|
on Health Economics |
| By: | Danea Horn; Adam Sacarny; R. Annetta Zhou |
| Abstract: | The adoption of healthcare technology is central to improving productivity in this sector. To provide new evidence on how technology affects healthcare markets, we focus on one area where adoption has been particularly rapid: surgery for prostate cancer. Over just six years, robotic surgery grew to become the dominant intensive prostate cancer treatment method. Using a difference-in-differences design, we show that adopting a robot drives prostate cancer patients to the hospital. To test whether this result reflects market expansion or business stealing, we also consider market-level effects of adoption and find they are significant but smaller, suggesting that adoption expands the market while also reallocating some patients across hospitals. Marginal patients are relatively young and healthy, inconsistent with the concern that adoption broadens the criteria for intervention to patients who would gain little from it. We conclude by discussing implications for the social value of technology diffusion in healthcare markets. |
| JEL: | I1 L1 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29301&r= |
| By: | Mohamed Ali Ben Halima (LIRSA - Laboratoire interdisciplinaire de recherche en sciences de l'action - CNAM - Conservatoire National des Arts et Métiers [CNAM], CEET - Centre d'études de l'emploi et du travail - CNAM - Conservatoire National des Arts et Métiers [CNAM] - M.E.N.E.S.R. - Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche - Ministère du Travail, de l'Emploi et de la Santé, TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique); Malik Koubi (DARES - Direction de l'animation de la recherche, des études et des statistiques - Ministère du Travail, de l'Emploi et de la Santé, CEET - Centre d'études de l'emploi et du travail - CNAM - Conservatoire National des Arts et Métiers [CNAM] - M.E.N.E.S.R. - Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche - Ministère du Travail, de l'Emploi et de la Santé) |
| Abstract: | This study evaluates the impact of the French reform of 11 January 2008 in the private sector, which modified the share of sick leave paid by the employer in addition to the social security benefit. The reform is comprised of two parts: the waiting period until complementary payment is made by the employer, reduced from ten to seven days; and the minimum required tenure to be eligible, reduced from three years to one year. In this study, we used the administrative panel data (Hygie) from 2006 to 2010 along with a new collective bargaining agreement (CBA) database. The latter was constructed by the authors in order to collect the parameters of complementary benefit for sick leave. We examined separately the effects of the waiting period part and the tenure part of the reform, using a difference-in-differences strategy with matching. When the waiting period is reduced, the number of sick days' increases significantly (+ 0.5 days). When the minimum tenure requirement is reduced, there is more impact on sick leave (+ 0.6 days on the number of sick days and + 0.9 pp on sickness probability). The effects of sick pay reform are different between men and women. The waiting part of the reform significantly increased the annual number of sick leave days and the frequency of sick leave for men, while the Tenure part of the reform has significant impact only for women. |
| Abstract: | La réforme issue de l'Accord national interprofessionnel (ANI) du 11 janvier 2008 vise à améliorer le niveau conventionnel de l'indemnité complémentaire des arrêts maladie versée par l'employeur. Scindée en deux volets, cette réforme réduit, d'une part, le délai de carence de l'indemnité complémentaire de 10 jours à 7 jours et, d'autre part, le critère de l'ancienneté minimale (de 3 ans à 1 an) pour bénéficier de l'indemnité complémentaire. Dans cette étude, nous utilisons un panel des données administratives Hygie de 2006 à 2010 enrichi par une nouvelle base de conventions collectives, construite par les auteurs, qui recueille les paramètres d'indemnisation complémentaire des arrêts maladie. Nous évaluons séparément les deux volets de la réforme, délais de carence et réduction de l'ancienneté minimale sur les arrêts maladie en utilisant la méthode de différence de différences avec appariement. Pour le volet carence, la réforme a un impact positif et significatif sur les absences, mesurées en termes de nombre annuel de jours d'absence (+0,5 jours). Pour le deuxième volet ancienneté, la réforme a impact significatif (+ 0,6 jours d'absence maladie + 0,9 pp la probabilité annuelle d'absence pour cause de maladie). La réforme a un impact différent entre les hommes et les femmes. Le volet carence de la réforme a augmenté de manière significative le nombre annuel de jours d'absence et la probabilité d'arrêt maladie pour les hommes, tandis que le volet ancienneté de la réforme n'a un impact significatif que pour les femmes. |
