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on Health Economics |
| By: | Adams-Prassl, A.; Boneva, T.; Golin, M.; Rauh, C. |
| Abstract: | Not all countries provide universal access to publicly funded paid sick pay. Amongst countries that do, compensation rates can be low and coverage incomplete. This leaves a significant role for employer-provided paid sick pay in many countries. In this paper, we study who has access to employer-provided sick pay, how access to sick pay relates to labor supply when sick, and how much it is valued by workers for themselves and others. We find that workers in jobs with high contact to others are particularly unlikely to have employer provided sick pay, as are economically insecure workers who are least able to afford unpaid time off work. We find that workers without sick pay are more likely to work when experiencing cold-like symptoms and are less willing to expose themselves to health risks at work during the pandemic. Using vignettes, we reveal that large shares of workers have a very high, but even more have a very low willingness to sacrifice earnings for access to sick pay. Together our findings highlight the unequal distribution of access to sick pay and the potentially strong negative externalities of not providing it publicly. The pandemic may have made these issues more salient as perceived probabilities of having to self-isolate are positively related to support for publicly provided sick pay. Finally, we find that providing information on the health externality of paid sick leave increases support for the public provision of sick pay, suggesting that there might be a public under-provision because individuals do not factor in the externalities. |
| Keywords: | Inequality, sick pay, sick leave, externalities, public finance, Covid-19, pandemic, coronavirus, market failure, vignette, information treatment |
| JEL: | J22 J32 J81 |
| Date: | 2021–09–06 |
| URL: | http://d.repec.org/n?u=RePEc:cam:camjip:2106&r= |
| By: | Han, Jeehoon; Kaiser, Caspar (University of Oxford) |
| Abstract: | We use large-scale diary data from a representative sample of Americans to proxy welfare at the level of individual activities. We make three contributions. First, we examine the association between individual activities and happiness, and show how this association has changed over time. Compared to 1985, domestic work and social care produce more happiness today. Watching TV produces less happiness today than it used to. Second, we combine activity-level data on happiness and time allocation to construct a measure of ‘time-weighted happiness’. We then analyse historical trends in this measure across population groups, particularly gender. We observe that, over the last 35 years, women’s time-weighted happiness has improved significantly relative to men’s. This trend is largely driven by gendered shifts in time allocation, rather than heterogenous trends in the enjoyability of individual activities. Our result is in stark contrast to previous work which showed a decline in women’s relative wellbeing. To explain this, our third contribution is to compare the determinants of life satisfaction – a global measure on which most previous work is built – with our measure of time-weighted happiness. Time-weighted happiness and life satisfaction turn out to only be weakly correlated. Moreover, although we obtain strong associations of income and employment status with life satisfaction, no such associations can be observed for time-weighted happiness. These findings highlight the importance of distinguishing between happiness as experienced in time and more global wellbeing measures. Finally, we verify the robustness our results by replicating them in data from the United Kingdom and show that our results are robust to alternative assumptions about how people use happiness scales. |
| Date: | 2021–10–03 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:qjdmu&r= |
| By: | Marcus Dillender; Anthony T. Lo Sasso; Brian J. Phelan; Michael R. Richards |
| Abstract: | We examine the labor market impact of states easing occupational license requirements by expanding the scope of practice (SOP) for nurse practitioners (NPs), allowing them to practice without physician oversight. Using data on job postings, we find that employers increase their demand for NPs when states expand NP SOP. We then show that these laws increase NP earnings and reallocate NPs across the healthcare sector, increasing self-employment and changing industrial employment. However, we see no evidence that these laws have increased overall NP employment. Our results suggest that expanding NP SOP has the potential to increase the number of primary care providers, but inelastic labor supply for NPs is largely preventing this from occurring. |
| JEL: | I11 J44 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29665&r= |
| By: | van den Berg, Gerard J. (University of Groningen); Janys, Lena (University of Bonn); Christensen, Kaare (University of Southern Denmark) |
| Abstract: | We examine the effects of a major national schooling reform in Denmark in 1903, opening up access to secondary and higher education for poorer and for female children, on mortality, using individual-level records of Danish twins. We digitized education out-comes from historical registers and augmented these with data we digitized on parental socioeconomic status. The study design is combined with an exogenous indicator of economic conditions at birth to investigate whether education mitigates mortality effects of adverse conditions at birth. We find that the reform reduces mortality rates among males, notably those with a middle-class family background. Also, secondary education is less beneficial if conditions at birth are adverse. In general, the reform effect does not seem to be driven by improved information on healthy living but rather by a shift in social classes among the inflow into higher education. |
| Keywords: | health, inequality, schooling, Correlated Frailty Model, twins |
| JEL: | I1 I14 I20 N33 C41 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15064&r= |
| By: | Ji, Sisi (Cardiff Business School); Zhu, Zheyi (Cardiff Business School) |
