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on Health Economics |
| By: | Alexander, Diane; Schwandt, Hannes |
| Abstract: | Car exhaust is a major source of air pollution, but little is known about its impacts on population health. We exploit the dispersion of emissions-cheating diesel cars-which secretly polluted up to 150 times as much as gasoline cars-across the United States from 2008-2015 as a natural experiment to measure the health impact of car pollution. Using the universe of vehicle registrations, we demonstrate that a 10 percent cheating-induced increase in car exhaust increases rates of low birth weight and acute asthma attacks among children by 1.9 and 8.0 percent, respectively. These health impacts occur at all pollution levels and across the entire socioeconomic spectrum. |
| Keywords: | Car pollution; emissions cheating; health |
| JEL: | I10 I14 J13 K32 |
| Date: | 2019–06 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:13805&r=all |
| By: | Analisa Packham |
| Abstract: | In light of the recent opioid crisis, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe needle disposal for injection drug users. This paper investigates the effects of recent SEP openings on HIV diagnoses and drug-related overdoses in the wake of the opioid crisis. I find that SEP openings decrease HIV diagnoses by up to 18.2 percent. However, I present new evidence that SEPs increase rates of opioid-related mortality and hospitalizations, suggesting that needle exchanges alone may be less effective than other interventions at stimulating recovery. |
| JEL: | I10 I18 K42 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26111&r=all |
| By: | Abhijit Banerjee; Eliana La Ferrara; Victor H. Orozco-Olvera |
| Abstract: | We test the effectiveness of an entertainment education TV series, MTV Shuga, aimed at providing information and changing attitudes and behaviors related to HIV/AIDS. Using a simple model we show that "edutainment" can work through an individual or a social channel. We conducted a randomized controlled trial in urban Nigeria where young viewers were exposed to MTV Shuga or to a placebo TV series. Among those exposed to MTV Shuga, we created additional variation in the social messages they received and in the people with whom they watched the show. We find significant improvements in knowledge and attitudes towards HIV and risky sexual behavior. Treated subjects are twice as likely to get tested for HIV eight months after the intervention. We also find reductions in STDs among women. These effects are stronger for viewers who report being more involved with the narrative, consistent with the psychological underpinnings of edutainment. Our experimental manipulations of the social norm component did not produce significantly different results from the main treatment. The individual effect of edutainment thus seems to have prevailed in the context of our study. |
| JEL: | D91 I12 O15 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26096&r=all |
| By: | Thomas C. Buchmueller; Colleen M. Carey; Giacomo Meille |
| Abstract: | Many opioid control policies target the prescribing behavior of health care providers. In this paper, we study the first comprehensive state-level policy requiring providers to access patients' opioid history before making prescribing decisions. We compare prescribers in Kentucky, which implemented this policy in 2012, to those in a control state, Indiana. Our main difference-in-differences analysis uses the universe of prescriptions filled in the two states to assess how the information provided affected prescribing behavior. As many as forty percent of low-volume opioid prescribers stopped prescribing opioids altogether after the policy was implemented. Among other providers, the major margin of response was to prescribe opioids to approximately sixteen percent fewer patients. While providers disproportionately discontinued treating patients whose opioid histories showed the use of multiple providers, there were also economically-meaningful reductions for patients without multiple providers and single-use acute patients. |
| JEL: | H75 I12 I18 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26159&r=all |
| By: | Katherine Baicker; Theodore Svoronos |
| Abstract: | Given the complex relationships between patients’ demographics, underlying health needs, and outcomes, establishing the causal effects of health policy and delivery interventions on health outcomes is often empirically challenging. The single interrupted time series (SITS) design has become a popular evaluation method in contexts where a randomized controlled trial is not feasible. In this paper, we formalize the structure and assumptions underlying the single ITS design and show that it is significantly more vulnerable to confounding than is often acknowledged and, as a result, can produce misleading results. We illustrate this empirically using the Oregon Health Insurance Experiment, showing that an evaluation using a single interrupted time series design instead of the randomized controlled trial would have produced large and statistically significant results of the wrong sign. We discuss the pitfalls of the SITS design, and suggest circumstances in which it is and is not likely to be reliable. |
| JEL: | C1 I1 I13 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26080&r=all |
| By: | Pamela Giustinelli; Charles F. Manski; Francesca Molinari |