| Keywords: | sickness absence,complementary benefit of sick leave,administrative panel data,difference-in-differences,health policy reform |
| Date: | 2021–09–23 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-03351470&r= |
| By: | Nakamura, Ryota; Yao, Ying |
| Abstract: | This paper estimates the causal effects of restricting cigarette availability on purchasing patterns. We design a research strategy that enables the estimation by leveraging the impact of an unforeseen discontinuation of products because of the 2011 Great East Japan Earthquake. We analyze nationally representative home scanner data in Japan and find that making certain products unavailable leads smokers to switch to products with less tar and nicotine and purchase 32 percent fewer cigarettes per month. As a result, the total amount of tar and nicotine in purchased cigarettes has decreased by 43 and 30 percentage points, respectively. Such effects persist over the years. |
| Keywords: | Tobacco consumption, Supply restriction, Product availability, Natural experiment, Japan |
| JEL: | D12 I12 I18 |
| Date: | 2021–08 |
| URL: | http://d.repec.org/n?u=RePEc:hit:hiasdp:hias-e-108&r= |
| By: | Costa-Font, J.;; Saenz de Miera Juarez, B. |
| Abstract: | We exploit the implementation of a national policy (the Aubry reform) that lead to the reduction of working time implemented across France (which kept individual salaries unaltered) to study the effect of a reduced working week on overweight. We draw variation from Alsace-Moselle, where hours of work fell by less than the rest of France for the first two years when it was forced to fully comply with national policy. We use longitudinal data for 1997-2006 following employees of the largest company in the country (EDF-GDF) which was among the very first to implement the 35-hour workweek in 2000. We show evidence of 6.7 percentage points increases in the probability of overweight among blue-collar workers exposed to the reform. That is, an average 9% increase in overweight resulting from an additional 10% working time reduction. In contrast, we find no effect among white-collar workers. The effect is driven by an increase in overweight among normal-weight individuals before the reform. The effects are robust to different specifications, the effect of retirement and placebo tests, alongside the effect on other areas of France, as well as on a weighted control group. |
| Keywords: | overweight; obesity; working times; difference-in-differences; blue collar; white collar; Body Mass Index; |
| JEL: | I13 J81 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:21/18&r= |
| By: | Angélica Meinhofer; Allison E. Witman; Jesse M. Hinde; Kosali I. Simon |
| Abstract: | We studied the effect of marijuana liberalization policies on perinatal health with a multiperiod difference-in-differences estimator that exploited variation in effective dates of medical marijuana laws (MML) and recreational marijuana laws (RML). We found that the proportion of maternal hospitalizations with marijuana use disorder increased by 23% (0.3 percentage points) in the first three years after RML implementation, with larger effects in states authorizing commercial sales of marijuana. This growth was accompanied by a 7% (0.4 percentage points) decline in tobacco use disorder hospitalizations, yielding a net zero effect over all substance use disorder hospitalizations. RMLs were not associated with changes in newborn health. MMLs had no significant effect on maternal substance use disorder hospitalizations nor on newborn health and fairly small effects could be ruled out. In absolute numbers, our findings implied modest or no adverse effects of marijuana liberalization policies on the array of perinatal outcomes considered. |
| JEL: | I0 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29296&r= |
| By: | Marieke Bos; Andrew Hertzberg; Andres Liberman |
| Abstract: | Almost two in 10 adults in the U.S. and Europe are, at any moment in time, diagnosed with a mental illness. This paper asks whether mental illness is over- (or under-) diagnosed, by looking at its causal effect on individuals at the margin of diagnosis. We follow all Swedish men born between 1971 and 1983 matched to administrative panel data on health, labor market, wealth and family outcomes to estimate the impact of a mental illness diagnosis on subsequent outcomes. Exploiting the random assignment of 18-year-old men to doctors during military conscription, we find that a mental illness diagnosis for people at the margin increases the future likelihood of death, hospital admittance, being sick from work, and unemployment, while lowering the probability of being married. Using a separate identification strategy, we measure the effect of military service on the same set of outcomes to rule out that the effect of diagnosis in our setting is primarily mediated by altering the probability of serving. Our findings are consistent with the potential over-diagnosis of mental illness |
