|
on Health Economics |
| By: | David C. Chan Jr; Yiqun Chen |
| Abstract: | Professions play a key role in determining the division of labor and the returns to skilled work. This paper studies the productivity difference between physicians and nurse practitioners (NPs), two health care professions performing overlapping tasks but with stark differences in background, training, and pay. Using data from the Veterans Health Administration and quasi-experimental variation in the patient probability of being treated by physicians versus NPs in the emergency department, we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes. We find evidence suggesting mechanisms relating to lower human capital among NPs relative to physicians and worker-task assignment responding to the lower skill of NPs. Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’. Despite large productivity differences between professions, we find even larger productivity differences within professions and substantial productivity overlap between professions. Yet there is little overlap in wages between NPs and physicians and, within professions, no significant correlation between productivity and wages. |
| JEL: | I11 I18 J24 J44 M53 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30608&r=hea |
| By: | David Dranove; Craig Garthwaite |
| Abstract: | Artificial intelligence (AI) is transforming production across all sectors of the economy, with the potential to both complement and substitute for traditional labor inputs. Healthcare is no exception. Dozens of recent academic studies demonstrate that AI can contribute to the healthcare value chain, by improving both diagnostic accuracy and treatment recommendations. In these ways, AI may wither complement or substitute for physicians. We argue that AI represents the culmination of decades of efforts to enhance medical decision making. Using an historical lens that considers long-standing institutional features of healthcare markets, we identify numerous obstacles to the implementation of AI in medical care, and identify which specialties are most at risk for substitution by AI. |
| JEL: | I11 I19 O32 O38 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30607&r=hea |
| By: | Alex Hoagland; David M. Anderson; Ed Zhu |
| Abstract: | Models of consumer responsiveness to medical care prices are central in the optimal design of health insurance. However, consumers are rarely given spending information at the time they consume care, a delay which many models do not account for and may create distortions in the choice of future care consumption. We study household responses to scheduled medical services before and after pricing information arrives, leveraging quasi-experimental variation in the time it takes for an insurer to process a bill. Immediately after scheduled services, households increase their spending by roughly 46%; however, a bill's arrival causes households to reduce their spending by 7 percentage points (nearly 20% of the initial increase). These corrections are concentrated among households who are under-informed about their deductible or whose expenditures fall just short of meeting the deductible, suggesting that a bill provides useful pricing information. These corrections occur across many types of health services, including high- and low-value care. We model household beliefs and learning about expenditures and find that households overestimate their expenditures by 10% prior to a bill's arrival. This leads to an over-consumption of $842.80 ($480.59) for the average (median) affected household member. There is evidence that households learn from repeated use of medical services; however, household priors are estimated to be as high as 80% larger than true prices, leaving low-spending households especially under-informed. Our results suggest that long deductible periods coupled with price non-transparency may lead to an over-consumption of medical care. |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2211.01116&r=hea |
| By: | Jeffrey S. DeSimone; Daniel S. Grossman; Nicolas R. Ziebarth |
| Abstract: | Increases in youth vaping rates and concerns of a new generation of nicotine addicts recently prompted an increase in the federal minimum legal purchase age (MLPA) for tobacco products, including e-cigarettes, to 21 years. This study presents the first regression discontinuity evidence on the effectiveness of e-cigarette MLPA laws. Using data on 12th graders from Monitoring the Future, we obtain robust evidence that federal and state age-18 MLPAs decreased underage e-cigarette use by 15–20% and frequent use by 20–40%. These findings suggest that the age-21 federal MLPA could meaningfully reduce e-cigarette use among 18–20-year-olds. |
| JEL: | H51 H75 I12 I18 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30614&r=hea |
| By: | Joan Costa-Font (IZA - Forschungsinstitut zur Zukunft der Arbeit - Institute of Labor Economics, LSE - LSE Health and Social Care - LSE - London School of Economics and Political Science); Sarah Fleche (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, CEP - LSE - Centre for Economic Performance - LSE - London School of Economics and Political Science); Ricardo Pagan (Universidad de Málaga [Málaga] = University of Málaga [Málaga]) |
| Abstract: | Daylight Saving Time (DST) is currently implemented by more than seventy countries, yet we do not have a clear knowledge of how it affects individuals' welfare. Using a regression discontinuity design combined with a differences-in-differences approach, we find that the Spring DST causes a significant decline in life satisfaction. By inducing a reallocation of time, the transition into DST deteriorates sleep and increases time stress, which in turn affects physical and emotional health. After performing a simple cost-benefit analysis, we find evidence suggestive that ending DST would exert a positive effect on welfare, namely the wellbeing costs associated with DST exceed its benefits. |
| Keywords: | Daylight Saving Time,wellbeing,health,sleep,time stress |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:cesptp:halshs-03835461&r=hea |
| By: | Iris Arbogast; Anna Chorniy; Janet Currie |