| Abstract: | Using 6 sweeps from 1958 British NCDS data we adopt a quasi-parametric approach of propensity score matching to estimate causal effects of higher education attainment on a wide range of cohorts’ health-related outcomes at ages 33, 42 and 50. The non-pecuniary benefits to HE attainments on health are substantial. Higher educated cohorts are more likely to report better health, maintain a healthy weight, be non-smokers and to have a higher sense of control on drinking alcohol and are less likely to be obese. We also highlight the importance of investigating incremental returns to HE within the lifetime of cohorts. Effects on self-reported health (SRH), BMI, drinking alcohol increase with age but continuously decrease with smoking frequency. When taking into account gender heterogeneity, HE has a larger effect on BMI and likelihood of being obese for males and a greater effect on SRH and drinking alcohol and smoking frequencies for females. Furthermore, we find no significant evidence that HE reduces the likelihood of depression, both for males and females. |
| Keywords: | Casual effect; Health; Higher Education; Propensity Score matching |
| JEL: | C21 I12 I23 I26 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:cdf:wpaper:2022/4&r= |
| By: | Lucas Finamor |
| Abstract: | College students graduating in a recession face large and persistent negative effects, including lower labor market earnings, worse health, higher crime rates, and adverse effects on family formation. This paper investigates whether college students delay graduation to avoid entering a depressed labor market. I explore variation in the labor market conditions across time, space, and chosen majors. Using data from the universe of students in higher education in Brazil, I find that students in public institutions expected to graduate in a recession are less likely to graduate on time. The delaying effect is larger for students in better programs, higher-earnings majors, and from more advantaged backgrounds. The results point to important inequality implications about who bears the costs of recessions: more privileged students are able to postpone graduation and avoid entering a depressed labor market. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.11047&r= |
| By: | Williams, Jenny (University of Melbourne); Bretteville-Jensen, Anne Line (Norwegian Institute for Alcohol and Drug Research (SIRUS)) |
| Abstract: | This research provides the first evidence on the impacts of waiting times for treatment for a substance use disorder (SUD). Using rich linked administrative information from Norway, we study the impact of waiting time on health-care utilization, employment and crime for patients who enter outpatient treatment for cannabis use disorder. Confounding due to unobserved severity of illness is addressed using an instrumental variables strategy that exploits plausibly exogenous variation in congestion in Norway's health-care system. We find that waiting to access treatment increases the use of health-care services at both the extensive and intensive margins, measured by the duration of a treatment episode and the number of consultations within a treatment episode, respectively. Waiting time also has spill-over effects, reducing employment after entering treatment and increasing crime both before and after treatment begins. Together, these findings suggest that waiting times to access treatment for a SUD imposes significant costs on patients, health-care systems, and on society more broadly. |
| Keywords: | waiting times, cannabis, substance use treatment, employment, crime |
| JEL: | I12 J22 K42 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15083&r= |
| By: | Derksen, Laura; Kerwin, Jason Theodore; Reynoso, Natalia Ordaz; Sterck, Olivier |
| Abstract: | Health behaviors are plagued by self-control problems, and commitment devices are frequently proposed as a solution. We show that a simple alternative works even better: appointments. We randomly offer HIV testing appointments and financial commitment devices to high-risk men in Malawi. Appointments are much more effective than financial commitment devices, more than doubling testing rates. In contrast, most men who take up financial commitment devices lose their investments. Appointments address procrastination without the potential drawback of commitment failure, and also address limited memory problems. Appointments have the potential to increase demand for healthcare in the developing world. |
| Date: | 2021–10–10 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:y8gh7&r= |
| By: | Bertille Daran (SADAPT - Sciences pour l'Action et le Développement : Activités, Produits, Territoires - AgroParisTech - Université Paris-Saclay - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Pierre Levasseur (SADAPT - Sciences pour l'Action et le Développement : Activités, Produits, Territoires - AgroParisTech - Université Paris-Saclay - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | To most people, sub-Saharan Africa (SSA) is synonymous with hunger and starvation. However, overweight and obesity are currently also a major public health concern in this region, sometimes even more than the prevalence of underweight. Despite the significant increase in the average body mass index (BMI) in SSA, the existing literature still considers a positive association between household socioeconomic status (SES) and individual BMI, suggesting that excess weight is a symbol of wealth while thinness is linked to poverty. This article aims to update this traditional and probably outdated perception by investigating potential nonlinearities and heterogeneity in the relationship between SES and BMI in SSA. First, we pool several cross-sectional female adultoriented demographic and health surveys that are representative of a large number of SSA countries from 1990 to 2019. Second, we implement both ordinary least-squares (OLS) and instrumental variables (IV) regressions. Once a comprehensive set of observed characteristics was controlled for, OLS estimates suggest a nonlinear association between SES indicators and female BMI, taking a U-inverted shape. IV corrections controlling for reverse causality and unobserved heterogeneity reveal similar trends, confirming the overrepresentation of excess weight in intermediate levels of wealth and education. Furthermore, this study dates the social shift of the obesity burden in SSA: changing from positive to curvilinear from the end of the 1990s, including for countries currently classified as lower middle income. To conclude, this article contributes to the literature demonstrating the ongoing nutrition transition in SSA and the role of an emergent middle class in the rise of the obesity epidemic. This result has important implications for public health policies. |
| Keywords: | sub-Saharan Africa,overweight,obesity,socioeconomic status,middle class |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03511042&r= |
| By: | William A. Masters; Amelia B. Finaret; Steven A. Block |