| Keywords: | Mental Illness; Long-run Effect of a Diagnosis; Economics |
| JEL: | D12 I18 L51 L66 |
| Date: | 2021–09–29 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedpwp:93092&r= |
| By: | Simon Bensnes (Statistics Norway) |
| Abstract: | Identifying the causal effect of resource use on health outcomes is generally complicated by endogenous supply and demand adjustments. This paper tackles these issues in the setting of the maternity ward using the number of women in local areas with the same due date as an instrument for congestion. I find that congestion leads to both fewer and less invasive interventions and better health outcomes, indicating medical overtreatment during slower periods. I also show that absent instrumentation I find similar results and similar signs of bias as the related literature on congestion in maternity wards. |
| Keywords: | Healthcare; crowdedness; congestion; maternity |
| JEL: | I12 I14 I18 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:ssb:dispap:963&r= |
| By: | Clark, Robert; Coviello, Decio; de Leverano, Adriano |
| Abstract: | We study how delivery times and prices for hospital medical devices respond to the introduction of centralized procurement. Our identification strategy leverages a legislative change in Italy that mandated centralized purchases for a sub-set of devices. The statutory centralization generated a reduction in prices and an increase in delivery times for centralized purchases relative to non-centralized purchases. We use data on quantities and on suppliers to discuss the mechanisms potentially underlying our findings. |
| Keywords: | Public Procurement,Centralization,Medical Devices,Delivery Times,Bulk Purchasing |
| JEL: | D44 H51 H57 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:21063&r= |
| By: | Ahmad, Hamna; Hussain, Sadia; Nazif, Muhammad Ahmed |
| Abstract: | We investigate the causal impact of offering telehealth services to female microfinance borrowers on their health and bargaining power in the household. Using a balanced panel of 1218 female borrowers, we observe a positive impact of offering telehealth services on self-reported physical and mental health of treated relative to control women. Treated women seek healthcare more proactively; they are more likely to consult a doctor and they do so sooner, as compared to control women. In addition, treated women report greater inclusion in household decision-making. We also find positive spillover effects of offering telehealth services within the household, where we observe a greater likelihood of the spouse and children (of treated women) to seek health care. |
| Keywords: | health microinsurance,telehealth,physical health,mental health,Pakistan |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:n939&r= |
| By: | Borra, Cristina; González, Libertad; Patiño, David |
| Abstract: | We study the effects of maternal age on infant health. Age at birth has been increasing for the past several decades in many countries, and correlations show that health at birth is worse for children born to older mothers. In order to identify causal effects, we exploit school entry cutoffs and the empirical finding that women who are older for their cohort in school tend to give birth later. In Spain, children born in December start school a year earlier than those born the following January, despite being essentially the same age. We show that as a result, January‐born women finish school later and are (several months) older when they marry and when they have their first child. We find no effect on educational attainment. We then compare the health at birth of the children of women born in January versus the previous December, using administrative, population‐level data, and following a regression discontinuity design. We find small and insignificant effects on average weight at birth, but the children of January‐born mothers are more likely to have very low birthweight. We interpret our results as suggestive of a causal effect of maternal age on infant health, concentrated in the left tail of the birthweight distribution, with older mothers more likely to give birth to (very) premature babies. |
| Keywords: | Maternal age, Infant health, School cohort |
| Date: | 2021–09–30 |
| URL: | http://d.repec.org/n?u=RePEc:ajt:wcinch:74847&r= |
| By: | Le, Kien; Nguyen, My |
