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on Health Economics |
| By: | Bolh, Nathalie; Wendner, Ronald |
| Abstract: | We build a theoretical model to explain the complex patterns of income and obesity, accounting for changes in behavior related to exercise. We combine the theory of time allocation with the theory of conspicuous leisure in a growth model, assuming that consumption expenditures connected to exercise time are conspicuous, and that conspicuous behavior changes with economic development. As a result, as economies develop, we show that there is a growing wedge between optimal exercise and consumption choices made by individuals with different income levels. We show that this pattern is connected to a dynamic Kuznets curve linking body weight to economic development over time, and a static Kuznets curve linking different steady state levels of income per worker to body weight. Thus, our model helps explain the rise and slowdown in obesity prevalence in the USA, as well as the positive correlation between obesity and income per worker in developing countries, and the negative correlation between obesity and income per worker in industrialized countries. We supplement our theoretical results with numerical simulations of the static and dynamic obesity Kuznets curves for the USA. We show that while exercise choices have contributed to a slowdown in the rise in obesity prevalence, there is to this date no dynamic Kuznets curve pattern for obesity in the USA. By contrast, we find the existence of a static Kuznets curve: the steady state level of average body weight increases with the per worker stock of capital up to a level of 186.5 pounds, corresponding to a capital stock 25% higher than the current steady state US capital stock, and decreases thereafter. We discuss policy implications of our findings. |
| Keywords: | Obesity, Status, Conspicuous leisure, Inequality, Kuznets Curve, Economic Development |
| JEL: | D11 D30 H31 I15 O41 |
| Date: | 2021–07–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:108644&r= |
| By: | Pedro Carneiro (Institute for Fiscal Studies and University College London); Lucy Kraftman (Institute for Fiscal Studies); Giacomo Mason (Institute for Fiscal Studies); Lucie Moore (Institute for Fiscal Studies); Imran Rasul (Institute for Fiscal Studies and University College London and IFS); Molly Scott (Institute for Fiscal Studies and Institute for Fiscal Studies) |
| Abstract: | We evaluate an intervention targeting early life nutrition and well-being for households in extreme poverty in Northern Nigeria. The intervention leads to large and sustained improvements in children’s anthropometric and health outcomes, including an 8% reduction in stunting four years post-intervention. These impacts are partly driven by information-related channels. However, the certain and substantial ‡ow of cash transfers is also key. They induce positive labor supply responses among women, and enables them to undertake productive investments in livestock. These provide protein rich diets for children, and generate higher household earnings streams long after the cash transfers expire. |
| Date: | 2020–12–14 |
| URL: | http://d.repec.org/n?u=RePEc:ifs:cemmap:61/20&r= |
| By: | Wang, Rui; Chen, Xi; Li, Xun |
| Abstract: | In 2014, the city of Flint, MI in the U.S. changed its public water source, resulting in severe water contamination and a public health crisis. Using the Flint Water Crisis as a natural experiment, we estimate the effect of in utero exposure to polluted water on health at birth. Matching vital statistics birth records with various sources of data, we use a Synthetic Control Method (SCM) to identify the causal impact of water pollution on key birth outcomes. Our results suggest that the crisis modestly increased the rate of low birth weight (LBW) by 1.8 percentage points (or 15.5 percent) but had little effect on the length of gestation or rate of prematurity. However, these effects are larger among children born to black mothers, as indicated by an increase in the rate of LBW by 2.5 percentage points (or 19 percent). Children born to white mothers exhibit, on average, a 30.1-gram decrease in birth weight. We find little evidence that the male-to-female sex ratio declines in the overall population, suggesting that the inutero scarring effect of the Flint Water Crisis may dominate the channel of mortality selection. However, we observe a slight decline in the sex ratio among children born to black mothers. Finally, we find no notable change in the fertility rates of either black women or white women in Flint. These results are robust to a rich set of placebo and falsification tests. Our findings highlight the importance and urgency of upgrading U.S. aging, lead-laced water systems in promoting racial and ethnic health equity. |
| Keywords: | water pollution,lead exposure,Flint Water Crisis,infants,low birth weight |
| JEL: | I14 I18 Q53 Q58 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:887&r= |
| By: | Johnsen, Julian Vedeler (SNF); Willén, Alexander (Norwegian School of Economics) |
| Abstract: | This paper provides novel evidence on the labor supply response to negative income shocks in retirement, exploiting an institutional feature that caused differential and unexpected income losses among otherwise identical individuals in a sharp regression discontinuity design. We conclude that retired pensioners do not return to work despite income losses of up to seven percent of their annual income. The paper further shows that the negative income shock had no impact on the health of pensioners. At the height of an ongoing global crisis in which public pension funds are rapidly losing value, these results may be particularly important. |