| Abstract: | Following decades of increasing child access to public health insurance, enrollments fell in many states between 2016 and 2019 and the number of uninsured children increased. This study provides the first national, quantitative assessment of the role of several common types of administrative burdens in driving the pre-pandemic drop in child health insurance coverage. In addition, we undertake to identify the groups of children who were most affected by administrative burden. We show that regulations that increased administrative burdens placed on families reduced public health insurance coverage by a mean of 5.4 percent within the year following the implementation of these changes. Declines were largest for children without college educated parents, Hispanic families, and families with non-citizen parents. Declines in insurance coverage have been temporarily arrested by federal measures taken in response to the COVID-19 public health emergency. But unless policies increasing administrative burden are reconsidered, the decline in children’s public health insurance enrollments is likely to resume when the emergency declaration is lifted. |
| JEL: | I13 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30580&r=hea |
| By: | Hedefalk, Finn; van Dijk, Ingrid K; Dribe, Martin |
| Abstract: | The socioeconomic health gradient has widened since the mid-21st century, but the role of childhood neighborhoods remains underexplored. Most neighborhood studies on health are cross-sectional, and longitudinal research is lacking. We analyze how socioeconomic neighborhood conditions in childhood influence cause-specific deaths in adulthood. We use uniquely detailed geocoded longitudinal microdata for the Swedish town of Landskrona, 1939-1967, linked to Swedish national registers, 1968-2015. We measure neighborhood SES by social class and use dynamic sizes of individual neighborhoods. Cox proportional hazards models are employed to estimate the impact of neighbor’s social class in childhood (ages 1-17) on mortality in ages 40-69. We control for class origin, class in adulthood, schools, and physical neighborhood characteristics. The class of the nearby, same-age, childhood neighbors had a lasting effect on male all-cause and preventable, but not non-preventable, mortality. Men who grew up with having 10% more children from white-collar families as close-proximity neighbors had an 8% lower mortality risk due to preventable causes of death in adulthood. The mortality for women was not affected by their childhood neighbors, although both a lower adult class and class origin increased their mortality. Because preventable causes of death are linked to lifestyle factors, this study suggests that childhood neighborhood peers had a strong and lasting influence on the health behavior of men growing up before the health gradient was fully established. Hence, our applied life-course perspective on childhood neighborhoods is crucial to better understand the mortality differentials by SES. |
| Date: | 2022–10–14 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:ynpb3&r=hea |
| By: | Marcella Alsan; Maya Durvasula; Harsh Gupta; Joshua Schwartzstein; Heidi L. Williams |
| Abstract: | This article examines the consequences and causes of low enrollment of Black patients in clinical trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is more relevant for decision-making by physicians and patients when it is more representative of the group that is being treated. This generates the key result that the perceived benefit of a medicine for a group depends not only on the average benefit from a trial, but also on the share of patients from that group who were enrolled in the trial. In survey experiments, we find that physicians who care for Black patients are more willing to prescribe drugs tested in representative samples, an effect substantial enough to close observed gaps in the prescribing rates of new medicines. Black patients update more on drug efficacy when the sample that the drug is tested on is more representative, reducing Black-White patient gaps in beliefs about whether the drug will work as described. Despite these benefits of representative data, our framework predicts that those who have benefited more from past medical breakthroughs are less costly to enroll in the present, leading to persistence in who is represented in the evidence base. |
| JEL: | D91 H5 I14 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30575&r=hea |
| By: | Collyer, Sophie; Gandhi, Jill; Garfinkel, Irwin; Ross, Schuyler; Waldfogel, Jane; Wimer, Christopher |
| Abstract: | The temporary monthly Child Tax Credit implemented in 2021 had the potential to affect many aspects of child and family well-being, including poverty, hardship, use of food pantries, spending on child-related items, and parents’ mental health and employment. We assess these effects using data from two longitudinal studies of well-being in New York City. We find that the monthly CTC led to significant declines in the risk of facing material hardship, multiple hardships, running out of money, and using food pantries. We do not find evidence of significant changes in parents’ mental health, employment, or spending on childcare or enrichment activities. |
| Date: | 2022–10–22 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:rnmfv&r=hea |
| By: | Dal Bianco, Chiara; Moro, Andrea |
| Abstract: | We generate a continuous measure of health to estimate a non-parametric model of health dynamics, showing that adverse health shocks are highly persistent when suffered by people in poor health, a pattern that cannot be accounted for by canonical models. We incorporate this health measure into a life-cycle model of consumption, savings, and labor force participation. After estimating the model parameters, we simulate the effects of health shocks on economic outcomes. We find that bad health shocks have persistent adverse economic effects that are more dramatic for poor individuals starting in bad health. Bad health shocks also increase the dispersion of asset accumulation within this category of individuals. A canonical model of health dynamics would not uncover these effects |
| Date: | 2022–10–18 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:dvhby&r=hea |
| By: | Michelle Acampora (University of Zurich); Francesco Capozza (Erasmus University of Rotterdam); Vahid Moghani (Erasmus University of Rotterdam) |
| Abstract: | This paper assesses the impact of a mental health literacy intervention on the demand for mental health support among university students. We run a field experiment with 2,978 university students from one of the largest Dutch universities. The literacy intervention provides information on the benefits of care-seeking and its potential returns in terms of academic performance. The intervention increases the willingness-to-pay for a mental health app among male respondents. Moreover, the information increases (decreases) the demand for information about coaching (psychological) services. We document that this substitution is concentrated among students with low to moderate anxiety/depressive symptoms, while the students with severe symptoms increase their demand for coaching without reducing their demand for psychological services. An increased perceived effectiveness of low-intensity therapy is likely to be the mechanisms. In a follow-up survey three weeks later, we find that the treated female respondents have improved their mental health. Finally, a model of mental health investment decisions in the presence of (self-)image concerns rationalizes the results. |
