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on Health Economics |
| By: | Mike Akesaka (Osaka University); Peter Eibich (Max Planck Institute for Demographic Research); Chie Hanaoka (Toyo University); Hitoshi Shigeoka (Simon Fraser University and NBER) |
| Abstract: | The poor live paycheck to paycheck and are repeatedly exposed to strong cyclical income fluctuations. We investigate whether such income fluctuations affect risk preference among the poor. If risk preference temporarily changes around payday, optimal decisions made before payday may no longer be optimal afterward, which could reinforce poverty. By exploiting Social Security payday cycles in the US, we find that risk preference among the poor relying heavily on Social Security changes around payday. Rather than cognitive decline before payday, the deterioration of mental health and relative deprivation may play a role. We find similar evidence among the Japanese elderly. |
| Keywords: | poverty, risk preference, Social Security, mental health, relative deprivation, elderly, Health and Retirement Survey, Japanese Study of Aging and Retirement |
| JEL: | D81 D91 I32 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:sfu:sfudps:dp21-05&r= |
| By: | Ager, Philipp; Feigenbaum, James J; Hansen, Casper Worm; Tan, Huiren |
| Abstract: | Fears of immigrants as a threat to public health have a long and sordid history. At the turn of the 20th century, when millions of immigrants crowded into dense American cities, contemporaries blamed the high urban mortality penalty on the newest arrivals. Nativist sentiments eventually led to the implementation of restrictive quota acts in the 1920s, substantially curtailing immigration. We capture the "missing immigrants" induced by the quotas to estimate the effect of immigration on mortality. We find that cities with more missing immigrants experienced sharp declines in deaths from infectious diseases from the mid-1920s until the late 1930s. The blame for these negative mortality effects lies not with the immigrants, but on the living conditions they endured. We show that mortality declines were largest in cities where immigrants resided in the most crowded and squalid conditions and where public health resources were stretched the thinnest. Though immigrants did die from infectious diseases at higher rates than the US-born, the mortality decline we find is primarily driven by crowding not changes in population composition or contagion, as we show mortality improvements for both US- and foreign-born populations in more quota-affected cities. |
| Keywords: | density; Immigration; Nativism; Urban Mortality |
| JEL: | I14 J15 N32 N92 |
| Date: | 2020–06 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:14949&r= |
| By: | Daniel Auer (University of Mannheim and WZB); Johannes S. Kunz (Monash University) |
| Abstract: | This paper investigates the intergenerational effect of communication barriers on child health at birth using a natural experiment in Switzerland. We leverage the fact that refugees arriving in Switzerland originate from places that have large shares of French (or Italian) speakers for historical reasons and upon arrival are by law randomly allocated across states that are dominated by different languages but subject to the same jurisdiction. Our findings based on administrative records of all refugee arrivals and birth events between 2010 and 2017 show that children born to mothers who were exogenously allocated to an environment that matched their linguistic heritage are on average 72 gram heavier (or 2.2%) than those that were allocated to an unfamiliar language environment. The differences are driven by growth rather than gestation and manifest in a 2.9 percentage point difference in low birth weight incidence. We find substantial dose-response relationships in terms of language exposure in both, the origin country and the destination region. Moreover, French (Italian) exposed refugees only benefit from French- (Italian-) speaking destinations, but not vice versa. Contrasting the language match with co-ethnic networks, we find that high-quality networks are acting as a substitute rather than a complement. |
| Keywords: | Infant health, Language Proficiency, Refugee allocation, Networks |
| JEL: | F22 I12 J13 J24 J61 J62 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:ajr:sodwps:2021-07&r= |
| By: | Atticus Bolyard (Harvard University); Peter Savelyev (The College of William & Mary) |
| Abstract: | We investigate an Educational Attainment Polygenic Score (EA PGS), an index that predicts years of formal education based on genetic data. In our analysis of the National Longitudinal Study of Adolescent to Adult Health we find that the EA PGS affects a number of health-related outcomes. Moreover, the EA PGS interacts with parental socioeconomic status (SES) in childhood: for a number of health outcomes we observe that the effect of the EA PGS is more beneficial for high-SES subjects. We decompose the total effects of the EA PGS into the indirect effect (through education) and the direct effect. We also decompose both the direct and the total effect with respect to potential mechanisms. The mechanisms that partially explain the effects of EA PGS include early skills, early health, education support in the family, and education. As a result of our discovery of a strong direct effect we cast our doubts on the validity of the EA PGS used as an instrumental variable for education affecting health, a case of an increasingly utilized technique called Mendelian Randomization. Finally, after controlling for the EA PGS, genetic health endowments, and unobserved heterogeneity in addition to more traditional controls, we still find that education is associated with better health outcomes, which adds evidence to the ongoing debate about the causal link between education and health. |
| Keywords: | Educational Attainment Polygenic Score, socioeconomic status, mechanisms, Mendelian Randomization, gene-environment interactions, add health, Health, health-related outcomes |
| JEL: | I12 I14 I24 J24 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2021-026&r= |
| By: | Anikó Bíró (Health and Population Lendület Research Group, Centre for Economic and Regional Studies, 1097 Budapest, Tóth Kálmán u. 4.); Réka Branyiczki (Central European University and TÁRKI); Péter Elek (Health and Population Lendület Research Group, Centre for Economic and Regional Studies, 1097 Budapest, Tóth Kálmán u. 4. and Institute of Economics, Corvinus University of Budapest) |