| Keywords: | Pension Policy; Retirement; Labor Supply; Health |
| JEL: | I38 J14 J26 |
| Date: | 2021–05–24 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:ifauwp:2021_007&r= |
| By: | Hanming Fang; Xiaoyan Lei; Julie Shi; Xuejie Yi |
| Abstract: | We use a natural experiment in China's health care reform, in which the government mandated zero markups for drugs sold in public hospitals, to study physician-induced demand for medical care. We develop a theoretical model that robustly predicts that the drug price zero markup policy (ZMP) will lead to a reduction in the demand for drugs but an increase in the demand for non-drug services, only when the demands for drugs and non-drug services are at least partially physician induced. Our model also yields testable predictions of the impact of the ZMP regarding the equilibrium number of treated patients. Exploiting the staggered rollout of the ZMP and a unique claims data set, we find that, at the admission level, the reform decreases drug expenses by 63.4 log points (47.0 percent), but the reduction in drug expenses is almost fully substituted by the increases in expenses for non-drug services. Quantitatively similar results are also obtained at the physician and at the hospital levels. We also show that the ZMP reduces the number of patients in the treated hospitals, as predicted by the model, and that the reform has little impact on the quality of health care proxied by the readmission rate. |
| JEL: | I10 I11 I18 |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28998&r= |
| By: | Helmuth Cremer; Jean-Marie Lozachmeur |
| Abstract: | This paper studies a market for a medical product in which there is perfect competition among health insurers, while the good is sold by a monopolist. Individuals differ in their severity of illness and there is ex post moral hazard. We consider two regimes: one in which insurers use coinsurance rates (ad valorem reimbursements) and one in which insurers use copayments (specific reimbursements). We show that the induced equilibrium with copayments involves a lower producer price and a higher level of welfare for consumers. This results provides strong support for a reference price based reimbursement policy. |
| Keywords: | ex post moral hazard, health insurance competition, copayments, imperfect competition |
| JEL: | I11 I13 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9160&r= |
| By: | Dan Zeltzer; Liran Einav; Joseph Rashba; Ran D. Balicer |
| Abstract: | We estimate the impact of increased access to telemedicine that followed widespread adoption during the March-April 2020 lockdown period in Israel (due to COVID-19). We focus on the post-lockdown period, which in Israel was characterized by a temporary return to normalcy. Prior to the lockdown, telemedicine accounted for about 5% of all primary care visits. It peaked at around 40% during the lockdown, and remained high, at around 20%, during the post-lockdown period. Using a difference-in-differences framework, we compare primary care episodes before and after the lockdown between patients with high and low access to telemedicine, with access defined based on their main primary care physician’s propensity to adopt telemedicine during the lockdown. Increased access to telemedicine results in a 3.5% increase in primary care visits, but a 5% lower per-episode cost, so overall resource utilization is slightly lower. We find that remote visits involve slightly fewer prescriptions and more follow-ups, mainly with the same physician, which is consistent with a prolonged diagnostic path in the absence of physical examination. However, analyzing specific conditions, we find no evidence of missed diagnoses or adverse outcomes. Taken together, our findings suggest that the increased convenience of telemedicine does not compromise care quality or raise costs. |
| JEL: | I11 O33 |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28978&r= |
| By: | Simon Amez; Suncica Vujic; Margo Abrath; Stijn Baert (-) |
| Abstract: | University students’ smartphone use has recently been shown to negatively affect their academic performance. Surprisingly, research testing the empirical validity of potential mechanisms underlying this relationship is very limited. In particular, indirect effects of negative health consequences due to heavy smartphone use have never been investigated. To fill this gap, we investigate, for the first time, whether deteriorated sleep quality drives the negative impact on academic performance. To this end, we examine longtudinal data on 1,635 students at two major Belgian universities. Based on a combination of a random effects approach and seemingly unrelated regression, we find no statistically significant mediating effect of sleep quality in the relationship between smartphone use and academic performance. |
| Keywords: | smartphone use, academic performance, sleep quality, mediation analysis. |
| JEL: | I21 I23 J24 |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:rug:rugwps:21/1019&r= |
| By: | Nguyen, Ha Trong; Christian, Hayley; Le, Huong Thu; Connelly, Luke; Zubrick, Stephen R.; Mitrou, Francis |
