 per 100 enrollee-months (SE = 0.10). Coverage had no effect on GLP-1 prescribing for diabetes or cardiovascular indications, suggesting that off-label prescribing of diabetes formulations for obesity is not very common in the Medicaid program. The expansions do not appear to affect consumer spending at major online GLP-1 compounding firms, which suggests that the utilization response in our main analysis reflects new utilization rather than crowd-out. We find that coverage increases net-of-rebate Medicaid spending by $751.6 per 100 enrollee-months (SE = $92.0), compared to $986.9 in gross reimbursements—manufacturer rebates reduce the state’s net spending by approximately 24 percent. Across the 17 states that ever covered obesity-indicated GLP-1 medications by mid 2025, coverage increased Medicaid net spending by around $2.68 billion per year. Extending Medicaid coverage in the remaining states would generate a further $3.63 billion in annual net spending. |
| JEL: | I11 I13 I18 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34949 |
| By: | Panle Jia Barwick; Hongyuan Xia; Tianli Xia |
| Abstract: | This paper examines China’s transition from pharmaceutical “free rider” to global innovator over the last decade. In 2010, China accounted for less than 8% of global clinical trials; by 2020, it had surpassed the US in annual registered clinical trial volume. To study this transformation, we compile a comprehensive, synchronized database spanning the pharmaceutical drug development supply chain, covering scientific publications, clinical trials, drug development milestones for China, the U.S., and Europe, alongside drug sales and government policies over the same period. We provide strong evidence that China’s rise was primarily driven by the National Reimbursement Drug List (NRDL) reform, which dramatically expanded the effective market size for innovative drugs. We document a sharp rise in both the quantity (86% increase) and novelty of drug trials post reform, with growth concentrated in reform-exposed disease categories, first- or best-in-class drugs, and among domestic firms. A decomposition exercise reveals that the NRDL reform accounts for 43% of the growth in oncology trial activity, nearly doubling the combined contribution of upstream knowledge accumulation and talent flows (24%), while other government policies play a minor role. Finally, dynamic gains from induced innovation exceed the reform’s static gains in consumer access to innovative drugs by threefold, underscoring the importance of accounting for the reform’s long-run effects on innovation incentives in addition to near-term improvements in drug affordability. |
| JEL: | I18 L65 O31 O38 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34977 |
| By: | Mariagrazia Cavallo; Elizabeth Dhuey; Luca Fumarco; Levi Halewyck; Simon ter Meulen |
| Abstract: | This article reviews the growing literature on age at school entry and its effects over the life course. Age at school entry affects a broad range of outcomes, including education, labor-market performance, health, social relationships, and family formation. We synthesize the evidence using a conceptual framework that distinguishes four empirically intertwined components of age at school entry: starting age, age at outcome, relative age, and time in school. Within this framework, we highlight six key channels through which age at school entry operates. While the effects of age at school entry are often substantial and persistent, many studies estimate bundled impacts without isolating specific components or directly measuring underlying mechanisms. We explain how different research designs capture distinct combinations of these components. We also highlight how institutional heterogeneity and behavioral responses can complicate the interpretation of results. We conclude by outlining directions for future research and policy design. |
| Keywords: | age at school entry, Relative age, School starting age, Institutional heterogeneity, Behavioral responses |
| JEL: | I12 I21 I24 I31 J12 J13 J24 K42 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12545 |
| By: | Eiji Yamamura |
| Abstract: | This study explores the different subjective values held by transgender people, including their subjective well-being, self-reported health status, and career-oriented decision-making. Using an individual-level panel dataset of over 19, 000 observations, we discovered the following statistically significant findings: (1) The likelihood of transgender people being happy and healthy is lesser than that of non-transgender people by 7% and 12%, respectively. (2) The likelihood of transgender people supporting women empowerment and giving importance to changing one's behavior for a desirable spouse is 5% lesser than that of non-transgender people. Transgender individuals are also less likely than others to endorse gender-related statements, irrespective of their direction. (3) Transgender people are 12% less likely than non-transgender people to make independent decisions for their future career and 2% more likely to follow their parents' and teachers' opinions. (4) Transgender people are 5% more likely to generally distrust others than non-transgender people. Transgender people's subjective well-being and health status outcomes are consistent with those of previous studies, whereas their results for gender-related issues and decision-making do not align with the progressive view. |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2603.09648 |
| By: | Clara Schäper; Katharina Wrohlich; Sabine Zinn |
