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on Health Economics |
| By: | Anderson, D. Mark (Montana State University); Charles, Kerwin Kofi (Yale University); McKelligott, Michael (University of Chicago); Rees, Daniel I. (Universidad Carlos III de Madrid) |
| Abstract: | In the mid-19th century, the urban milk supply in the United States was regularly skimmed or diluted with water, reducing its nutritional value. At the urging of public health experts, cities across the country hired milk inspectors, who were tasked with collecting and analyzing milk samples with the goal of preventing adulteration and skimming. Using city-level data for the period 1880-1910, we explore the effects of milk inspections on infant mortality and mortality among children under the age of 5. Event-study estimates are small and statistically insignificant, providing little evidence of post-treatment reductions in either infant or child mortality. |
| Keywords: | mortality transition, milk inspections, infant mortality, child mortality, public health |
| JEL: | I18 J1 N31 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14975&r= |
| By: | Antman, Francisca M. (University of Colorado, Boulder) |
| Abstract: | This paper explores the impact of water quality on mortality by exploiting a natural experiment. the rise of tea consumption in 18th century England. This resulted in an unintentional increase in consumption of boiled water, thereby reducing mortality rates. The methodology uses two identication strategies tying areas with lower initial water quality to larger declines in mortality rates after tea drinking became widespread and following larger volumes of tea imports. Results are robust to the inclusion of controls for income and access to trade. The hypothesis is further bolstered by suggestive evidence from cause-specific deaths and early childhood mortality. |
| Keywords: | tea, water quality, mortality, Industrial Revolution |
| JEL: | N33 I15 Q25 Q56 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15016&r= |
| By: | Brian Beach; John Parman; Martin H. Saavedra |
| Abstract: | U.S. cities invested heavily in water and sewer infrastructure throughout the late 19th and early 20th centuries. These investments improved public health and quality of life by helping U.S. cities control typhoid fever and other waterborne diseases. We show that segregated cities invested in water infrastructure earlier but were slower to reach universal access and slower to eliminate typhoid fever. We develop a theoretical model that illustrates how segregation, by facilitating the exclusion of Black households from water and sewer systems, explains these seemingly paradoxical findings. |
| JEL: | H4 J1 N3 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29678&r= |
| By: | Schneider, Eric B. |
| Abstract: | There is a complex inter-relationship between nutrition and morbidity in human health. Many diseases reduce nutritional status, but on the other hand, having low nutritional status is also known to make individuals more susceptible to certain diseases and to more serious illness. Modern evidence on these relationships, determined after the introduction of antibiotics and vaccines, may not be applicable to historical settings before these medical technologies were available. This paper uses a historical cohort study based on records from the London Foundling Hospital to determine the causal effect of nutritional status of children, proxied by weight- and height-for-age Z-scores, on the odds of contracting five infectious diseases of childhood (measles, mumps, rubella, chicken pox and whooping cough) and on sickness duration from these diseases. I identify a causal effect by exploiting the randomisation of environmental conditions as foundling children were removed from their original homes, then fostered with families in counties nearby London and later returned to the Foundling Hospital’s main site in London. I find no effect of nutritional status on the odds of contracting the five diseases, but I do find a historically important and statistically significant effect of nutritional status on sickness duration for measles and mumps. These findings have three implications. First, historical incidence of these diseases was unrelated to nutritional status, meaning that poor nutritional status during famines or during the Colombian Exchange did not affect the spread of epidemics. However, undernutrition in these events may have exacerbated measles severity. Second, improving nutritional status in the past 150 years would have reduced the severity of measles and mumps infections but not affect the decline in whooping cough mortality. Finally, selective culling effects from measles would be larger than those from whooping cough since whooping cough severity was not correlated with underlying nutritional status. |
| Keywords: | morbidity; nutritional status; infectious diseases; health transition; T&F deal |
| JEL: | N01 N30 |
| Date: | 2022–01–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:112690&r= |
| By: | Michael Baker (University of Toronto [Scarborough, Canada]); Janet Currie (Princeton University); Boriana Miloucheva (University of Toronto [Scarborough, Canada]); Hannes Schwandt (Northwestern University [Evanston]); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | This study provides comparisons of inequalities in mortality between the United States, Canada and France using the most recent available data. The period between 2010 and 2018 saw increases in mortality and in inequality in mortality for most age and gender groups in the United States. The main exceptions were children under 5 and adults over 65. In contrast, Canada saw a further flattening of mortality gradients in most groups, as well as further declines in overall mortality. The sole exception was Canadian women over 80 years old, who saw small increases in mortality rates. France saw continuing improvements in mortality rates in all groups. Both Canada and France have distributions of mortality that are much more equal than those in the United States, demonstrating the importance of public policy in the achievement of equality in health. |
| Keywords: | age-specific mortality,Canada,France,mortality inequality,United States |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-03214607&r= |
| By: | Alexander Cardazzi (West Virginia University); Brad Humphreys (West Virginia University); Jane E. Ruseski (West Virginia University); Brian P. Soebbing (University of Alberta); Nicholas Watanabe (University of South Carolina) |