| Keywords: | Mental Health Literacy, Demand for Mental Health Support, Beliefs, Stigma, Survey Experiment |
| JEL: | C93 D83 D91 I12 I31 |
| Date: | 2022–11–13 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20220079&r=hea |
| By: | Joan Costa-i-Font; Cristina Vilaplana-Prieto |
| Abstract: | Individual preferences for ‘ageing in place’ (AIP) in old age are not well understood. One way to test the strength of AIP preference is to investigate the effect of health shocks on residential mobility to smaller size or value dwellings, which we refer to as ‘housing downsizing’. This paper exploits more than a decade worth of longitudinal data to study older people’s housing decisions across a wide range of European countries. We estimate the effect of health shocks on the probability of different proxies for housing downsizing (residential mobility, differences in home value, home value to wealth ratio), considering the potential endogeneity of the health shock to examine the persistence of AIP preferences. Our findings suggest that consistently with the AIP hypothesis, every decade of life, the likelihood of downsizing decreases by two percentage points (pp). However, the experience of a health shock partially reverts such culturally embedded preference for AIP by a non-negligible magnitude on residential mobility (9pp increase after the onset of a degenerative illness, 9.3pp for other mental disorders and 6.5pp for ADL), home value to wealth ratio and the new dwelling’s size (0.6 and 1.2 fewer rooms after the onset of a degenerative illness or a mental disorder). Such estimates are larger in northern and central European countries. |
| Keywords: | ageing in place, housing downsizing, health shocks at old age, Europe, residential mobility, mental degenerative mental illness, mental disorder |
| JEL: | I18 G51 J61 R31 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10022&r=hea |
| By: | Coen van de Kraats (Erasmus University Rotterdam); Titus Galama (University of Southern California); Maarten Lindeboom (Vrije Universiteit Amsterdam) |
| Abstract: | We provide evidence that the social norm (expectation) of work has a detrimental causal effect on the mental well-being of individuals not able to abide by it. Using SHARE data on men aged 50+ from 10 European countries, we identify the social norm of work effect in a difference-in-differences (DiD) model that compares mental well-being scores of unemployed / disabled individuals (the treatment group) with those of employed / retired individuals (the control group) at varying levels of the fraction of retirees of comparable age. The initial mental well-being gap at age 50 is large, with unemployed / disabled men experiencing lower levels of mental well-being. Beyond age 50, the mental well-being of unemployed and disabled men improves as peers of comparable age retire, and full convergence occurs generally at an age that is slightly above the normal retirement age, when everyone has retired. We estimate the social norm of work effect to be comparable to the benefit of tertiary education, the detriment of being widowed, and the benefit of having a household income of 2,000,000 Euros. We explore income-security and leisure-coordination channels as alternative interpretations of the effect to show that these cannot explain our findings. |
| Keywords: | mental well-being, social norm of work, retirement institutions |
| JEL: | I10 I31 J60 D63 |
| Date: | 2022–11–13 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20220081&r=hea |
| By: | Jason Fletcher; Hans G. Schwarz; Michal Engelman; Norman Johnson; Jahn Hakes; Alberto Palloni |
| Abstract: | A rich literature shows that early life conditions shape later life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic place (e.g., state of residence at death), thereby potentially conflating the role of early life conditions, migration patterns, and effects of destinations. We use the newly available Mortality Disparities in American Communities (MDAC) dataset, which links respondents in the 2008 ACS to official death records and estimate consequential differences by method of aggregation; the mean absolute deviation of the difference in life expectancy at age 50 measured by state of birth versus state of residence is 0.58 (0.50) years for men and 0.40 (0.29) years for women. These differences are also spatially clustered, and we show that regional inequality in life expectancy is higher based on life expectancies by state of birth, implying that interstate migration mitigates baseline geographical inequality in mortality outcomes. Finally, we assess how state-specific features of in-migration, out-migration, and non-migration together shape measures of mortality disparities by state (of residence), further demonstrating the difficulty of clearly interpreting these widely used measures. |
| JEL: | I14 J0 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30572&r=hea |
| By: | Céline Bonnet (TSE-R - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Cécile Détang-Dessendre (CESAER - Centre d'Economie et de Sociologie Rurales Appliquées à l'Agriculture et aux Espaces Ruraux - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - Institut Agro Dijon - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement); Valérie Orozco (TSE-R - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Elodie Rouviere (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: | In 2019, obesity affected 17% of French adults. In this article, we use a unique data set that combines individual-level health and consumption data with living environment data (food, sports and health amenities). We develop a spatial econometric framework to address French health disparities in obesity prevalence across space. We find that regulations on fast food restaurant locations could be a policy instrument to counter the prevalence of obesity. We also establish the existence of spatial spillovers of sports and medical amenities on obesity. This new evidence points to the need to consider a wider context than just the immediate local environment in the fight against the obesity pandemic. |
| Keywords: | Health inequalities,Spatial patterns,Living environment |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03672491&r=hea |
| By: | Bergeron-Boucher, Marie-Pier; Vázquez-Castillo, Paola; Missov, Trifon |