| Abstract: | This study explores the differential impact of weather on time allocation to physical activity and sleep by children and their parents. We use nationally representative data with time use indicators objectively measured on multiple occasions for more than 1,100 child-parent pairs, coupled with daily meteorological data. Employing an individual fixed effects regression model to estimate the causal impact of weather, we find that unfavourable weather conditions, as measured by cold or hot temperatures or rain, cause children to reduce physical activity time and increase sedentary time. However, such weather conditions have little impact on children's sleep time or the time allocation of their parents. We also find substantial differential weather impact, especially on children's time allocation, by weekdays/weekends and parental employment status, suggesting that these factors may contribute to explaining the differential weather impact that we observed. Our results additionally provide evidence of adaptation, as temperature appears to have a more pronounced impact on time allocation in colder months and colder regions. The results suggest that extreme weather conditions, including those associated with climate change, could make children vulnerable to reduced physical activity. |
| Keywords: | Weather,time allocation,physical activity,sleep,family,dyad |
| JEL: | I12 J13 J22 Q54 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:886&r= |
| By: | Dias, Mateus; Fontes, Luiz Felipe |
| Abstract: | This paper studies the Brazilian psychiatric reform, which reorganized mental healthcare provision by the public system building a network of community-based services centered on the Psychosocial Care Centers (CAPSs). Our research design exploits the roll-out of CAPSs in a differences-in-differences framework. We show that these centers improved outpatient mental healthcare utilization and reduced hospital admissions due to mental and behavioral disorders. Those reductions were more pronounced for long-stay admissions and among patients with schizophrenia. Additionally, centers delivering substance abuse treatment reduced deaths caused by alcoholic liver disease. Finally, we also find that this shift away from inpatient care increased homicides. |
| Keywords: | Mental Health, Community care, Psychiatric Reform, CAPS |
| JEL: | I10 I12 I18 |
| Date: | 2020–11 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:108658&r= |
| By: | Deng, Zichen (Norwegian School of Economics); Lindeboom, Maarten (Vrije Universiteit Amsterdam) |
| Abstract: | We use newly collected individual-level hunger recall information from the China Family Panel Survey to estimate the causal effect of undernourishment on later-life health. We develop a Two-Sample Instrumental Variable (TSIV) estimator that can deal with heterogeneous samples. We find a non-linear relationship between mortality rates, a commonly used famine indicator, and the individual hunger experience. The nonlinearity in famine exposure may explain the variation in the famine's effect on later life health found in previous studies. We also find that exposure to famine-induced hunger early in life leads to worse health among females fifty years later. This effect is much larger than the reduced-form effect found in previous studies. For males, we find no impact. |
| Keywords: | famine, hunger, developmental origins, two-sample instrumental variable |
| JEL: | I12 J11 C21 C26 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14487&r= |
| By: | Adnan M. S. Fakir (Business School, The University of Western Australia); Tushar Bharati (Business School, The University of Western Australia) |
| Abstract: | We evaluate the performance of two behavioral interventions aimed at reducing tobacco consumption in an ultra-poor, rural region of Bangladesh where conventional methods like taxes and warning labels are infeasible. The first intervention asked participants to daily log their tobacco consumption expenditure. The second intervention placed two graphic posters warning participating households of the harmful effects of tobacco consumption on their children and themselves in their sleeping quarters. While both interventions reduced household tobacco consumption expenditure, male participants who logged their expenditure substituted cigarettes with cheaper smokeless tobacco. Risk-averse males who spent relatively more on tobacco responded more to the logbook intervention. Relatively more educated, patient males with children below age five responded better to the poster intervention. The findings suggest extending policies that worked elsewhere to the rural poor in developing countries, where cheaper substitutes are readily available, might be unwise. Instead, policies can leverage something as universal as parents’ concern for their children’s health for promoting healthy decision-making. |
| Keywords: | tobacco; smoking; healthy decision-making; nudge; field experiment; Bangladesh |
| JEL: | C93 D9 I1 I12 I18 O1 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:uwa:wpaper:21-13&r= |
| By: | John Cawley; Michael R. Daly; Rebecca Thornton |
| Abstract: | Taxes on sugar-sweetened beverages (SSBs) are relatively new and there is little evidence about their impact on SSB consumption or body mass index (as opposed to prices, purchases, or sales), their impact on youth (as opposed to on adults), or their impact in non-Western nations. This paper adds to the evidence base on all of these dimensions by estimating the effect of an SSB tax on the consumption and BMI of youth in Mauritius, an island nation in the Indian Ocean, which we compare to Maldives, another island nation in the Indian Ocean which did not implement an SSB tax during the time of our data. Results of difference-in-differences models indicate that the tax in Mauritius had no detectable impact on the consumption of SSBs or the body mass index of the pooled sample of boys and girls. However, models estimated separately by sex indicate that the probability that boys consumed SSBs fell by 9.4 percentage points (11%). These are among the first estimates of the effect of SSB taxes on youth consumption, and contribute to the limited evidence base on the impact of SSB taxes on weight, or in non-Western countries. |