| Abstract: | Many countries use job-retention schemes, such as short-time work (STW), to stabilize the labor market during economic downturns. While these schemes might prevent unemployment (UE) and its adverse effects on workers, STW could also deter workers from moving to more productive firms, thereby negatively affecting their labor market outcomes in the long run. We analyze the long-term effects of STW and UE on individual workers using survey data from the SOEP for 1984–2023, which allows us to examine a broad set of yearly measured outcome variables, including employment, weekly working hours, real hourly wages, time spent on unpaid care work and life satisfaction. For the empirical analysis, we employ a two-step procedure that includes propensity score matching and an event-study model with individual fixed effects. Our findings suggest that, in the German institutional context, STW had no significant negative effects on workers’ labor market outcomes in the financial crisis of 2008/2009 and the economic crisis caused by the COVID-19 pandemic. This suggests that STW did not deter workers from switching to more productive firms. For the economic crisis following German reunification in the 1990s, however, we find that STW negatively affects workers’ long-term outcomes, albeit less strongly than episodes of UE. These findings suggest that the stabilizing effect of STW strongly depends on the economic context. |
| Keywords: | labor market shocks, job loss, short-time work, unemployment, event-study analysis |
| JEL: | H31 E32 J13 J16 J22 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:diw:diwwpp:dp2160 |
| By: | Sintos, Andreas; Chletsos, Michael; Xydea, Eleni |
| Abstract: | The relationship between health spending and economic growth is shaped by multiple transmission channels, leading to inconsistencies in the empirical literature and a lack of definitive conclusions. To address this issue, we perform a meta‐analysis encompassing 522 estimates from 107 studies that examine the effect of health spending on economic growth. Our analysis uncovers the presence of a negative publication bias of moderate magnitude in the literature. However, after accounting for both publication bias and methodological shortcomings in the primary studies, we find that health spending exerts a substantial positive effect on economic growth. Furthermore, our findings demonstrate that the reported estimates are shaped by various factors, including differences in how economic growth and health spending are measured, the characteristics of the data, publication attributes, and the inclusion of other growth‐related variables. |
| Keywords: | economic growth; health spending; meta‐analysis |
| JEL: | N0 |
| Date: | 2026–03–20 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137717 |
| By: | Owen Thompson; Jason Fletcher; Karin Wu |
| Abstract: | The U.S. hospital sector expanded rapidly in the 1950s and 1960s, largely due to construction subsidies provided under federal legislation known as the Hill-Burton Act. This paper examines the impact of Hill-Burton grants on maternity care access and infant health. We find that grants for public hospitals significantly reduced out-of-hospital births and infant mortality, particularly among non-white populations. In contrast, grants for private non-profit hospitals had no measurable effects on out-of-hospital births or infant mortality. |
| JEL: | H40 I39 J18 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:34976 |
| By: | Jean-Loup Dupret; Edouard Motte |
| Abstract: | In life insurance, life tables are used to estimate the survival distribution of individuals from a given population. However, these tables only provide survival probabilities at integer ages but no information about the distribution of deaths between two consecutive integer values. Many actuarial quantities, such as variable annuities, are functionals of the lifetime and computing them requires full information about mortality rates. One frequent solution is to postulate fractional age assumptions or mortality rate models, but it turns out that the results of the computations strongly depend on these assumptions, which makes it difficult to generalize them. We hence derive upper and lower bounds of functionals of the lifetime with respect to mortality rates, which are compatible with the observed life table at integer ages. We derive two sets of results under distinct assumptions. In the first, we assume that each mortality trajectory is almost surely consistent with all the given one-year survival probabilities from the table. In the second, we consider a relaxed formulation that allows for deviations of the mortality rates while still being consistent in expectation with the given one-year reference survival probabilities. These distinct yet complementary approaches provide a new robust framework for managing mortality risk in life insurance. They characterize the worst- and best-case contract values over all mortality processes that remain compatible with the observed life-table information, thereby enabling insurers to quantify the impact on prices of deviations of the observed mortality rates from their mortality assumptions/models. |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2603.06238 |
| By: | Martin Huber; Kevin Kloiber; Luk\'a\v{s} Laff\'ers |