| Abstract: | Recent studies have shown that there are some advantages in forecasting mortality with other indicators than death rates. In particular, the age-at-death distribution provides readily available information on central longevity measures: mean, median and mode, as well as information on lifespan variation. The modal age at death has been increasing linearly since the second half of the 20th century, providing a strong basis to extrapolate past trends. We develop a model to forecast the age-at-death distribution that directly forecasts the modal age at death and lifespan variation while accounting for dependence between ages. We forecast mortality at age 40 and above in six Western European countries. The introduced model increases forecast accuracy compared with other forecasting models and provides consistent trends in life expectancy and lifespan variation at age 40 over time. |
| Date: | 2022–11–10 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:5zr2k&r=hea |
| By: | Aaron Chalfin; Maxim N. Massenkoff |
| Abstract: | In 2015, for the first time in nearly forty years, the rate of motor vehicle fatalities for Black Americans exceeded that of white Americans. By 2020, the gap in death rates stood at 34%, accounting for approximately 4,000 excess deaths between 2014 and 2020. This disproportionate increase occurred in nearly all states, in rural as well as urban areas, and was shared by drivers of all ages and genders. We consider a variety of potential explanations for the emerging race gap including race-specific changes in time spent driving, the circumstances of driving, the quality of medical care for crash victims, decreases in other types of mortality, changes in policing, and risky driving behaviors such as speeding, driving without a seat belt and driving while intoxicated. We can rule out many of these factors as important contributors to the race gap, but find evidence for two of them. The first is opportunity: Relative to white Americans, Black Americans are spending more time in vehicles than they have in the past. Changes in time spent driving, while modest, likely explain an important share of the emergent race gap. The second is a relative increase in drug use, manifested by a quadrupling of the rate of overdose deaths among Black Americans after 2014. Increased drug use appears to have resulted in a concomitant increase in fatal crashes involving drivers under the influence of drugs. Finally, we consider whether the emerging race gap is explained by the so-called "Ferguson effect," the idea that police officers have pulled back from enforcement activity in recent years. On the one hand, traffic stops made by police officers do appear to have declined after 2014. However, the decline in traffic stops does not appear to be race-specific and there is little evidence of a broad increase in risky driving behaviors like speeding and driving without a seat belt. |
| JEL: | I0 K0 R49 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30636&r=hea |
| By: | Ali, Amjad; Audi, Marc; Al-Masri, Razan |
| Abstract: | This article has examined the role of environmental conditions and purchasing power parity in deciding the quality of life among big Asian cities. The study has constructed an index for quality of life with the help of housing, crime rates, death rate, average life expectancy, environmental degradation, and level of education. Quality of life has been selected as the dependent variable and the level of pollution, availability of health care facilities, local purchasing power, availability of groceries, level of democracy, cost of living, restaurants, level of traffic, and level of rents are selected explanatory variables. For empirical analysis, this study uses data for the years 2017, 2018, and 2019. The estimated results show that pollution has a negative and significant impact on the quality of life in the case of Asian cities. Local purchasing power has a positive and significant relationship with the quality of life in the cities of Asia. Groceries and democracy are very important parts of the daily life of human beings but they have insignificant impacts on the quality of life in Asian cities. Restaurants have a positive and significant impact on quality of life. This study finds that level of traffic and the level of rent have a negative and significant impact on the quality of life in the case of Asian cities. The overall results conclude that selected indicators play a significant role in determining the quality of life in Asian cities. |
| Keywords: | quality of life, environmental conditions, purchasing power parity |
| JEL: | E31 J17 R11 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:115166&r=hea |
| By: | Finocchiaro Castro, Massimo; Guccio, Calogero; Romeo, Domenica |
| Abstract: | Behavioral economics is, nowadays, a well-established approach to investigate agents’ actions under economic incentives. In the last decade, a fast-growing number of studies have focused on the application of behavioral to health policy issues. The results of that stream of literature have been intriguing and strongly policy-oriented. However, those findings are scattered between different health-related topics, making difficult to grasp the overall state-of-the-art. Hence, to make the main contributions understandable at a glance, we conduct a systematic literature review of laboratory experiments on the supply of health services. Of the 1,084 articles retrieved from 2011, 36 articles published in peer review journals have met our inclusion criteria. For them, we describe the different experimental settings, and we classify them according to the main area of interest. Finally, we provide some insights for future research in the field. |
| Keywords: | laboratory experiments,health services,supply,systematic literature review,physicians’ behavior,payment systems,health policy |
| JEL: | C91 C92 I11 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:esprep:266248&r=hea |
| By: | David Sturrock (University College London and Institute for Fiscal Studies); Stefan Groot (Rabobank); Jan Möhlmann (CPB Netherlands Bureau for Economic Policy Analysis) |