| Abstract: | This article evaluates the extent to which armed conflicts influence early childhood health for 56 developing countries over nearly 30 years. Exploiting both spatial and temporal variations in conflict exposure within a difference-in-differences framework, we uncover detrimental ramifications of armed conflicts on the health outcomes of children under five years old. Particularly, children exposed to armed conflicts have lower height-for-age, weight-for-height, and weight-for-age z-scores by 0.08, 0.05, and 0.10 standard deviations, respectively, compared to the average corresponding z-scores of children unexposed to armed conflicts. Besides, exposure to armed conflicts make children 2.2, 0.8, and 2.6 percentage points more likely to be stunted, wasted, and underweight, respectively. Taking the proportions of stunted, wasted, and underweight children who were unexposed to armed conflicts as the benchmarks, these estimates represent the 7.3%, 7.9%, 10.2% increases in the incidences of stunting, wasting, and underweight, respectively. Our heterogeneity analyses further suggest that children born to low education mothers, children from relatively poor households, and children living in rural areas are especially vulnerable. |
| Keywords: | Armed Conflicts; Child Heath; Anthropometry; Developing Countries |
| JEL: | I10 I15 J13 O15 |
| Date: | 2020 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:109896&r= |
| By: | Antoine Bozio (IFS - Laboratory of the Institute for Fiscal Studies - Institute for Fiscal Studies, 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); Clémentine Garrouste (Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres, LEDa - Laboratoire d'Economie de Dauphine - CNRS - Centre National de la Recherche Scientifique - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres); Elsa Perdrix (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 investigates the impact of delaying retirement on mortality amongthe French population. We take advantage of the 1993 pension reform in the private sector to identify the causal effect of an increase in claiming age on mortality. We use administrative data which provide detailed information on career characteristics, dates of birth and death. Our results, precisely estimated, show that an exogenous increase of one year in the claiming age has no significant impact on the probability to die, measured between age 61 and 79. To test the power of our sample to detect statistically significant effects for rare events like death, we compute minimum detectable effects (MDE). Our MDE estimates suggest that, if an impact of later retirement on mortality would be detectable, it would remain very small in magnitude. |
| Keywords: | Mortality,Pension reform,Health |
| Date: | 2021–09–23 |
| URL: | http://d.repec.org/n?u=RePEc:hal:psewpa:hal-03352846&r= |
| By: | Marcus Dillender; Andrew I. Friedson; Cong T. Gian; Kosali I. Simon |
| Abstract: | Conventional wisdom often holds that the healthcare sector fares better than other sectors during economic downturns. However, little research has examined the relationship between local economic conditions and healthcare employment. Understanding how the healthcare sector responds to economic conditions is important for policy makers seeking to ensure an adequate supply of healthcare workers, as well as for those directing displaced workers into new jobs. We examine the impact of macroeconomic conditions on both the healthcare labor market and the pipeline of healthcare workers receiving healthcare degrees during a pre-COVID time period, 2005-2017. Our results indicate that the healthcare sector is stable across past business cycles. If anything, when areas experience more severe local economic downturns, healthcare employment increases. Much remains unknown about the adjustments and lasting impacts for the healthcare sector associated with the COVID era. Our study represents an important backdrop as policy makers consider ways to sustain the healthcare sector during economic and public health turbulence. |
| JEL: | I1 J01 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29287&r= |
| By: | Philippe de Donder (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Marie-Louise Leroux (UCL - Université Catholique de Louvain) |
| Abstract: | We study the demand for actuarially fair Long Term Care (LTC hereafter) insurance in a setting where autonomous agents only care for daily life consumption while dependent agents also care for LTC expenditures. We assume that dependency decreases the marginal utility of daily life consumption. We rst obtain that some agents optimally choose not to insure themselves, while no agent wishes to buy complete insurance. We then show that the comparison of marginal utility of income (as opposed to consumption) across health states depends on (i) whether agents do buy LTC insurance at equilibrium or not, (ii) the comparison of the degree of risk aversion for consumption and for LTC expenditures, and (iii) the income level of agents. Our results then oer testable implications that can explain (i) why few people buy Long Term Care insurance and (ii) the discrepancies between various empirical works when measuring the extent of state-dependent preferences for LTC. |