| JEL: | H2 H3 I12 I18 L66 O1 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28960&r= |
| By: | Francesconi, Marco (University of Essex); James, Jonathan (University of Bath) |
| Abstract: | Reducing drink drive limits is generally regarded an effective strategy to save lives on the road. Using several new administrative data sources, we evaluate the effect of a stricter limit introduced in Scotland in 2014. This reduction had no effect on drink driving and road collisions. Estimates from a supply-of-offenses function suggests that the reform did not have much ex-ante scope for sizeable effects. The unavailability of cheaper alternative means of transportation and weak law enforcement seem to have been the main channels behind the lack of an impact. We find no externality on a wide range of domains, from alcohol consumption to criminal activities other than drink driving. |
| Keywords: | driving under the influence, road collisions, health, alcohol, crime |
| JEL: | I12 I18 D62 K42 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14499&r= |
| By: | Gopalan, Maithreyi (The Pennsylvania State University); Lombardi, Caitlin; Bullinger, Lindsey Rose |
| Abstract: | Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010-2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents’ self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p < 0.05), a 4.7% improvement. We found no significant changes in children’s utilization of routine doctor visits or parents’ assessment of their children’s health status. We observed modest decreases in children’s body mass index (BMI) of about 2% (p < 0.05), especially for girls. |
| Date: | 2021–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:vghk6&r= |
| By: | Sayli Javadekar (University of Bath); Kritika Saxena (IHEID, Graduate Institute of International and Development Studies, Geneva) |
| Abstract: | How is prenatal sex selective behaviour influenced by the presence of cheap fetal gender identification technology and financial incentives? We analyze a conditional cash transfer program in India called Janani Suraksha Yojna. By providing access to prenatal sex detection technology like the ultrasound scans, and simultaneously providing cash incentives to both households and community health workers for every live birth, this program altered existing trends in prenatal sex selection. Using difference-in-differences and triple difference estimators we find that the policy led to an increase in female births. This improvement comes at a cost, as we observe an increase in under-5 mortality for girls born at higher birth orders, indicating a shift in discrimination against girls from pre-natal to post-natal. Our calculations show that the net effect of the policy was that nearly 300,000 more girls survived in treatment households between 2006 and 2015. Finally, we find that the role played by community health workers in facilitating the program is a key driver of the decline in prenatal sex selection. |
| Keywords: | Sex selection; gender; health; India; missing girls; prenatal sex detection; sex-selection; community health workers |
| JEL: | J13 J16 I12 I28 |
| Date: | 2021–07–02 |
| URL: | http://d.repec.org/n?u=RePEc:gii:giihei:heidwp15-2021&r= |
| By: | Mott, D.; Kumar, G.; Sampson, C.; Garau, M. |
| Abstract: | Cost-effectiveness analysis (CEA) is the economic evaluation method that is typically preferred by health technology assessment agencies. Quality-adjusted life years (QALYs) – a composite measure of quality and quantity of life – are often used as the measure of benefit in a CEA. The quality of life component requires health state utilities, which are anchored at one (indicating full health) and zero (indicating being dead). This short report summarises the typical approach for obtaining utilities (i.e. through the use of generic preference-based measures such as EQ-5D). It then describes the potential limitations of this approach and outlines some alternatives such as - a) alternative generic preference-based measures; b) bolt-on questions for EQ-5D; c) condition-specific preference-based measures; and d) mapping to EQ-5D from condition-specific non-preference-based measures. |
| Keywords: | Measuring and Valuing Outcomes |
| JEL: | I1 |
| Date: | 2021–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:briefg:002357&r= |
| By: | David G. Blanchflower (Bruce V. Rauner ’78 Professor of Economics, Dartmouth College, Hanover, NH 03755-3514. Adam Smith School of Business, University of Glasgow and NBER); Alex Bryson (Professor of Quantitative Social Science, UCL Social Research Institute, University College London, 20 Bedford Way, London WC1H 0AL) |