| Abstract: | The COVID-19 pandemic shut down sporting events worldwide. Local policy makers and league officials face important decisions about restarting play, especially in professional leagues that draw large numbers of spectators to games. We analyze the impact of professional sporting events on local seasonal influenza mortality to develop evidence that will help inform sports league reopening policy decisions. Results from a difference-in-differences model applied to data from a sample of US cities that gained new professional sports teams over the period 1962-2016 show that the presence of games in these cities increased local influenza mortality by between 4% and 24%, depending on sport, relative to cities with no professional sports teams and relative to mortality in those cities before a new team arrived. Influenza mortality fell in cities with teams in some years when work stoppages occurred in sports leagues. Sports league reopening policies should take into account the role played by sporting events in increasing local seasonal flu mortality. |
| Keywords: | influenza mortality; sporting events; health policy |
| Date: | 2020–06 |
| URL: | http://d.repec.org/n?u=RePEc:wvu:wpaper:20-08&r= |
| By: | Braga, Breno (Urban Institute); Butrica, Barbara A. (Urban Institute); Mudrazija, Stipica (Urban Institute); Peters, H.E. |
| Abstract: | Since 2004 six states plus Washington, DC have implemented laws that provide paid leave benefits to workers caring for family members who have a disability or serious medical condition. Focusing on the most established state programs—California and New Jersey—this paper investigates whether paid family leave (PFL) policies facilitate greater labor supply, caregiving, and improvements in health outcomes for those likely to provide family care. Using our preferred estimation method, we find that women with a spouse in poor health are 7.4 percentage points more likely to work while providing care after the implementation of PFL compared to those not living in a PFL state. Similarly, women living within 10 miles of a parent in poor health are more likely to work while providing care (5.6 percentage points) after PFL. The implementation of state PFL also leads to improvements in mental health outcomes for these two groups of women. We fail to find strong evidence that PFL affects labor and care decisions for women living more than 10 miles from a parent in poor health. PFL also has less consistent effects on men. |
| Keywords: | family leave, older workers, caregiving |
| JEL: | I38 J14 J16 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15007&r= |
| By: | Dhaval M. Dave; Yang Liang; Michael F. Pesko; Serena Phillips; Joseph J. Sabia |
| Abstract: | Public health experts caution that legalization of recreational marijuana may normalize smoking and undermine the decades-long achievements of tobacco control policy. However, very little is known about the impact of recreational marijuana laws (RMLs) on adult tobacco use. Using information from four national datasets (National Survey of Drug Use and Health, Behavioral Risk Factor Surveillance System, Current Population Survey-Tobacco Use Supplements, and Population Assessment of Tobacco and Health) and dynamic difference-in-differences and discrete-time hazard approaches, we find little support for the hypothesis that RML enactment leads to increases in adult tobacco use. In the short-run, RMLs have no effect on tobacco use and in the medium-run, we find some evidence of a lagged reduction in tobacco use on the order of approximately 0.5 to 2 percentage points. This finding generally persists across cigarettes and e-cigarettes, is robust to event-study analyses generated from estimators designed to expunge bias due to heterogeneous dynamic treatment effects, and persists in panel data-based survival analyses that account for consumption dynamics. We conclude that fears of adult tobacco-related public health costs from RMLs are, at least in the short- and medium-run, unfounded; instead, there may be important public health benefits from reductions in adult tobacco use. |
| JEL: | I12 I18 K14 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29706&r= |
| By: | Rusty Tchernis; Keith F. Teltser; Arjun Teotia |
| Abstract: | Smoking and obesity are the two leading causes of preventable deaths in the United States. Because smoking is subject to heavy government intervention, understanding the effect of smoking on obesity is important in determining the extent of unintended costs or benefits of such intervention. The existing literature on this question is mixed among studies using experimental and observational data, which we attempt to reconcile by accounting for misreporting in observational data. We use self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS), cigarette taxes to instrument for changes in smoking, and survey completion to instrument for misreporting. Starting with the baseline two-stage least squares (2SLS) estimator common in the earlier observational literature, we obtain similar estimates suggesting quitting smoking substantially reduces BMI. However, we find the results are sensitive to specification, functional form, and the presence of misreporting. We show that accounting for misreporting using the 2-step estimator developed by Nguimkeu et al. (2019) yields estimates consistent with the experimental literature; quitting smoking has a small positive effect on BMI. Our preferred estimate suggests reduced smoking accounts for 6% of the concurrent rise in obesity. |
| JEL: | I1 I12 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29701&r= |
| By: | Harris, Timothy F. (Illinois State University); Yelowitz, Aaron (University of Kentucky); Talbert, Jeffery (University of Kentucky); Davis, Alison (University of Kentucky) |
| Abstract: | The employer-sponsored life insurance (ESLI) market is particularly susceptible to adverse selection due to community-rated premiums, guaranteed issue coverage, and the existence of a well-functioning individual market as a substitute. Using administrative payroll and healthcare claims data from a large university, we find evidence of adverse selection in the supplemental ESLI market. Employees in worse health, as measured by the Charlson's Comorbidity Index, are more likely to elect coverage than those in better health. Nonetheless, we also find that employees typically do not increase coverage following diagnosis of a severe illness even when they can without providing evidence of insurability. Furthermore, demand estimation shows that employees are not price-sensitive and that the estimated increases in premiums due to adverse selection are unlikely to cause significant welfare loss. |