| Abstract: | We elicit numerical expectations for late-onset dementia in the Health and Retirement Study. Our elicitation distinguishes between precise and imprecise probabilities, while accounting for rounding of reports. Respondents quantify imprecision using probability intervals. Nearly half of respondents hold imprecise dementia probabilities, while almost a third of precise-probability respondents round their reports. We provide the first empirical evidence on dementia-risk perceptions among dementia-free older Americans and novel evidence about imprecise probabilities in a nationally-representative sample. We show, in a specific framework, that failing to account for imprecise or rounded probabilities can yield incorrect predictions of long-term care insurance purchase decisions. |
| JEL: | D80 D84 I0 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26125&r=all |
| By: | Pamela Giustinelli; Matthew D. Shapiro |
| Abstract: | The Subjective ex ante Treatment Effect is the difference between the probabilities of an outcome conditional on a treatment. The SeaTE yields ex ante causal effects at the individual level. The paper gives an interpretation in two workhorse econometric frameworks: potential outcomes and dynamic programming. It finds large effect heterogeneity of health on work in two surveys of older workers, the VRI and the HRS. It shows how reduced-form estimates of health on work are biased when there is unobserved heterogeneity in taste for work. Using the VRI’s panel structure, it validates the elicited conditional probabilities of work given health. |
| JEL: | C21 C83 D84 J26 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26087&r=all |
| By: | Richard Domurat; Isaac Menashe; Wesley Yin |
| Abstract: | We experimentally varied information mailed to 87,000 households in California's health insurance marketplace to study the role of frictions in insurance take-up. Reminders about the enrollment deadline raised enrollment by 1.3 pp (16 percent), in this typically low take-up population. Heterogeneous effects of personalized subsidy information indicate systematic misperceptions about program benefits. Consistent with an adverse selection model with frictional enrollment costs, the intervention lowered average spending risk by 5.1 percent, implying that marginal respondents were 37 percent less costly than inframarginal consumers. We observe the largest positive selection among low income consumers, who exhibit the largest frictions in enrollment. Finally, the intervention raised average consumer WTP for insurance by $25 to $54 per month. These results suggest that frictions may partially explain low measured WTP for marketplace insurance, and that interventions reducing them can improve enrollment and market risk in exchanges. |
| JEL: | D03 I11 I13 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26153&r=all |
| By: | Kritee Gujral; Anirban Basu |
| Abstract: | This paper examines the impact of California's hospital closures occurring from 1995-2011 on adjusted inpatient mortality for time-sensitive conditions: sepsis, stroke, asthma/chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI). Using a difference- in-difference approach on California's Office of Statewide Health Planning and Development (OSHPD) data, the impact of hospital closures on inpatient mortality is estimated. Outcomes of admissions in hospital service areas (HSAs) with and without closure(s) are compared before and after the closure year. The paper aims to fill gaps in prior work by using a reconciled list of California's hospital closures and by studying differential impacts of rural and urban hospital closures. To our best knowledge, this is also the first paper explicitly studying patient outcomes of California's rural closures. Results suggest that when treatment groups are not differentiated by hospital rurality, closures appear to have no measurable impact. However, estimating differential impacts of rural and urban closures shows that rural closures increase inpatient mortality by 0.46% points (an increase of 5.9%), whereas urban closures have no impact. Results differ across diagnostic conditions; the general effect of closures is to increase mortality for stroke patients by 3.1% and for AMI patients by 4.5%, and decrease mortality for asthma/COPD patients by 8.8%. |
| JEL: | I11 I12 I14 I18 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26182&r=all |
| By: | Sarah Miller; Sean Altekruse; Norman Johnson; Laura R. Wherry |
| Abstract: | We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic and citizenship status, and public program participation. We find a 0.13 percentage point decline in annual mortality, a 9.3 percent reduction over the sample mean, associated with Medicaid expansion for this population. The effect is driven by a reduction in disease-related deaths and grows over time. We find no evidence of differential pre-treatment trends in outcomes and no effects among placebo groups. |
| JEL: | I1 I13 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26081&r=all |
| By: | Diane Alexander; Molly Schnell |