| Abstract: | We analyse the causal effect of involuntary retirement on detailed indicators of healthcare use and health status. Our identification strategy is based on a pension reform in Hungary which forced public sector workers above the statutory retirement age to full time retirement. Using rich administrative data, we find that on the three-year horizon, involuntary retirement decreases the number of primary care doctor visits, the consumption of antiinfectives for systemic use and drugs of the respiratory system, and the non-zero spending on antiinfectives, the drugs of the alimentary tract and metabolism and of the cardiovascular system. We also find that the impact on the latter two drug categories is driven by the drop in income due to involuntary retirement. The effects of involuntary retirement are comparable to the short-run effects of voluntary retirement, identified from a change in the statutory retirement age. We conclude that there is little evidence for health deteriorating effects of involuntary retirement and provide explanations for the possible mechanisms behind our results. |
| Keywords: | healthcare use, involuntary retirement, voluntary retirement |
| JEL: | I10 J26 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:has:discpr:2122&r= |
| By: | Toshiaki Iizuka (The University of Tokyo); Hitoshi Shigeoka (Simon Fraser University and NBER) |
| Abstract: | Do consumers react differently to zero prices? We test the presence of a zero-price effect in child healthcare and find that a zero price is indeed special and it boosts demand discontinuously. A zero price affects resource allocations by encouraging healthier children to use more services and exacerbates behavioral hazard by increasing inappropriate use of antibiotics. A copayment, as small as 2USD per visit, alleviates these problems without increasing financial and health risks. However, a zero price may be used to boost demand for highly cost-effective treatments. Strategically choosing zero and non-zero prices is a key to improving welfare. |
| Keywords: | Zero-price Effects, Patient Cost-Sharing, Children, Healthcare Utilization, Price Elasticity, Moral Hazard |
| JEL: | I18 I13 I11 J13 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:sfu:sfudps:dp21-06&r= |
| By: | Castro, M.F.; Romeo, D. |
| Abstract: | Coordination is the key to the success of any organization such as the healthcare sector, where higher level of coordination result in greater promptness and quality of care and lower mortality rates. In a framed field experiment, we assess the level of coordination among healthcare providers and monitor whether common practices are adopted in a metropolitan hospital in Italy, by using the Krupka-Weber norm elicitation task. Upon being provided with three clinical vignettes, physicians have been asked to evaluate the appropriateness of each of the possible actions to match the modal judgement. Afterwards, physicians may ask for information on the actions corresponding to national guidelines and eventually change decisions. Data show that the average frequency of coordination across the experiment is 52% and that coordination increases when physicians often exchange opinions and share positive feedbacks with colleagues. Only 23% of participants changed their appropriateness judgment, after realizing they were in contrast with guidelines. In addition, the presence of a leader in the ward facilitates coordination. Finally, the more physicians consult scientific sources, the more willing to accept guidelines suggestions have been. Since guidelines knowledge significantly increases the coordination between physicians, hospitals should implement effective programs to spread guidelines contents. |
| Keywords: | coordination game; framed field experiment; vignette; guidelines; physicians’behavior; |
| JEL: | C72 C93 D83 I12 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:21/09&r= |
| By: | Claudio Lucifora (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore); Antonio Russo; Daria Vigani (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore) |
| Abstract: | We evaluate the effectiveness of a reform to contain health-care costs by restraining general practitioners' (GP) ability to prescribe outpatient treatments, on the basis of strict appropriateness criteria. Using register data for a large Metropolitan area in Italy, we find a significant contraction in both outpatient expenditures (-24%) and volumes (-12%) after the reform. The effects on expenditures are found to be heterogeneous across GPs' characteristics, pointing out the mediating role of GPs' prescribing behavior. The reform also affected the composition of outpatient spending and produced unintended consequences on the demand for medical services of vulnerable groups, who were originally excluded from its application, as well as on access to emergency care. |
| Keywords: | Prescribing appropriateness, Health-care expenditures, Primary care. |
| JEL: | H51 I38 I18 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:ctc:serie1:def103&r= |
| By: | Matteo Lippi Bruni; Cristina Ugolini; Rossella Verzulli |
| Abstract: | We study patient mobility in the Italian National Health System, using patient-episode level data on elective Percutaneous Transluminal Coronary Angioplasty procedures over the years 2008-2011. We examine how patients’ choice of the hospital is affected by changes in waiting times and clinical quality within hospitals over time. We estimate mixed-logit specifications and show the importance of jointly controlling for time-invariant and time varying clinical quality to identify the effect of waiting times. Conversely, failure to capture variations in clinical quality over time does not affect the estimate of the discouraging effect of travel distance. We provide evidence that patients are responsive to changes in waiting times and clinical quality: average demand elasticity with respect to own waiting times and mortality is estimated to be – 0.17 and – 1.38, respectively. Patients’ personal characteristics significantly influence how they trade off distance and waiting times with quality of care. We find a higher Willigness-To-Wait and Willingness-to-Travel to seek higher quality care for patients in the younger age groups and who are more severely ill. The results convey important policy implications for highly regulated healthcare markets. |
| JEL: | I11 I18 R22 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:bol:bodewp:wp1162&r= |
| By: | Kalenkoski, Charlene M. (Texas Tech University); Pabilonia, Sabrina Wulff (U.S. Bureau of Labor Statistics) |