| Keywords: | adverse selection, employer-sponsored life insurance |
| JEL: | D82 G22 J33 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14985&r= |
| By: | Daniel S. Grossman ⓡ; Sebastian Tello-Trillo ⓡ; Barton Willage ⓡ |
| Abstract: | A rich literature documents the benefits of social safety net programs for children. This paper focuses on an unexplored margin: how children’s programs impact parents’ well-being. We explore changes in children’s public health insurance and its effects on parents’ economic and behavioral outcomes. Using a simulated eligibility for Medicaid eligibility expansions in the 1980s and 1990s, we isolate variation in children’s Medicaid eligibility due to changes in government policies. We find that increases in children’s Medicaid eligibility increases the likelihood a mother is married, decreases her labor market participation, and reduces her smoking and alcohol consumption. Our findings suggest improved maternal well-being as measured by the Center for Epidemiological Studies-Depression score, a proxy for mental health. These results uncover a new link that provides an important mechanism, parental well-being, for interpreting the literature’s findings on the long-term, short-term, and intergenerational effects of Medicaid coverage. |
| JEL: | I1 I13 I14 I18 J10 J12 J18 J20 J21 J22 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29661&r= |
| By: | Katja Hanewald; Hazel Bateman; Hanming Fang; Tin Long Ho |
| Abstract: | This paper explores new mechanisms to fund long-term care using housing wealth. Using data from an online experimental survey fielded to a sample of 1,200 Chinese homeowners aged 45-64, we assess the potential demand for new financial products that allow individuals to access their housing wealth to buy long-term care insurance. We find that access to housing wealth increases the stated demand for long-term care insurance. When they could only use savings, participants used on average 5% of their total (hypothetical) wealth to purchase long-term care insurance. When they could use savings and a reverse mortgage, participants used 15% of their total wealth to buy long-term care insurance. With savings and home reversion, they used 12%. Reverse mortgages do not require regular payments until the home is sold, while home reversion involves a partial sale and leaseback. Our results inform the design of new public or private sector programs that allow individuals to access their housing wealth while still living in their homes. |
| JEL: | D14 G11 G21 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29689&r= |
| By: | Diana Horvath; Francesca Borgonovi |
| Abstract: | Global warming and air pollution threaten human health, economic prosperity and human capital accumulation. The current review presents empirical findings on the effect of adverse environmental conditions on cognition, with a focus on pollution and high temperatures. The review takes a life-course perspective and quantifies both the direct and indirect effects of cumulative and transitory exposure to adverse conditions on cognition starting in-utero all the way to exposure in old age. The review makes clear that exposure to pollutants and high temperatures has economically meaningful costs for both individuals and societies, stemming from lower human capital accumulation. Furthermore, the evidence presented indicates that adverse environmental conditions have large distributional consequences, leading to widening disparities in educational opportunities both across countries and across socio-economic groups within-countries. The review discusses the mechanisms underpinning these effects and explores policies that have the potential to mitigate the negative impact of adverse conditions on cognition. |
| Date: | 2022–02–25 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaab:269-en&r= |
| By: | Nguyen, Cuong Viet; Nguyen, Manh-Hung; Nguyen, Toan Truong |
| Abstract: | We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios. |
| Keywords: | climate change,weather extremes,mortality,health,Vietnam |
| JEL: | I10 Q54 O15 R23 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1034&r= |
| By: | Marending, Myriam (Department of Economics, Copenhagen Business School); Tripodi, Stefano (Department of Economics, Copenhagen Business School) |
| Abstract: | Desert locust outbreaks and other pests pose a significant threat to food security for millions of people. In this paper we quantify the size of the productivity and welfare loss caused by a desert locust outbreak that hit Ethiopia in 2014. We identify the causal effect of locust swarms on agricultural output and children’s nutritional status by modelling swarms’ movements based on wind speed and direction to identify areas in which they likely land (affected areas). We corroborate our finding by using a “recentered” measure of exposure to swarms that removes the bias due to non random exposure. We find that agricultural output is about 10-11% lower in areas hit by the shock compared to areas that are not affected. On average, children nutritional status is not negatively impacted by the shock, but each additional swarm affecting an enumeration area decreases BMI and weight-for-height z-scores by about 0.03 standard deviations, compared to children living in non affected areas. |
| Keywords: | agricultural shocks; desert locust swarms; food security; Ethiopia; child health |
| JEL: | D13 I15 Q12 Q18 Q54 |
| Date: | 2022–01–24 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:cbsnow:2021_020&r= |
| By: | Nkiruka Eze (University of Manitoba); Michele Cecchini (OECD); Tiago Cravo Oliveira Hashiguchi (University of Manitoba) |