| Abstract: | We show that gifts made to heirs before death are substantial and highly responsive to taxation. Therefore, characterising them and understanding their determinants is crucial for tax design. We use high-quality, intergenerationally-linked data on wealth, gifts, and medical expenses from the Netherlands. Exploiting variation in the timing of death, we find that the wealthiest half of singles (including widows) with children transfer over 10% of their wealth to their children in anticipation of death. Giving is highly sensitive to how heavily gifts are taxed, relative to bequests. Using bunching estimation and exploiting the 2010 reform to gift taxation, we estimate Frisch elasticities of gifts to the net-of-tax rate between 9, for those giving around 27,000 euro, and 1, for those giving around 125,000 euro. Giving is concentrated among those singles who have grandchildren. However, the amount transferred does not vary substantively with the number of heirs and, within families, only slightly larger gifts are made to children who are less-wealthy or who have more children. These findings conflict with the predictions of a fully altruistic model of bequests. Rather, they are consistent with giving being driven by a warm-glow bequest motive that depends on net-of-tax transfers made and is operative for those with grandchildren. |
| JEL: | D12 D14 D64 H26 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:442&r=hea |
| By: | Carole Treibich (GAEL - Laboratoire d'Economie Appliquée de Grenoble - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - UGA - Université Grenoble Alpes - Grenoble INP - Institut polytechnique de Grenoble - Grenoble Institute of Technology - UGA - Université Grenoble Alpes); Eleanor Bell (Office of Health Economics); Elodie Blanc (MIT - Massachusetts Institute of Technology); Aurélia Lépine (Institute for Global Health, University College London) |
| Abstract: | Each year there are over 300 natural disasters globally with millions of victims that cost economic losses near USD$100 billion. In the context of climate change, an emerging literature linking extreme weather events to HIV infections suggests that efforts to control the HIV epidemic could be under threat. We used Demographic and Health Survey (DHS) data collected during the 2015-2016 harsh drought that affected several areas of Malawi to provide new evidence on the effect of an unanticipated economic shock on sexual behaviours of young women and men. We find that amongst women employed in agriculture, a six-months drought doubles their likelihood of engaging in transactional sex compared to women who were not affected by the drought and increases their likelihood of having a sexually transmitted infections (STI) by 48% in the past twelve months. Amongst men employed outside of agriculture, drought increases by 50% the likelihood of having a relationship with a woman engaged in transactional sex. These results suggest that women in agriculture experiencing economic shocks as a result of drought use transactional sex with unaffected men, i.e. men employed outside agriculture, as a coping mechanism, exposing themselves to the risk of contracting HIV. The effect was especially observed among noneducated women. A single drought in the last five years increases HIV prevalence in Malawi by around 15% amongst men and women. Overall, the results confirm that weather shocks are important drivers of risky sexual behaviours of young women relying on agriculture in Africa. Further research is needed to investigate the most adequate formal shock-coping strategies to be implemented in order to limit the negative consequences of natural disasters on HIV acquisition and transmission. |
| Keywords: | Malawi,HIV/AIDS,Transactional sex,Sexually transmitted infections,Climate change,Drought |
| Date: | 2022–09–03 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03818619&r=hea |
| By: | Alison Andrew; Sonya Krutikova; Gabriela Smarrelli; Hemlata Verma |
| Abstract: | Striking gender gaps persist in fundamental aspects of human welfare. In India, the setting of this paper, these gaps are particularly large. Interventions often target adolescent girls with the aim of empowering them to make choices that go against the status quo - to remain in school longer or marry later, for example. This approach may inadvertently expose girls, who are often marginalized within their communities, to new risks if it encourages them to violate prevailing gender norms. In this study, we design an experiment to compare the effectiveness of targeting only adolescent girls with an approach that additionally engages with the enforcers of gender norms in the wider community. We find that both arms of the trial led to a reduction in school dropout and early marriage. We see large improvements in girls' mental health but only in the arm which engages with the wider community. Improvements in mental health can be explained by community engagement causing gender norms to become more progressive and causing a reduction in the severity of sanctions that girls face for breaking norms. Both adolescent girls and their mothers perceived these shifts in norms and sanctions. Our results demonstrate that in settings where unequal outcomes are sustained through restrictive gender norms, change in the attitudes and behavior of the enforcers of these norms is critical for achieving meaningful improvements in womens well-being. |
| Date: | 2022–09–08 |
| URL: | http://d.repec.org/n?u=RePEc:oxf:wpaper:984&r=hea |
| By: | Ulep, Valerie Gilbert T.; Casas, Lyle Daryll D. |
| Abstract: | This paper has two objectives: (1) assess the health sector performance of the Philippines relative to other ASEAN member states and (2) assess regional health integration and cooperation in the Philippines and identify challenges and opportunities. The Philippines is lagging in critical health outcome and access indicators in the region. This is a reflection of the long-standing challenges in terms of health financing, health service delivery, governance, and health human resources. Health integration and cooperation could be instrumental in achieving health system goals. While the country has made significant stride in facilitating regional integration and cooperation in recent years, challenges related to regulations, infrastructure, and implementation remain. Comments to this paper are welcome within 60 days from date of posting. Email publications@mail.pids.gov.ph. |
| Keywords: | regional integration; cooperation; ASEAN; Philippines |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2021-16&r=hea |
| By: | Durevall, Dick (Department of Economics, School of Business, Economics and Law, Göteborg University); Isaksson, Ann-Sofie (The Research Institute of Industrial Economics) |
