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on Health Economics |
| By: | Kok Fong See (Universiti Sains Malaysia, Malaysia); Shawna Grosskopf (Oregon State University, United States); Vivian Valdmanis (Western Michigan University, United States); Valentin Zelenyuk (School of Economics and Centre for Efficiency and Productivity Analysis (CEPA) at The University of Queensland, Australia) |
| Abstract: | Not only does healthcare play a key role in a country’s economy, but it is also one of the fastest-growing sectors for most countries, resulting in rising expenditures. In turn, efficiency and productivity analyses of the healthcare industry have attracted attention from a wide variety of interested parties, including academics, hospital administrators, and policy makers. As a result, a very large number of studies of efficiency and productivity in the healthcare industry have appeared over the past three decades in a variety of outlets. In this paper, we conduct a comprehensive and systematic review of these studies with the aid of modern machine technology learning methods for bibliometric analysis. This approach facilitated our identification and analysis and allowed us to reveal patterns and clusters in the data from 477 efficiency and productivity articles associated with the healthcare industry from 1983 to 2019, produced by nearly 1000 authors and published in a multitude of academic journals. Leveraging on such ‘biblioanalytics’, combined with our own understanding of the field, we then highlight the trends and possible future of efficiency and productivity studies in healthcare. |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:qld:uqcepa:161&r= |
| By: | D'Albis, Hippolyte; Fougère, Denis; Gouëdard, Pierre |
| Abstract: | This paper proposes an evaluation of the pre-retirement consequences of a reform of the French pension system that increased the minimum legal retirement age. Our empirical strategy relies on the comparison of two groups of cohorts. The control group consists of cohorts not affected by the increase in the minimum legal retirement age while the treatment group consists of cohorts born later. Using a sample of 38,652 high-school teachers, we identify the effect of increasing the minimum retirement age on short sick leaves (i.e., of less than three months) by comparing probabilities to take at least one sick leave during a schooling year before retirement across the two groups. Estimates of panel data models show that teachers affected by the reform have an increased probability to take short sick leaves before retirement. This is mainly due to teachers who decide to retire at the minimum legal retirement age, while those who continue to work above the minimum retirement age do not increase the frequency of their short sick leaves before retirement. This last result is predicted by a theoretical model that analyzes the optimal retirement choice over the life-cycle, and it is confirmed by using an empirical strategy that distinguishes teachers according to their retirement age. |
| Keywords: | pension reform; Retirement age; sick leaves; teachers' absenteeism |
| JEL: | I12 J26 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15142&r= |
| By: | Azmat, Ghazala Y.; Hensvik, Lena; Rosenqvist, Olof |
| Abstract: | Following the arrival of the first child, women's absence rates soar and become less predictable due to the greater frequency of their own sickness and the need to care for sick children. In this paper, we argue that this fall in presenteeism in the workplace hurts women's wages, not only indirectly and gradually, through a slower accumulation of human capital, but also immediately, through a direct negative effect on productivity in unique jobs (i.e., jobs with low substitutability). Although both presenteeism and job uniqueness are highly rewarded, we document that women's likelihood of holding jobs with low substitutability decreases substantially relative to men's after the arrival of the first child. This gap persists over time, with important long-run wage implications. We highlight that the parenthood wage penalty for women could be reduced by organizing work in such a way that more employees have tasks that, at least in the short run, can be performed satisfactorily by other employees in the workplace. |
| JEL: | J16 J22 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:14982&r= |
| By: | Bartel, Ann P. (Columbia University); Kim, Soohyun (Columbia University); Ruhm, Christopher J. (University of Virginia); Waldfogel, Jane (Columbia University) |
| Abstract: | Paid family leave allows workers to take time off from work to care for a family member with a serious health condition, with reduced financial risk and increased job continuity. In 2004, California was the first state in the nation to implement a paid family leave program allowing workers to take up to eight weeks off work with partial pay to care for their own or a family member's serious health condition. While the effects of California's law on the labor supply of parents of newborns have been extensively studied, the role of paid family leave in the labor supply of workers who may need to provide care for a spouse has not been studied widely. We examine the effects of California's law on the employment of workers who are aged 45-64 and have a disabled spouse, using the 2001-2008 American Community Survey. Our preferred estimates suggest the paid leave program increased the employment of 45-64 year old women with a disabled spouse in California by around 0.9 percentage points (or 1.4% on a pre-law base rate of 65.9%) in the post-law period compared to their counterparts in other states, with a 2.9 percentage point rise in private sector employment. The employment of men with a disabled spouse in California also increased, but by a smaller amount: 0.7 percentage points (or 0.8% on a pre-law base 86.8%) (with a non-significant 0.4 percentage point decrease in private sector employment). |
| Keywords: | paid family leave, older workers, employment |
| JEL: | J01 J20 J22 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14380&r= |
| By: | Kunz, Johannes; Propper, Carol; Staub, Kevin; Winkelmann, Rainer |
| Abstract: | We examine variation in hospital quality across ownership, market concentration and membership of a hospital system. We use a measure of quality derived from the penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program. We employ a novel estimation approach that extracts latent hospital quality from panel data on penalties and addresses the problem of never- or always-penalized hospitals in short panels. Our quality measure correlates strongly across penalized conditions and with other non-incentivized quality metrics. We document a robust and sizable for-profit quality gap, which is largely crowded out by competition, particularly amongst high-quality and system-organized hospitals. |
| Keywords: | A ordable Care Act; Competition; Hospital quality |
| JEL: | H51 I1 I11 I18 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15045&r= |