| Abstract: | Using US Census Household Pulse Survey data for the period April 2020 to June 2021 we track the evolution of the mental health of nearly 2.3 million Americans during the COVID pandemic. We find anxiety, depression and worry peaked in November 2020, coinciding with the Presidential election. The taking of prescription drugs for mental health conditions peaked two weeks later in December 2020. Mental health improved subsequently such that by April 2021 it was better than it had been a year previously. The probability of having been diagnosed with COVID did not rise significantly in the first half of 2021 but COVID infection rates were higher among the young than the old. COVID diagnoses were significantly lower in States that had voted for Biden in the Presidential Election. The probability of vaccination rose with age, was considerably higher in Biden states, and rose precipitously over the period among the young and old. Anxiety was higher among people in Biden states, whether they had been diagnosed or not, and whether they were vaccinated or not. The association between anxiety and depression and having had COVID was not significant in Biden or Trump states but being vaccinated was associated with lower anxiety and depression, with the effect being larger in Biden states. Whilst being in paid work was associated with lower anxiety, worry and depression and was associated with higher vaccination rates, it also increased the probability of having had COVID. |
| Keywords: | COVID-19; pandemic; mental health; anxiety; depression; worry; vaccination; Biden; Trump |
| JEL: | I1 I18 I31 I38 H12 |
| Date: | 2021–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:qss:dqsswp:2121&r= |
| By: | Marcella Alsan; Amitabh Chandra; Kosali I. Simon |
| Abstract: | We measure inequities from the COVID-19 pandemic on mortality and hospitalizations in the United States during the early months of the outbreak. We discuss challenges in measuring health outcomes and health inequality, some of which are specific to COVID-19 and others that complicate attribution during most large health shocks. As in past epidemics, pre-existing biological and social vulnerabilities profoundly influenced the distribution of disease. In addition to the elderly, Hispanic, Black and Native American communities were disproportionately affected by the virus, particularly when assessed using the years of potential life lost metric. For example, Hispanic and Black Americans in 2020 saw 39.5 and 25 percent increases in excess mortality relative to trend, compared to a less than 15 percent increase for Whites; we find losses in potential years of life three to four times larger among Hispanic and Black compared to White Americans. Individual-level data from a commercially insured population show that otherwise similar Black and Hispanic enrollees were hospitalized due to COVID-19 at a higher rate than White enrollees. We provide a conceptual framework and initial empirical analysis which seek to shed light on contributors to pandemic-related health inequality, and suggest areas for future research. |
| JEL: | I1 I14 I18 J1 J78 N0 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28958&r= |
| By: | Euijin Jung (Peterson Institute for International Economics); David Wilcox (Peterson Institute for International Economics) |
| Abstract: | South Korea has been exceedingly successful in suppressing the virus that causes COVID-19. It benefited enormously from the adoption of a stringent set of public health measures that turned out to have been highly appropriate for addressing this particular health crisis and from the acquiescence of its population in adopting those measures, which included aggressive testing, contact tracing, quarantining, and graduated treatment of people with COVID-19. The United States did not adopt comparable public health measures. Even if it had done so, it is highly debatable whether the population would have tolerated them. Jung and Wilcox provide an overview of the course of the disease in each country, review the health outcomes, and describe the impact of the pandemic on key economic indicators, including real GDP, employment and unemployment, and inflation. They examine the policy choices that contributed to the outcomes in each country and conclude by identifying near-term priorities for both countries. |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iie:pbrief:pb21-15&r= |
| By: | Luca Pensieroso (Université Catholique de Louvain); Alessandro Sommacal (Department of Economics (University of Verona)); Gaia Spolverini (Université Catholique de Louvain) |
| Abstract: | This paper investigates the relation between intergenerational coresidence and mortality from Covid-19 in 2020. Using a crosssection of U.S. counties, we show that this association is positive, significant, and robust to the inclusion of several demographic and socio-economic controls. Furthermore, using historical evidence from pre-pandemic years (1980-2019) and the Spanish influenza (1918), we argue that this positive association is specific to the Covid-19 pandemic only. |
| Keywords: | family economics; Spanish influenza; mortality; disease; health economics |
| JEL: | I10 J10 J14 |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:ver:wpaper:10/2021&r= |
| By: | Zivin, Joshua Graff; Neidell, Matthew; Sanders, Nicholas; Singer, Gregor |
| 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; ES/R009708/1 |
| JEL: | Q53 I12 I11 |
| Date: | 2021–06–28 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:110964&r= |
| By: | Gabler, Janos (IZA); Raabe, Tobias (quantilope); Röhrl, Klara (University of Bonn); Gaudecker, Hans-Martin von (University of Bonn) |