| Abstract: | Rapid increases in food supplies have reduced global hunger, while rising burdens of diet-related disease have made poor diet quality the leading cause of death and disability around the world. Today's "double burden" of undernourishment in utero and early childhood then undesired weight gain and obesity later in life is accompanied by a third less visible burden of micronutrient imbalances. The triple burden of undernutrition, obesity, and unbalanced micronutrients that underlies many diet-related diseases such as diabetes, hypertension and other cardiometabolic disorders often coexist in the same person, household and community. All kinds of deprivation are closely linked to food insecurity and poverty, but income growth does not always improve diet quality in part because consumers cannot directly or immediately observe the health consequences of their food options, especially for newly introduced or reformulated items. Even after direct experience and epidemiological evidence reveals relative risks of dietary patterns and nutritional exposures, many consumers may not consume a healthy diet because food choice is driven by other factors. This chapter reviews the evidence on dietary transition and food system transformation during economic development, drawing implications for how research and practice in agricultural economics can improve nutritional outcomes. |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2202.02579&r= |
| By: | Cárdenas, María Kathia; Cazzulino, Pablo; Popkin, Barry; Miranda, J. Jaime |
| Abstract: | The production and sales of carbonated soda have doubled in the last two decades in Peru. Such an increase in availability and access to carbonated soda, a major category of SSBs, presents a public health risk. In Peru, 70% of adults are either overweight or obese, and the existing health care system struggles to provide adequate patient care for all the related non-communicable diseases. Peru has had a tax, called ISC tax or “Impuesto Selectivo al Consumo”, of 17% for carbonated soda since 1999. In May 2018, the Peruvian government raised the ISC tax to 25%, an eight percentage points increase, for SSBs that contains 6g of sugar or more per 100 ml to fight against rising obesity and diabetes rates. Then, in June 2019, the ISC was modified for SSBs that contain 0.5 grams/100 ml of sugar or less. In September 2021, the upper range of the threshold was reduced from 6 to 5 grams per 100 ml, to match the requirements of the recently introduced front-of-package labeling Law, technically named Law to promote healthy eating among children and adolescents. In this article, we discuss the evolution of the SSBs tax in Peru since its inception, including its overlap with front-of-package labeling, in order to understand the historical context of taxation for prevention purposes and inform future robust monitoring and evaluation of the impact of such taxes, much needed to timely inform decision-makers. |
| Date: | 2021–09–25 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:9y67w&r= |
| By: | Lukas Mahler; Minchul Yum |
| Abstract: | We document significant gaps in wealth across health status over the life cycle in Germany—a country with a universal healthcare system and negligible out-of-pocket medical expenses. To investigate the underlying sources of the empirical patterns in wealth-health gaps, we build a heterogeneous-agent life-cycle model in which health and wealth evolve endogenously. In the model, agents exert efforts to lead a healthy lifestyle, which helps maintain good health status in the future. Effort choices, or lifestyle behaviors, are subject to adjustment costs to capture various aspects of micro-level effort adjustment behaviors in the data. We find that our calibrated model generates around half of the wealth gaps by health observed in the German micro data, and that variations in health-related lifetime outcomes are largely explained by uncertainty realizations over the life cycle, rather than initial conditions at age 25. Our counterfactual experiments indicate that variations in individual health efforts account for over half of the model-generated wealth gaps by health status. Their importance is due not only to the fact that they affect labor income and savings rates, both of which influence wealth accumulation, but also because they act as an amplification device since richer households exert relatively more efforts to maintain a healthy lifestyle. |
| Keywords: | Health Inequality, Wealth Inequality, Healthy Lifestyle, Germany |
| JEL: | E2 D3 I1 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2022_338&r= |
| By: | Daoud, Adel; Jordan, Felipe; Sharma, Makkunda; Johansson, Fredrik; Dubhashi, Devdatt; Paul, Sourabh; Banerjee, Subhashis |
| Abstract: | The application of deep learning methods to survey human development in remote areas with satellite imagery at high temporal frequency can significantly enhance our understanding of spatial and temporal patterns in human development. Current applications have focused their efforts in predicting a narrow set of asset-based measurements of human well-being within a limited group of African countries. Here, we leverage georeferenced village-level census data from across 30 percent of the landmass of India to train a deep-neural network that predicts 16 variables representing material conditions from annual composites of Landsat 7 imagery. The census-based model is used as a feature extractor to train another network that predicts an even larger set of developmental variables (over 90 variables) included in two rounds of the National Family Health Survey (NFHS) survey. The census-based model outperforms the current standard in the literature, night-time-luminosity-based models, as a feature extractor for several of these large set of variables. To extend the temporal scope of the models, we suggest a distribution-transformation procedure to estimate outcomes over time and space in India. Our procedure achieves levels of accuracy in the R-square of 0.92 to 0.60 for 21 development outcomes, 0.59 to 0.30 for 25 outcomes, and 0.29 to 0.00 for 28 outcomes, and 19 outcomes had negative R-square. Overall, the results show that combining satellite data with Indian Census data unlocks rich information for training deep learning models that track human development at an unprecedented geographical and temporal definition. |
| Date: | 2021–12–14 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:vf28g&r= |
| By: | Aksoy, Cevat Giray; Carpenter, Christopher S.; De Haas, Ralph; Dolls, Mathias; Windsteiger, Lisa |
| 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. |
| Date: | 2022–01–07 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:tgvyb&r= |