| By: | Rym Ben Bachouch (Univ. Orléans, PRISME, CE - PRISME - Laboratoire Pluridisciplinaire de Recherche en Ingénierie des Systèmes, Mécanique et Energétique - UO - Université d'Orléans - ENSI Bourges - Ecole Nationale Supérieure d'Ingénieurs de Bourges); Jihène Tounsi (Université de Sousse, SMART-LAB - Strategies for Modelling and ARtificial inTelligence Laboratory - Université de Tunis); Chouari Borhen (Université de Sousse, SMART-LAB - Strategies for Modelling and ARtificial inTelligence Laboratory - Université de Tunis) |
| Abstract: | In this paper, we are interested in the Home health care (HHC) scheduling problem. The HHC office needs to minimize traveling costs and to optimize caregiver assignment to patients. Scheduling patient visits have to take into account unexpected situations based on the latest scheduling information. We first analyze the HHC scheduling problem as deterministic, then discuss the dynamic challenges and propose a rescheduling approach based on genetic algorithm. A platform is designed to evaluate the proposed approach. The obtained results showed that the scheduling system is able to compute high quality schedules and can deal with urgent unpredictable situations. |
| Keywords: | home health care,scheduling,routing,genetic algorithm,rescheduling |
| Date: | 2020–10–26 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03229580&r= |
| By: | Rodrigo Ceni (Universidad de la República (Uruguay). Facultad de Ciencias Económicas y de Administración. Instituto de Economía); Cecilia Parada (Universidad de la República (Uruguay). Facultad de Ciencias Económicas y de Administración. Instituto de Economía); Ivone Perazzo (Universidad de la República (Uruguay). Facultad de Ciencias Económicas y de Administración. Instituto de Economía); Eliana Sena (Universidad de la República (Uruguay). Facultad de Ciencias Económicas y de Administración. Instituto de Economía) |
| Abstract: | We estimate the quantitative impact of a long-acting reversible contraceptive (LARCs) policy on the unexpected recent collapse of the Total Fertility Rate (TFR) in Uruguay. We exploit, first, the expansion schedule of a large-scale policy of access to sub-dermal implants in public hospitals across the country, through an event study to capture causal effects, and second, detailed birth administrative records for the last 20 years. We document an average reduction of 3% in the birth rate in public hospitals across the two years after the policy was implemented. These effects were concentrated among teens, with a decrease of 5.5%, and this decrease affects mainly the first birth. In the context of a reduction of 20% in births in three years, the use of implants can explain one-third of the reduction in births in public hospitals. We also document a more significant effect on first births and no effect on pregnancy outcomes such as childbirth weight or weeks of gestation. |
| Keywords: | Long-acting reversible contraceptive, Fertility, Adolescent fertility, Public policy, Birth collapse |
| JEL: | H42 H75 I12 J13 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:ulr:wpaper:dt-14-20&r= |
| By: | Mehic, Adrian (Department of Economics, Lund University); Olofsson, Charlotta (Department of Economics, Lund University) |
| Abstract: | We evaluate a natural experiment at a Swedish university, in which students were randomized to either taking all their courses online, or to have some courses online and some on campus (blended learning). Our setting creates two groups for the online courses: One group with no access to campus whatsoever, and one group treated with campus classes in parallel, but unrelated, courses. We show that campus access in parallel courses improved academic performance in online courses only among female students with affluent parents. Detailed individual-level survey data suggests that there was no relationship between social status and adverse mental health amid the COVID-19 pandemic. Instead, by estimating each student's network position, linked with administrative data on parental income, we show that female students with wealthy parents have significantly less constrained social networks, enabling them to utilize scarcely available campus time to communicate with classmates more efficiently. |
| Keywords: | COVID-19; blended learning; online education; social networks |
| JEL: | I23 I28 J16 Z13 |
| Date: | 2021–05–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2021_008&r= |
| By: | Bautista, María Angélica; González, Felipe; Martínez, Luis R.; Muñoz, Pablo; Prem, Mounu |
| Abstract: | We provide new evidence on the causal effect of education on health. Our empirical strategy exploits the reduction in access to college experienced by individuals reaching college age shortly after the 1973 military coup in Chile, which led to a sharp downward kink in enrollment for the affected cohorts. Using data from the vital statistics for the period 1994-2017, we document an upward kink in the age-adjusted yearly mortality rate for these cohorts, a pattern that we also observe in matched individual-level records for hospitalized patients. Leveraging the downward kink in college enrollment, we estimate a negative effect of college on mortality, which is larger for men, but also sizable for women. Affected individuals have worse labor market outcomes, lower income, and are more likely to be enrolled in the public health system. They also report lower consumption of health services, which suggests that economic disadvantage and limited access to care plausibly contribute to the effect of education on health. |
| Keywords: | Higher education; mortality; Chile |
| JEL: | I |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:rie:riecdt:80&r= |
| By: | Klauber, Hannah (Mercator Research Institute on Global Commons and Climate Change (MCC)); Holub, Felix (University of Mannheim); Koch, Nicolas (Mercator Research Institute on Global Commons and Climate Change (MCC)); Pestel, Nico (IZA); Ritter, Nolan (Mercator Research Institute on Global Commons and Climate Change (MCC)); Rohlf, Alexander (Mercator Research Institute on Global Commons and Climate Change (MCC)) |
| Abstract: | We examine the persistence of the impact of early-life exposure to air pollution on children's health from birth to school enrollment using administrative public health insurance records covering one third of all children in Germany. For identification, we exploit air quality improvements caused by the implementation of Low Emission Zones, a policy imposing driving restrictions on high-emission vehicles. Our results indicate that children exposed to cleaner air around birth require less medication for at least five years. The initially latent health response materializes only gradually in lower medication usage, leaving important but subtle health benefits undetected in common measures of infant health. |
| Keywords: | policy evaluation, cohort study, air pollution, health, children, Low Emission Zone |
| JEL: | I18 Q51 Q53 Q58 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14376&r= |