| Abstract: | Long-term care facilities (LTCFs) provide care for extended periods to older people who frequently require antimicrobials to treat and prevent infection, a leading cause of morbidity and mortality among older LTCF residents. Evidence indicates that, due to a combination of factors related to LTCF residents, prescribers and health care systems, up to 75% of antimicrobial prescriptions in LTCFs are inappropriate, in terms not only of the duration and choice of therapy, but also the need for therapy in the first place. Inappropriate use of antimicrobials is associated with the high rates of multi-drug resistant organisms that are recovered in LTCFs, and may exacerbate the threat of antimicrobial resistance (AMR), both in LTCFs and in the community. Yet, policies to tackle inappropriate antimicrobial use and AMR in LTCFs, such as antimicrobial stewardship and infection prevention and control (IPC), remain underused or suboptimal. Some countries are starting to act but they are a minority. Countries seeking to improve antimicrobial consumption, and minimise the threat of AMR, in LTCFs can: set up routine surveillance systems dedicated to collecting and reporting data on antimicrobial use and resistance in LTCFs; design, implement and enforce multifaceted antimicrobial stewardship programmes that comprehensively address multiple determinants of inappropriate antimicrobial prescribing and use; and adopt IPC programmes tailored to the specific needs and risks of LTCFs. |
| JEL: | I10 F50 H75 O38 |
| Date: | 2022–02–22 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:136-en&r= |
| By: | Serra-Sastre, Victoria; Bianchi, Simona; Mestre-Ferrandiz, Jorge; O’Neill, Phill |
| Abstract: | The aim of this paper is to examine generic competition in the UK, with a special focus on the role of Health Technology Assessment (HTA) on generic market entry and diffusion. In the UK, where no direct price regulation on pharmaceuticals exists, HTA has a leading role for recommending the use of medicines providing a non-regulatory aspect that may influence the dynamics in the generic market. The paper focuses on the role of Technology Appraisals issued by the National Institute for Health and Care Excellence (NICE). We follow a two-step approach. First, we examine the probability of generic entry. Second, conditional on generic entry, we examine the determinants of generic market share. We use data from IQVIA British Pharmaceutical Index (BPI) for the primary care market for 60 products that lost patent between 2003 and 2012. Our results suggest that market size remains one of the main drivers of generic entry. After controlling for market size, intermolecular substitution and difficulty of manufacturing increase the likelihood of generic entry. After generic entry, our estimates suggest that generic market share is highly state dependent. Our findings also suggest that while NICE recommendations do influence generic uptake, there is only marginal evidence they affect generic entry. |
| Keywords: | generic competition; generic entry; market share; NICE |
| JEL: | I11 I18 |
| Date: | 2021–12–07 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113639&r= |
| By: | Adriana Lleras-Muney |
| Abstract: | Education and income are strong predictors of health and longevity. In the last 20 years many efforts have been made to understand if these relationships are causal and what the possible role of policy should be as a result. The evidence from various studies is ambiguous: the effects of education and income policies on health are heterogeneous and vary over time, and across places and populations. I discuss explanations for these disparate results and suggest directions for future research. |
| JEL: | I1 I18 I26 I38 J10 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29694&r= |
| By: | Bratti, Massimiliano (University of Milan); Cottini, Elena (Catholic University Milan); Ghinetti, Paolo (University of Piemonte Orientale) |
| Abstract: | This study throws light on the potential non-linear effects of education on individual health and health-related behaviors, finding a strong role for higher education. Using an instrumental variables (IVs) strategy, which leverages changes in within-province between-municipality college proximity across birth cohorts, we demonstrate that higher education affects individual health-related behavior. By contrast, IVs estimates based on a compulsory schooling age reform show mostly non-significant effects. Our results point to a complex link between education and health. On the one hand, higher education channels individuals into some healthy behaviors and better health outcomes namely healthy eating, more physical activity and a lower risk of obesity. On the other hand, it also appears to increase the prevalence of certain unhealthy behaviors, such as greater smoking and drinking prevalence and higher cigarettes consumption. Albeit effects are generally similar across genders, except in few cases (e.g. smoking behavior), our analysis highlights heterogeneous effects by age and helps explain potential differences in results reported in past quasi-experimental studies in which the cohorts affected by the educational reforms used for identification are observed at given ages and not over an individual's entire life-cycle. |
| Keywords: | education, health, higher education expansion, health-related behavior |
| JEL: | I12 I24 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15035&r= |
| By: | Aksoy, Cevat Giray (European Bank for Reconstruction and Development); Carpenter, Christopher S. (Vanderbilt University); De Haas, Ralph (EBRD, London); Dolls, Mathias (Ifo Institute for Economic Research); Windsteiger, Lisa (Max Planck Institute for Tax Law and Public Finance) |
| Abstract: | We study basic information treatments regarding sexual orientation using randomized experiments in three countries with strong and widespread anti-gay attitudes: Serbia, Turkey, and Ukraine. Participants who received information about the economic costs to society of sexual-orientation discrimination were significantly more likely than those in a control group to support equal employment opportunities based on sexual orientation. Information that the World Health Organization (WHO) does not regard homosexuality as a mental illness increased social acceptance of sexual minorities, but only for those who reported trust in the WHO. Our results have important implications for policy makers aiming to expand the rights of lesbian, gay, and bisexual people worldwide. |
| Keywords: | sexual minorities, information treatments, discrimination, attitudes |
| JEL: | D91 J16 J71 O15 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14998&r= |
| By: | Cobb-Clark, Deborah A. (University of Sydney); Dahmann, Sarah C. (University of Melbourne); Kamhöfer, Daniel A. (Düsseldorf Institute for Competition Economics (DICE)); Schildberg-Hörisch, Hannah (Heinrich Heine University Düsseldorf) |