| Abstract: | In causal analysis, understanding the causal mechanisms through which an intervention or treatment affects an outcome is often of central interest. We propose a test to evaluate (i) whether the causal effect of a treatment that is randomly assigned conditional on covariates is fully mediated by, or operates exclusively through, observed intermediate outcomes (referred to as mediators or surrogate outcomes), and (ii) whether the various causal mechanisms operating through different mediators are identifiable conditional on covariates. We demonstrate that if both full mediation and identification of causal mechanisms hold, then the conditionally random treatment is conditionally independent of the outcome given the mediators and covariates. Furthermore, we extend our framework to settings with non-randomly assigned treatments. We show that, in this case, full mediation remains testable, while identification of causal mechanisms is no longer guaranteed. We propose a double machine learning framework for implementing the test that can incorporate high-dimensional covariates and is root-n consistent and asymptotically normal under specific regularity conditions. We also present a simulation study demonstrating good finite-sample performance of our method, along with two empirical applications revisiting randomized experiments on maternal mental health and social norms. |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2603.04109 |
| By: | Dennis Guignet; Linda Bui; Caroline Fehlman; Jennifer Runkle; Ron Shadbegian; Maggie Sugg; Sarah Ulrich |
| Abstract: | There is little known about the health effects from ambient levels of hazardous air pollutants (HAPs), particularly in regard to maternal health. We help fill this gap by investigating whether pregnant women from diverse sociodemographic backgrounds face systematic differences in HAPs exposure, assess the impact of ambient HAP levels on gestational hypertension (GH) and gestational diabetes mellitus (GDM), and determine whether historically underserved groups experience disproportionately more severe health effects at comparable exposure levels. We compile data on the population of pregnant women and singleton births in North Carolina from 2002-2016, and combine these data with a comprehensive, spatially explicit measure of ambient HAP concentrations. We estimate multivariate regression models that employ high-resolution fixed effects and an instrumental variables approach based on reported fugitive emissions to identify the plausibly causal effects of ambient HAP levels on maternal health. The results demonstrate that pregnant women from historically underserved subsets of the population face higher baseline risks of GH and GDM, and are exposed to greater levels of HAPs during pregnancy. We find evidence that a one percent increase in HAPs leads to a roughly 0.03% increase in the risks of GH and GDM, and examine heterogeneity in these health effects based on race, ethnicity, and proxies for income. Considering the average 31% reduction in ambient HAP concentrations during our study period, these results suggest a reduction of 61 to 68 statistical cases of GH in North Carolina each year, and a comparable decrease of 57 to 59 statistical cases of GDM. Our quantified estimates of the maternal health effects can be used to inform future policy decisions and demonstrate how HAPs exacerbate maternal health disparities. Key Words: air pollution; environmental justice; hazardous air pollution; HAP; maternal health; gestational hypertension; gestational diabetes mellitus |
| JEL: | I14 I18 Q53 Q56 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:apl:wpaper:26-03 |
| By: | Chris M. Boyd (Department of Economics, Towson University); Norma Correa (Department of Social Sciences, Pontifical Catholic University of Peru); Angelo Cozzubo (Department of Economics, Pontifical Catholic University of Peru); Jose Maria Renteria (Department of Economics, Pontifical Catholic University of Peru) |
| Abstract: | We investigate the unintended impacts of exiting Peru’s Cuna Más public childcare program on child and maternal health. With increased public child- care use in developing countries, understanding the effects of program exit is critical. We use Cuna Más’ strict age-based graduation rule to identify causal impacts, leveraging comprehensive data from the Demographic and Family Health Survey for the period 2015-2019. Our results suggest that mothers prioritize their children’s health over their own upon program exit. While maternal mental health shows a notable decline, children's health remains unaffected. These results have important policy implications, highlighting the need for post-program transitional support to mitigate hidden costs for mothers and enhance the positive outcomes children gain during program participation. |
| Keywords: | Early childhood interventions, Childcare, Child development. |
| JEL: | I12 I21 J13 J24 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:tow:wpaper:2026-06 |
| By: | Nozaki, Yuko |
| Abstract: | Using data from the 2010 birth cohort of the Longitudinal Survey of Newborns in the 21st Century, this paper examines how parental nonstandard work schedules (NSWS) and children's screen time are associated with children's weekday sleep duration, with particular attention to sex heterogeneity. The analysis reveals a modest but statistically significant reduction in daughters’ weekday sleep (approximately 4 minutes per night), whereas no corresponding association is detected for sons. Paternal NSWS is not significantly related to sleep duration for either sex, a pattern that is consistent with limited variation and measurement constraints in fathers’ work schedules in this dataset. Longer screen time (television viewing and video gaming) is strongly associated with shorter sleep for both boys and girls. Overall, the results suggest that the direct impact of parental NSWS on children’s sleep is limited in magnitude, but that attention to children’s screen use and family-friendly scheduling for mothers working nonstandard hours—especially in families with daughters—are likely to support healthier sleep habits. |