| Abstract: | Using the 2003–2019 American Time Use Survey, we examine how living with a parent who has a work-limiting disability is related to teenagers' time allocation. For girls, we find that living with a disabled parent is associated with less time spent on educational activities, including both class time and homework, less time spent on shopping, and more time spent on market work, pet care, and leisure. For boys, living with a disabled parent is associated with less time spent sleeping. In addition, when examining the time spent by girls and boys in two-parent households, we find that the gender of the disabled parent matters. Girls living with a disabled mother in a two-parent household spend less time on educational activities and more time on market work and pet care, suggesting that girls may take on some of a disabled mother's activities. Boys living with a disabled mother in a two-parent household spend more time on homework and less time on housework and caring for household children. However, if their father is disabled, boys spend more time on food preparation and cleanup. Boys living with a disabled father also spend less time with their mother. Thus, there are differences in teens' time use that depend on both the gender of the teen and of the disabled parent, with teen girls likely being worse off than teen boys. Our results suggest that differences in teenagers' time investments are a plausible mechanism for gender differences in intergenerational economic mobility by parental-disability status. |
| Keywords: | disability, gender, time use, teenagers, schooling, homework |
| JEL: | I14 I24 J13 J14 J22 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14416&r= |
| By: | Jan Marcus; Thomas Siedler; Nicolas R. Ziebarth |
| Abstract: | Starting in 2009, the German state of Saxony distributed sports club membership vouchers among all 33,000 third graders in the state. The policy’s objective was to encourage them to develop a long-term habit of exercising. In 2018, we carried out a large register-based survey among several cohorts in Saxony and two neighboring states. Our difference-in-differences estimations show that, even after a decade, awareness of the voucher program was significantly higher in the treatment group. We also find that youth received and redeemed the vouchers. However, we do not find significant short- or long-term effects on sports club membership, physical activity, overweightness, or motor skills. |
| Keywords: | physical activity, voucher, primary school, obesity, habit formation, objective health measures, school health examinations, windfall gains, crowd-out, taxpayer subsidies |
| JEL: | I12 I14 I18 I28 I38 Z28 H71 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp1133&r= |
| By: | Roman, Monica; Zimmermann, Klaus F.; Plopeanu, Aurelian-Petruș |
| Abstract: | While under communism, identity-providing religion was suppressed, religiosity is strong today even among the youth in post-communist countries. This provides an appropriate background to investigate how external and internal religiosity relates to addictive behaviors like smoking, drinking and drugs among the young. This study shows that not religion as such or internal religiosity, but largely observable (external) religiosity prevents them from wallowing those vices |
| Keywords: | addictive behavior,Orthodox,external and internal religiosity,youth,smoking,drinking,drugs,Romania |
| JEL: | I12 N34 Z12 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:859&r= |
| By: | Timothy J. Moore; Kevin T. Schnepel |
| Abstract: | In 2001, a large and sustained supply shock halted a heroin epidemic in Australia. We use outpatient drug treatment records to identify individuals who accounted for nearly half of opioid overdoses prior to the shock, and examine how the reduced supply of heroin affected their health and criminal activity over the next eight years. Initially, the gains from fewer overdose deaths are offset by individuals substituting to other drugs and committing more violent crime, including homicides. Most adverse effects dissipate after one year, and are followed by further decreases in deaths and a large reduction in property crime. Our results demonstrate that reducing the supply of illicit opioids can lead to meaningful longer-term improvements, even when the short-term effects are ambiguous. |
| JEL: | I12 K42 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28848&r= |
| By: | Sonja Spitzer; Mujaheed Shaikh |
| Abstract: | Health perception biases can have serious consequences on health. Despite their relevance, the role of such biases in determining healthcare utilisation is severely underexplored. Here we study the relationship between health misperception, doctor visits, and concomitant out-of-pocket expenditures for the population 50+ in Europe. We conceptualise health misperception as arising from either overconfidence or underconfidence, where overconfidence is measured as overestimation of health and underconfidence is measured as underestimation of health. Comparing objective performance measures and their self-reported equivalents from the Survey of Health, Ageing and Retirement in Europe, we find that individuals who overestimate their health visit the doctor 14% less often than individuals who correctly assess their health, which is crucial for preventive care such as screenings. Lower healthcare utilisation is accompanied by lower out-of-pocket spending (38% less). In contrast, individuals who underestimate their health visit the doctor more often (28% more) and have higher out-of-pocket spending (17% more). We project that underestimating health of the population 50+ will cost the average European country Intl$ 71 million in 2020 and Intl$ 81 million by 2060. Country-specific estimates based on population and demographic projections show that countries such as Germany, Denmark and The Netherlands will experience significantly large costs of such misperception. The results are robust to several sensitivity tests and, more important, to various conceptualisations of the misperception measure. |
| Keywords: | Healthcare utilisation, health perception, overconfidence and underconfidence, doctor visits, out-of-pocket expenditures, SHARE data |
| Date: | 2020–01 |
| URL: | http://d.repec.org/n?u=RePEc:vid:wpaper:2001&r= |
| By: | Luis Sarmiento; Nicole Wägner; Aleksandar Zaklan |
| Abstract: | We study the effectiveness, spillovers, and well-being effects of low emission zones in Germany, an emission-intensity-based driving restriction rapidly growing in popularity. Using regression discontinuity and group-time difference-in-differences designs, we show that previous estimates of the policy’s impact on traffic-related air pollution significantly underestimate its effectiveness. We provide evidence of beneficial and harmful policy spillovers to neighboring areas, and increases in ozone due to changes in the chemical balance with precursor contaminants. Policy effects are heterogeneous by season, with greater decreases in traffic pollutants during winter and increases in ozone during spring and summer. Using individual-level data from the German Socio-Economic Panel, we further find that the policy decreases subjective well-being despite clear evidence of health benefits. The decline in well-being is especially pronounced in the first year after policy implementation and is transitory. |