| Abstract: | We examine the relationship between trait self-control and body weight. Data from a population representative household survey reveal that limited self-control is strongly associated with both objective and subjective measures of unhealthy body weight. Those with limited self-control are characterized by reduced exercising, repeated dieting, unhealthier eating habits, and poorer nutrition. We propose an empirical method to isolate two facets of self-control limitations—high impulsivity and low restraint. Each has differential predictive power. Physical activity, dieting, and overall body weight are more strongly associated with restraint; impulsivity is more predictive of when, where, and what people eat. |
| Keywords: | brief self-control scale, obesity, body mass index, diet, exercise |
| JEL: | D91 I12 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14987&r= |
| By: | Cobb-Clark, Deborah A. (University of Sydney); Kong, Nancy (University of Sydney); Schildberg-Hörisch, Hannah (Heinrich Heine University Düsseldorf) |
| Abstract: | We investigate the stability of self-control at the population level. Analyzing repeated Brief Self-Control Scale scores, we demonstrate that self-control exhibits a high degree of mean-level, rank-order, and individual-level stability over the medium term. Changes in self-control are not associated with major life events, nor are they economically important. The stability of self-control is particularly striking given our study period (2017-2020) spans the onset of the COVID-19 pandemic. |
| Keywords: | self-control, Brief Self-Control Scale, SOEP, stability |
| JEL: | D91 D01 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14976&r= |
| By: | Bayer, Peter; Brown, Joel; Dubbeldam, Johan; Broom, Mark |
| Keywords: | This paper develops and analyzes a Markov chain model for the treatment of cancer. Cancer therapy is modeled as the patient’s Markov Decision Problem, with the objective of maximizing the patient’s discounted expected quality of life years. Patients make decisions on the duration of therapy based on the progression of the disease as well as their own preferences. We obtain a powerful analytic decision tool through which patients may select their preferred treatment strategy. We illustrate the tradeoffs patients are facing in a numerical example and calculate the value lost to a cohort who choose suboptimal strategies. In a second model patients may make choices to include drug holidays. By delaying therapy, the patient temporarily forgoes the gains of therapy in order to delay its side effects. We obtain an analytic tool that allows numerical approximations of the optimal times of delay. |
| Date: | 2022–01–21 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:126508&r= |
| By: | Andelic, Nicole (University of Aberdeen); Allan, Julia (University of Aberdeen); Bender, Keith A. (University of Aberdeen); Powell, Daniel (University of Aberdeen); Theodossiou, Ioannis (University of Aberdeen) |
| Abstract: | Much of the literature on performance-related pay (PRP) and poor health relies on self-reported data, and the relationship is particularly difficult to examine due to confounding variables. To address these limitations we examine three groups of health measures using data from the UKHLS: blood pressure (n=5667), inflammation markers in blood (n=4025) and self-reported health (n=6120). Physiological markers of health allow us to circumvent some of the issues associated with self-reported measures and by using size of firm and % share of PRP workers in occupation we also statistically control for some of the endogeneity associated with self-selection bias. Regressions correcting for self-selection bias and socio-demographic covariates find that PRP contracts are associated with poorer self-reported mental health, higher systolic blood pressure and higher levels of fibrinogen. These findings have implications for firms that use PRP as they may need to implement policies to mitigate against stress. |
| Keywords: | performance-related pay, health, sample selection |
| JEL: | J33 M52 I1 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15000&r= |
| By: | Asaria, Miqdad; Mcguire, Alistair; Street, Andrew |
| Abstract: | There is a prevailing popular belief that expenditure on management by health-care providers is wasteful, diverts resources from patient care, and distracts medical and nursing staff from getting on with their jobs. There is little existing evidence to support either this narrative or counter-claims. We explore the relationship between management and public sector hospital performance using a fixed effects empirical econometric specification on a panel data set consisting of all 129 non-specialist acute National Health Service (NHS) hospitals in England for the financial years 2012/13 to 2018/19. Measures of managerial input and quality of management practice are constructed from NHS Electronic Staff Records and NHS Staff Survey data. Hospital accounts and Hospital Episode Statistics data are used to construct five measures of financial performance and of timely and high-quality care. We find no evidence of association either between quantity of management and management quality or directly between quantity of management and any of our measures of hospital performance. However, there is some evidence that higher-quality management is associated with better performance. NHS managers have limited discretion in performing their managerial functions, being tightly circumscribed by official guidance, targets, and other factors outside their control. Given these constraints, our findings are unsurprising. |
| Keywords: | personnel management; analysis of health care markets; firm performance; size; diversification and scope; panel data models; labor force and employment; structure; Visiting Research Fellowship |
| JEL: | C33 I11 J21 L25 M12 |
| Date: | 2021–12–09 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113312&r= |
| By: | Claudia Senik (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, SU - Sorbonne Université); Guglielmo Zappalà (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); 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); Chloé Gerves-Pinquié (IRSRPL - Institut Recherche en Santé Respiratoire des Pays de la Loire); Patricia Dargent-Molina (INSERM - Institut National de la Santé et de la Recherche Médicale) |