| Keywords: | Risk Aversion,Actuarially Fair Insurance,Long Term Care Insurance Puzzle,State-dependent Preferences. |
| Date: | 2021–09–13 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03351447&r= |
| By: | Ash, Elliott (ETH Zurich and ESRC CAGE Centre); Sgroi, Daniel (University of Warwick, ESRC CAGE Centre and IZA Bonn); Tuckwell, Anthony (University of Warwick, ESRC CAGE Centre and Alan Turing Institute); Zhuo, Shi (University of Warwick) |
| Abstract: | Mindfulness meditation has been found to influence various important outcomes such as health, stress, depression, productivity, and altruism. We report evidence from a randomised controlled trial on a previously untested effect of mindfulness: information avoidance. We find that a relatively short mindfulness treatment (two weeks, 15 minutes a day) is able to induce a statistically significant reduction in information avoidance – that is, avoiding information that may cause worry or regret. Supplementary evidence supports mindfulness’s effects on emotion regulation as a possible mechanism for the effect. |
| Keywords: | mindfulness ; information avoidance ; randomized controlled trial JEL Classification: D91 ; I31 ; C91 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:wrk:warwec:1372&r= |
| By: | Bhalotra, Sonia (University of Warwick); Clots-Figueras, Irma (University of Kent); Iyer, Lakshmi (University of Notre Dame) |
| Abstract: | Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality increase in Muslim-won districts |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:wrk:warwec:1375&r= |
| By: | Lazuka, Volha (Department of Business and Economics and Interdisciplinary Centre for Population Dynamics, University of Southern Denmark) |
| Abstract: | This paper sets up a quasi-experiment to estimate both total and heterogeneous impacts of medical innovations on the individual’s economic outcomes for a comprehensive set of around 90 health conditions. The rich administrative panel data for Sweden covering more than 1 million individuals combined with disease-specific data on new molecular entities and patents granted in healthcare have allowed me to emulate such an experiment. I find that an increase in medical innovations by one standard deviation raises disposable family income by 14.8% [95% CI: 14.4%; 15.1%]. Regarding the sources of income response, medical innovations strongly influence not only own disposable and labour income and sickness and unemployment payments but also a spouse’s income. The effects of medical innovations are especially strong for cancer and circulatory diseases, are moderate for mental and nervous, infectious and respiratory diseases, and are absent or appear as losses for other health shocks. Results also suggest decreasing returns – yet far from reaching zeros – rather than constant returns to scale. |
| Keywords: | medical innovation; health shock; disposable income; difference-in-differences approach; Sweden |
| JEL: | I12 I14 I24 J22 J24 O31 |
| Date: | 2021–08–26 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:luekhi:0225&r= |
| By: | Laura Coroneo,; Fabrizio Iacone,; Giancarlo Manzi,; Silvia Salini |
| Abstract: | We use a SIRD model to predict the dynamics of the COVID-19 epidemic in the Italian regions at 1 to 4 weeks ahead. Out of sample forecasting results indicate that national forecasts obtained by aggregating regional forecasts are more accurate than predictions from a national model. These results suggest that national health authorities should take into account the level of heterogeneity across regions when predicting the spread of a national epidemic. |
| Keywords: | Forecasting, Aggregation, Forecast evaluation, Epidemic. |
| JEL: | C12 C53 I18 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:yor:yorken:21/06&r= |
| By: | Stéphane Justeau (ESSCA School of Management (UER Economics, Law & Society),); Anne Musson (SMART-LERECO - Structures et Marché Agricoles, Ressources et Territoires - AGROCAMPUS OUEST - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Damien Rousselière (SMART-LERECO - Structures et Marché Agricoles, Ressources et Territoires - AGROCAMPUS OUEST - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | The COVID-19 epidemic has caused the closure of French higher education institutions leading to a series of lockdowns that have affected the mental health of students. We use the POMS (Profile of Mood States) questionnaire developed by McNair et al. (1971) to identify the state of the mental health of students in a French Management School (post-high school level, aged 18+). Our results show that a significant proportion of students show altered mental states and generalized fatigue. 41% of the 1,123 respondents had a worrying mental health condition. We highlight the impact of the absence of social ties and of physical and sports activities. Finally, we suggest that techniques to reduce states such as stress and anxiety be introduced into the curriculum. |