| Keywords: | Nonstandard work schedules; Child sleep; Screen time; Sex differences. |
| JEL: | I12 J22 |
| Date: | 2026–01–24 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:127834 |
| By: | He; Z.;; Huynh, L.D.T.; |
| Abstract: | This paper leverages China's 2006 housing reform and a non-parametric Regression Discontinuity Design (RDD) to identify the causal impact of housing wealth on health and healthcare spending across age groups. We document a rich series of findings. A positive housing wealth shock leads to an increase in out -of-pocket medical expenses of the elderly and children, at both the extensive and intensive margins, thereby improving their health. These effects differ across age cohorts, highlighting how positive wealth shocks are translated into health improvements through both direct spending and private insurance uptake. In contrast, these health effects are not evident among young adults. Overall, these results indicate that wealth shock reduces health inequality within vulnerable households. The underlying mechanisms also differ by age group:a pure wealth effect for the elderly, precautionary savings incentives for younger adults, and inter-generational investments for children. |
| Keywords: | housing wealth; medical expenditure; health; China; age differences; |
| JEL: | G51 I11 I14 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:yor:hectdg:26/04 |
| By: | Nita Handastya |
| Abstract: | Childhood socioeconomic disadvantage is a well established determinant of health in later life. Less is known about how early-life deprivation unfolds when individuals experience major institutional transformation and migration in adulthood. Cohorts socialized under Soviet institutions provide a useful setting to examine life-course divergence under systemic change. This study uses harmonized data from the Survey of Health, Ageing and Retirement in Europe (SHARE) on older adults residing in Estonia, Latvia, and Israel to examine the association between retrospectively reported childhood deprivation and multiple health outcomes in later life, including poor self-rated health, chronic disease burden, functional limitation, depression, and a composite multifrailty indicator. Logistic regression models and predicted probabilities assess whether childhood deprivation predicts late-life health across different adult institutional contexts and whether associations vary by linguistic affiliation. Higher levels of childhood deprivation are consistently associated with poorer health outcomes across all three countries. Individuals in the highest deprivation quintile show substantially higher odds of adverse health outcomes, including multifrailty. Stratified analyses for Estonia and Latvia indicate broadly similar deprivation-health gradients among national-language and Russian-speaking populations. These findings highlight the persistence of childhood disadvantage and the importance of early-life conditions in shaping health inequalities in ageing populations exposed to systemic transformation. |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2603.14118 |
| By: | Dushamova, Khilola; Javed, Rashid; Suyunov, Gayrat; Zakirova, Munira |
| Abstract: | In this study, we use data from the recent round of the Multiple Indicator Cluster Surveys (MICS) to estimate the effect of son preference on reproductive behaviour in Uzbekistan. We find strong evidence of differential stopping and spacing behaviour among Uzbek women. Women are significantly less likely to have a subsequent birth if they have at least one son at a given birth order. The effect is particularly strong among rural women at higher birth orders. The likelihood of discontinuation of childbearing increases as the number of sons increases. However, the sex of the firstborn child, whether male or female, plays no role in women's decisions about having additional children. We find that the probability of a subsequent short or risky birth interval is lower among women with at least one son. In addition, women with at least one son are more likely to use contraceptives. These patterns persist regardless of women's age. The findings have important implications for policymakers and practitioners in helping to design targeted interventions and programs in the country to improve reproductive health outcomes, promote gender equality, increase access to family planning services, and support women's reproductive autonomy. |
| Keywords: | Son Preference, Birth Spacing, Fertility, Uzbekistan |
| JEL: | D13 J13 C13 Z10 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:esprep:338885 |
| By: | Siyi Lu; Ilan Noy; Daithi Stone |
