nep-hea New Economics Papers
on Health Economics
Issue of 2024‒05‒13
seventeen papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. Misperceived Effectiveness and the Demand for Psychotherapy By Christopher Roth; Peter Schwardmann; Egon Tripodi
  2. Early child care, maternal labor supply, and gender equality: A randomized controlled trial By Hermes, Henning; Krauß, Marina; Lergetporer, Philipp; Peter, Frauke; Wiederhold, Simon
  3. The Impact of EU Enlargement on Immigrants’ Mental Health By Andrea Berlanda; Elisabetta Lodigiani; Elisa Tosetti; Giorgio Vittadini
  4. Are Medicaid and Medicare Patients Treated Equally? By Calvin Ackley; Abe Dunn; Eli Liebman; Adam Hale Shapiro
  5. Combining Part-Time Work and Social Benefits: Empirical Evidence from Finland By Kalin, Salla; Kyyrä, Tomi; Matikka, Tuomas
  6. A Direct Measure of Medical Innovation on Health Care Spending: A Condition-Specific Approach By Abe C. Dunn; Lasanthi Fernando; Eli Liebman
  7. Cost-Effectiveness of Women´s Vaccination Against HPV: Results for the Czech Republic By Martina Luskova; Kseniya Bortnikova
  8. A neglected determinant of eating behaviors: Relative age By Fumarco, Luca; Hartmann, Sven A.; Principe, Francesco
  9. Macroeconomics of Mental Health By Boaz Abramson; Job Boerma; Aleh Tsyvinski
  10. Consumer impatience: A key motive for Covid-19 vaccination By Marlène Guillon; Phu Nguyen-Van; Bruno Ventelou; Marc Willinger
  11. The Hidden Toll of the Pandemic: Excess Mortality in non-COVID-19 Hospital Patients By Fetzer, Thiemo; Rauh, Christopher; Schreiner, Clara
  12. Intimate Partner Abuse and Child Health By Bharati, Tushar; Mavisakalyan, Astghik; Vu, Loan
  13. COVID-19 and gender-biased violence: current knowledge, gaps, and implications for public policy By Fabiana Rocha; Maria Dolores Montoya Diaz; Paula Carvalho Pereda; Isadora Bousquat à rabe; Filipe Cavalcanti; Samuel Lordemus; Noemi Kreif; Rodrigo Moreno-Serra
  14. Drivers of COVID-19 deaths in the United States: A two-stage modeling approach By Andrés Garcia-Suaza; Miguel Henry; Jesús Otero; Kit Baum
  15. Elections and (mis)reporting of COVID-19 mortality By Parrendah Adwoa Kpeli; Günther G. Schulze; Nikita Zakharov
  16. Parental Employment at the Onset of the Pandemic: Effects of Lockdowns and Government Policies By Kabir Dasgupta; Linda Kirkpatrick; Alexander Plum
  17. Well-Being throughout the COVID-19 Pandemic in Germany: Gendered Effects of Daycare and School Closures By Huebener, Mathias; Waights, Sevrin; Spieß, C. Katharina

  1. By: Christopher Roth; Peter Schwardmann; Egon Tripodi
    Abstract: While psychotherapy has been shown to be effective in treating depression, take-up remains low. In a sample of 1, 843 depressed individuals, we document that effectiveness concerns are top-of-mind when respondents consider the value of therapy. We then show that the average respondent underestimates the effectiveness of therapy and that an information treatment correcting this misperception increases participants’ incentivized willingness to pay for therapy. Information affects therapy demand by changing beliefs rather than by shifting attention. Our results suggest that information interventions that target the perceived effectiveness of therapy are a potent tool in combating the ongoing mental health crisis.
    Keywords: Mental Health, Depression, Psychotherapy, Beliefs, Effectiveness, Information policy
    Date: 2024–04–17
  2. By: Hermes, Henning; Krauß, Marina; Lergetporer, Philipp; Peter, Frauke; Wiederhold, Simon
    Abstract: We provide experimental evidence that enabling access to universal early child care increases maternal labor supply and promotes gender equality among families with lower socioeconomic status (SES). Our intervention offers information and customized help with child care applications, leading to a boost in child care enrollment among lower-SES families. 18 months after the intervention, we find substantial increases in maternal full-time employment (+160%), maternal earnings (+22%), and household income (+10%). Intriguingly, the positive employment effects are not only driven by extended hours at child care centers, but also by an increase in care hours by fathers. Gender equality also benefits more broadly from better access to child care: The treatment improves a gender equality index that combines information on intra-household division of working hours, care hours, and earnings by 40% of a standard deviation, with significant increases in each dimension. For higher-SES families, we consistently observe negligible, insignificant treatment effects.