| Keywords: | Low emission zones, air pollution, well-being, health, group-time differencein-differences, regression discontinuity |
| JEL: | Q53 Q58 I31 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp1947&r= |
| By: | Bilgrami, A.; Cutler, H.; Sinha, K. |
| Abstract: | We estimated the impact of standardising workplace health and safety (WHS) laws and increasing enforcement activities in Australia on the probability of receiving workers' compensation. Standardised WHS laws were introduced in all but two Australian states over 2012-2013, creating a unique natural experiment. We exploited this jurisdictional variation to perform difference-in-difference estimation on a sample of workers from the Household, Income and Labour Dynamics in Australia survey. We found standardising WHS laws and increasing enforcement activities reduced the probability of receiving workers' compensation by 0.9 percentage points (p=0.047). Subgroup analysis suggests the probability of receiving workers' compensation declined by 2.9-3.6 percentage points (p=0.030) in the high-risk construction industry. The larger impact in construction may have resulted from more opportunities to reduce workplace risk and changes to laws specifically targeted at this industry. Our estimation results suggest reduced workers' compensation claims resulted from reduced injuries, supported by injury reduction trends and increased enforcement activity in national datasets. However, we cannot rule out that some policy effect component may also reflect employers discouraging claims due to stricter WHS requirements and higher non-compliance penalties. |
| Keywords: | workplace health and safety; Australia; workers' compensation; causal analysis; workplace injury; |
| JEL: | D04 I18 J28 J38 L52 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:21/08&r= |
| By: | Zhibo Tan; Shang-Jin Wei; Xiaobo Zhang |
| Abstract: | We examine an indirect but potentially deadly consequence of the “missing girls” phenomenon. A shortage of brides causes many parents with sons of marriageable age to work harder and seek higher-paying but potentially dangerous jobs. In response, employers invest less in workplace safety, which in turn increases work-related mortality. Drawing from a broad range of data sets and taking advantage of large regional and temporal variations in sex ratios in China, we demonstrate that in areas with a more severe shortage of young women, the parents with unmarried sons suffer a significantly higher incidence of accidental injuries and workplace deaths. |
| JEL: | J16 O1 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28830&r= |
| By: | Zivin, Joshua Graff (University of California, San Diego); Neidell, Matthew (Columbia University); Sanders, Nicholas (Cornell University); Singer, Gregor (London School of Economics) |
| Abstract: | Influenza and air pollution each pose significant public health risks with large global economic consequences. The common pathways through which each harms health presents an interesting case of compounding risk via interacting externalities. Using instrumental variables based on changing wind directions, we show increased levels of contemporaneous pollution significantly increase influenza hospitalizations. We exploit random variations in the effectiveness of the influenza vaccine as an additional instrument to show vaccine protection neutralizes this relationship. This suggests seemingly disparate policy actions of pollution control and vaccination campaigns jointly provide greater returns than those implied by addressing either in isolation. |
| Keywords: | air pollution, influenza, hospitalizations, vaccines, externalities |
| JEL: | Q53 I12 I11 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14399&r= |
| By: | Marc Luy |
| Abstract: | A central question of interdisciplinary health research is whether the life years gained through increasing life expectancy are primarily spent in good or poor health. Two opposing models have been proposed: “expansion of morbidity” and “compression of morbidity”. Existing research based on longitudinal data and time series has supported both approaches, depending on the particular dimension of health under consideration. In this paper we hypothesize that the longitudinal health dimension-specific expansion and compression effects exist equivalently in the cross-sectional association between health and mortality (CroHaM), affecting differences in the number of healthy life years between populations and subpopulations with different levels of life expectancy. The CroHaM hypothesis roots in the observation that most health differentials within and between populations are caused primarily by social factors and it builds on Link and Phelan’s “theory of fundamental social causes” (1995). We present empirical support for the hypothesis by analyzing the relationship between life expectancy and healthy life years on the basis of different health dimensions for a sample of female and male Catholic order members and their counterparts in the general populations of Germany and Austria. Finally, we outline that the CroHaM hypothesis may also contribute to a better understanding of differences in life years spent in good or poor health and make suggestions for further testing of the CroHaM hypothesis. |
| Keywords: | Mortality, health, life expectancy, healthy life years, expansion of morbidity, compression of morbidity, CroHaM hypothesis, order members, Cloister Study |
| Date: | 2020–05 |
| URL: | http://d.repec.org/n?u=RePEc:vid:wpaper:2003&r= |
| By: | Gazze, Ludovica (University of Warwick); Heissel, Jennifer (Naval Postgraduate School) |
| Abstract: | Concerns about drinking water contamination through lead service lines, which connect street water mains to homes in many cities in the United States, might hinder resource-constrained municipalities from performing important infrastructure upgrades. Construction on water mains might disturb the service lines and increase lead levels in drinking water. We estimate the effects of water main maintenance on drinking water and children's blood levels by exploiting unique geocoded data and over 2,200 water main replacements in Chicago, a city with almost 400,000 known lead service lines. By comparing water and blood samples in homes at different distances from replaced mains before and after replacement, we find no evidence that water main replacement affects water or children's lead levels. |
| Keywords: | Lead ; Children ; Health ; Infrastructure JEL Classification: I100 ; H41 ; H72 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:wrk:warwec:1359&r= |