| Abstract: | In order to slow the spread of the CoViD-19 pandemic, governments around the world have enacted a wide set of policies limiting the transmission of the disease. Initially, these focused on non-pharmaceutical interventions; more recently, vaccinations and large-scale rapid testing have started to play a major role. The objective of this study is to explain the quantitative effects of these policies on determining the course of the pandemic, allowing for factors like seasonality or virus strains with different transmission profiles. To do so, the study develops an agent-based simulation model, which is estimated using data for the second and the third wave of the CoViD-19 pandemic in Germany. The paper finds that during a period where vaccination rates rose from 5% to 40%, rapid testing had the largest effect on reducing infection numbers. Frequent large-scale rapid testing should remain part of strategies to contain CoViD-19; it can substitute for many non-pharmaceutical interventions that come at a much larger cost to individuals, society, and the economy. |
| Keywords: | COVID-19, agent based simulation model, rapid testing, non-pharmaceutical interventions |
| JEL: | C63 I18 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14510&r= |
| By: | Germain Gauthier |
| Abstract: | In the context of the Covid-19 pandemic, multiple studies rely on two-way fixed effects (FE) models to assess the impact of mitigation policies on health outcomes. Building on the SIRD model of disease transmission, I show that FE models tend to be misspecified for three reasons. First, despite misleading common trends in the pre-treatment period, the parallel trends assumption generally does not hold. Second, heterogeneity in infection rates and infected populations across regions cannot be accounted for by region-specific fixed effects, nor by conditioning on observable time-varying confounders. Third, epidemiological theory predicts heterogeneous treatment effects across regions and over time. Via simulations, I find that the bias resulting from model misspecification can be substantial, in magnitude and sometimes in sign. Overall, my results caution against the use of FE models for mitigation policy evaluation. |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2106.10949&r= |
| By: | HIROTA Shigeru; SETOH Kazuya; YODO Masato; YANO Makoto |
| Abstract: | In overcoming the COVID-19 crisis, contribution from social science is indispensable as well as medical research. With this consideration, we have initiated a socio-life scientific survey on COVID-19, which is associated with the antibody test for the virus, targeting 3,000 participants of the Nagahama Survey and 1,000 medical workers at the Kyoto University Hospital. The survey is designed to highlight respondents' changes in behavior, the effect of the COVID-19 outbreak on respondents' values, and the actual spread of COVID-19 among the respondents. |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:21041&r= |
| By: | Ján Palguta; Levínský, René; Škoda, Samuel |
| Abstract: | Elections define representative democracies, but also produce spikes in physical mobility if voters need to travel to electoral rooms. In this paper, we examine whether large-scale, in-person elections propagate the spread of COVID-19. We exploit a natural experiment from the Czech Republic which biannually renews mandates in 1/3 of Senate constituencies rotating according to the 1995 election law. We show that in the second and third weeks after the 2020 elections (held on October 9-10), new COVID-19 infections grow significantly faster in voting compared to non-voting constituencies. A temporarily-related peak in hospital admissions and essentially no changes in test positivity rates suggest that the acceleration is not merely due to increased testing. The acceleration is absent in population above 65, consistently with strategic risk-avoidance by older voters. Our results have implications for postal voting reforms or postponing of large-scale, in-person (electoral) events during viral outbreaks. |
| Keywords: | election,COVID-19,natural experiment,event study |
| JEL: | D70 D72 H0 H12 H75 I10 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:891&r= |
| By: | David Turner; Balazs Egert; Yvan Guillemette; Jamila Botev |
| Abstract: | New variants of the virus are spreading which, together with seasonal effects, are estimated to be able to raise effective reproduction numbers by up to 90%. Meanwhile, many countries are rolling out vaccination programmes, but at varying speeds. Hence the race is on to beat the variants with the vaccines. Vaccination is very powerful at reducing virus transmission: fully vaccinating 20% of the population is estimated to have the same effect as closing down public transport and all-but-essential workplaces; fully vaccinating 50% of the population would have a larger effect than simultaneously applying all forms of containment policies in their most extreme form (closure of workplaces, public transport and schools, restrictions on travel and gatherings and stay-at-home requirements). For a typical OECD country, relaxing existing containment policies would be expected to raise GDP by about 4-5%. Quick vaccination would thus help limit the extent to which containment policies need to be escalated in future epidemic waves, providing huge welfare benefits both in terms of fewer infections and stronger economic activity. |
| Keywords: | Covid, Sars-Cov-2, reproduction number, vaccine, variant, lockdown, weekly tracker |
| JEL: | I18 E61 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9151&r= |
| By: | Patrick Mellacher |