    Keywords: child care, gender equality, maternal employment, randomized controlled trial
    JEL: C93 J13 J18 J22
    Date: 2024
  3. By: Andrea Berlanda (University of Padova); Elisabetta Lodigiani (University of Padova and LdA); Elisa Tosetti (University of Padova); Giorgio Vittadini (University of Milano Bicocca and LdA)
    Abstract: In this paper we explore the impact of the 2007 European Union enlargement on the mental health of documented immigrants. Using data from a unique Italian administrative data set and employing a difference-in-differences individual fixed effect estimator, we find that the enlargement causes a significant improvement in the mental health of young male immigrants. To shed light on the mechanisms behind these results, we use data from a unique survey and show that the enlargement mitigates sources of health concerns and increases income and employment stability through permanent job contracts for young male immigrants. Overall, these findings suggest that enhanced labor market conditions due to enlargement may lead to subsequent important decrease in psychological distress among immigrants.
    Keywords: Mental health; migration; drug prescriptions; EU enlargement.
    Date: 2023–12
  4. By: Calvin Ackley; Abe Dunn; Eli Liebman; Adam Hale Shapiro
    Abstract: We examine whether Medicaid recipients receive the same health care services as those on Medicare. We track the services provided to the same individual as they age into Medicare from Medicaid at age 65, becoming dual enrolled. Cost sharing remains negligible across the insurance switch, implying that observed changes in service provision reflect supply-side factors. Service provision increases by about 20 percent upon switching to Medicare, across a range of categories and treatments including high-value care. We find that 60 to 90 percent of the increase in office visits is explained by physicians averse to accepting new Medicaid patients. Geographic variation in our estimates shows that the average increase in utilization is larger in those states with lower Medicaid acceptance rates and higher Medicare acceptance rates. By contrast, we find relatively small increases in care from existing Medicaid providers. This analysis indicates that Medicaid’s smaller provider network plays a large role in limiting service provision.
    Keywords: Medicaid; Medicare; health care; health insurance
    JEL: I11 I18
    Date: 2024–04–16
  5. By: Kalin, Salla (University of Helsinki); Kyyrä, Tomi (VATT, Helsinki); Matikka, Tuomas (VATT, Helsinki)
    Abstract: We use detailed, population-wide data from Finland to provide evidence of the impact of earnings disregard policies on part-time work during unemployment spells, and describe the longer-run trends in combining part-time work and social benefits. We find that part-time work while receiving unemployment benefits is strongly concentrated in the service and social and health care sectors, and that women participate in part-time work much more commonly than men (25% vs. 12% of benefit recipients). The share of part-time workers among benefit recipients increased sharply from 10% to 18% over a few years after the implementation of earnings disregards in unemployment benefits and housing allowances, which allowed individuals to earn up to 300 euros per month without reductions in their benefits. Using variation in the impact of the reforms on incentives between individuals eligible for different types of benefits, we estimate a 16–28% increase in participation in part-time work due to the implementation of earnings disregards. However, we find no evidence of economically significant positive or negative effects of increased participation in part-time work on transitions to full-time employment.
    Keywords: labor supply, social benefits, part-time work, earnings disregards
    JEL: H24 J21 J22
    Date: 2024–04
  6. By: Abe C. Dunn; Lasanthi Fernando; Eli Liebman
    Abstract: While technological innovation is believed to be a key driver of spending growth, measuring this relationship is challenging. We address this challenge using a large database of cost-effectiveness studies, which we use to develop proxy measures of inno- vation for specific conditions. We connect to data on spending growth at the condition level from the Bureau of Economic Analysis (BEA) Health Care Satellite Account (HCSA). We find our proxy for innovation is significantly related to spending growth, even after accounting for a number of factors. We estimate that about 18 percent of real spending growth per capita is explained by our proxy for innovation, which we argue is likely a lower bound for the actual contribution of technology on spending growth.