| By: | Davillas, Apostolos (University of East Anglia); de Oliveira, Victor Hugo (Instituto de Pesquisa e Estratégia Econômica do Ceará (IPECE)); Jones, Andrew M. (University of York) |
| Abstract: | We capitalise on an opportunity in the UK Household Longitudinal Study, which asks respondents the same SAH question with identical wording two times. This is done once with a self-completion and once with an open interview mode within the same household interview over four waves. We estimate multivariate models to explore which individual and household-level characteristics are systematically relevant for the likelihood and frequency of inconsistent reporting across the two modes. We find evidence of some inconsistency in reporting; 11%-24% of those who reported a particular SAH category in the self-completion mode reported inconsistently in the open interview. The probability of inconsistency is systematic and influenced by an individual's demographics, education, income, employment status, cognitive and non-cognitive skills. The same characteristics are also systematically associated with the frequency of inconsistent reporting across four UKHLS waves. Analysis of the implications of reporting inconsistencies shows no impact of SAH measurement on the magnitude of the association between income and health, estimated separately using the two SAH measures. A set of dimensions of people's physiological and biological health, captured using biomarkers, is associated equally with both SAH measures, suggesting that reporting inconsistencies in SAH may be driven by mechanisms other than people's underlying health. |
| Keywords: | measurement error, reporting bias, self-assessed health, UKHLS |
| JEL: | C10 C33 C83 I10 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15085&r= |
| By: | Singer, Leo (University of Liverpool) |
| Abstract: | The study presents a pathway model of the risk of multimorbidity and functional limitation from childhood to old age. Childhood circumstances, measured as parents’ social class, adverse experiences and child’s health, influenced multimorbidity and functional limitation at old age indirectly via material, psychosocial and behavioural pathways. These pathways acted as magnifiers of early inequalities: they enhanced the unequal impacts of the pre-existing differences between individuals in socio-economic position, psychological connections and health. The pathway effects measured at age 50-64 years were larger than the total effects of childhood social class, adverse experiences and child’s health. Thus pre-retirement appears to be an important period for the health of ageing adults in England. However, in people suffering from complex multimorbidity the total effect of the adverse experiences of abuse and family dysfunction in childhood surpassed the effect of adult psychosocial circumstances. This suggests an early-life sensitive period for this outcome. The strength of the paper is that childhood circumstances were approached from a broader angle than the usual focus on either the material conditions or extreme experiences of children. The framework is based on a complex mediation analysis with both parallel and serial mediators where the SEM framework with latent factors is an excellent tool to handle multiple regression relationships and measurement error. |
| Date: | 2021–09–30 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:qhbx9&r= |
| By: | Jaeger Nelson |
| Abstract: | This paper builds on previous studies published by the Congressional Budget Office about single-payer health care systems. It uses a general-equilibrium, overlapping-generations model to analyze the economic and distributional implications of five illustrative single-payer health care systems. The systems vary by their payment rates to providers, degree of cost sharing, and inclusion of benefits for long-term services and supports (LTSS). The economic effects of financing a single-payer system are beyond the scope of this paper. However, the results can be paired with some |
| JEL: | E62 H31 I10 |
| Date: | 2022–02–23 |
| URL: | http://d.repec.org/n?u=RePEc:cbo:wpaper:57637&r= |
| By: | Thompson, Jason; McClure, Roderick; Scott, Nick; Hellard, Margaret; Abeysuriya, Romesh; Vidinaarachichi, Rajith; Thwaites, John; Lazarus, Jeffrey; Michie, Susan (University College London); Bullen, Chris |
| Abstract: | The COVID-19 pandemic has brought the discipline of public health, infectious disease, and policy modeling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation from the level of individuals and communities through to global leaders. And nor previously have models – developed at rapid pace and often in the absence of complete information - been so central to the decision-making process. However, after more than 18 months of experience with pandemic modeling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions. We combine the authors’ collective international experience of modelling for and with Governments and policy-makers with prior research utilisation scholarship to describe a framework to assist both modelers and policy-makers consider the utility of models that may be available to them when faced with difficult public health and policy decisions. To illustrate these principles, a set of three independent but complementary modeling case-studies undertaken at the same time in NSW, Australia during that state’s unfolding second wave of COVID-19 infections is presented. |
| Date: | 2021–11–09 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:2duk5&r= |
| By: | Katherine de Bienassis (OECD); Emily Hewlett (OECD); Candan Kendir (OECD); Solvejg Kristensen; Jan Mainz (Aalborg University); Niek Klazinga (OECD) |
| Abstract: | Patient-reported measures are a critical tool for improving policy and practice in mental health care. However, to date, the use of patient-reported measures in mental health care is limited to a small number of countries and settings—and there is a pressing need, both within and across countries, to consistently and effectively measure the effects and impact of care for patients who use mental health care services. The PaRIS pilot data collection on mental health included 15 data sources from 12 countries, collected over the course of 2021. While the scope of included data varied, the results demonstrate increased adoption of national and subnational efforts to capture patient-reported information in mental health care systems. Analysis of data collected through the PaRIS mental health pilot documents, in general, positive patient-reported experiences of mental health care. The results also suggest improvement in patient-reported outcomes for those receiving mental health care services. |