| By: | Dahl, Gordon; Kreiner, Claus T.; Nielsen, Torben Heien; Serena, Benjamin Ly |
| Abstract: | We decompose changing gaps in life expectancy between rich and poor into differential changes in age-specific mortality rates and differences in "survivability". Declining age-specific mortality rates increases life expectancy, but the gain is small if the likelihood of living to this age is small (ex ante survivability) or if the expected remaining lifetime is short (ex post survivability). Lower survivability of the poor explains half of the recent rise in life expectancy inequality in the US and the entire rise in Denmark. Cardiovascular mortality declines favored the poor, but differences in lifestyle-related survivability led inequality to rise. |
| Keywords: | inequality; Life Expectancy; Mortality |
| JEL: | I14 J10 |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:14983&r= |
| By: | Seth Richards-Shubik; Mark S. Roberts; Julie M. Donohue |
| Abstract: | Unlike demand studies in other industries, models of provider demand in health care often must omit a price or any other factor that equilibrates the market. Estimates of the consumer response to quality may consequently be attenuated, if the limited capacity of individual providers prevents some consumers from obtaining higher quality. We propose a tractable method to address this problem by adding a congestion effect to standard discrete-choice models. We show analytically how this improves forecasts of the consumer response to quality. We then apply this method to the market for heart surgery, and find that the attenuation bias in estimated quality effects can be important empirically. |
| JEL: | C31 I11 L15 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28817&r= |
| By: | Injete Amondo, Emily; Mirzabaev, Alisher; Nshakira-Rukundo, Emmanuel |
| Abstract: | Children in rural farming households across the developing countries are often vulnerable to a multitude of risks, including health risks associated with climate change and variability. This study empirically traced the effect of extreme weather events on nutritional health outcomes among rural children in Uganda, while accounting for households’ behavioural responses. We combined four waves of the Uganda National Panel Survey (UNPS) for the period 2009-2014, with long-term rainfall and temperature datasets and study the effect of extreme weather shocks on child health. We find that droughts and heat waves worsened child anthropometrics, particularly child chronic undernutrition. Exposure to drought significantly lowered height-for-age scores (HAZ) of up to -0.57 standard deviations. The main causal transmission channels were through lower crop production and increased frequency of child diseases. We highlight on the importance of ex-ante resilience building against extreme weather events particularly when compared to ex-post relief actions. |
| Keywords: | Health Economics and Policy, Labor and Human Capital |
| Date: | 2021–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:ags:ubzefd:311135&r= |
| By: | Nandita Saikia; Moradhvaj Moradhvaj |
| Abstract: | The objective of this study is to analyze the pattern and risk factors of all-cause and external- cause mortality among adults in India. Using a nationally-representative, population-based survey, known as the National Family Health Survey, 2015-2016, we calculate age-specific death rates among adults aged 15-64 for all causes and external causes in the three years before the survey. We estimate external cause-deleted life expectancy by sex and apply logistic regression to investigate the socioeconomic determinants of all-cause and external- cause mortality in India. The male disadvantage in external-cause mortality is higher than in all-cause mortality. For all-cause mortality, caste and household wealth quintile (WQ) are significant predictors for both sexes. For external-cause mortality, Hindu adults experience a higher risk than adults from other religious groups. Moreover, the risk of death from external causes is negatively associated with household WQ. Our study demonstrates that people belonging to lower socioeconomic strata disproportionately carry the burden of death from external causes. |
| Keywords: | Adult mortality, external-causes, socioeconomic status, India, NFHS |
| Date: | 2020–07 |
| URL: | http://d.repec.org/n?u=RePEc:vid:wpaper:2004&r= |
| By: | Koloma, Yaya |
| Abstract: | The objective of this paper is to assess the effects of long-term participation in a mutual health insurance programme on urban households health expenses and vulnerability in Burkina Faso. With data collected in 2013 from a series of interviews with beneficiaries of two mutual health insurance, the study performs a descriptive approach and an econometric technique (propensity score matching). The mutual health insurance program is highly valued, with 90.7% of short term (STB) and 98.3% long-term (LTB) beneficiaries willing to renew their policy insurance. They considered mutual health insurance schemes to be a good mechanism for covering disease risks, as 63.5% of STB and 79.3% of LTB were ready to take out insurance with another company if their mutual insurance no longer offered it. With a higher vulnerability incidence among STB (48.2%) compared to LTB (41.4%), access to mutual health insurance services seems to have a different impact on the well-being of beneficiary households. Indeed, long-term participation in a mutual health insurance has a positive impact on reducing household health expenses (ATT=0.185; t = 2.152**) and no statistically significant effect on their vulnerability (ATT=0.002; t=0.022). More efforts should be made to improve its effect on vulnerability, especially for the poorest. |
| Keywords: | Mutual Health Insurance,Vulnerability,Households,Impact,Burkina Faso |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:esprep:234465&r= |
| By: | Bettina Siflinger (Department of Econometrics and OR, Tilburg University, The Netherlands); Michaela Paffenholz (Center for Doctoral Studies in Economics, University of Mannheim, Germany); Sebastian Seitz (Center for Doctoral Studies in Economics, University of Mannheim, Germany); Moritz Mendel (Bonn Graduate School of Economics, Bonn, Germany); Hans-Martin von Gaudecker (University of Bonn, Germany; IZA, Bonn, Germany) |