    JEL: E01 I10 O3
    Date: 2023–10
  7. By: Martina Luskova (Institute of Economic Studies, Charles University, Prague, Czech Republic); Kseniya Bortnikova (Institute of Economic Studies, Charles University, Prague, Czech Republic)
    Abstract: This paper evaluates the cost-effectiveness of vaccinating women against human papillomaviruses (HPV) in the Czech Republic, where HPV is the main cause of most cervical carcinomas. It examines the cost-effectiveness of the current reimbursement policy for HPV vaccination compared to the suggested change. Using a homogeneous multistate Markov model, we approximate transitions among states that represent the progression stages of cervical carcinoma, utilizing healthcare reimbursement data from public health insurance. The analysis reveals that increasing immunization coverage from 65.8% to 80% is cost-effective, given the threshold of 1.2 million CZK per quality-adjusted life year. Similarly, expanding the eligible age for vaccination reimbursement from 13 to include ages 13 through 15 years, while also increasing coverage, results in comparable cost-effectiveness. Despite certain limitations, our findings suggest that enhancing the immunization coverage of HPV vaccination for women is economically justified. Consequently, we advocate for the implementation of the proposed policy modifications.
    Keywords: Cost-effectiveness, Markov model, HPV, vaccination, cervical carcinoma, women, Czech Republic
    JEL: I11 I13 I18 C61
    Date: 2024–04
  8. By: Fumarco, Luca; Hartmann, Sven A.; Principe, Francesco
    Abstract: This study investigates a neglected determinant of adolescents' dietary behaviors: the within-class age difference, in isolation from confounding factors (e.g., absolute age, season-of-birth, and countries' specific characteristics, such as expected age at school start). We study a multi-country dataset, with more than 500k students, from dozens of very diverse countries. We find that the youngest students in a class have worse dietary behaviors; they are more likely overweight, they eat fewer vegetables and fruits, they eat more sweets and drink more soft drinks, they tend to skip breakfast, go to bed hungry, and be on a diet. These findings are likely to reflect peer effects: two students with the same absolute age, who were born in the same season, and started school at the same time, have different dietary behaviors because of how their age compares to that of their classmates. Finally, we show that this result holds across countries, which demonstrate the ubiquity of relative age effects on eating behaviors.
    Keywords: Diet, Adolescence, Causal, External validity, Relative age
    JEL: I12 I18 I24
    Date: 2024
  9. By: Boaz Abramson (Columbia GSB); Job Boerma (University of Wisconsin-Madison); Aleh Tsyvinski (Yale University)
    Abstract: We develop an economic theory of mental health. The theory is grounded in classic and modern psychiatric literature, is disciplined with micro data, and is formalized in a life-cycle heterogeneous agent framework. In our model, individuals experiencing mental illness have pessimistic expectations and lose time due to rumination. As a result, they work less, consume less, invest less in risky assets, and forego treatment which in turn reinforces mental illness. We quantify the societal burden of mental illness and evaluate the efficacy of prominent policy proposals. We show that expanding the availability of treatment services and improving treatment of mental illness in late adolescence substantially improve mental health and welfare.
    Date: 2024–04
  10. By: Marlène Guillon (MRE - Montpellier Recherche en Economie - UM - Université de Montpellier); Phu Nguyen-Van (EconomiX - EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Marc Willinger (CEE-M - Centre d'Economie de l'Environnement - Montpellier - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - Institut Agro Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - UM - Université de Montpellier)
    Abstract: We study the behavioral determinants of COVID-19 vaccination uptake. The vaccine-pass policy, implemented in several countries in 2021, conditioned the access to leisure and consumption places to being vaccinated against COVID-19 and created an unprecedented situation where individuals' access to consumption goods and vaccine status were interrelated. We rely on a quasi-hyperbolic discounting model to study the plausible relationships between time preference and the decision to vaccinate in such context. We test the predictions of our model using data collected from a representative sample of the French population (N = 1034) in August and September 2021. Respondents were asked about their COVID-19 vaccination status (zero, one, or two doses), as well as their economic and social preferences. Preference elicitations were undertaken online through incentivized tasks, with parallel collection of self-stated preferences. Factors associated with COVID-19 vaccination were investigated using a logistic model. Both elicited and stated impatience were found to be positively associated with COVID-19 vaccination decisions. These results suggest that impatience is a key motivational lever for vaccine uptake in a context where the vaccination decision is multidimensional and impacts the consumption potential. Results also serve to highlight the potential effectiveness of public communications campaigns based on time preferences to increase vaccination coverage.