| Abstract: | We explore the effects of adapted physical exercise programs in nursing homes, in which some residents suffer from dementia and/or physical limitations and other do not. We use data from 452 participants followed over 12 months in 32 retirement homes in four European countries. Using a difference-in-difference with individual random effects model, we show that the program has exerted a significant impact on the number of falls and the self-declared health and health-related quality of life of residents (EQ-5D). The wide scope of this study, in terms of sites, countries, and measured outcomes, brings generality to previously existing evidence. A simple computation, in the case of France, suggests that such programs are highly cost-efficient. |
| Keywords: | Physical activity,Retirement homes,Impact study,Subjective health,Falls |
| Date: | 2021–05–14 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-03205172&r= |
| By: | Masset, Edoardo |
| Abstract: | A civil conflict broke out in northern Mali in 2012, which is continuing to the present day. Very little is known about its impact on civilians. In this paper we show how to use birth history data to build long time series of mortality rates, and we use novel synthetic control methods to estimate the impact of the Malian civil conflict on child mortality. We find that conflict produced a significant increase in under-5 mortality, and that the impact was negligible on infant mortality but large on child mortality. We analyse trends of key mortality determinants, and conclude that a reduction in vaccination rates and in access to health care in childhood were the most likely mediators of impact. Northern Mali is today one of the poorest and most neglected areas of the world where humanitarian assistance is urgently needed. |
| Keywords: | MALI; WEST AFRICA; AFRICA SOUTH OF SAHARA; AFRICA; children; mortality; conflicts; civil conflict; control methods; health |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:2082&r= |
| By: | Remi Yin (Uni.lu - Université du Luxembourg); Anthony Lepinteur (Uni.lu - Université du Luxembourg); Andrew E. Clark (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); Conchita D’ambrosio (Uni.lu - Université du Luxembourg) |
| Abstract: | We use annual data on over 150 countries between 2005 and 2018 to look at the relationship between subjective well-being (both cognitive and affective) and the Human Development Index (HDI). The HDI appears to be more closely related to cognitive than affective well-being. We also consider the relationships between the three HDI components (the Income, Health, and Education Indices) and well-being, and find that, on average, the Income Index has the strongest predictive power. Importantly, we find that the three HDI components only matter equally in Western and rich countries. Our analysis contributes to the discussion about cultural sensitivity in paradigms of societal development in two ways. We first show that differences in preferences toward development aims exist. Second, we propose a weighting procedure for a culturally-sensitive version of the HDI. |
| Keywords: | Human Development Index,Subjective well-being,Gallup World Poll,Country groups |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-03467218&r= |
| By: | Brunori, Paolo; Davillas, Apostolos; Jones, Andrew M.; Scarchilli, Giovanna |
| Abstract: | We measure unfair health inequality in the UK using a novel data- driven empirical approach. We explain health variability as the result of circumstances beyond individual control and health-related behaviours. We do this using model-based recursive partitioning, a supervised machine learning algorithm. Unlike usual tree-based algorithms, model-based recursive partitioning does identify social groups with different expected levels of health but also unveils the heterogeneity of the relationship linking behaviors and health outcomes across groups. The empirical application is conducted using the UK Household Longitudinal Study. We show that unfair inequality is a substantial fraction of the total explained health variability. This finding holds no matter which exact definition of fairness is adopted: using both the fairness gap and direct unfairness measures, each evaluated at different reference values for circumstances or effort. |
| Keywords: | inequality of opportunity; health equity; machine learning; unhealthy lifestyle behaviours |
| JEL: | D63 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113538&r= |
| By: | Mr. Edward F Buffie; Mr. Christopher S Adam; Mr. Kangni R Kpodar; Luis-Felipe Zanna |
| Abstract: | We analyze the medium-term macroeconomic impact of the Covid-19 pandemic and associated lock-down measures on low-income countries. We focus on the impact over the medium-run of the degradation of health and human capital caused by the pandemic and its aftermath, exploring the trade-offs between rebuilding human capital and the recovery of livelihoods and macroeconomic sustainability. A dynamic general equilibrium model is calibrated to reflect the structural characteristics of vulnerable low-income countries and to replicate key dimensions of the Covid-19 shock. We show that absent significant and sustained external financing, the persistence of loss-of-learning effects on labor productivity is likely to make the post-Covid recovery more attenuated and more expensive than many contemporary analyses suggest. |
| Keywords: | Covid-19, Public Investment, Growth, Debt, Fiscal Policy Human Capital, Labor Markets, Welfare |
| Date: | 2022–02–04 |
| URL: | http://d.repec.org/n?u=RePEc:imf:imfwpa:2022/025&r= |
| By: | Strong, Peter; Shenvi, Aditi; Yu, Xuewen; Papamichail, K. Nadia; Wynn, Henry P.; Smith, Jim Q. |
| Abstract: | Decision making in the face of a disaster requires the consideration of several complex factors. In such cases, Bayesian multi-criteria decision analysis provides a framework for decision making. In this paper, we present how to construct a multi-attribute decision support system for choosing between countermeasure strategies, such as lockdowns, designed to mitigate the effects of COVID-19. Such an analysis can evaluate both the short term and long term efficacy of various candidate countermeasures. The expected utility scores of a countermeasure strategy capture the expected impact of the policies on health outcomes and other measures of population well-being. The broad methodologies we use here have been established for some time. However, this application has many novel elements to it: the pervasive uncertainty of the science; the necessary dynamic shifts between regimes within each candidate suite of countermeasures; and the fast moving stochastic development of the underlying threat all present new challenges to this domain. Our methodology is illustrated by demonstrating in a simplified example how the efficacy of various strategies can be formally compared through balancing impacts of countermeasures, not only on the short term (e.g. COVID-19 deaths) but the medium to long term effects on the population (e.g. increased poverty). |