| Abstract: | Since the start of the CoViD-19 pandemic, a major source of concern has been its effect on mental health. Using pre-pandemic information and five customized questionnaires in the Dutch LISS panel, we investigate how mental health in the working population has evolved along with the most prominent risk factors associated with the pandemic. Overall, mental health decreased sharply with the onset of the first lockdown but recovered fairly quickly. In December 2020, levels of mental health are comparable to those in November 2019. We show that perceived risk of infection, labor market uncertainty, and emotional loneliness are all associated with worsening mental health. Both the initial drop and subsequent recovery are larger for parents of children below the age of 12. Among parents, the patterns are particularly pronounced for fathers if they shoulder the bulk of additional care. Mothers’ mental health takes a particularly steep hit if they work from home and their partner is designated to take care during the additional hours. |
| Keywords: | COVID-19, mental health, gender inequality, lockdown |
| JEL: | I10 I14 I18 I30 J22 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:ajk:ajkdps:092&r= |
| By: | Michael Vlassopoulos (Economics Department, Social Sciences, University of Southampton, UK); Abu Siddique (Economics Group, Technical University of Munich); Tabassum Rahman (School of Medicine and Public Health, University of Newcastle); Debayan Pakrashi (Department of Economic Sciences, Indian Institute of Technology Kanpur); Asad Islam (Centre for Development Economics and Sustainability (CDES) and Department of Economics, Monash University); Firoz Ahmed (Economics Discipline, Khulna University) |
| Abstract: | In low-income settings, women are vulnerable to the psychological distress caused by the social and economic impact of epidemics and other large-scale shocks. This paper evaluates a randomized telecounseling intervention aimed at mitigating the mental health impact of COVID-19 on a sample of 2,402 women across 357 villages in Bangladesh. We find that the provision of mental support to participating women improves their mental health leading to reductions of 26% in the prevalence of moderate and severe stress and 60% in depression relative to women in the control group. We also find improvements in household food security and time invested in children. Finally, we examine the impact of the intervention on a range of other outcomes and attitudes: subjective well-being, preventive health behavior, and women's empowerment and find significant advances throughout. Our results suggest that this type of low-cost intervention can be effective in providing rapid psychological support to vulnerable groups in times of crises. |
| Keywords: | Mental health, COVID-19, food security, telecounseling, randomized experiment, women empowerment, rural Bangladesh. |
| JEL: | I10 I12 I18 I31 O12 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:aiw:wpaper:11&r= |
| By: | Jaeger, David A. (University of St. Andrews); Arellano-Bover, Jaime (Yale University); Karbownik, Krzysztof (Emory University); Martínez Matute, Marta (Universidad Autónoma de Madrid); Nunley, John M. (University of Wisconsin, La Crosse); Seals, Jr., R. Alan (Auburn University); Almunia, Miguel (Universidad Carlos III de Madrid); Alston, Mackenzie (Florida State University); Becker, Sascha O. (Monash University); Beneito, Pilar (Universidad de Valencia); Böheim, René (University of Linz); Boscá, José E. (Universidad de Valencia); Brown, Jessica H. (University of South Carolina); Chang, Simon (University of Western Australia); Cobb-Clark, Deborah A. (University of Sydney); Danagoulian, Shooshan (Wayne State University, Detroit); Donnally, Sandra (Lund University); Eckrote-Nordland, Marissa (University of Wisconsin, La Crosse); Farré, Lídia (University of Barcelona); Ferri, Javier (Universidad de Valencia); Fort, Margherita (University of Bologna); Fruewirth, Jane Cooley (University of North Carolina, Chapel Hill); Gelding, Rebecca (University of Sydney); Goodman, Allen C. (Wayne State University, Detroit); Guldi, Melanie (University of Central Florida); Häckl, Simone (University of Stavanger); Hankin, Janet (Wayne State University, Detroit); Imberman, Scott A. (Michigan State University); Lahey, Joanna (Texas A&M University); Llull, Joan (MOVE, Barcelona); Mansour, Hani (University of Colorado Denver); McFarlin, Isaac (University of Florida); Meriläinen, Jaakko (ITAM, Mexico); Mortlund, Tove (IFAU); Nybom, Martin (Uppsala University); O'Connell, Stephen D. (Emory University); Sausgruber, Rupert (Wirtschaftsuniversität Wien); Schwartz, Amy (Syracuse University); Stuhler, Jan (Universidad Carlos III de Madrid); Thiemann, Petra (Lund University); van Veldhuizen, Roel (Lund University); Wanamaker, Marianne H. (University of Tennessee); Zhu, Maria (Syracuse University) |
| Abstract: | University students have been particularly affected by the COVID-19 pandemic. We present results from the first wave of the Global COVID-19 Student Survey, which was administered at 28 universities in the United States, Spain, Australia, Sweden, Austria, Italy, and Mexico between April and October 2020. The survey addresses contemporaneous outcomes and future expectations regarding three fundamental aspects of students' lives in the pandemic: the labor market, education, and health. We document the differential responses of students as a function of their country of residence, parental income, gender, and for the US their race. |
| Keywords: | mental health, job market expectations, students, COVID-19 |
| JEL: | I23 I10 J1 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14419&r= |
| By: | Ajay Shah (xKDR Forum and Jindal Global University) |
| Abstract: | The pandemic has constituted a severe stress test for the Indian health system. In this article, we review India's experience with Covid-19 in 2020. An array of initiatives are required in response to these experiences, in public health and in health care. In testing and in health care, the substantial role of the private sector needs to be recognised, and integrated into thinking about health policy. There is a need to reform government organisations, which wield coercive power or spend public money, so as to refocus them upon addressing market failure, and achieving state capacity. There is considerable knowledge, in the field of state capacity in India, which can help in this task. |
| JEL: | I18 H4 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:anf:wpaper:4&r= |
| By: | Busemeyer, Marius R. |
| Abstract: | The COVID-19 pandemic poses a tremendous challenge to health care systems around the globe. Using original panel survey data for the case of Germany, this paper studies how specific trust in the health care system’s ability to cope with this crisis has evolved over the course of the pandemic. It also examines whether this specific form of trust is associated with general political trust, as well as individual willingness to support additional public spending on health care. The paper finds that levels of trust in the health care system, both regarding efficiency and fairness, are relatively high and have (so far) remained stable or even slightly increased. The analysis also reveals a strong positive association between general political trust and specific trust in the health care system. In contrast, willingness to increase health care spending—taking into account fiscal constraints—is less strongly related to perceptions of performance and political trust. |