| Abstract: | Motivated by a recent setback in the fight against child malnutrition, this study explores whether aid projects help to reduce stunting, or impaired growth, among children in the local area. Focusing on Malawi, a country with very high stunting prevalence and for which we have access to geo-referenced data on aid projects from a broad range of donors, we geographically match spatial data on 778 aid project sites of 22 different donors with anthropometric and background data on 26,604 children under the age of 5. To identify the effect of aid, we rely on spatial and temporal variation in aid project coverage and survey rollout, coupled with variation in childbirth years in relation to project start. The empirical results consistently indicate a positive impact of early life aid exposure on child growth. The positive treatment effect materializes already for children born in the early project implementation phase and lasts for children born up to 3 years after project start and is seemingly driven primarily by multilateral aid and projects focusing on rural development, vulnerability, infrastructure, and education. |
| Keywords: | Aid; stunting; malnutrition; child health; Malawi; Africa |
| JEL: | F35 I15 O12 O15 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:gunwpe:0830&r=hea |
| By: | Dora Costa |
| Abstract: | Much of the increase in the prevalence of overweight and obesity has been in developing countries with a history of famines and malnutrition. Prior research has pointed to the association between overweight and famine exposure during developmental ages as one of several explanations and has hypothesized that ancestral famine exposure may play a role. Data limitations have prevented researchers from investigating the multigenerational effects of famine shocks on descendant overweight. This paper examines overweight among adult grandsons of grandfathers exposed to starvation during developmental ages. I study grandsons born to grandfathers who served in the Union Army during the US Civil War (1861-5) where some grandfathers experienced severe net malnutrition because they were POWs during times of extreme hardship. I find that male-line but not female-line grandsons of grandfathers who experienced a severe captivity during their growing years faced a 21% increase in mean overweight and a 2% increase in mean BMI compared to grandsons of non-POWs. This increase was mediated by fathers’ and to a lesser extent own in-utero conditions, as proxied by season of birth, suggesting a dynamic process of inheritance. Male-line grandsons descended from grandfathers who experienced a harsh captivity faced a 22-28% greater risk of dying every year after age 45 relative to grandsons descended from non-POWs, with overweight accounting for 9-14% of the excess risk. |
| JEL: | I10 I15 N30 |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30599&r=hea |
| By: | Ute Rink; Theresa Rollwage |
| Abstract: | This paper investigates individual time preferences between individuals living in a disability household and those who live in a non-disability household in Vietnam. Using randomized primes together with experimental tasks to elicit time preferences, our empirical results show that individuals living in a disability household are (i) more likely to be present biased, and (ii) more patient. The effects are even more pronounced when the disability happened recently (within the last 8 years). These findings show causal evidence that time preferences differ among more vulnerable groups of society and may be one cause for their often observed adverse socioeconomic conditions. |
| Keywords: | Impact; Disability, Time preferences, Priming, Vietnam |
| JEL: | D01 D91 I14 |
| Date: | 2022–09 |
| URL: | http://d.repec.org/n?u=RePEc:tvs:wpaper:wp-027&r=hea |
| By: | Bénédicte Apouey (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - 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, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - 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); Rémi Yin (University of Luxembourg [Luxembourg]); Fabrice Etilé (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - 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, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - 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); Alan Piper (Leeds University Business School - University of Leeds); Claus Vögele (University of Luxembourg [Luxembourg]) |
| Abstract: | Using nationally representative panel data on 7,766 individuals (22,878 observations), we investigate the association between several well-being indicators (depression, anxiety, stress, and loneliness) and the general tendency to follow official recommendations regarding selfprotection against COVID-19, in France, Germany, Italy, Spain, and Sweden over the course of four data collection waves. Employing a flexible specification that allows the correlation to be non-monotonic, we find a U-shaped relationship, in which transitions to low and high levels of psychological well-being are associated with higher overall compliance, while transitions to medium levels of psychological well-being are associated with less compliance. Moreover, anxiety, stress, and loneliness levels at baseline also have a U-shaped effect on following the recommendations later (i.e., recommendations are followed best by those with lowest and highest levels of anxiety, stress, and loneliness at baseline, while following the recommendations is lowest for those with moderate levels of these variables). These U shapes are in contrast to previous studies which report monotonic relationships between various measures of mental health and compliance, or ambiguous results. Additionally, we observe a U-shaped correlation between the well-being indicators and a number of specific behaviours (including washing hands and mask wearing). Importantly, most of these specific behaviours play a role in the general tendency to follow recommendations. Finally, we uncover the role of gender composition effects in some of our results. While variations in depression and stress are negatively correlated with variations in overall compliance for males, the association is positive for females. The relation in the full sample (composed of males and females) will reflect first the negative slope for males and then the positive slope for females, explaining the U shape |
| Keywords: | Psychological well-being,Adherence,Compliance,COVID-19,Longitudinal research design,Europe |
| Date: | 2022–10 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-03828081&r=hea |
| By: | Zhang, Huafeng (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Holden, Stein T. (Centre for Land Tenure Studies, Norwegian University of Life Sciences) |