| Abstract: | We examine how the amount a physician is paid influences who they are willing to see. Exploiting large, exogenous changes in Medicaid reimbursement rates, we find that increasing payments for new patient office visits reduces reports of providers turning away beneficiaries: closing the gap in payments between Medicaid and private insurers would reduce more than two-thirds of disparities in access among adults and would eliminate disparities among children. These improvements in access lead to more office visits, better self-reported health, and reduced school absenteeism. Our results demonstrate that financial incentives for physicians drive access to care and have important implications for patient health. |
| JEL: | H51 H75 I13 I14 I18 I24 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26095&r=all |
| By: | LEBIHAN, Laetitia; MAO TAKONGMO, Charles Olivier |
| Abstract: | Little is known about the effects of paid parental leave (in particular fathers' quotas) on parental health and involvement. In this paper, we exploit a reform that took place in the Canadian province of Quebec to address that important topic. In 2006, Quebec opted out of the federal plan and established its own parental insurance plan, named the Quebec Parental Insurance Plan (QPIP). This program has lowered the eligibility criteria, increased income replacement and introduced fathers' quotas. Using three data sets, we investigate the impact of the QPIP on breastfeeding and parental health and behavior. Our results show that the reform increased breastfeeding duration and parental involvement. Results also suggest that the policy had limited positive effects on parental health. |
| Keywords: | Parental leave; family health; breastfeeding; parental behavior. |
| JEL: | I12 I18 I30 J18 |
| Date: | 2019–08–25 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:95719&r=all |
| By: | Victoria Perez; Justin M. Ross; Kosali I. Simon |
| Abstract: | A mainstream motivation for decentralized government is to enable public service investments to better align with political preferences that may differ by geographical region. This paper examines how political preferences determine local government provision of hospital services. We find that local governments in areas more supportive of public insurance expansion responded to such state action by increasing expenditures on hospitals, whereas those in areas that voted against such expansions used the savings to reduce property taxes. This finding suggests that local government financial responses indeed align with political preferences. |
| JEL: | H71 H72 I1 I11 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26094&r=all |
| By: | Arduini, Tiziano; Bisin, Alberto; Ozgur, Onur; Patacchini, Eleonora |
| Abstract: | We study risky behavior of adolescents. Concentrating on smoking and alcohol use, we structurally estimate a dynamic social interaction model in the context of students' school networks included in the National Longitudinal Study of Adolescent Health (Add Health). The model allows for forward-looking behavior of agents, addiction effects, and social interactions in the form of preferences for conformity in the social network. We find strong evidence for forward looking dynamics and addiction effects. We also find that social interactions in the estimated dynamic model are quantitatively large. A misspecified static model would fit data substantially worse, while producing a much smaller estimate of the social interaction effect. With the estimated dynamic model, a temporary shock to students' preferences in the 10th grade has effects on their behavior in grades 10, 11, 12, with estimated social multipliers 1.53, 1.03, and 0.76, respectively. The multiplier effect of a permanent shock is much larger, up to 3.7 in grade 12. Moreover, (semi-) elasticities of a permanent change in the availability of alcohol or cigarettes at home on child risky behavior implied by the dynamic equilibrium are 25%, 63%, and 79%, in grades 10, 11, 12, respectively. |
| JEL: | C18 C33 C62 C63 C73 I12 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:13918&r=all |
| By: | Rahi Abouk; Scott Adams; Bo Feng; Johanna Catherine Maclean; Michael F. Pesko |
| Abstract: | We use the universe of birth records in the United States from 2013 to 2017 to examine the effect of e-cigarette taxes on pre-pregnancy smoking, prenatal smoking, and birth outcomes (birth weight, gestational length, and Apgar 5 score). We apply a differences-in-differences model to study these questions. We have two principle findings. First, e-cigarette tax adoption increases pre-pregnancy and prenatal smoking, implying that e-cigarettes and traditional cigarettes are substitutes among pregnant women. Second, in line with clinical literature suggesting that both e-cigarettes and traditional cigarettes are harmful to developing fetuses, birth outcomes are largely unchanged following adoption of an e-cigarette tax. In sum, our results suggest that e-cigarettes reduce prenatal smoking, but have no observable benefit towards the goal of promoting fetal development. |
| JEL: | I12 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26126&r=all |
| By: | Alberto Chong (Department of Economics, Georgia State University, USA); Carla Srebot (Universidad del Pacifico, Peru) |