| Keywords: | COVID-19,health care attitudes,performance perceptions,inequality,public spending |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cexwps:01&r= |
| By: | Wang, Jueyu; McDonald, Noreen |
| Abstract: | Transportation disruptions caused by COVID-19 have exacerbated difficulties in health care delivery and access, which may lead to changes in health care use. This study uses mobile device data from SafeGraph to explore the temporal patterns of visits to health care points of interest (POIs) during 2020 and examines how these patterns are associated with socio-demographic and spatial characteristics at the block group level in North Carolina. Specifically, using the k-medoid time-series clustering method, we identify three distinct types of temporal patterns of visits to health care POI. Furthermore, by estimating the multinomial logit models, we find that socio-demographic and spatial characteristics are strongly correlated with both the intensity and trend of medical visits during the pandemic. The results suggest that the ability to conduct in-person medical visits during the pandemic has been unequally distributed, which highlights the importance of tailoring policy strategies for specific socio-demographic groups to ensure health care delivery and access in a timely, equitable, and safe manner. |
| Date: | 2021–05–23 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:ghptz&r= |
| By: | Alipour, Jean-Victor; Fadinger, Harald; Schymik, Jan |
| Abstract: | This paper studies the relation between work and public health during the COVID-19 pandemic in Germany. Combining administrative data on SARS-CoV-2 infections and short-time work registrations, firm- and worker-level surveys and cell phone tracking data on mobility patterns, we find that working from home (WFH) is very effective in economic and public health terms. WFH effectively shields workers from short-time work, firms from COVID-19 distress and substantially reduces infection risks. Counties whose occupation structure allows for a larger fraction of work to be done from home experienced (i) much fewer short-time work registrations and (ii) less SARS-CoV-2 cases. Health benefits of WFH appeared mostly in the early stage of the pandemic and became smaller once tight confinement rules were implemented. Before confinement, mobility levels were lower in counties with more WFH jobs and counties experienced a convergence in traffic levels once confinement was in place. |
| Keywords: | BIBB-BAuA; COVID-19; infections; labor supply shock; mitigation; SARS-CoV-2; Working from Home |
| JEL: | H12 I18 J22 J68 R12 R23 |
| Date: | 2020–06 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:14871&r= |
| By: | Adamecz-Völgyi, Anna; Szabó-Morvai, Ágnes |
| Abstract: | This paper investigates the relative importance of confidence in public institutions to explain cross-country differences in the severity of the COVID-19 pandemic. We extend the related literature by employing regression and machine learning methods to identify the most critical predictors of deaths attributed to the pandemic. We find that a one standard deviation increase (e.g., the actual difference between the US and Finland) in confidence is associated with 350.9 fewer predicted deaths per million inhabitants. Confidence in public institutions is one of the most important predictors of deaths attributed to COVID-19, compared to country-level measures of individual health risks, the health system, demographics, economic and political development, and social capital. Our results suggest that effective policy implementation requires citizens to cooperate with their governments, and willingness to cooperate relies on confidence in public institutions. |
| Keywords: | COVID-19,death rate,confidence in public institutions,machine learning |
| JEL: | I18 P16 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:861&r= |
| By: | Bello, Piera (University of Zurich); Rocco, Lorenzo (University of Padova) |
| Abstract: | We study the role of education during the COVID-19 epidemic in Italy. We compare the trends of mortality rates between municipalities with different shares of educated residents between 2012 and 2020, by means of a continuous event study model and controlling for many confounders. We find that education played a protective role against the pandemic, significantly reducing mortality rates, during the first wave of the pandemic (between March and May 2020), but not during the second wave (between October and December 2020). We interpret this finding as the outcome of the interplay between education and the quality of information about preventive strategies, which was available at the different phases of the epidemic. |
| Keywords: | municipality, excess mortality, information, education, COVID-19, parallel trend |
| JEL: | I14 I18 I26 R00 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14402&r= |
| By: | Eugenio Proto; Anwen Zhang |
| 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:gla:glaewp:2021_08&r= |
| By: | Bartscher, Alina; Seitz, Sebastian; Siegloch, Sebastian; Slotwinski, Michaela; Wehrhöfer, Nils |
| Abstract: | We explore the role of social capital in the first wave of the recent Covid-19 pandemic in independent analyses for Austria, Germany, Great Britain, Italy, the Netherlands, Sweden and Switzerland. Exploiting within-country variation, we show that a one standard deviation increase in social capital leads to between 14% and 40% fewer Covid-19 cases per capita accumulated from mid-March until end of June, as well as between 7% and 16% fewer excess deaths per capita. Our results have important implications for the design of local containment policies in possible future waves of the pandemic. |
| Keywords: | collective action; COVID-19; Europe; health costs; social capital |
| JEL: | A13 D04 D91 H11 H12 I10 I18 |
| Date: | 2020–06 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:14866&r= |
| By: | Klaus Gründler; Armin Hackenberger; Anina Harter; Niklas Potrafke |