| Abstract: | L'épidémie de COVID-19 a provoqué la fermeture des Universités et des périodes de confinements affectant la santé mentale des étudiants. Nous utilisons le questionnaire POMS (Profile of Mood States) développé par McNair et al. (1971) pour identifier la santé mentale des étudiants d'une Ecole de management française (école post-bac). Nos résultats montrent qu'une part importante d'étudiants présente une altération des états mentaux et une fatigue généralisée. 41% des 1123 répondants présente un état de santé mentale préoccupant. Nous mettons en évidence les impacts de l'absence de liens sociaux et des activités physiques et sportives. Enfin, nous proposons d'intégrer à la pédagogie des techniques permettant de réduire les états mentaux tels que le stress et l'anxiété. |
| Keywords: | Business School,Mental Health,Mental Preparation,Students,C42,Ecole de Management,Etudiants,Covid-19,Santé Mentale,Préparation mentale,POMS |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03350516&r= |
| By: | Fischer, Martin; Karlsson, Martin; Prodromidis, Nikolaos |
| Abstract: | This paper analyzes the long‐term effects on mortality and socio-economic outcomes from institutional delivery. We exploit two Swedish interventions that affected the costs of hospital deliveries and the supply of maternity wards during the 1926–46 period. Using exogenous variation in the supply of maternity wards to instrument the likelihood of institutional delivery, we find that delivery in hospital has substantial effects on later‐life outcomes such as education and mortality. We argue that a decrease in child morbidity due to better treatment of complications is a likely mechanism. This interpretation is corroborated by evidence from primary school performance, showing a large reduction in the probability of low performance. In contrast to an immediate and large take‐up in hospital deliveries as response to an increase in the supply, we find no increase in hospital births from the abolishment of fees – but some degree of displacement of high‐SES parents. |
| Keywords: | Institutional delivery, diffusion of innovations, difference‐in‐discontinuities |
| Date: | 2021–08–12 |
| URL: | http://d.repec.org/n?u=RePEc:ajt:wcinch:74712&r= |
| By: | Merike Blofield; Cecilia Giambruno; Jennifer Pribble |
| Abstract: | Given the devastating health and economic effects of the COVID-19 pandemic in Latin America, social protection responses have been crucial for safeguarding access to basic needs among vulnerable households. Yet policy design has varied widely across countries. In this working paper, we develop comparative measures to assess the breadth and sufficiency of the cash transfer responses of ten Latin American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Peru and Uruguay) during the first twelve months of the pandemic, from April 2020 to March 2021. We assess it for two particularly vulnerable groups: children in existing cash transfer programs, and informal workers and households in new emergency programs. Four broad types of responses emerge, detailed in Figures 1-4: the first group -Brazil and Chile- provided benefits with relatively high breadth and sufficiency. The second group -Argentina, Costa Rica, Uruguay, Peru and Bolivia- is more heterogeneous, but shares the characteristics of high breadth of benefits. Sufficiency of benefits varies from medium to low sufficiency, often with differences between programs. The third group - Colombia and Ecuador- is characterized both by low breadth and low sufficiency of benefits. The fourth type of response is a non-response, ie., no national-level pandemic cash transfer response, and comprises Mexico. |
| Keywords: | COVID-19, social protection, children, informal workers, poverty, Latin America |
| JEL: | I30 I31 I32 I38 I39 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:tul:ceqwps:114&r= |
| By: | Pinka Chatterji; Yue Li |