| By: | Quanjer, Björn; van Dijk, Ingrid K; Rosenbaum-Feldbrugge, Matthias (Federal Institute for Population Research) |
| Abstract: | We investigate how parental death in infancy, childhood and adolescence affects boys’ health using two distinct measures: mortality before age 20 and height in young adulthood. These indicators enable us to identify critical age periods at which parental loss was most harmful for health, and to gain more insights into the mechanisms at play. Employing nationally representative data for the Netherlands for the period 1850-1940, we analyze survival of roughly 18,000 boys using Cox proportional hazard models, and stature of more than 4,000 young men using linear regression models. Results reveal that experiencing parental death in general and maternal death in particular during infancy and in early childhood is strongly associated with increased mortality risk. Among children aged 5-20, however, only paternal death is associated with increased mortality. Young adult height, in contrast, is most strongly affected by parental death taking place between the ages five and 12. While maternal death in this age group is associated with shorter height, paternal death is associated with taller stature among surviving children. Our results demonstrate that both indicators of health complement each other, and suggest that the loss of resources and care traditionally provided by mothers was particularly harmful for child well-being. |
| Date: | 2021–05–17 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:uzxsr&r= |
| By: | Böckerman, Petri (Labour Institute for Economic Research); Haapanen, Mika (Jyväskylä University School of Business and Economics); Jepsen, Christopher (University College Dublin) |
| Abstract: | This paper studies the causal effect of parental death on children's mental health. Combining several nationwide register-based data for Finnish citizens born between 1971 and 1986, we use an event study methodology to analyze hospitalization for mental health-related reasons by the age of 30. We find that there is no clear evidence of increased hospitalization following the death of a parent of a different gender, but there are significant effects for boys losing their fathers and girls losing their mothers. Depression is the most common cause of hospitalization in the first three years following paternal death, whereas anxiety and, to a lesser extent, self-harm are the most common causes five to ten years after paternal death. We also provide descriptive evidence of an increase in the use of mental health-related medications and sickness absence, as well as substantial reductions in years of schooling, employment, and earnings in adulthood for the affected children. |
| Keywords: | parental death, mental health, hospitalization, depression, labor market |
| JEL: | I10 I12 J12 J13 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14385&r= |
| By: | Daniel Graeber (DIW Berlin, University of Potsdam, CEPA, BSE); Felicitas Schikora (DIW Berlin, FU Berlin) |
| Abstract: | Against a background of increasing violence against non-natives, we estimate the effect of hate crime on refugees’ mental health in Germany. For this purpose, we combine two datasets: administrative records on xenophobic crime against refugee shelters by the Federal Criminal Office and the IAB-BAMF-SOEP Survey of Refugees. We apply a regression discontinuity in time design to estimate the effect of interest. Our results indicate that hate crime has a substantial negative effect on several mental health indicators, including the Mental Component Summary score and the Patient Health Questionnaire-4 score. The effects are stronger for refugees with closer geographic proximity to the focal hate crime and refugees with low country-specific human capital. While the estimated effect is only transitory, we argue that negative mental health shocks during the critical period after arrival have important long-term consequences. Keywords: Mental health, hate crime, migration, refugees, human capital. |
| Keywords: | mental health, hate crime, migration, refugees, human capital |
| JEL: | I10 J15 J24 F22 O15 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:pot:cepadp:31&r= |
| By: | Alan Piper (Paris School of Economics; International Public Economics Department, School of Business and Economics, Freie Universität Berlin); David G. Blanchflower (Bruce V. Rauner Professor of Economics, Dartmouth College, Adam Smith Business School, University of Glasgow; NBER and Bloomberg); Alex Bryson (University College London; IZA, Bonn; NIESR, London) |
| Abstract: | The cross-sectional association between pain and unemployment is well-established. But the absence of panel data containing data on pain and labor market status has meant less is known about the direction of any causal linkage. Those longitudinal studies that do examine the link between pain and subsequent labor market transitions suggest results are sensitive to the measurement of pain and model specification We contribute to this literature using large-scale panel data from the German Socio-Economic Panel (GSOEP) for the period 2002 to 2018. We show that pain leads to job loss. Workers suffering pain are more likely than others to leave their job for unemployment or economic inactivity. This probability rises with the frequency of the pain suffered in the previous month. The effect persists having accounted for fixed unobserved differences across workers, is apparent among those who otherwise report good general health and is robust to the inclusion of controls for mental health, life satisfaction and the employee’s occupation |
| Keywords: | pain; health; unemployment; job loss; economic inactivity; underemployment; panel analysis; GSOEP |
| JEL: | I10 J60 J64 |
| Date: | 2021–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:qss:dqsswp:2119&r= |
| By: | De Giorgi, Giacomo; Gambetti, Luca; Naguib, Costanza |
| Abstract: | Life expectancy for Blacks is about 8 year shorter than for Whites. A shorter life expectancy, in line with the theoretical prediction of a simple model, determines a much lower amount of savings and wealth accumulation and therefore a lower degree of insurance. This, in turn, contributes to persistent racial differentials in life-cycle consumption. Starting from the same position in the consumption distribution Blacks end up in a lower percentile than Whites after a few decades. This is particularly marked for those Blacks who start at the top of the consumption distribution, where Whites are much more persistent. We document these facts using 40 years of PSID data (1981-2017). |
| Keywords: | Consumption; health; Income; inequality; Persistence |
| JEL: | C3 D12 E21 E63 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15182&r= |
| By: | Kronk, Clair; Everhart, Avery R. (University of Southern California); Ashley, Florence; Thompson, Hale; Schall, Theodore E.; Goetz, Teddy G.; Hiatt, Laurel; Derrick, Zackary; Queen, Roz; Ram, A |
| Abstract: | There are over one million transgender people living in the United States and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health. |