| Abstract: | We propose that crisis experience influences preferences towards COVID-19 vaccination and the speed of vaccination during the initial phase when vaccines became available. We use macro and micro data to empirically investigate our theory and introduce a novel crisis experience index. Evidence based on macro data shows that a one-standard-deviation increase in our new crisis experience index gives rise to around 10 additional administered vaccine doses per 100 citizens (around one standard deviation). Our micro-level analysis provides evidence for a microfoundation of the macro-level results, indicating that the crisis history of countries is positively correlated with preferences towards COVID-19 vaccination. Disentangling socialization effects and experience effects, we find that citizens who have experienced crises during their impressionable years (ages 18–25) have stronger preferences for being vaccinated against COVID-19 than others. |
| Keywords: | Covid-19 vaccination, crisis experience, crisis management, experience effects |
| JEL: | H12 H51 I12 I15 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9096&r= |
| By: | Daniela Del Boca; Noemi Oggero; Paola Profeta; Maria Cristina Rossi |
| Abstract: | The COVID-19 pandemic has had a dramatic impact on families’ lives, with parents all over the world struggling to meet the increased demands of housework, childcare and home-schooling. Much of the additional burden has been shouldered by women, particularly in countries with a traditionally uneven division of household labor. Yet the dramatic increase in remote work from home since the pandemic also has the potential to increase paternal involvement in family life and thus to redress persistent domestic gender role inequalities. This effect depends on the working arrangements of each partner, whether working remotely, working at their usual workplace or ceasing work altogether. We examine the role of working arrangements during the pandemic on the traditional division of household labor in Italy using survey data from interviews with a representative sample of working women conducted during the two waves of COVID-19 (April and November 2020). Our data show that the gender gap in household care related activities was widest during the first wave of the pandemic, and although it was less pronounced during the second wave, it was still higher than pre-COVID-19. The time spent by women on housework, childcare, and assisting their children with distance learning did not depend on their partners’ working arrangements. Conversely, men spent fewer hours helping with the housework and distance learning when their partners were at home. It is interesting, however, that although men who worked remotely or not at all did devote more time to domestic chores and child care, the increased time they spent at home did not seem to lead to a reallocation of couples’ roles in housework and child care. Finally, we find that working arrangements are linked to women’s feelings of uncertainty, with heterogeneous effects by level of education. |
| Keywords: | COVID-19, work arrangements, housework, childcare, distance learning. |
| JEL: | J13 J16 J21 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:cca:wpaper:654&r= |
| By: | Alejandro Buesa (Banco de España); Javier J. Pérez (Banco de España); Daniel Santabárbara (Banco de España) |
| Abstract: | “Awareness” about the occurrence of viral infectious (or other) tail risks can influence their socioeconomic inter-temporal impacts. A branch of the literature finds that prior lifetime exposure to signicant shocks can affect people and societies, i.e. by changing their perceived probability about the occurrence of an extreme, negative shock in the future. In this paper we proxy “awareness” by historical exposure of a country to epidemics, and other catastrophic events. We show that in a large cross-section of more tan 150 countries, more “aware” societies suffered a less intense impact of the COVID-19 disease, in terms of loss of lives and, to some extent, economic damage. |
| Keywords: | socioeconomic impact of pandemics, global health crises |
| JEL: | E43 F41 N10 N30 N40 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:bde:wpaper:2123&r= |
| By: | Muhammad Maaz; Anastasios Papanastasiou; Bradley J. Ruffle; Angela L. Zheng |
| Abstract: | Despite well-documented benefits of wearing a mask to reduce COVID-19 transmission, wide spread opposition to mandating mask-wearing persists. Both our game-theoretic model and our unique survey dataset point to heterogeneity in the perceived benefits and perceived costs of mask-wearing.Young, healthy, Canadian-born adult males who are politically conservative or without a college education are all more likely to oppose mandatory mask laws, as are individuals who do not takeclimate change seriously and who express less trust in doctors and in elected officals. Political conservatives disproportionately cite not wanting to live in fear and infringements on personal freedoms as reasons for not wearing masks. Our findings cannot be explained by individuals who substitutephysical distancing for mask-wearing. We show that these two precautionary measures are complements. |
| Keywords: | COVID-19; mandatory protective masks; heterogeneity in beliefs; ideology; politicalpartisanship |
| JEL: | I12 I18 J38 |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:cch:wpaper:210001&r= |
| By: | Nora Lustig (Tulane University); Valentina Martinez Pabon (Tulane University); Guido Neidhöfer (ZEW); Mariano Tommasi (Universidad de San Andres) |
| Abstract: | We simulate the short- and long-term distributional consequences of COVID-19 in the four largest Latin American economies: Argentina, Brazil, Colombia and Mexico. We show that the short-term impact on income inequality and poverty can be very significant, but that additional spending on social assistance more than offsets the effect in Brazil. The offsetting effect is significant in Argentina and Colombia, and nil in Mexico where there has been no such expansion. We find that a universal basic income that would have produced the same reduction in the poverty gap as actual policies would have cost slightly more but would have benefited the poor (the nonpoor) slightly less (more). To project the long-term consequences, we estimate the impact of the pandemic on school achievement and its intergenerational persistence. We use information on school closures, educational mitigation policies, and account for educational losses related to health shocks and parental job loss. Our findings show that in all four countries the impact is strongly asymmetric and affects particularly the high-school completion rates of children from disadvantaged families. Our simulations suggest that mitigation policies seem to have a minor impact on containing these negative effects. |
| Keywords: | COVID-19, lockdowns, inequality, poverty, human capital, school closures, social spending, intergenerational persistence, Latin America, Argentina, Brazil, Colombia, Mexico |
| JEL: | C63 D31 I24 I32 I38 J62 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:sad:wpaper:153&r= |