| Keywords: | Covid-19; decision support system; expected utility; emergency management; multi-criteria; evaluation methodology; coronavirus |
| JEL: | C1 |
| Date: | 2022–01–18 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113632&r= |
| By: | Fotini, Christia; Larreguy, Horacio; Muhab, Norhan; Parker-Magyar, Elizabeth |
| Abstract: | Women’s exposure to gender-based and intimate partner violence (GBV and IPV) is particularly acute due to COVID-19, especially in the Global South. We test whether edutainment interventions that have been shown to success-fully combat GBV and IPV when delivered in person can be effectively de-livered using social (WhatsApp and Facebook) and traditional (TV) media. To do so, we randomized the mode of implementation of an intervention con-ducted by an Egyptian women’s rights non-governmental organization seeking to support women while accommodating social distancing amid COVID-19. We found WhatsApp to be a more effective way to deliver the intervention than Facebook, but no differences across outcomes between WhatsApp and TV dis-semination. Our findings show that these media campaigns had no impact on women’s attitudes toward gender or marital equality, or the justifiability of vi-olence. However, the campaign did increase women’s knowledge, hypothetical, and reported use of resources available to those exposed to GBV and IPV. |
| Date: | 2022–01–24 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:126521&r= |
| By: | Anup Malani; Satej Soman; Sabareesh Ramachandran; Alice Chen; Darius N. Lakdawalla |
| Abstract: | Vaccination is a critical tool, along with suppression and treatment, for controlling epidemics such as SARS-CoV-2. To maximize the impact of vaccination, doses should be allocated to the highest value targets, accounting for health and potential economic benefits. We examine what allocation strategy is optimal and how to translate that strategy into actionable procurement decisions in the context of India. We compare 3 different allocation strategies (oldest first, highest contact rate first, random order) across 4 outcomes (lives saved, life-years saved, value of statistical lives saved, value of statistical life-years saved). We make 3 methodological contributions. First, we estimate the incremental health benefit of vaccination using novel, local seroprevalence data from India. Second, we estimate the value of statistical life-years using disaggregated, monthly data on consumption during the pandemic. Third, and most importantly, we estimate social demand curves for vaccines that can practically guide government procurement decisions. Our analysis yields 4 novel findings. First, the need to speed-up vaccination does not justify deviation from elderly-first prioritization. Second, much of the value of vaccination comes from improvements in consumption rather than longevity. Moreover, vaccination increases the value of a life year because it increases consumption. Third, social demand for vaccination falls over time as natural immunity from infections increases. Therefore, the slower a country vaccinates its population, the fewer doses it should procure. Fourth, there is enough variation in consumption and infection risk that it makes sense to vaccinate some areas before others. Our approach of connecting epidemiological models and data on health and consumption to economic valuation methods generalizes to other infection control strategies, such as suppression, and public health crises, such as influenza and HIV. |
| JEL: | I1 I18 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29682&r= |
| By: | Galizzi, Matteo M.; W. Lau, Krystal; Miraldo, Marisa; Hauck, Katharina |
| Abstract: | ‘Nudge’-based social norms messages conveying high population influenza vaccination coverage levels can encourage vaccination due to bandwagoning effects but also discourage vaccination due to free-riding effects on low risk of infection, making their impact on vaccination uptake ambiguous. We develop a theoretical framework to capture heterogeneity around vaccination behaviors, and empirically measure the causal effects of different messages about vaccination coverage rates on four self-reported and behavioral vaccination intention measures. In an online experiment, N = 1365 UK adults are randomly assigned to one of seven treatment groups with different messages about their social environment's coverage rate (varied between 10% and 95%), or a control group with no message. We find that treated groups have significantly greater vaccination intention than the control. Treatment effects increase with the coverage rate up to a 75% level, consistent with a bandwagoning effect. For coverage rates above 75%, the treatment effects, albeit still positive, stop increasing and remain flat (or even decline). Our results suggest that, at higher coverage rates, free-riding behavior may partially crowd out bandwagoning effects of coverage rate messages. We also find significant heterogeneity of these effects depending on the individual perceptions of risks of infection and of the coverage rates. |
| Keywords: | behavioral economics; free-riding; influenza; online experiments; social norms; vaccines; Global Infectious Disease Analysis (reference MR/R015600/1); jointly funded by the UK Medical Research Council (MRC) and the UK Foreign; Commonwealth & Development Office (FCDO); under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union; and acknowledges funding by Community Jameel; NIHR200908 |
| JEL: | I12 D91 Z13 |
| Date: | 2022–01–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113487&r= |
| By: | Chen, Xi (Yale University); Qiu, Yun (Jinan University); Shi, Wei (Jinan University); Yu, Pei (Rice University) |