| Date: | 2021–05–19 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:qnc2g&r= |
| By: | Dupas, Pascaline; Nhlema, Basimenye; Wagner, Zachary; Wolf, Aaron; Wroe, Emily |
| Abstract: | Using data from an 18-month randomized trial, we estimate large and sustained impacts on water purification and child health of a program providing monthly coupons for free water treatment solution (diluted chlorine) to households with young children. The program is more effective and much more cost-effective than asking Community Health Workers (CHWs) to distribute free chlorine to households during routine monthly visits. That is because only 40% of households make use of free chlorine, targeting through CHWs is worse than self-targeting through coupon redemption, and water treatment promotion by CHWs does not increase chlorine use among free chlorine beneficiaries. Non- use of free chlorine is driven by households who have a protected water source and those who report that chlorine makes water taste bad. |
| Keywords: | child health; Chlorine; Community Health Workers; targeting |
| JEL: | D10 I11 I12 O12 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15095&r= |
| By: | Troesken, Werner; Tynan, Nicola; Yang, Yuanxiaoyue |
| Abstract: | What are the benefits of moving from intermittent water delivery (which limits user access to less than 24 hours per day) to constant service? To address this question, we study the transition from intermittent to constant water supply in London. Between 1871 and 1910, the proportion of London households with access to a constant water supply (24 hours a day, 7 days a week) rose from less than 20 to 100 percent. Idiosyncratic delays in the negotiation process between companies and property owners generated random variation in the timing of the transition across London districts. Exploiting this variation, we find that a one percentage point increase in a local population with access to constant service decreased deaths from waterborne diseases by as much as 0.5 percent and explains approximately a fifth of the late nineteenth century decline in waterborne disease mortality. Results are robust to the inclusion of controls for population density, concerns regarding the reporting of cause-of-death, district-specific time trends, and spatial autocorrelation. In placebo tests, we find no evidence that the extension of constant service affected mortality from non-water borne diseases or deaths from violence. |
| Keywords: | Water supply; Mortality; London, 19th century; Public health |
| JEL: | I18 L95 N33 N93 O18 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:107872&r= |
| By: | van der Meulen Rodgers , Yana (Rutgers University); Zveglich, Jr. , Joseph E. (Asian Development Bank) |
| Abstract: | Populations become increasingly feminized with age. Since older women are more vulnerable to poverty, they may find it more difficult than men to access health care. This study examines factors that may constrain older persons in Southeast Asia from meeting their health-care needs when sick. Our analysis of household survey data from Cambodia, the Philippines, and Viet Nam shows that women are more likely to have reported sickness or injury than men, a difference that is meaningful and statistically significant. While women in Cambodia and the Philippines are more likely to seek treatment than men, the gender difference is reversed in Viet Nam where stigma and discrimination associated with some diseases may more strongly deter women. The probability of seeking treatment rises with age more sharply for women than men in all countries. However, for the subsample of elders, the gender difference is not significant. |
| Keywords: | elderly; gender; health; health care; women |
| JEL: | I14 J16 O53 |
| Date: | 2021–02–12 |
| URL: | http://d.repec.org/n?u=RePEc:ris:adbewp:0633&r= |
| By: | Callen, Michael |
| Abstract: | We evaluate a program in Pakistan that equips government health inspectors with a smartphone app which channels data on rural clinics to senior policy makers. The system led to rural clinics being inspected 104% more often after 6 months, but only 43.8% more often after a year, with the latter estimate not attaining significance at conventional levels. There is also no clear evidence that the increase in inspections led to increases in general staff attendance. In addition, we test whether senior officials act on the information provided by the system. Focusing only on districts where the app is deployed, we find that highlighting poorly performing facilities on a dashboard viewed by supervisors raises doctor attendance by 75%. Our results indicate that technology may be able to mobilize data to useful effect, even in low capacity settings. |
| Keywords: | Bureaucracies; Data-informed policy; health; Information Communication Technology |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15169&r= |
| By: | Susanna B. Berkouwer; Pierre E. Biscaye; Steven L. Puller; Catherine Wolfram |
| Abstract: | Government transfer programs to distribute food, water, or electricity at low or no cost have been widespread during the COVID-19 global health crisis. How does program design affect the efficiency and distributional implications of these policies? And what design features determine their political popularity? We study these questions in the context of a program to distribute relief through the electric utility in Accra, Ghana, using data from 1,200 households surveyed during the COVID-19 crisis. We find that distributing relief through electricity transfers has significant advantages. It enables an immediate government response to the crisis because it leverages the existing financial infrastructure between the government utility and households. Moreover, theoretical efficiency concerns about in-kind transfers are mitigated because the transfers are inframarginal for most households and electricity credit can be stored, with many even preferring electricity transfers over cash. These advantages do not preclude delays in transfer receipt and the exclusion of some eligible households, and the program is regressive in both design and implementation. The households least likely to receive relief are those who use less electricity, pay a landlord or other intermediary for electricity, or share an electricity meter with other users – all common among low-income electricity consumers in urban settings. Finally, transfer receipt increases support for the governing party, but support for the program drops significantly if even a fraction of its costs are to be recovered through future electricity tariff increases. Concerns around disbursing relief through utility transfers in this context thus arise not from efficiency loss, but from regressivity, distributional challenges, and politicization. |
| JEL: | H50 H84 O12 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28818&r= |
| By: | Berg, Gerard van den; Siflinger, Bettina |