| Abstract: | Significant progress has been achieved in universal basic education in African countries since the late 1990s. This study provides empirical evidence on the within- and across-country variation in numeracy skills performance among children based on nationally representative data from eight African countries (DR Congo, The Gambia, Ghana, Lesotho, Sierra Leone, Togo, Tunisia, and Zimbabwe). We assess whether and to what extent children with disabilities lag in numeracy skills and how much it depends on their type of disabilities. More specifically, we explore whether disabled children benefit equally from better school system quality. The assessment is analysed as a natural experiment using the performance of non-disabled children as a benchmark and considering the different types of disabilities as random treatments. We first evaluate the variation in average numeracy skills in the eight African countries. They can roughly be divided into low- and high-numeracy countries. We apply Instrumental Variable (IV) methods to control the endogeneity of completed school years when assessing subjects’ school performance and heterogeneous disability effects. Children with vision and hearing disabilities are not especially challenged in numeracy skills performance. The low numeracy skills among physically and intellectually disabled children are mainly attributable to their limited school attendance. Children with multiple disabilities are constrained both by low school attendance and by poor numeracy skills return to schooling. The average differences in school performance across the high- versus low-numeracy skill country groups are larger than the within-group average differences for disabled versus non-disabled kids. This indicates that school enrolment and quality are crucial for children’s learning of numeracy skills, and that disabled children benefit equally from better school quality across these African countries. |
| Keywords: | Numeracy skills learning; across-country comparison; children with disabilities; disability types; disability effects; school enrolment; SDG; Africa |
| JEL: | I24 |
| Date: | 2022–11–10 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:nlsclt:2022_010&r=hea |
| By: | Ulep, Valerie Gilbert T. |
| Abstract: | Understanding the direct and indirect health consequences of the COVID-19 pandemic is critical in designing a holistic public health response. This study has two objectives. First, we demonstrated the disruption of essential healthcare services using data from selected government facilities. Second, we estimated the productivity losses from direct and indirect health impacts of the pandemic. Validating our earlier study using health insurance claims, our findings showed a sharp decline in admissions and consultations in selected government facilities, particularly among the vulnerable population. Based on our estimates, the long-run costs from productivity losses from direct and indirect health impacts of the pandemic amount to PHP 2.3 trillion (at net present value). Indirect health impacts account for the majority of these costs. Click here to download the discussion paper. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | health;COVID-19; broad impact |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2021-23&r=hea |
| By: | Motta, Matt (Boston University School of Public Health); Callaghan, Timothy; Trujillo, Kristin Lunz; Lockman, Alee |
| Abstract: | Throughout the COVID-19 pandemic, researchers have studied how Americans' attitudes toward health experts influence their health behaviors and policy opinions. Fewer, however, consider the potential gap between individual and expert opinion about COVID-19, and how that might shape health attitudes and behavior. This omission is notable, as discrepancies between individual and expert opinion could help explain why some Americans fail to take action to protect themselves and others from the virus. In novel demographically representative surveys of the US adult population (N = 5,482) and primary care physician subpopulations (PCPs; N = 625), we contrast the relationship between: (1) Americans’ and (2) PCPs' preferences regarding who ought to be responsible for taking action to combat the spread of COVID-19, as well as (3) Americans' perceptions of PCP preferences ("PCP meta-opinion"). In the aggregate, we find that Americans are far less likely than PCPs to see a role for both private and state actors in taking action to combat COVID-19. Interestingly, though, this disjuncture is not reflected in individual-level PCP meta-opinion; as most Americans think that PCPs share their views on state and private intervention (𝛕b = 0.44 - 0.49). However, this consonance is often erroneous, which we show can have problematic health consequences. Multivariate models suggest that Americans who both see little place for individual responsibility in taking action to stop viral spread and who think that PCPs share those views are significantly less likely to vaccinate against COVID-19. We conclude by discussing the public health benefits of efforts to bring public opinion in line with expert opinion. |
| Date: | 2022–10–25 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:8hnxd&r=hea |
| By: | Lisa Y. Ho; Emily Breza; Marcella Alsan; Abhijit Banerjee; Arun G. Chandrasekhar; Fatima Cody Stanford; Renato Fior; Paul Goldsmith-Pinkham; Kelly Holland; Emily Hoppe; Louis-Maël Jean; Lucy Ogbu-Nwobodo; Benjamin A. Olken; Carlos Torres; Pierre-Luc Vautrey; Erica Warner; Esther Duflo |
| Abstract: | COVID-19 vaccines are widely available in wealthy countries, yet many people remain unvaccinated. Understanding the effectiveness -- or lack thereof -- of popular vaccination campaign strategies is therefore critical. In this paper, we report results from two studies that tested strategies central to current vaccination outreach: (1) direct communication by health professionals addressing questions about vaccination and (2) efforts to motivate individuals to promote vaccination within their social networks. Near the peak of the Omicron wave, doctor- and nurse-produced videos were disseminated to 17.8 million Facebook users in the US and 11.5 million in France. In both countries, we cannot reject the null of no effect of any of the interventions on any of the outcome variables (first doses - US and France, second doses and boosters - US). We can reject very small effects on first doses during the interventions in both countries (0.16pp - US, 0.021pp - France). In contrast with similar campaigns earlier in the pandemic to encourage health-preserving behaviors, messaging at this stage of the pandemic -- whether aimed at the unvaccinated or those tasked with encouraging others -- did not change vaccination decisions. |
| JEL: | C93 D83 I12 L86 O33 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30618&r=hea |
| By: | Anthonin Levelu; Alexander-Nikolai Sandkamp |