| JEL: | I11 I18 I31 |
| Date: | 2022–02–15 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:135-en&r= |
| By: | Messono, Omang; Asongu, Simplice |
| Abstract: | This study examines the effects of the historical prevalence of infectious diseases on contemporary entrepreneurship. Previous studies reveal the persistence of the effects of historical diseases on innovation, through the channel of culture. Drawing on the epidemiological origin of institutions, we propose a framework which argues that the impact of infectious disease prevalence on contemporary entrepreneurship is mediated by property rights. The central hypothesis posits that a guarantee of property rights reduces the effect of past diseases on entrepreneurship. Using data from 125 countries, we find strong and robust evidence on the proposed hypothesis and other results. Property rights are higher in countries where the prevalence of diseases was low, which leads to good entrepreneurship scores. In contrast, countries with high disease prevalence did not have time to develop strong institutions to secure property rights. This explains their low level of entrepreneurship today. These results are robust to alternative methods and measures of property rights. Furthermore, our results also confirm the level of development, culture and the digitalization of economies as transmission channels between past diseases and the current level of entrepreneurship. |
| Keywords: | entrepreneurship; institutions; diseases; property rights |
| JEL: | I0 I23 I31 J24 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:111842&r= |
| By: | Cochran, Abigail L. (University of North Carolina at Chapel Hill); McDonald, Noreen; Prunkl, Lauren; Vinella-Brusher, Emma; Wang, Jueyu; Oluyede, Lindsay; Wolfe, Mary |
| Abstract: | Objective: To investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users. Data Sources: Between June 21 and July 23, 2021, primary survey data were collected for a sample of patients in North Carolina. Study Design: The study analyzed the prevalence of arriving late to, delaying, or missing medical care and examined how transportation barriers contributed to negative health care outcomes. Data Collection Methods: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers. Principal Findings: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64 were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health. Conclusions: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs. |
| Date: | 2021–12–22 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:qf7kt&r= |
| By: | Barili, E.; Bertoli, P.; Grembi, V.; Rattini, V. |
| Abstract: | Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, besides personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel brings the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency. |
| Keywords: | healthcare workers; job satisfaction; COVID-19 pandemic; |
| JEL: | I10 J28 Z12 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:22/04&r= |
| By: | Jill Furzer; Maripier Isabelle; Boriana Miloucheva; Audrey Laporte |
| Abstract: | While the long-term consequences of unmet child mental health needs are well-documented, out-of-pocket costs remain an important barrier to accessing medication in childhood and adolescence. This paper exploits the implementation of a public drug insurance program in Québec, Canada, to estimate the impact of out-of-pocket costs on uptake of pharmaceutical treatment for mental health issues in children. To investigate the potential for low-benefit consumption or moral hazard due to lowered drugs costs, we combine a difference-in-differences estimation framework with novel machine learning techniques to predict the likelihood of diagnosis for ADHD, anxiety or depression across childhood in a nationally representative longitudinal sample of children. Our results suggest that eliminating out-of-pocket costs led to a 3-percentage point increase in treatment uptake and adherence. When adjusting for predicted risk, the effects are concentrated among the top two deciles of risk. For children in the bottom half of the risk distribution, treatment use changes were not statistically different from zero. We find that treatment uptake is driven by changes in stimulants, which are generally prescribed for ADHD. Our results suggest that reductions in out-of-pocket costs could help achieve better uptake of mental health treatment, without leading to low-benefit care among lower-risk individuals. Bien que les conséquences à long terme des besoins non satisfaits des enfants en matière de santé mentale soient bien documentées, les frais remboursables demeurent un obstacle important à l'accès aux médicaments pendant l'enfance et l'adolescence. Cet article exploite la mise en œuvre d'un programme public d'assurance-médicaments au Québec, Canada, pour estimer l'impact des frais remboursables sur l'adoption de traitements pharmaceutiques pour les problèmes de santé mentale chez les enfants. Pour étudier la possibilité d'une consommation à faible bénéfice ou d'un aléa moral dû à la baisse du coût des médicaments, nous combinons un cadre d'estimation de la différence dans les différences avec de nouvelles techniques d'apprentissage automatique pour prédire la probabilité d'un diagnostic de TDAH, d'anxiété ou de dépression au cours de l'enfance dans un échantillon longitudinal d'enfants représentatif au niveau national. Nos résultats suggèrent que l'élimination des frais remboursables a conduit à une augmentation de 3 points de pourcentage de la prise de traitement et de l'observance. Après ajustement du risque prédit, les effets sont concentrés sur les deux déciles supérieurs de risque. Pour les enfants situés dans la moitié inférieure de la distribution du risque, les changements dans l'utilisation du traitement n'étaient pas statistiquement différents de zéro. Nous constatons que l'utilisation du traitement est déterminée par les changements dans les stimulants, qui sont généralement prescrits pour le TDAH. Nos résultats suggèrent que la réduction des frais remboursables pourrait contribuer à une meilleure prise en charge des traitements de santé mentale, sans pour autant conduire à des soins à faible bénéfice chez les personnes à faible risque. |
| Keywords: | Children Health,Public Health Insurance,Mental Health,Prescription Drugs, Santé des enfants,Assurance maladie publique,Santé mentale,Médicaments sur ordonnance |
| JEL: | I10 I13 I18 I19 |
| Date: | 2021–09–21 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2021s-34&r= |