| Abstract: | Lockdowns with lack of access to day care may have severe detrimental long-run health and behavioral effects on the children involved. This paper studies the effects of day care exposure on behavioral problems and mental health as well as on various aspects of physical health, at various ages during childhood. We draw on a unique set of comprehensive individual-level outpatient and inpatient health care register data merged with other register data. By exploiting variation in day care exposure by age generated by a major day care policy reform, we estimate cumulative and instantaneous effects on child health at different ages. We find sizeable beneficial cumulative impacts of day care on behavioral and mental health at primary school ages, and substitution of the incidence of infections from primary school ages to low ages. The evidence suggests that the main beneficiaries of day care are in low socio-economic households. Day care usage affects health care utilization and leads to a moderate reduction in health care costs. |
| Keywords: | behavioral disorders; Child Care; day care fees; Education; health registers; illness; infections; Non-cognitive ability; pre-school |
| JEL: | C23 C25 C83 I12 J13 J14 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15036&r= |
| By: | Santeramo, Fabio Gaetano; Tappi, Marco; Lamonaca, Emilia |
| Abstract: | The fast-moving coronavirus disease 2019 (COVID-19) called for a rapid response to slowing down the viral spread and reduce the fatality associated to the pandemic. Policymakers have implemented a wide range of non-pharmaceutical interventions to mitigate the spread of the pandemic and reduce burdens on healthcare systems. An efficient response of healthcare systems is crucial to handle a health crisis. Understanding how non-pharmaceutical interventions have contributed to slowing down contagions and how healthcare systems have impacted on fatality associated with health crisis is of utmost importance to learn from the COVID-19 pandemic. We investigated these dynamics in Italy at the regional level. We found that the simultaneous introduction of a variety of measures to increase social distance is associated with an important decrease in the number of new infected patients detected daily. Contagion reduces by 1% with the introduction of lockdowns in an increasing number of regions. We also found that a robust healthcare system is crucial for containing fatality associated with COVID-19. Also, proper diagnosis strategies are determinant to mitigate the severity of the health outcomes. The preparedness is the only way to successfully adopt efficient measures in response of unexpected emerging pandemics. |
| Keywords: | Health outcome; Lockdown; Social distancing; Policy response |
| JEL: | H51 I18 R58 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:107968&r= |
| By: | Brotherhood, Luiz; Cavalcanti, Tiago; Da Mata, Daniel; Santos, Cezar |
| Abstract: | This paper studies the role of slums in shaping the economic and health dynamics of pandemics. Using data from millions of mobile phones in Brazil, an event-study analysis shows that residents of overcrowded slums engaged in less social distancing after the outbreak of Covid-19. We develop a choice-theoretic equilibrium model in which poorer agents live in high-density slums and others do not. The model is calibrated to Rio de Janeiro. Slum dwellers account for a disproportionately high number of infections and deaths. In a counterfactual scenario without slums, deaths fall overall but increase in non-slum neighborhoods. Policy simulations indicate that: reallocating medical resources cuts deaths and raises output and the welfare of both groups; mild lockdowns favor slum individuals by mitigating the demand for hospital beds whereas strict confinements mostly delay the evolution of the pandemic; and cash transfers benefit slum residents in detriment of others, highlighting important distributional effects. |
| Keywords: | COVID-19; health; Public Policies; Slums; Social distancing |
| JEL: | C63 D62 E17 I10 I18 O18 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15131&r= |
| By: | Bar-On, Yinon; Baron, Tatiana; Cornfeld, Ofer; Milo, Ron; Yashiv, Eran |
| Abstract: | Rapidly expanding research on COVID19 in Economics typically posits an economy subject to a model of epidemiological dynamics, which is at the core of the analysis. We place this model on the foundations of an epidemiological analysis of the SARS-CoV-2 virus transmission timescales. The contribution is twofold. First, we formulate a full model with epidemiologically-based and clinically-based parameterization. The model features two blocks: an infection transmission block, described by the SEIR-Erlang model, and a clinical block, characterizing the development of symptoms, hospitalization, ICU admission, and recovery or death. The latter is important for the analysis of dynamics of the public health system. Second, we show that there is often serious mis-specification of the model, erroneously characterizing a relatively slow-moving disease, thereby distorting the policymaker decisions towards less severe, delayed intervention. Moreover, the scale of the disease is under-estimated. We also discuss misguided modelling of lockdown policies. |
| Keywords: | COVID19; optimal policy; the economy and epidemiological dynamics; transmission timescales |
| JEL: | H12 I12 I18 J17 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15107&r= |
| By: | Chen , Liming (Asian Development Bank); Raitzer, David (Asian Development Bank); Hasan, Rana (Asian Development Bank); Lavado, Rouselle (Asian Development Bank); Velarde , Orlee (Asian Development Bank) |
| Abstract: | We use cross-country panel data to examine the effects of a variety of nonpharmaceutical interventions used by governments to suppress the spread of coronavirus disease (COVID-19). We find that while lockdown measures lead to reductions in disease transmission rates as captured by the reproduction number, R_t, gathering bans appear to be more effective than workplace and school closures, both of which are associated with large declines in gross domestic product. Further, our estimates suggest that stay-at-home orders are less effective in countries with larger family size and in developing economies. We also find that incentives are very important, as efforts at ramping up testing and tracing COVID-19 cases are more effective in controlling the spread of disease in countries with greater coverage of paid sick leave benefits. As future waves of the disease emerge, the use of more targeted and better incentivized measures can help keep the epidemic controlled at lower economic cost. |
| Keywords: | COVID-19; cross-country data; economic impact; nonpharmaceutical interventions |
| JEL: | I10 I18 O40 |
| Date: | 2020–12–04 |
| URL: | http://d.repec.org/n?u=RePEc:ris:adbewp:0625&r= |
| By: | Bertocchi, Graziella; Dimico, Arcangelo |