| Abstract: | Extreme heat is increasing in frequency and intensity, with disproportionate risks for clinically and socially vulnerable groups. This paper identifies the relationship between acute heat and mortality in Aotearoa New Zealand. To estimate same-day heat-mortality associations, we link weather-station observation data to national administrative mortality records for all deceased individuals. Both wet bulb globe temperature (WBGT) and air temperature (daily mean, maximum, minimum) were used to estimate same-day effects using time-stratified case-crossover models with month×weekday strata for four samples: all-cause or only non-injury mortality, and full year or only warm season mortality. We additionally examine discrete exposure bins, distributed lag non-linear curves (lags 0–7), and heterogeneity by location, sex, and age. Across daily summaries, the mean series of both variables yields the largest effect: over the full year, all-cause mortality rises by 0.44% per +1 °C for WBGT (mean) versus 0.39% per +1 °C for Temperature (mean). Similar results are identified for non-injury mortality. Warm season effects are larger: all-cause mortality increases by about 0.57% per 1 °C in mean WBGT, versus 0.51% per 1 °C in mean air temperature. Across samples, WBGT estimates are generally larger than temperature-only measures. A simple scaling using average death counts suggests that a uniform +1 °C increase in mean WBGT would correspond to approximately 140 additional all-cause deaths and 110 non-injury deaths per year, and about 85 and 70 extra deaths per warm season, respectively. |
| Keywords: | extreme heat, Wet-Bulb temperature, mortality risk, time-stratified case-crossover |
| JEL: | Q54 I10 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12549 |
| By: | Callen, Michael; Gulzar, Saad; Hasanain, Ali; Khan, Muhammad Yasir; Rezaee, Arman |
| Abstract: | This paper presents evidence that selecting better people to work in government and improving their incentives are complements in improving government effectiveness. To do so, this paper combines a policy that improved incentives for health service delivery in Punjab, Pakistan, with data on health worker personalities. We present three key results. First, government doctors with higher personality scores perform better, even under status quo incentives. Second, health inspectors with higher personality scores exhibit larger treatment responses when incentives are reformed. Last, senior health officials with higher personality scores respond more to data on staff absence by compelling better subsequent attendance. |
| JEL: | H83 I18 J45 D73 |
| Date: | 2025–03–18 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:127766 |
| By: | Boettger, Priyanka; Juenemann, Martin; Buerke, Michael; Agarwal, Ayush; Omar, Omar Alhaj |
| Abstract: | Purpose of review: This review examines global inequalities in stroke rehabilitation in low- and middle-income countries (LMICs). It aims to identify key system-level determinants, including access to services, workforce capacity, financing, and policy frameworks—that contribute to disparities in post-stroke rehabilitation and long-term outcomes. Recent findings: Recent research demonstrates a growing mismatch between rehabilitation needs and service availability in LMICs. Persistent barriers include severe shortages of trained rehabilitation professionals, inadequate infrastructure, fragmented care pathways, and high out-of-pocket expenditures. Although task shifting, community-based rehabilitation, family-mediated therapy, and telerehabilitation have been introduced to mitigate these gaps, evidence for their scalability and sustained effectiveness remains heterogeneous. Summary: Stroke rehabilitation inequities in LMICs primarily reflect structural health system constraints rather than lack of therapeutic efficacy. Sustainable improvement requires integration of rehabilitation into universal health coverage, investment in workforce development, and strengthened post-acute care pathways. These findings highlight priorities for future implementation and health system research. |
| Keywords: | low- and middle-income countries; global health inequities; stroke rehabilitation; rehabilitation workforce; access to care; health system capacity |
| JEL: | R14 J01 |
| Date: | 2026–03–24 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137763 |
| By: | Mayorga Camus, Joaquín |
| Abstract: | Disabled people and their households face greater vulnerability to poverty and deprivation due to both lower incomes and higher resource needs. Research on this topic remains limited in developing countries, where disability prevalence is higher and social protection systems are less developed. This study estimates the direct extra costs of disability for Chilean households and examines their implications for poverty and inequality measurement. Using the Standard of Living (SoL) approach with data from a nationally and regionally representative household survey, I find that households with a disabled member would require an additional 46% of their monthly disposable income to achieve the same living standards as households without disabled members. These extra costs are larger in urban areas, exhibit significant regional variations, and are particularly pronounced among households with members experiencing severe or multiple disabilities. Accounting for these extra costs reveals increased levels of poverty and inequality. These findings point to inadequacies in Chile’s current social benefit system and underscore the need for enhanced disability benefits, disability-adjusted poverty measurement, and social policies to reduce the social exclusion and economic vulnerability experienced by disabled individuals and their households. |
| Keywords: | disability costs; standard of living; poverty measurement |
| JEL: | I32 J14 |
| Date: | 2026–03–13 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137088 |
| By: | Cook, Elizabeth A.J.; Ambler, Kate; Hoffmann, Vivian; Otoigo, Lilian Kwamboka; Kiarie, Alice Njoki; Wagner, Julia |