| Abstract: | Countries have employed a variety of non-pharmaceutical interventions (NPIs) in order to curtail the Covid-19 pandemic. However, the success of individual measures in reducing the number of infections remains controversial. This paper exploits a panel data set of 182 countries to estimate the effects of 14 NPIs on the spread of the disease in 2020. The employed fixed effects estimation greatly reduces endogeneity concerns. While almost all measures had a dampening effect on the reproduction rate of the virus, public information campaigns and school closings were most effective, followed by testing policies and contact tracing. The obligation to wear face masks was more effective during the second wave. Other measures, in contrast, were less successful in the second half of 2020. |
| Keywords: | Covid-19, non-pharmaceutical interventions, policy analysis, panel data |
| JEL: | C10 C50 I10 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10023&r=hea |
| By: | Ablam Estel Apeti (CERDI - Centre d'Études et de Recherches sur le Développement International - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne) |
| Abstract: | Countries have adopted several measures to control the spread of Covid-19. However, substantial differences remain in terms of performance in controlling the virus, potentially due to heterogeneity in citizen engagement with government measures. Although the literature documents the effects of trust in government on compliance with health restrictions related to the health crisis, little is said about the direct effect of trust in government on managing the Covid-19 crisis, defined as the number of cases and deaths. Drawing on this observation, this paper seeks to analyze the effect of pre-crisis ties, particularly trust in government, on crisis management, proxied by the number of Covid-19 cases and deaths per million population. We examine this question based on a sample of 41 countries for which data are available and using the Ordinary Least Squares (OLS) method. Results reveal that a high level of trust in government predicts better crisis management in terms of relatively low levels of cases and deaths. These results, which successfully pass a series of robustness tests, may vary according to level of contamination and increase with time. This paper, therefore, suggests that building trust between the public and the authorities, essentially governments and citizens, is essential for crisis management, taking the example of the Covid-19 pandemic. |
| Keywords: | E71,H12,I12,I18,I38,Z18 Covid-19,containment measures,trust in government,recovery plans |
| Date: | 2022–09–21 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03819808&r=hea |
| By: | Smith, Morrison Luke; Chi, Guangqing; Hennighausen, Hannah; Holen, Davin; Howe, E Lance |
| Abstract: | Bristol Bay in Alaska is home to the world’s largest commercial salmon fishery. During an average fishing season, the population of the Bristol Bay region more than doubles as thousands of workers from out of state converge on the fishery. In the months leading up to 2020 commercial fishery opening, as the COVID-19 pandemic exploded worldwide, great uncertainty existed about the health risks of opening the fishery. Bristol Bay residents had not yet experienced any cases of COVID-19, yet the livelihoods of most were closely tied to the commercial fishery opening. To better understand how COVID-19 risk perceptions affected decisions to participate in the fishery, we administered an online survey to community members and fishery participants. We collected standard socioeconomic data and posed questions to gauge risk perceptions related to COVID-19. We find that COVID-19 risk perceptions vary across race/ethnic groups by residency and income. People with below median income who are members of minority groups—notably, non-resident Hispanic workers and resident Alaska Native respondents—reported the highest risk perceptions related to COVID-19. This study highlights the important linkages among risk perceptions, socioeconomic characteristics, and employment decisions during an infectious disease outbreak. |
| Date: | 2022–10–29 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:k7fvw&r=hea |
| By: | Marta Furlan |
| Abstract: | As COVID-19 spread worldwide, armed groups in control of territory were called to address the health emergency. However, our knowledge in this regard is limited. Specifically, it remains poorly understood why different armed groups responded to the crisis differently. Recognizing this lacuna, this paper aims to illuminate the responses that different armed groups throughout the Middle East implemented in order to address COVID-19 and to explain why armed groups responded to the pandemic as they did. |
| Keywords: | Armed conflict, COVID-19, Middle East and North Africa, Governance, Wartime governance |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:unu:wpaper:wp-2022-130&r=hea |
| By: | Alessandro Saccal |
| Abstract: | The present research conducts a formal analysis of the interactive decisions concerning the enterprise of COVID-19 vaccination on the part of governments and citizens. It specifically constructs a non-cooperative static game with complete information between the citizen and the government encompassing the strategies of vaccination and no vaccination with regard to the former and the strategies of direct imposition, subsistence restrictions, luxury restrictions and no imposition with regard to the latter. On account of its payoff structure the present analysis finds that the game in question presents one sole and strict pure strategy Nash equilibrium, being that of strategies no vaccination and no imposition, respectively. The core rationale is that the citizen accepts COVID-19 vaccination only if his subsistence survival is placed at risk, because of the inherent unlawfulness presented by COVID-19 vaccination, itself due to foetal exploitation and potentially adverse effects, thereby prompting the government not to impose it, lest individual integrity and societal rights be violated as well. It furthermore shows that the exogenous elimination of the no imposition strategy on the part of the government transforms the Nash equilibrium into that of strategies vaccination and direct imposition, respectively, as materially come to pass. It finally determines that the unlikely addition of the revolution strategy on the part of the citizen in the presence of the elimination of the no imposition strategy on the part of the government likewise admits one sole and strict pure strategy Nash equilibrium, either in strategies vaccination and direct imposition or in strategies revolution and direct imposition, respectively. |
| Keywords: | Citizen, COVID-19, equilibrium, game, government, imposition, pandemic, payoff, vaccination |
| JEL: | C72 D74 I12 I18 |
| Date: | 2022–10–11 |
| URL: | http://d.repec.org/n?u=RePEc:eei:rpaper:eeri_rp_2022_11&r=hea |