| Abstract: | How will the novel coronavirus evolve? I study a simple SEPAIRD model, in which mutations may change the properties of the virus and its associated disease stochastically and antigenic drifts allow new variants to partially evade immunity. I show analytically that variants with higher infectiousness, longer disease duration, and shorter latency period prove to be fitter. "Smart" containment policies targeting symptomatic individuals may redirect the evolution of the virus, as they give an edge to variants with a longer incubation period and a higher share of asymptomatic infections. Reduced mortality, on the other hand, does not per se prove to be an evolutionary advantage. I then implement this model as an agent-based simulation model in order to explore its aggregate dynamics. Monte Carlo simulations show that a) containment policy design has an impact on both speed and direction of viral evolution, b) the virus may circulate in the population indefinitely, provided that containment efforts are too relaxed and the propensity of the virus to escape immunity is high enough, and crucially c) that it may not be possible to distinguish between a slowly and a rapidly evolving virus looking only at short-term epidemiological outcomes. Thus, what looks like a successful mitigation strategy in the short run, may prove to have devastating long-run effects. These results suggest that optimal containment policy must take the propensity of the virus to mutate and escape immunity into account, strengthening the case for genetic and antigenic surveillance even in the early stages of an epidemic. |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2107.04358&r= |
| By: | Angelov, Nikolay (Uppsala Center for Fiscal Studies); Waldenström, Daniel (Research Institute of Industrial Economics, Stockholm) |
| Abstract: | We use population-wide tax register data to document the impact of the COVID-19 pandemic on firm sales, tax revenues, and sick pay in Sweden. The pandemic impact is identified using within-year, between-year, and geographical variation, and our data allows us to run placebo tests. Our findings confirm the large negative effects of the pandemic, but shed new light on their magnitudes and sensitivity to COVID-19 morbidity rates. Specifically, we find that the impact on VAT and firm sales was larger than on commonly used industrial and service production indexes, larger than the effect on electricity for industrial use, but less than the effect on excise taxes on air travel. The pandemic's impact on short-term sick pay is large, but unlike tax payments, it does not vary with local infection rates, indicating behavioral responses to more generous rules for sickness insurance during the pandemic. |
| Keywords: | COVID-19, VAT, excise taxes, sick pay |
| JEL: | H24 H25 J22 J24 |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izapps:pp179&r= |
| By: | Raphael Bruce; Alexsandros Cavgias, Luis Meloni, Mario Remigio |
| Abstract: | In this paper, we study the effect of women's public leadership in times of crisis. More specifically, we use a regression discontinuity design in close mayoral races between male and female candidates to understand the impact of having a woman as a mayor during the COVID-19 pandemic in Brazil. We provide evidence that municipalities under female leadership had fewer deaths and hospitalizations per 100 thousand inhabitants and enforced more non-pharmaceutical interventions (e.g., mask usage and prohibition of gatherings). We also show that these results are not due to measures taken before the pandemic or other observable mayoral characteristics such as education or political preferences. Finally, we provide evidence that these effects are stronger in municipalities where Brazil's far-right president, who publicly disavowed the importance of non-pharmaceutical interventions, had a higher vote share in the 2018 election. Overall, our findings provide credible causal evidence that female leaders outperformed male ones when dealing with a global policy issue. Moreover, our results also showcase the role local leaders can play in counteracting bad policies implemented by populist leaders at the national level. |
| Keywords: | Gender; Politics; Health; COVID-19; Brazil |
| JEL: | J16 D72 D78 I18 |
| Date: | 2021–07–13 |
| URL: | http://d.repec.org/n?u=RePEc:spa:wpaper:2021wpecon19&r= |
| By: | Charles F. Manski (Institute for Fiscal Studies and Northwestern University); Francesca Molinari (Institute for Fiscal Studies and Cornell University) |
| Abstract: | As a consequence of missing data on tests for infection and imperfect accuracy of tests, reported rates of cumulative population infection by the SARS CoV-2 virus are lower than actual rates of infection. Hence, reported rates of severe illness conditional on infection are higher than actual rates. Understanding the time path of the COVID-19 pandemic has been hampered by the absence of bounds on infection rates that are credible and informative. This paper explains the logical problem of bounding these rates and reports illustrative findings, using data from Illinois, New York, and Italy. We combine the data with assumptions on the infection rate in the untested population and on the accuracy of the tests that appear credible in the current context. We find that the infection rate might be substantially higher than reported. We also find that the infection fatality rate in Illinois, New York, and Italy is substantially lower than reported. |
| Date: | 2020–05–11 |
| URL: | http://d.repec.org/n?u=RePEc:ifs:cemmap:20/20&r= |