| Abstract: | Using a difference-in-difference approach, we test the causal link between environmental disasters and mental health indicators in rural areas of Peru by exploiting the spatial variation of exogeneous oil spills as well as the differences in their timing for the period 2014–16. We find that, after controlling for time-varying controls and for year fixed effects, oil spills lead to significantly higher probability of suffering psychological distress, such as lack of motivation, fatigue or feeling of failure. In particular, we find that an individual is 25.2 percentage points more likely to suffer from depression after an oil spill occurrence. Falsification tests provide further support that the main results are not simply the result of spurious correlations. |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:ays:ispwps:paper1908&r=all |
| By: | Mesfin G. Genie (Department of Economics, University Of Venice Cà Foscari); Antonio Nicolò (Dipartamento di Scienze Economiche “Marco Fanno”, Università degli Studi di Padova; School of Social Sciences, The University of Manchester); Giacomo Pasini (Ca’ Foscari University of Venice; NETSPAR, Network for Studies on Pensions, Ageing and Retirement, Tilburg) |
| Abstract: | We elicit time and risk preferences for kidney transplantation from the entire population of patients of the largest Italian transplant centre using a discrete choice experiment (DCE). We measure patients’ willingness-to-wait (WTW), expressed in months, for receiving a kidney with one-year longer expected graft survival, or low risk of complication. Using a mixed logit in WTW-space model, we find heterogeneity in patients’ preferences. Our model allows WTW to vary with the patient’s age and duration of dialysis. The results suggest that WTW correlates with age and duration of dialysis. The implication for transplant practice is that including individual preferences in kidney allocation protocols that assign “non-ideal” (expanded donor criteria) organs may not only increase the expected survival rates of patients with transplanted organs but also improve patients’ satisfaction. |
| Keywords: | Stated preferences, Mixed logit, Willingness to wait, Marginal kidney |
| JEL: | I18 I14 C90 D61 |
| Date: | 2019 |
| URL: | http://d.repec.org/n?u=RePEc:ven:wpaper:2019:25&r=all |
| By: | Jang, Youngsoo |
| Abstract: | How do defaults and bankruptcies affect optimal health insurance policy? I answer this question using a life-cycle model of health investment with the option to default on emergency room (ER) bills and financial debts. I calibrate the model for the U.S. economy and compare the optimal health insurance in the baseline economy with that in an economy with no option to default. With no option to default, the optimal health insurance is similar to the health insurance system in the baseline economy. In contrast, with the option to default, the optimal health insurance system (i) expands the eligibility of Medicaid to 22 percent of the working-age population, (ii) replaces 72 percent of employer-based health insurance with a private individual health insurance plus a progressive subsidy, and (iii) reforms the private individual health insurance market by improving coverage rates and preventing price discrimination against people with pre-existing conditions. This result implies that with the option to default, households rely on bankruptcies and defaults on ER bills as implicit health insurance. More redistributive healthcare reforms can improve welfare by reducing the dependence on this implicit health insurance and changing households’ medical spending behavior to be more preventative. |
| Keywords: | Credit, Default, Bankruptcy, Optimal Health Insurance |
| JEL: | E21 H51 I13 K35 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:95705&r=all |
| By: | Bolin, Kristian (Department of Economics, School of Business, Economics and Law, Göteborg University); Caputo, Michael R. (Department of Economics, University of Central Florida) |
| Abstract: | The time at which a rational patient might choose an elective medical procedure for a non-life-threatening ailment is contemplated. The resulting model is purposely uncomplicated but general, and accounts for several basic factors that might affect such a decision. One such factor is that a patient cannot know with certainty the degree to which the medical procedure will be successful. Even so, patients have information about the expected outcome of the procedure and its risk, and about how the expected outcome and risk are affected by medical technological progress and surgeon experience. The effect of changes in exogenous variables on the timing of the medical procedure and on patient welfare are investigated. It is shown that risk averse and prudent patients behave in an unambiguous manner in response to changes in all of the exogenous variables. |
| Keywords: | Health Behavior; Optimal Timing; Medical Decisions |
| JEL: | I12 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:gunwpe:0772&r=all |
| By: | Anya Samek; Arie Kapteyn; Andre Gray |
| Abstract: | Evidence shows that people have difficulty understanding complex aspects of retirement planning, which leads them to under-utilize annuities and claim Social Security benefits earlier than is optimal. To target this problem, we developed vignettes about the consequences of different annuitization and claiming decisions. We evaluated our vignettes using an experiment with a representative online panel of nearly 2,000 Americans. In our experiment, respondents were either assigned to a control group with no vignette, to a written vignette, or to a video vignette. They were then asked to give advice to hypothetical persons on annuitization or Social Security claiming, and were asked factual questions about these concepts. We found evidence that being exposed to vignettes led respondents to give better advice. For example, the gap between advised claim age for a relatively healthy person versus a relatively sick person was larger by nearly a year in the vignette treatments versus the control group. Further, the vignettes increased financial literacy related to these concepts by 10-15 percentage points. Interestingly, the mode of communication did not have a significant impact – the video and written vignettes were equally effective. |