| Abstract: | Discussion on the disproportionate impact of COVID-19 on African Americans has been at center stage since the outbreak of the epidemic in the United States. To present day, however, lack of race-disaggregated individual data has prevented a rigorous assessment of the extent of this phenomenon and the reasons why blacks may be particularly vulnerable to the disease. Using individual and georeferenced death data collected daily by the Cook County Medical Examiner, we provide first evidence that race does affect COVID-19 outcomes. The data confirm that in Cook County blacks are overrepresented in terms of COVID-19 related deaths since---as of June 16, 2020---they constitute 35 percent of the dead, so that they are dying at a rate 1.3 times higher than their population share. Furthermore, by combining the spatial distribution of mortality with the 1930s redlining maps for the Chicago area, we obtain a block group level panel dataset of weekly deaths over the period January 1, 2020-June 16, 2020, over which we establish that, after the outbreak of the epidemic, historically lower-graded neighborhoods display a sharper increase in mortality, driven by blacks, while no pre-treatment differences are detected. Thus, we uncover a persistence influence of the racial segregation induced by the discriminatory lending practices of the 1930s, by way of a diminished resilience of the black population to the shock represented by the COVID-19 outbreak. A heterogeneity analysis reveals that the main channels of transmission are socioeconomic status and household composition, whose influence is magnified in combination with a higher black share. |
| Keywords: | blacks; Chicago; Cook County; COVID-19; deaths; redlining; Vulnerability |
| JEL: | I14 J15 N32 N92 R38 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15013&r= |
| By: | Azzimonti, Marina; Fogli, Alessandra; Perri, Fabrizio; Ponder, Mark |
| Abstract: | We develop an ECON-EPI network model to evaluate policies designed to improve health and economic outcomes during a pandemic. Relative to the standard epidemiological SIR set-up, we explicitly model social contacts among individuals and allow for heterogeneity in their number and stability. In addition, we embed the network in a structural economic model describing how contacts generate economic activity. We calibrate it to the New York metro area during the 2020 COVID-19 crisis and show three main results. First, the ECON-EPI network implies patterns of infections that better match the data compared to the standard SIR. The switching during the early phase of the pandemic from unstable to stable contacts is crucial for this result. Second, the model suggests the design of smart policies that reduce infections and at the same time boost economic activity. Third, the model shows that re-opening sectors characterized by numerous and unstable contacts (such as large events or schools) too early leads to fast growth of infections. |
| Keywords: | Complex Networks; COVID-19; epidemiology; SIR; social distance |
| JEL: | D85 E23 E65 I18 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15229&r= |
| By: | Engel, Claudia (Stanford University); Rodden, Jonathan (Stanford University); Tabellini, Marco (Harvard Business School) |
| Abstract: | Choropleth disease maps have become the main tool for communicating information about the geography of health threats to the public. These maps have the potential to shape perceptions of threat, preferences about policy, and perhaps even behavior, but they are unfortunately often poorly designed and misleading. In a large survey of residents of the U.S. state of Georgia conducted in June 2020, we randomly assigned respondents to view one of two maps produced in the spring of 2020 by the Georgia Department of Public Health. The first is a map of county-level COVID case counts, which generated the false perception that the COVID threat was concentrated almost exclusively in the Atlanta metro area. The second is a map of the case rate per 100,000 people, which clarified that the virus was widespread in much of Georgia. Those who saw the second map were less likely to consider the virus as an urban problem, and more likely to perceive it as a concern for Georgia and its economy. Moreover, respondents from non-metro areas who saw the case rate map were more concerned that they, their friends, or community members might contract the virus. Respondents who saw the case rate map also expressed greater support for policies aimed at mitigating the virus – an effect driven by self-identified Republicans, who were far more skeptical about public health measures to mitigate the spread of the virus in general. |
| Keywords: | COVID-19, policy, maps, public health |
| JEL: | I18 I38 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14365&r= |
| By: | Adams-Prassl, Abigail; Boneva, Teodora; Golin, Marta; Rauh, Christopher |
| Abstract: | Over 9 million jobs were furloughed in the UK during the Coronavirus pandemic. Using real time survey evidence from the UK in April and May, we document which workers were most likely to be furloughed and analyze variation in the terms on which they furloughed. We find that women were significantly more likely to be furloughed. Inequality in care responsibilities seem to have played a key role: mothers were 10 percentage points more likely than fathers to initiate the decision to be furloughed (as opposed to it being fully or mostly the employer's decision) but we find no such gender gap amongst childless workers. The prohibition of working whilst furloughed was routinely ignored, especially by men who can do a large percentage of their work tasks from home. Women were less likely to have their salary topped up beyond the 80% subsidy paid for by the government. Considering the future, furloughed workers without employer-provided sick pay have a lower willingness to pay to return to work, as do those in sales and food preparation occupations. Compared to non-furloughed employees, furloughed workers are more pessimistic about keeping their job in the short to medium run and are more likely to be actively searching for a new job even when controlling for detailed job characteristics. These results have important implications for the design of short-time work schemes and the strategy for effectively reopening the economy. |
| Keywords: | Coronavirus; COVID-19; crisis; furlough; inequality; Recession; Short-time work |
| JEL: | J21 J22 J24 J33 J63 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15194&r= |
| By: | Glaeser, Edward L; Gorback, Caitlin; Redding, Stephen J. |
| Abstract: | How effective are restrictions on geographic mobility in limiting the spread of the COVID-19 pandemic? Using zip code data for Atlanta, Boston, Chicago, New York (NYC), and Philadelphia, we estimate that total COVID-19 cases per capita decrease on average by approximately 20 percent for every ten percentage point fall in mobility between February and May 2020. To address endogeneity concerns, we instrument for travel by the share of workers in remote work friendly occupations, and find a somewhat larger average decline of COVID-19 cases per capita of 27 percent. Using weekly data by zip code for NYC and a panel data specification including week and zip code fixed effects, we estimate a similar average decline of around 17 percent, which becomes larger when we measure mobility using NYC turnstile data rather than cellphone data. We find substantial heterogeneity across both space and over time, with stronger effects for NYC, Boston and Philadelphia than for Atlanta and Chicago, and the largest estimated coefficients for NYC in the early stages of the pandemic. |