| By: | Lise Haddouk (UNIROUEN - Université de Rouen Normandie - NU - Normandie Université, CB - CB - Centre Borelli - UMR 9010 - Service de Santé des Armées - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay - CNRS - Centre National de la Recherche Scientifique - ENS Paris Saclay - Ecole Normale Supérieure Paris-Saclay - UP - Université de Paris); Carine Milcent (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | This paper uses an original telepsychology European survey conducted by the EFPA (European Federation of Psychologists Associations) Project Group in e-Health between March 18th and May 5th, 2020, to consider online practices of psychologists. We set up evidence from France compared with other European countries. First, we observe that France is the European country where psychologists' perception of the concept of online consultations is the worse. It goes through the lowest rate of specific training concerning online consultations. Also France is the European country where psychologists have the worse experience (after Belgium) with online consultations, prior to the COVID-19 outbreak. Second, we address the issue of determinants of the teleconsultation feelings. We take advantage of this survey panel of 13 European countries that allows us to consider within-country telepractice behaviour. Our results show that a specific training is a key factor for a positive feeling with the concept of online consultation practices. In addition, telepresence (feeling of being connected with one another) and positive overall experience capture the effect of the specific training. French psychologists differ from the other European countries telepsychologists by an absence of specific training effect on the feeling with online consultation that may be explained by the lack of specific training. However, as for European psychologists, French psychologists' perception of telepractice depends on their level of telepresence and on their overall experience in telepractice. |
| Keywords: | Comparison France and European countries telepsychology,Specific training,Teleconsultation,Telepresence,Psychologists,Telepsychology,Comparison France and European countries |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:psewpa:halshs-03265054&r= |
| By: | HATTORI Takahiro; KOMURA Norihiro; UNAYAMA Takashi |
| Abstract: | We estimate the marginal propensity to consume (MPC) out of the Special Cash Payment conducted in Japan during the COVID-19 pandemic. The MPC is identified by exploiting differences in the timing of the payment among cities using publicly available data from the Family Income and Expenditure Survey. The estimated MPC is approximately 10 percent, which does not differ from those estimated in previous studies conducted during the non-pandemic period. We also estimate the different MPCs by consumption subcategories defined based on the infection risk, finding that households did not increase spending on "face-to-face services" while "goods/services purchased at home" and "goods/services purchased at stores" increased. |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:21043&r= |
| By: | Prateek Bansal; Roselinde Kessels; Rico Krueger; Daniel J Graham |
| Abstract: | The COVID-19 pandemic has drastically impacted people's travel behaviour and out-of-home activity participation. While countermeasures are being eased with increasing vaccination rates, the demand for public transport remains uncertain. To investigate user preferences to travel by London Underground during the pandemic, we conducted a stated choice experiment among its pre-pandemic users (N=961). We analysed the collected data using multinomial and mixed logit models. Our analysis provides insights into the sensitivity of the demand for the London Underground with respect to travel attributes (crowding density and travel time), the epidemic situation (confirmed new COVID-19 cases), and interventions (vaccination rates and mandatory face masks). Mandatory face masks and higher vaccination rates are the top two drivers of travel demand for the London Underground during COVID-19. The positive impact of vaccination rates on the Underground demand increases with crowding density, and the positive effect of mandatory face masks decreases with travel time. Mixed logit reveals substantial preference heterogeneity. For instance, while the average effect of mandatory face masks is positive, preferences of around 20% of the pre-pandemic users to travel by the Underground are negatively affected. The estimated demand sensitivities are relevant for supply-demand management in transit systems and the calibration of advanced epidemiological models. |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2107.02394&r= |
| By: | Francesco Sarracino; Talita Greyling; Kelsey J. O'Connor; Chiara Peroni; Stephanie Rossouw |
| Abstract: | Previous evidence indicates that trust is an important correlate of compliance with Covid-19 containment policies. However, this conclusion hinges on two crucial assumptions: first, that compliance does not change over time, and second, that mobility and self-reported measures are good proxies for compliance. We demonstrate that compliance changes over the period March 2020 to January 2021, in ten mostly European countries, and that increasing (decreasing) trust in others predicts increasing (decreasing) compliance. We develop the first time-varying measure of compliance, which is calculated as the association between containment policies and people’s mobility behavior using data from Oxford Policy Tracker and Google. We also develop new measures of both trust in others and national institutions by applying sentiment analysis to Twitter data. We test the predictive role of trust using a variety of dynamic panel regression techniques. This evidence indicates compliance should not be taken for granted and confirms the importance of cultivating social trust. |
| Keywords: | compliance; covid-19; trust; big data; Twitter. |
| JEL: | D91 I18 H12 |
| Date: | 2021–06 |
| URL: | http://d.repec.org/n?u=RePEc:usi:wpaper:858&r= |