| JEL: | H3 J26 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26176&r=all |
| By: | Popova, Olga; Otrachshenko, Vladimir; Tavares, José |
| Abstract: | We examine the relationship between extreme temperatures and violent mortality across Russian regions, with implications for the social costs of climate change. We assess the unequal impact of temperature shocks across gender and age groups by exploring a dataset on temperature and violence in Russia, between the years 1989 and 2015. Hot days lead to an increase in both female and male victims, one hot day resulting in the loss of 1,579 person-years of life for men, and 642 for women. However, the likelihood of victimization during weekends rises noticeably for women, with women between 25 and 59 more victimized on weekends. Our results suggest that female victimization on hot days would be mitigated by increases in regional income and job opportunities, and on cold days, by decreasing the consumption of spirits. |
| Keywords: | Violence,Gender Homicide,Extreme Temperatures,Russia |
| JEL: | I14 K42 P52 Q54 |
| Date: | 2019 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:382&r=all |
| By: | Pedro Carneiro; Emanuela Galasso; Italo Lopez Garcia; Paula Bedregal; Miguel Cordero |
| Abstract: | This paper experimentally estimates medium term impacts of a large-scale and low-cost parenting program targeting poor families in Chile. Households in 162 public health centers were randomly assigned to three groups: a control group, a second group that was offered eight weekly group parenting sessions, and a third group that was offered the same eight group sessions plus two sessions of guided interactions between parents and children focused on responsive play and dialogic reading. In spite of its short duration and intensity, three years after the end of the intervention, the receptive vocabulary and the socio-emotional development of children of families participating in either of the treatment arms improved (by 0.43 and 0.54 standard deviation, respectively) relative to children of nonparticipating families. The treatments also led to improvements in home environments and parenting behaviors of comparable magnitudes, which far outlasted the short duration of the intervention. |
| Keywords: | parenting, early childhood development |
| JEL: | H43 I10 I20 I38 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2019-051&r=all |
| By: | Widmer, Philine; Zurlinden, Noémie |
| Abstract: | To determine whether health ministers engage in regional favoritism, we hand-collect geocoded data on the birth regions of cabinet members in 45 African countries between 2001 and 2014. We combine this data with information on World Bank health aid projects and retrospective data on neonatal and infant mortality from Demographic and Health Surveys. We provide two pieces of evidence suggesting health ministers engage in favoritism. First, using administrative region and country-year fixed effects, we show that administrative regions receive more health aid when a region-born health minister is in office. Second, comparing siblings, we find that neonates (and possibly infants) born in the same region as the health minister are less likely to die. These two results imply that not only do country leaders exercise their power to influence the allocation of funds (as shown in previous literature), but so do cabinet members. We do not find any descriptive evidence that the lower neonatal (and possibly infant) mortality in health ministers' birth regions can be explained by the additional health aid allocated to these regions. |
| Keywords: | Foreign aid, favoritism, political capture, patronage, clientelism, corruption, aid allocation, Africa, World Bank, infant mortality, child health, georeferenced data, spatial analysis |
| JEL: | D73 F35 I10 J13 I18 R11 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:usg:econwp:2019:11&r=all |
| By: | Mark R. Rosenzweig; Junsen Zhang |
| Abstract: | Obesity is an important global health problem. Although obesity is not directly related to access to health care or constrained by resource deprivation, overweight status is predominantly found in poor, less-educated populations. This paper seeks to identify the causal role of schooling in affecting obesity among children and adolescents, using new estimation methods that exploit unique panel data on young twins in China. The estimates indicate that higher levels of schooling negatively affect being overweight and positively affect healthy behavior, with a large component of the causal effects due to increased information on the benefits of maintaining a healthy weight. There is also evidence that the higher-income associated with increased schooling increases incentives to invest in health. |
| JEL: | I12 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26089&r=all |