| By: | Fu, Mingqi; Guo, Jing; Chen, Xi; Han, Boxun; Ahmed, Farooq; Shahid, Muhammad; Zhang, Qilin |
| Abstract: | The COVID-19 pandemic has posed challenges to emotional well-being of individuals. With 1582 respondents from the Health and Retirement Survey (HRS), this study investigates the heterogeneity in older adults’ vulnerability and examines the relationship between vulnerability types, aging attitudes and emotional responses. International Positive and Negative Affect Schedule Short-form (I-PANAS-SF) and Attitudes toward own aging (ATOT) were used to assess the emotional experiences and aging attitudes, and 14 types of pandemic-related deprivations evaluated individuals' vulnerability. Latent class analysis was used to explore the vulnerability types, and weighted linear regressions examined the relationship between vulnerability, aging attitudes and emotional responses. Results showed that the proportion for individuals with mild vulnerability (MV), health care use vulnerability (HV), and dual vulnerability in health care use and finances (DVs) was 67%, 22%, and 11%, respectively. Older adults aged below 65, Hispanics and non-Hispanic Blacks, and those not eligible for Medicaid were more likely to have HV or DVS. The relationship between vulnerability and positive emotions was insignificant, yet individuals with HV (beta=0.10, SE=0.16) or DVs (beta=0.09, SE=0.28) were likely to have more negative emotions than their mildly vulnerable counterparts. Furthermore, aging attitudes moderated the relationship between vulnerability and emotions. Encouraging positive aging attitudes might be helpful for older adults to have better emotional well-being, especially for those with DVs. |
| Keywords: | Vulnerability,Aging attitudes,Emotion,Older adults,COVID-19 |
| JEL: | J14 D91 I14 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1054&r= |
| By: | Aziz, Abdul; Islam, Mohammad Morshedul; Zakaria, Muhammad |
| Abstract: | This paper gives an overview of digital inequalities and sociocultural factors (e.g., stigma, religious faith) associated with health-related misinformation during COVID-19 in Bangladesh. It aims to explore how digital inequalities, digital surveillance, socio-cultural and religious factors, and health-related misinformation spread through social media have further exacerbated the crisis. Highlighting the growing digital inequalities and health crisis in Bangladesh, it proposes some recommendations to ensure digital inclusion and improve overall public health education and change behaviour in order to mitigate the risks of COVID-19. This essay will provide a forum and research agenda for academicians and practitioners from the Global South to develop and identify new opportunities or challenges regarding emerging health crisis issues relevant to communication practice in the use of digital media and technology. |
| Date: | 2020–11–07 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:j3hux&r= |
| By: | Casey B. Mulligan |
| Abstract: | Marginal prices fell, and disposable incomes increased, for drug and alcohol consumers during the pandemic. Most of the amount, timing, and composition of the 240,000 deaths involving alcohol and drugs since early 2020 can be explained by income effects and category-specific price changes. For alcohol, the pandemic shifted consumption from bars and restaurants to homes, where marginal money prices are lower. For more dangerous illegal drugs like fentanyl and methamphetamine, the full price of consumption also significantly fell whenever employment became financially less attractive, as it was while unemployment bonuses were elevated. Both the wage effect and income effects further reduced marginal opioid prices by inducing shifts toward cheap fentanyl. Drug mortality dipped in the months between the $600 and $300 bonuses, especially for age groups participating most in UI. A corollary to this analysis is that national employment rates will be slow to recover due to the increased prevalence of alcohol and, especially, drug addiction. |
| JEL: | E24 I18 L51 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29719&r= |
| By: | Martha J. Bailey; Lea J. Bart; Vanessa Wanner Lang |
| Abstract: | Multiple episodes in U.S. history demonstrate that birth rates fall in response to recessions. However, the 2020 COVID-19 recession differed from earlier periods in that employment and access to contraception and abortion fell, as reproductive health centers across the country temporarily closed or reduced their capacity. This paper exploits novel survey and administrative data to examine how reductions in access to reproductive health care during 2020 affected contraceptive efficacy among low-income women. Accounting for 2020’s reductions in access to contraception and the economic slowdown, our results predict a modest decline in births of 1.1 percent in 2021 for low-income women. Further accounting for reductions in access to abortion implies that birth rates may even rise for low-income women. These results also suggest that already economically disadvantaged families disproportionately affected by the COVID-19 economy will experience a large increase in unplanned births. |
| JEL: | J1 J11 J13 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29722&r= |
| By: | Cohen, Philip N. (University of Maryland, College Park) |
| Abstract: | Background. Protective facemasks are important for preventing the spread of COVID-19, and almost all Americans have worn them at least some of the time during the pandemic. There are reasonable concerns about some ill effects of mask-wearing, especially for people who wear masks for extended periods, and for the risk of falling as a result of visual obstruction. But there are also unsupported fears and objections stemming from misinformation and fueled by political disputes. Methods. The study analyzed the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) for 2020, using the product code for Respiratory Protection Devices, and calculated population incidence rates using Census data. Results. The NEISS included 128 cases, representing an estimated 5122 reported injuries in the population (95% CI 3322, 6922). The overall rate of injury reports was 1.54 per 100,000 U.S. residents (95% CI 1.00, 2.08). People over age 75 had higher rates than the population overall, with 5.27 injuries per 100,000 (95% CI 2.17, 8.37). The most common type of incidents involved facial injuries, rashes, falls, and those that might be considered anxiety-related. Conclusion. Wearing protective face masks is extremely safe, especially in comparison with other common household products, and in light of their protective benefits with regard to prevent the spread of COVID-19. This information may be useful for public health messaging, and for practitioners trying to increase compliance with mask-wearing guidance. |