    Keywords: Time preferences, Time inconsistency, Health behavior, COVID-19 Vaccination
    Date: 2024–06
  11. By: Fetzer, Thiemo (University of Warwick & University of Bonn & CEPR & ECONtribute); Rauh, Christopher (University of Cambridge, PRIO, CEPR, IZA & HCEO); Schreiner, Clara (Nuffield College, University of Oxford.)
    Abstract: Seasonal infectious diseases can cause demand and supply pressures that reduce the ability of healthcare systems to provide high-quality care. This may generate negative spillover effects on the health outcomes of patients seeking medical help for unrelated reasons. Separating these indirect burdens from the direct consequences for infected patients is usually impossible because of a lack of suitable data and an absence of population testing. However, this paper finds robust empirical evidence of excess mortality among non-COVID-19 patients in an integrated public healthcare system: the English NHS. Analysing the forecast error in the NHS’ model for predicted mortality, we find at least one additional excess death among patients who sought medical help for reasons unrelated to COVID-19 for every 42 COVID-19-related deaths in the population. We identify COVID-19 pressures as a key driver of non-COVID-19 excess mortality in NHS hospitals during the pandemic, and characterise the hospital populations and medical conditions that are disproportionately affected. Our findings have substantive relevance in shaping our understanding of the wider burden of COVID-19, and other seasonal diseases more generally, and can contribute to debates on optimal public health policy.
    Keywords: Externalities; spillovers; COVID-19; public health; seasonal diseases; excess mortality; prediction error JEL Classification: I1, I18
    Date: 2024
  12. By: Bharati, Tushar; Mavisakalyan, Astghik; Vu, Loan
    Abstract: Despite the harmful effects of intimate partner abuse (IPA) on child health, survivors with children often continue in abusive relationships. It is often, they claim, to ensure a better future for their children. We explore the puzzle and this potential explanation using rich, longitudinal data from Australia. We show that IPA has large, long-lasting negative effects on children's health. These findings stay robust across several identification techniques, including instrumental variables, sequential difference-in-differences, and event studies. The effects seem to be driven by worsening physical and mental health of the parents, which also adversely impacts their risk-taking behavior, decrease in parents' confidence in their parenting, decrease in warm parenting, and increase in angry parenting. Finally, comparing event study graphs reveal that children of parents who separate after IPA events are no better off than children of parents who do not separate after IPA events, weakly supporting the popular explanation.
    Keywords: domestic abuse, child health, divorce
    JEL: J12 J13
    Date: 2024
  13. By: Fabiana Rocha; Maria Dolores Montoya Diaz; Paula Carvalho Pereda; Isadora Bousquat à rabe; Filipe Cavalcanti; Samuel Lordemus; Noemi Kreif; Rodrigo Moreno-Serra
    Abstract: On a global scale, 1 in 3 women experience physical and/or sexual violence in their lifetime, and women of disadvantaged backgrounds are at an even higher risk. Since the outbreak of COVID-19, data have shown that violence against women (VAW) has intensified. In this paper, we review an incipient but rapidly growing literature that evaluates the effects of stay-at-home measures to reduce the spread of COVID-19 on VAW. We focus on low and middle-income countries and classify existing studies into three categories according to the quality of the data used and the reliability of the identification strategies: not causal, less causal, and causal. Overall, the existing literature offers mixed evidence about the VAW effects of stay-at-home measures, although increases in VAW have been more frequently observed where stay-at-home measures were stricter. Important reasons for the mixed evidence found in the literature seem to be the different types of violence analyzed (physical, sexual, psychological, or economic) and the corresponding difficulties in reporting. The main methodological challenges for this literature are data availability and the reliability of the methods employed to separate the effects of social isolation on VAW from those VAW effects associated with the income and emotional shocks from the COVID-19 pandemic. Innovative methods and data can help to improve our understanding and design better policy responses to this major social and public health challenge.