| Keywords: | Cities; COVID-19; mobility |
| JEL: | H12 I12 J17 R41 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15050&r= |
| By: | Franke, Richard |
| Abstract: | The paper provides a detailed analysis of excess mortality during the "Spanish Flu" in a developing German economy and the effect of poverty and air pollution on pandemic mortality. The empirical analysis is based on a difference-in-differences approach using annual all-cause mortality statistics at the parish level in the Kingdom of Württemberg. The paper complements the existing literature on urban pandemic severity with comprehensive evidence from mostly rural parishes. The results show that middle and high-income parishes had a significantly lower increase in mortality rates than low-income parishes. Moreover, the mortality rate during the 1918 influenza pandemic was significantly higher in highly polluted parishes compared to least polluted parishes. |
| Keywords: | Pandemics, Spanish Flu, Income, Air Pollution, Mortality |
| JEL: | I14 I15 N34 Q53 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:107570&r= |
| By: | Astri Syse (Statistics Norway); Alyona Artamonova; Michael Thomas (Statistics Norway); Marijke Veenstra |
| Abstract: | Elderly’s use of long-term care (LTC) services are likely to be influenced by family members, but there is scarce research on the role played by partners and/or adult children, especially taking geographic proximity into account. We thus examine how partners and adult children influence elderly’s LTC use, taking regional differences into account. We employ logistic discrete-time hazard regression models on linked registry data for complete cohorts of elderly individuals (65+ years), their partners, their adult children, residing in Norway in the period 2010-2016 (N=820 000). We also include municipal characteristics. One’s own, partner’s and child(ren)’s characteristics are all associated with elderly individuals’ LTC use. Partners’ resources matter the most, but those of adult children are relevant when partners are less resourceful or absent. Childless elderly use more LTC services than elderly with children, and elderly with resourceful children living nearby use the least LTC services. The trends are similar across municipalities, but the magnitudes vary slightly depending on their geographic location and sociodemographic and economic resources. Future demographic and economic changes warrant a better understanding of the role played by family members for elderly’s use of LTC services. |
| Keywords: | Care use, Family, Formal care, Geographic, Informal care, Long-term care (LTC) |
| JEL: | I10 I12 I18 J10 H41 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:ssb:dispap:954&r= |
| By: | Ferreira, Francisco H. G. (London School of Economics); Sterck, Olivier (University of Oxford); Mahler, Daniel Gerszon (World Bank); Decerf, Benoit (World Bank) |
| Abstract: | The Covid-19 pandemic has brought about massive declines in wellbeing around the world. This paper seeks to quantify and compare two important components of those losses – increased mortality and higher poverty – using years of human life as a common metric. We estimate that almost 20 million life-years were lost to Covid-19 by December 2020. Over the same period and by the most conservative definition, over 120 million additional years were spent in poverty because of the pandemic. The mortality burden, whether estimated in lives or in years of life lost, increases sharply with GDP per capita. The poverty burden, on the contrary, declines with per capita national incomes when a constant absolute poverty line is used, or is uncorrelated with national incomes when a more relative approach is taken to poverty lines. In both cases the poverty burden of the pandemic, relative to the mortality burden, is much higher for poor countries. The distribution of aggregate welfare losses – combining mortality and poverty and expressed in terms of life-years – depends both on the choice of poverty line(s) and on the relative weights placed on mortality and poverty. With a constant absolute poverty line and a relatively low welfare weight on mortality, poorer countries are found to bear a greater welfare loss from the pandemic. When poverty lines are set differently for poor, middle and high-income countries and/or a greater welfare weight is placed on mortality, upper-middle and rich countries suffer the most. |
| Keywords: | COVID-19, pandemic, welfare, poverty, mortality, global distribution |
| JEL: | D60 I15 I31 I32 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14370&r= |
| By: | Schüller, Simone (German Youth Institute (DJI)); Steinberg, Hannah S. (German Youth Institute (DJI)) |
| Abstract: | What are the effects of school and daycare facility closures during the COVID-19 pandemic on parental well-being and parenting behavior? Can emergency childcare policies during a pandemic mitigate increases in parental stress and negative parenting behavior? To answer these questions, this study leverages cross-state variation in emergency childcare eligibility rules during the first COVID-19 lockdown in Germany and draws on unique data from the 2019 and 2020 waves of the German AID:A family panel. Employing a DDD and IV approach we identify medium-term ITT and LATE effects and find that while emergency care policies did not considerably affect parents' life satisfaction, partnership satisfaction or mental health, they have been effective in diminishing harsh parenting behavior. We find partly gendered effects, specifically on paternal parenting behavior. Our results suggest that decreasing parental well-being likely constitutes a general effect of the pandemic, whereas the observed increase in negative and potentially harmful parenting behavior is largely directly caused by school and daycare facility closures. |
| Keywords: | parental well-being, harsh parenting, COVID-19, policy evaluation, school and daycare closures, AID:A, difference-in-difference-in-differences, instrumental variable estimation |
| JEL: | D04 D13 I18 I31 J13 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14359&r= |
| By: | Deb, Pragyan; Furceri, Davide; Ostry, Jonathan D.; Tawk, Nour |