| Date: | 2021–12–17 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:f3wbn&r= |
| By: | Aksoy, Ozan |
| Abstract: | Compliance with public health measures of adolescents who are often unfairly portrayed as spreaders of the Coronavirus is essential for controlling the pandemic. But does adolescents’ compliance develop independently from their parents? Using nationally representative longitudinal data and cross-lagged Structural Equation Panel Models I study compliance with social distancing measures of 6,754 triplets that comprise the adolescent child (age 19), their mother, and father during two national lockdowns in the UK. Results show that adolescents have the lowest and their mothers have the highest levels of compliance, and compliance generally drops over time. Moreover, parents, particularly mothers have significant influence on their adolescent child’s compliance. The child also has, albeit smaller effects on their parents’ compliance. Parental influence on adolescents’ compliance documented here thus redistributes some of the responsibility off adolescents towards all generations and calls for public health policies and campaigns that consider these family dynamics. |
| Date: | 2022–01–13 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:y7wc6&r= |
| By: | Anna Gassman-Pines; Elizabeth Ananat; John Fitz-Henley II; Jane Leer |
| Abstract: | The COVID-19 pandemic has profoundly affected American children, including disruptions to their care and school settings. Children attending in-person child care or school have contended with unpredictable closures and time in remote school, which in turn is subject to its own types of disruptions (hardware, software, and internet failures). This study investigated the frequency and consequences of disruptions to children’s child care and school arrangements during fall 2020. The study includes a representative sample of hourly service-sector workers parents of a young child from a major U.S. city (N = 679); half are non-Hispanic Black, 23% are Hispanic; 18% are non-Hispanic White. Parents were asked to complete 30 days of daily surveys about whether their care and school arrangements went smoothly and as predicted that day, and about their mood, parenting behaviors, and children’s behavior. Results showed that daily disruptions to care and school were common, with families reporting a disruption on 24% of days. Families with children in remote schooling experienced more frequent disruption than families with children in in-person care or school. For all families, care or school disruptions strongly predicted worse child behavior, more negative parental mood, and increased likelihood of losing temper and punishment. |
| JEL: | I0 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29659&r= |
| By: | Persico, Claudia L (American University); Marcotte, Dave E. (American University) |
| Abstract: | Though there is clinical evidence linking pollution induced inflammatory factors and major depression and suicide, no definitive study of risk in the community exists. In this study, we provide the first population-based estimates of the relationship between air pollution and suicide in the United States. Using detailed cause of death data from all death certificates in the U.S. between 2003 and 2010, we estimate the relationship between daily variation in air quality measured using NASA satellite data, and suicide rates. Using wind direction as an instrument for reducing potentially endogeneity and measurement error in daily pollution exposure, we find that a 1 μg/m3 increase in daily PM2.5 is associated with a 0.49 percent increase in daily suicides (a 19.3 percent increase). We also estimate the impact of days with high air pollution on contemporaneous suicide rates compared to other days in the same state-month, month-year, day of the week and county with lower air pollution, conditional on the same weather and total population. Estimates using 2SLS are larger and more robust, suggesting a bias towards zero arising from measurement error. Event study estimates further illustrate that contemporaneous pollution exposure matters more than exposure to pollution in previous weeks. |
| Keywords: | air pollution, suicide, health |
| JEL: | I10 Q52 Q53 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15087&r= |
| By: | Bertrand Achou; Philippe De Donder; Franca Glenzer; Marie-Louise Leroux; Minjoon Lee |
| Abstract: | COVID-19 outbreaks at nursing homes during the recent pandemic, which received ample media coverage, may have lasting negative impacts on individuals' perceptions regarding nursing homes. We argue that this could have sizable and persistent implications for savings and long-term care policies. We first develop a theoretical model predicting that higher nursing home aversion should induce higher savings and stronger support for policies subsidizing home care. We further document, based on a survey on Canadians in their 50s and 60s, that higher nursing home aversion is widespread: 72% of respondents are less inclined to enter a nursing home because of the pandemic. Consistent with our model, we find that the latter are much more likely to have higher intended savings for older age because of the pandemic. We also find that they are more likely to strongly support home care subsidies. Les épidémies de COVID-19 survenues dans les maisons de retraite au cours de la récente pandémie, qui ont fait l'objet d'une large couverture médiatique, peuvent avoir un impact négatif durable sur la perception qu'ont les individus des maisons de retraite. Nous soutenons que cela pourrait avoir des implications importantes et persistantes pour les politiques d'épargne et de soins à long terme. Nous développons d'abord un modèle théorique prédisant qu'une aversion plus élevée pour les maisons de retraite devrait induire une épargne plus importante et un soutien plus fort aux politiques de subvention des soins à domicile. Nous démontrons ensuite, à partir d'une enquête menée auprès de Canadiens âgés de 50 à 60 ans, que une plus grande aversion pour les maisons de retraite est largement répandue : 72% des répondants sont moins enclins à entrer dans une maison de retraite en raison de la pandémie. Conformément à notre modèle, nous constatons que ces derniers sont beaucoup plus susceptibles d'avoir une épargne prévue plus élevée pour la vieillesse en raison de la pandémie. Nous constatons également qu'ils sont plus susceptibles de soutenir fortement les subventions pour les soins à domicile. |