    Keywords: gender-based violence; COVID-19 pandemic; Low- and middle-income countries
    JEL: I18 J16 H12
    Date: 2024–04–17
  14. By: Andrés Garcia-Suaza (University del Rosario); Miguel Henry (Greylock McKinnon Associates); Jesús Otero (University del Rosario); Kit Baum (Boston College)
    Abstract: We offer a two-stage (time-series and cross-section) econometric modeling approach to examine the drivers behind the spread of COVID-19 deaths across counties in the United States. Our empirical strategy exploits the availability of two years (January 2020 through January 2022) of daily data on the number of confirmed deaths and cases of COVID-19 in the 3, 000 U.S. counties of the 48 contiguous states and the District of Columbia. In the first stage of the analysis, we use daily time-series data on COVID-19 cases and deaths to fit mixed models of deaths against lagged confirmed cases for each county. Because the resulting coefficients are county specific, they relax the homogeneity assumption that is implicit when the analysis is performed using geographically aggregated cross-section units. In the second stage of the analysis, we assume that these county estimates are a function of economic and sociodemographic factors that are taken as fixed over the course of the pandemic. Here we employ the novel one-covariate-at-atime variable-selection algorithm proposed by Chudik et al. (2018) to guide the choice of regressors.
    Date: 2023–09–10
  15. By: Parrendah Adwoa Kpeli; Günther G. Schulze; Nikita Zakharov (Department of International Economic Policy, University of Freiburg)
    Abstract: We investigate the effect of elections on underreporting COVID-19 mortality, measured as the difference between excess mortality and official statistics. Our identification strategy takes advantage of a natural experiment of the unanticipated onset of the Coronavirus pandemic in 2020 and the asymmetric electoral schedule of presidential elections around the world, in which some countries faced the pandemic with upcoming elections in the next two years, while others did not have this electoral pressure. Contrary to conventional wisdom that governments manipulate information downwards to enhance reelection probabilities, we find that democratic governments facing elections in the following years report COVID fatalities more truthfully. We explain the result by a potential aversion to the costs associated with exposed underreporting: using Gallup poll data for 2020 we show that underreporting of COVID-19 mortality potentially undermines trust in government but only in relatively democratic countries.
    Keywords: COVID-19, data manipulation, elections, democracy
    Date: 2024–04
  16. By: Kabir Dasgupta; Linda Kirkpatrick; Alexander Plum
    Abstract: The COVID-19 pandemic had disproportionate impacts on women's employment, especially for mothers with school-age and younger children.However, the impacts likely varied depending on the type of policy response adopted by various governments. New Zealand presents a unique policy setting in which one of the strictest lockdown restrictions was combined with a generous wage subsidy scheme to secure employment. We utilize tax records to compare employment patterns of parents from the pandemic period (treatment group) to similar parents from a recent pre-pandemic period (control group). For mothers whose youngest child is aged between one and 12, we find a 1-2-percentage point decline in the likelihood of being employed in the first six months of the pandemic; for fathers, we hardly see any significant changes in employment. Additionally, the decline in mothers' employment rates is mainly driven by those not employed in the month before the lockdown. We also find similar employment patterns for future parents who had no children during the evaluation period. This indicates that the adverse labour market impacts are not uniquely experienced by mothers, but by women in general.
    Keywords: Pandemic; Employment; Parental gap; Administrative data
    JEL: D10 D13 E24
    Date: 2024–03–22
  17. By: Huebener, Mathias (Bundesinstitut für Bevölkerungsforschung (BiB)); Waights, Sevrin (Humboldt University Berlin); Spieß, C. Katharina (Bundesinstitut für Bevölkerungsforschung (BiB))
    Abstract: In this chapter, we aim to improve the understanding of the well-being impacts of the COVID-19 pandemic. We provide an overview of the existing literature and carry out empirical analysis aimed at addressing certain gaps in the knowledge. Specifically, we examine the evolution of parental well-being over the course of the COVID-19 pandemic in Germany and relate changes to the severity of restrictions on school and daycare facilities. Our analysis makes use of unique data from the COMPASS survey collected at 17 different point throughout the pandemic in Germany. We find that there is a large difference in retrospective stress-feelings between women and men that is present only for individuals living with children under the age of 12. We also show that the size of the gender gap in life satisfaction fluctuates over time in a way that is related to severity of restrictions to daycare and school operation.
    Keywords: well-being, gender inequality, COVID-19, school closures
    JEL: I31 I24 J1 I20
    Date: 2024–04

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