| Abstract: | Countries have implemented several containment measures to halt the spread of the 2019 coronavirus disease, but it remains unclear the extent to which these unprecedented measures have been successful. We examine this question using daily data on the number of coronavirus disease cases as well as on real-time containment measures implemented by countries. Results suggest that these measures have been very effective in flattening the "pandemic curve", but there is significant heterogeneity across countries. Effectiveness is enhanced when measures are implemented quickly, where de facto mobility is curtailed, in countries with lower temperatures and population density, as well as in countries with a larger share of the elderly in total population and stronger health systems. We also find that easing of containment measures has resulted in an increase in the number of cases, but the effect has been lower (in absolute value) than that from a tightening of measures. |
| Keywords: | containment measures; COVID-19; Pandemics |
| JEL: | D43 E52 E58 L11 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15086&r= |
| By: | Proto, Eugenio (University of Glasgow); Zhang, Anwen (University of Glasgow) |
| Abstract: | Several studies have been devoted to establishing the effects of the Covid-19 pandemic on mental health across gender, age and ethnicity. However, much less attention has been paid to the differential effect of lockdown according to different personalities. We do this using the UKHLS longitudinal dataset, representative of the UK population. The UKHLS dataset allows us to assess the mental health of the same respondent during the Covid-19 period and the year before based on their personality "Big Five" traits and cognitive skills. We find that during the Covid-19 period individuals who have more Extrovert and Open personality report a higher mental health deterioration, while the ones scoring higher in Agreeableness are less affected. The effect of Openness is particularly strong: one more standard deviation predict one more symptom on the GHQ12 test for about 1 respondent over 4. In female respondents, Cognitive Skills and Openness are particularly strong predictors of deterioration. Neuroticism seems to predict more mental health deterioration, as it is normal to expect, but this effect is not significant in the main specifications of the estimated model. The study's results are robust to the inclusion of potential confounding variables such as changes in: physical health, household income and job status (like unemployed or furloughed). |
| Keywords: | COVID-19, mental health, Big 5, cognitive skills |
| JEL: | I3 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14388&r= |
| By: | Bazzi, Samuel; Fiszbein, Martin; Gebresilasse, Mesay |
| Abstract: | Rugged individualism---the combination of individualism and anti-statism---is a prominent feature of American culture with deep roots in the country's history of frontier settlement. Today, rugged individualism is more prevalent in counties with greater total frontier experience (TFE) during the era of westward expansion. While individualism may be conducive to innovation, it can also undermine collective action, with potentially adverse social consequences. We show that America's frontier culture hampered the response to the COVID-19 pandemic. Across U.S. counties, greater TFE is associated with less social distancing and mask use as well as weaker local government effort to control the virus. We argue that frontier culture lies at the root of several more proximate explanations for the weak collective response to public health risks, including a lack of civic duty, partisanship, and distrust in science. |
| Keywords: | American Frontier; COVID-19; Individualism; Social distancing |
| JEL: | H12 H23 H75 I12 I18 P16 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15232&r= |
| By: | Li, Haizheng (Georgia Tech); Liu, Qinyi (University of International Business and Economics Beijing); Ma, Mingyu (Central University of Finance and Economics Beijing) |
| Abstract: | This study investigates how the COVID-19 pandemic has affected teachers' job-specific stresses and their enthusiasm for the teaching occupation. We use unique data from China that cover the periods before and after the start of the pandemic and apply difference-in-differences type methods. We find that, among rural young teachers, the pandemic has caused higher teaching stress and career development stress and has reduced passion towards the teaching occupation. We investigate the working channels of the pandemic, including job-related activities and social network. After controlling for possible working channels, the COVID-19 pandemic still shows a strong direct impact on job sentiments. |
| Keywords: | enthusiasm for occupation, job stress, pandemic, COVID-19 |
| JEL: | I18 J24 J28 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14366&r= |
| By: | Desierto, Desiree; Koyama, Mark |
| Abstract: | Pandemics have heterogeneous effects on the health and economic outcomes of members of the population. To stay in power, politician-policymakers have to consider the health vulnerability-economic vulnerability (HV-EV) profiles of their coalition. We show that the politically optimal pandemic policy (POPP) reveals the HV-EV profile of the smallest, rather than the largest, group in the coalition. The logic of political survival dictates that the preferences of the least loyal, most pivotal, members of the coalition determine policy. |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15129&r= |
| By: | Eckardt, Matthias; Kappner, Kalle; Wolf, Nikolaus |
| Abstract: | Attempts to constrain the spread of Covid-19 included the temporal reintroduction of travel restrictions and border controls within the Schengen area. While such restrictions clearly involve costs, their benefits have been disputed. We use a new set of daily regional data of confirmed Covid-19 cases from the respective statistical agencies of 18 Western European countries. Our data starts with calendar week 10 (starting 2nd March 2020) and extends to calendar week 17 (ending 26th April 2020), which allows us to test for treatment effects of border controls. We use Poisson models with fixed effects and controls for the stringency of national measures, as well as a Bayesian spatio-temporal specification using an integrated nested Laplace approximation (INLA) to take unobserved spatio-temporal heterogeneity into account. Both approaches suggest that border controls had a significant effect to limit the pandemic. |
| Keywords: | Border effects; COVID-19; INLA |
| JEL: | C33 I18 R23 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15178&r= |
| By: | Ivaldi, Marc; Palikot, Emil |
| Abstract: | Using data collected from one of the most popular ridesharing platforms, we illustrate how mobility has changed after the exit from the Covid-19 induced confinement. We measure the impact of the Covid-19 outbreak on the level of mobility and the price of ridesharing. Finally, we show that the pandemic has exacerbated ethnic discrimination. Our results suggest that a decision-maker encouraging the use of ridesharing during the pandemic should account for the impact of the perceived health risks on ridesharing prices and should find ways to ensure fair access. |
| Keywords: | digital mobility; price discrimination; Ridesharing |
| JEL: | L91 R40 |
| Date: | 2020–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:15202&r= |