| Abstract: | We consider a model of network interactions where the outcome of a unit depends on the outcomes of the connected units. We determine the key network link, i.e., the network link whose removal results in the largest reduction in the aggregate outcomes, and provide a measure that quantifies the contribution of a network link to the aggregate outcomes, which complements the intercentrality measure of the key network node proposed by Ballester, Calvó-Armengol, and Zenou (2006). We provide an example examining the spread of Covid-19 in China. Travel restrictions were imposed to limit the spread of infectious diseases. As uniform restrictions can be inefficient and incur unnecessarily high costs, we examine the design of restrictions that target specific travel routes. Our approach may be generalized to multiple countries to guide policies during epidemics ranging from ex ante route-specific travel restrictions to ex post health measures based on travel histories, and from the initial travel restrictions to the phased reopening. |
| Keywords: | network interactions, key network links, COVID-19, transmission |
| JEL: | C21 I18 D85 H75 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15038&r= |
| By: | Aminjonov, Ulugbek (University of Bordeaux); Bargain, Olivier (Université Montesquieu Bordeaux IV); Bernard, Tanguy (IFPRI, International Food Policy Research Institute) |
| Abstract: | Strict containment limits the spread of pandemics but is difficult to achieve when people must continue to work to avoid poverty. A new role is emerging for income support: by enabling people to effectively stay home, it can produce substantial health externalities. We examine this issue using data on human mobility and poverty rates in 729 subnational regions of Africa, Latin America and Asia during the first year of COVID-19. We focus on within-country differential mobility changes between higher- and lower-poverty regions. Conditional on country-day fixed effects, shelter-in-place orders decrease work-related mobility significantly less in poorer regions. Emergency income support programs seem to help people to reduce their mobility on average, mitigating the poverty-driven gap in mobility between regions and, hence, regional differences in contagion rates. |
| Keywords: | COVID-19, poverty, policy, lockdown, social protection, compliance, mobility |
| JEL: | H12 I12 I18 I38 O15 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14967&r= |
| By: | Grimalda, Gianluca (Kiel Institute for the World Economy); Murtin, Fabrice (OECD); Pipke, David (Kiel Institute for the World Economy); Putterman, Louis (Brown University); Sutter, Matthias (Max Planck Institute for Research on Collective Goods) |
| Abstract: | We investigate the relationship between political attitudes and prosociality in a survey of a representative sample of the U.S. population during the first summer of the COVID-19 pandemic. We find that an experimental measure of prosociality correlates positively with adherence to protective behaviors. Liberal political ideology predicts higher levels of protective behavior than conservative ideology, independently of the differences in prosociality across the two groups. Differences between liberals and conservatives are up to 4.4 times smaller in their behavior than in judging the government's crisis management. This result suggests that U.S. Americans are more polarized on ideological than behavioral grounds. |
| Keywords: | health behavior, worries, polarization, ideology, trust in politicians, COVID-19, prosociality |
| JEL: | D01 D72 D91 I12 I18 H11 H12 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15032&r= |
| By: | Bhalotra, Sonia R. (University of Warwick); Brito, Emilia (Brown University); Clarke, Damian (University of Chile); Larroulet, Pilar (Pontificia Universidad Catolica de Chile); Pino, Francisco J. (University of Chile) |
| Abstract: | We leverage staggered implementation of lockdown across Chile's 346 municipalities, identifying dynamic impacts on domestic violence (DV). Using administrative data, we find lockdown imposition increases indicators of DV-related distress, while decreasing DV reports to the police. We identify male job loss as a mechanism driving distress, and female job loss as driving decreased reporting. Stimulus payments to poor households act on both margins, their impacts partially differentiated by lockdown status. Once lockdown is lifted, police reports surge but we see a ratchet effect in distress. Our findings accentuate the controversy around welfare impacts of lockdown mandates. |
| Keywords: | public health, social safety net, domestic violence, COVID-19 |
| JEL: | J12 I38 H53 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14958&r= |
| By: | Thapa, Manish |
| Abstract: | While the country slowly progressed on a federal structure, the management aspect from the three-tier government to contain COVID and respond to the immediate needs of citizens remained an interesting area. The research adopted a systematic review of the peer-reviewed articles with the selection of articles written within the Nepali context in the areas of COVID management. The research found the contrasting response strategy adopted between the first wave (2020) and the second wave (2021). Management strategies were centralized and dictated by the federal government citing the lack of clear acts and policies to delegate roles and responsibilities during the first wave, thus failing to respond timely and effectively. Roles were much clearer and decentralized during the second wave, as the federal government emphasized maintaining diplomatic relations to receive health equipment’s, test kits and vaccines, while local government emphasizes the management of isolation, quarantines, health care services and vaccination. |
| Keywords: | Government, COVID-19 management, federal, effectiveness, citizen |
| JEL: | I0 I3 O2 Z0 |
| Date: | 2021–11–14 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:111666&r= |
| By: | Amr Hosny; Kevin Pallara |
| Abstract: | This paper argues that the type of COVID-19 containment measures affects the trade-offs between infection cases, economic activity and sovereign risk. Using local projection methods and a year and a half of high-frequency daily data covering 44 advanced and emerging economies, we find that smart (e.g. testing) as opposed to physical (e.g. lockdown) measures appear to be best placed to tackle these trade-offs. Initial conditions also matter whereby containment measures can be less disruptive when public health response time is fast and public debt is low. We also construct a database of daily fiscal announcements for Euro area countries, and find that sovereign risk is improved under a combination of large support packages and smart measures. |
| Keywords: | COVID-19, fiscal measures, containment measures, fiscal space, sovereign risk. |
| Date: | 2022–01–28 |
| URL: | http://d.repec.org/n?u=RePEc:imf:imfwpa:2022/012&r= |