| Keywords: | Pandemic Risk,Nursing Home,Long-Term Care,Savings,Public Policy, Risque de pandémie,Maisons de retraite,Soins de longue durée,Ãconomies Politique publique |
| JEL: | D14 H31 H51 H53 I10 I31 |
| Date: | 2021–09–21 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2021s-35&r= |
| By: | Treglia, Dan; Cutuli, J. J.; Arasteh, Kamyar; Bridgeland, John; Edson, Gary; Phillips, Steven; Balakrishna, Anjali |
| Abstract: | The COVID-19 pandemic has been the single deadliest acute public health crisis in American history, and these deaths are a salient threat to the functioning of family and social networks. We assess counts and rates of parental and other in-home caregiver loss using death data published by the CDC and household composition data available through the American Community Survey's Public Use Microdata Sample. We find that, through mid-November 2021, more than 167,000 children under the age of 18 lost a parent or other in-home caregiver to COVID-19. Most of these children are under the age of 13 and, though this experience is universal across racial and ethnic groups, ages, and states, racial and ethnic disparities in caregiver loss exceed already high disparities in COVID-19 deaths. We summarize literature on the impacts of parental loss and, after reviewing potential interventions for these children, offer recommendations to policymakers and practitioners. |
| Date: | 2021–12–09 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:jnr93&r= |
| By: | Kairon Shayne D. Garcia; Benjamin W. Cowan |
| Abstract: | A substantial fraction of schools and childcare facilities in the United States closed their in-person operations during the COVID-19 pandemic. These closures may carry substantial costs to the families of affected children. In this paper, we examine the impact of school and childcare closures on parental labor market outcomes during the COVID-19 pandemic. In particular, we test whether COVID-19 school closures have a disproportionate impact on parents of school-age children (age 5-17 years old) and whether childcare closures affect parents of young children (age |
| JEL: | I18 J16 J22 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29641&r= |
| By: | Richard B. Freeman |
| Abstract: | This chapter analyzes the implications of the unexpected 2020-2021 COVID-19 pandemic for work and retirement in the U.S. The pandemic induced the greatest loss of jobs in the shortest period of time in U.S. history. A slow economic recovery would surely have endangered work longer/retire later policies that seek to adjust the finances of Social Security retirement to an aging population. Boosted by the huge CARES (March 2020) and ARPA (April 2021) rescue packages, the early recovery from the COVID-19 recession was faster and stronger than the recovery from the 2007-2009 Great Recession. Even so, the pandemic greatly altered the job market, with workers suffering from long COVID having difficulty returning to work and more workers working from home. In its immediate effect and potential long-run impact, the pandemic recession/recovery is a wake-up call to the danger that shocks from the natural world pose to work and retirement. Realistic planning for the future of work and retirement should go beyond analyzing socioeconomic trends to analyzing expected unexpected changes from the natural world as well. |
| JEL: | C53 J01 J11 J20 J26 J38 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29653&r= |
| By: | Nael Alsaleh; Bilal Farooq |
| Abstract: | The COVID-19 pandemic has significantly influenced all modes of transportation. However, it is still unclear how the pandemic affected the demand for ridesourcing services and whether these effects varied between small towns and large cities. We analyzed over 220 million ride requests in the City of Chicago (population: 2.7 million), Illinois, and 52 thousand in the Town of Innisfil (population: 37 thousand), Ontario, to investigate the impact of the COVID-19 pandemic on the ridesourcing demand in the two locations. Overall, the pandemic resulted in fewer trips in areas with higher proportions of seniors and more trips to parks and green spaces. Ridesourcing demand was adversely affected by the stringency index and COVID-19-related variables, and positively affected by vaccination rates. However, compared to Innisfil, ridesourcing services in Chicago experienced higher reductions in demand, were more affected by the number of hospitalizations and deaths, were less impacted by vaccination rates, and had lower recovery rates. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.10961&r= |
| By: | Arpino, Bruno; LUPPI, FRANCESCA; Rosina, Alessandro (Catholic University of the Sacred Heart) |
| Abstract: | Early evidence shows mixed effects of the COVID-19 pandemic on births in Europe. This study examines changes in births at the regional level in the four European countries that have been affected by the pandemic earlier and to a larger extent. It is also investigated the association between birth changes and some labour market characteristics, the pandemic impact in terms of COVID-deaths, and the share of population at risk of poverty. Results show considerable within-country heterogeneity in birth changes after the pandemic and that higher share of poverty, worse labour market performance, and higher excess mortality are associated with births decline. |
| Date: | 2021–12–14 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:mnwh8&r= |
| By: | Munoz, Pau |
| Abstract: | The year 2020 has been characterized by the outbreak of covid19. The spread of the disease has had a severe impact in many aspects of our lives that go beyond our health. From economical to psychological or social contexts, covid19 caused a halt in our daily activities and forced us to adapt or develop new habits. The following study uses data retrieved from 800 groups in the platform meetup.com to study and compare the impact of the coronavirus in the social life of two vibrant but culturally different cities such as Washington DC and Barcelona. Results suggest that though groups have been able to maintain their activity, mostly through complementing offline with online events, communities have become more fragmented in 2020. The results also suggest that the halt in activity along with the fragmentation has been higher in Barcelona where a very strict lockdown policy was implemented and that Washington DC has been more able to effectively switch to online events after the outbreak of the pandemic. |
| Date: | 2021–11–06 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:px74d&r= |