| Abstract: | We test for heterogeneity in the effects of the COVID-19 recession on young workers by estimating month-by-month effects of the pandemic on labor market outcomes among workers aged 15-19 and aged 20-24. We use CPS data from January 2016 to June 2021, limiting the sample to childless individuals who lack a college degree. In the younger group (aged 15-19), we observe the expected sharp reduction in outcomes at the start of the pandemic, followed by a return to pre-pandemic levels of work hours, employment, and labor force participation starting in September 2020, with outcomes even surpassing pre-pandemic levels in April and May 2021. In the older age group (20-24-year-olds), however, work hours, employment, and labor force participation were still lagging below pre-pandemic levels as of June 2021. As of June 2021, weekly earnings and hourly wages were higher than typical pre-pandemic levels for that month for both age groups. Although we cannot test directly whether enhanced UI programs have played a role in these differences by age group, our findings show that within the 15-24-year-old age group, there is significant heterogeneity in labor market recovery from the COVID-19 recession. |
| JEL: | I0 J0 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29307&r= |
| By: | M. Mehrab Bakhtiar; Raymond Guiteras; James A. Levinsohn; Ahmed Mushfiq Mobarak |
| Abstract: | Addressing public health externalities often requires community-level collective action. Each person’s sanitation behavior can affect the health of neighbors. We report on a cluster randomized controlled trial conducted with 19,000 households in rural Bangladesh where we randomized (1) either group financial incentives or a non-financial “social recognition” reward, and (2) asking each household to make either a private pledge or a public pledge to maintain hygienic latrines. The group financial reward has the strongest impact in the short term (3 months), inducing a 7.5-12.5 percentage point increase in hygienic latrine ownership. Getting people to publicly commit to maintaining and using a hygienic latrine in front of their neighbors induced a 4.2-6.1 percentage point increase in hygienic latrine ownership in the short term. In the medium term (15 months), the effect of the financial reward dissipates while the effect of the public commitment persists. Neither social recognition nor private commitments produce effects statistically distinguishable from zero. |
| JEL: | O1 Q56 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29294&r= |
| By: | Clémentine Garrouste (Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres, LEDa - Laboratoire d'Economie de Dauphine - CNRS - Centre National de la Recherche Scientifique - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres); Arthur Juet; Anne-Laure Samson (LEM - Laboratoire d'Economie et de Management - UNS - Université Nice Sophia Antipolis (... - 2019) - COMUE UCA - COMUE Université Côte d'Azur (2015 - 2019) - UCA - Université Côte d'Azur - CNRS - Centre National de la Recherche Scientifique, EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique, Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres, LEM - Lille économie management - UMR 9221 - UA - Université d'Artois - UCL - Université catholique de Lille - Université de Lille - CNRS - Centre National de la Recherche Scientifique, LEDa - Laboratoire d'Economie de Dauphine - CNRS - Centre National de la Recherche Scientifique - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres) |
| Abstract: | We evaluate the impact of a French vaccination campaign against Hepatitis B (HB) in 1994. Usinga regression discontinuity design, we show that this campaign created an exogenous shock on vaccinationbehavior, increasing the vaccination rate for children aged 11 and above. We also show that this vaccinationscheme led to a decline in the knowledge about HB transmission modes, as well as public confusion aboutthe target population. But our most important result is a drop in measles, mumps, and rubella (MMR)vaccination rate and an increase in the belief that measles is a benign disease. We interpret these results asa salience effect: the focus on HB vaccination may lead to a decrease in the beliefs that other vaccines are asimportant. We find that the decrease in MMR vaccination is mostly due to high-educated parents who aremore likely to substitute MMR with HB for their children, and could have been influenced by their familydoctor. The effect on MMR vaccination was relatively unexpected and may imply a negative externality.Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further,raising the question of the net effect of the HB vaccination campaign on the well-being of the population.Overall, it shows the necessity - but also the difficulty- to evaluate the effects of a public policy as a whole,taking into account all potential side effects but also unexpected adverse effects. |
| Keywords: | Vaccination campaign,hepatitis B,measles,mumps,rubella,spillover effects,regression discontinuity design,sharp design |
| Date: | 2021–09–23 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03352826&r= |