| Abstract: | Weak enforcement of regulatory standards is widespread in low- and middle-income countries. Low firm capacity and standards inappropriate to local contexts imply that traditional punitive enforcement approaches may be counterproductive. We test the impact of a regulatory oversight intervention leveraging the soft power of meat inspectors in the context of 140 rural slaughterhouses in western Kenya. The intervention focused meat inspector attention on hygiene practices and was combined with training of workers and provision of basic equipment and supplies. Practices improved significantly relative to control facilities, but microbial contamination of meat did not. Outcomes were similar in a subset of treatment facilities where workers were additionally given a hygiene performance incentive. Higher volume of business in treatment facilities, which customers perceived as cleaner, suggests that retailers value less contaminated meat, but may counteract the effects of improved practices through cross-contamination and crowding. |
| Keywords: | training; regulations; food safety; monitoring; livestock; meat; abattoirs; workers; meat inspection; meat hygiene; vocational training; Kenya; Africa; Sub-Saharan Africa; Eastern Africa |
| Date: | 2025–12–19 |
| URL: | https://d.repec.org/n?u=RePEc:fpr:gsspwp:179188 |
| By: | Eiji Yamamura; Fumio Ohtake |
| Abstract: | Using an individual-level panel dataset from Japan covering the period 2016-2024, we examined how the COVID-19 pandemic, as an unanticipated public crisis, affected preferences for income redistribution. Furthermore, we investigated how the association between redistribution preferences and trust in government changed before and after COVID-19. The major findings are as follows: (1) individuals in the high-income group are less likely to prefer redistribution after COVID-19 than before it; (2) the degree of decline in redistribution preference is lower when trust in government is higher; and (3) generalised trust and reciprocity did not influence the decline in preference. |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2603.06106 |
| By: | Gabriele Letta; Mario Cesare Nurchis; Luca Salmasi; Gilberto Turati (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore) |
| Abstract: | Vaccine hesitancy is a crucial public health issue worldwide. In this paper, we evaluate the causal impact of a vaccination-based access restriction policy on vaccine uptake by exploiting the introduction of the EU Digital COVID-19 Certificate at the country level. We compare two countries, Italy and Spain, which despite using the Certificate as a prerequisite for many daily activities—experienced different adoption patterns. In Spain, the Certificate was introduced regionally, temporarily suspended by the Courts, and later reintroduced in several regions. In Italy, it was introduced in June 2021 and progressively expanded, culminating in mandatory vaccination for individuals aged over 50. We test the impact of the Certificate on vaccination rates using a Sharp Regression Kink Design, identifying changes in the slope of vaccination rates around the announcements by the two governments relative to the introduction of the Certificate. We find that the digital COVID-19 Certificate increased vaccinations in Italy in a range spanning from 3 to 11 percent. In Spain, by contrast, only the reintroduction seems to have been able to affect vaccinations. This result for Spain is also supported by a Difference-in-Differences model, exploiting the staggered reintroduction of the Certificate at the regional level. |
| Keywords: | vaccine hesitancy; Digital COVID-19 Certificate, Sharp Regression Kink Design. |
| JEL: | I12 I18 |
| Date: | 2026–03 |
| URL: | https://d.repec.org/n?u=RePEc:ctc:serie1:def153 |
| By: | Serra‐Sastre, Victoria; Pinilla, Jaime; Kalansooriya, Wasana |
| Abstract: | The COVID‐19 pandemic placed exceptional strain on essential services, raising urgent concerns about the mental well‐being of workers in critical sectors. This study examines the short‐ and medium‐term effects of the COVID‐19 pandemic on the mental health of health and social care (HSC) workers in the UK relative to other occupational groups. Using data from the UK Household Longitudinal Study and measuring mental health via the General Health Questionnaire (GHQ), we apply a difference‐in‐differences strategy, where both groups could be treated only in the second period (a pre‐post design), to investigate whether HSC workers experienced distinct mental health trajectories compared to other key workers (KWs) and workers in non‐essential sectors (non‐KWs). The results for the immediate post‐pandemic period (April–November 2020) show no significant differences in mental health for HSC workers compared with either comparator worker groups. Medium‐term outcomes remained statistically insignificant across occupational comparisons. Additional analyses of individual GHQ items and potential mechanisms (financial stability and social isolation) suggest limited heterogeneous effects for each worker group using yearly data. While all studied groups exhibited some deterioration in mental health after 2020, HSC workers' trajectories largely mirrored those of other KWs and non‐KWs, suggesting that factors such as stable employment and financial security may have cushioned the psychological impact for this sector. |
| Keywords: | difference‐in‐differences estimator; keyworker; mental health; Covid‐19; health and social care worker |
| JEL: | J45 J28 |
| Date: | 2026–03–09 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:137618 |