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on Health Economics |
| By: | Abe Dunn; Joshua D. Gottlieb; Adam Hale Shapiro; Daniel J. Sonnenstuhl; Pietro Tebaldi |
| Abstract: | Who bears the consequences of administrative problems in healthcare? We use data on repeated interactions between a large sample of U.S. physicians and many different insurers to document the complexity of healthcare billing, and estimate its economic costs for doctors and consequences for patients. Observing the back-and-forth sequences of claim denials and resubmissions for past visits, we can estimate physicians’ costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 18% of Medicaid revenue to billing problems, compared with 4.7% for Medicare and 2.4% for commercial insurers. Identifying off of physician movers and practices that span state boundaries, we find that physicians respond to billing problems by refusing to accept Medicaid patients in states with more severe billing hurdles. These hurdles are quantitatively just as important as payment rates for explaining variation in physicians’ willingness to treat Medicaid patients. We conclude that administrative frictions have first-order costs for doctors, patients, and equality of access to healthcare. We quantify the potential economic gains—in terms of reduced public spending or increased access to physicians—if these frictions could be reduced, and find them to be sizable. |
| Keywords: | healthcare; Medicaid; physicians; insurance |
| Date: | 2023–01–14 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedfwp:95615&r=hea |
| By: | Daron Acemoglu |
| Abstract: | In the presence of markup differences, externalities and other social considerations, the equilibrium direction of innovation can be systematically distorted. This paper builds a simple model of endogenous technology, which generalizes existing comparative static results and characterizes potential distortions in the direction of innovation. I show that empirical findings across a number of different areas are consistent with this framework's predictions and I use data from several studies to estimate its key parameters. Combining these numbers with rough estimates of differential externalities and markups, I provide suggestive evidence that equilibrium distortions in the direction of technology can be substantial in the context of industrial automation, health care, and energy, and correcting these distortions could have sizable welfare benefits. |
| JEL: | C65 J23 J24 L65 O14 O31 O33 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30922&r=hea |
| By: | John Cawley; Davide Dragone |
| Abstract: | A subset of harm reduction strategies encourages individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and buprenorphine (substitutes for opioids). Such harm reduction methods have proven to be controversial. Advocates argue that people struggling with addiction benefit because they can switch to a less harmful substance, but opponents argue that this could encourage abstainers to begin using the harm reduction method or even the original addictive good. This paper builds on theories of addiction to model the introduction of a harm reduction method, and it demonstrates the conditions under which each side is correct. The three key factors determining whether the introduction of a harm reduction method reduces or worsens health harms are: 1) the enjoyableness of the harm reduction method, 2) the addictiveness of the harm reduction method, and 3) the substitutability of the harm reduction method with the original addictive good. Knowledge of these conditions can help inform regulation of harm reduction methods. |
| JEL: | D11 I12 I18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30926&r=hea |
| By: | Johannes S. Kunz (Monash University); Carol Propper (Imperial College London); Kevin E. Staub (University of Melbourne); Rainer Winkelmann (University of Zurich) |
| Abstract: | We examine variation in US hospital quality across ownership, chain membership, and market concentration. We use a new measure of quality derived from the penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program. We document a robust and sizable negative for-profit quality gap: for-profit hospitals are consistently of lower quality. We find that a substantial part of the gap is related to being located in less competitive markets. This reduction occurs most for hospitals that are part of large national chains. For such hospitals we find no quality gap in fully competitive markets. |
| Keywords: | Hospital Readmissions, Affordable Care Act, Hospital Quality, Competition, Hospital Chains |
| JEL: | H51 I11 I18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:mhe:chemon:2023-01&r=hea |
| By: | Christian Dustmann (University College London); Malte Sandner (Technical University Nürnberg); Uta Schönberg (University College London) |
| Abstract: | Obesity not only leads to immense medical costs associated with treating obesity-related illness but is also associated with lower employment prospects and earnings. This study shows that sunshine-induced vitamin D may have a preventive effect on obesity for children. It investigates the relation between sun intensity from pregnancy until infancy on obesity at age six, using population data of more than 600, 000 children. Our findings show that the effects of sun intensity on subsequent obesity are concentrated in the first six months of life: 100 hours of additional sunshine over this period reduce overweight by 1.1 percent and severe obesity by 6.2 percent. We offer two main explanations for this pattern. First, infants’ vitamin D levels are particularly sensitive to sunshine in the first six months of life, when lactation is highest. Second, the first six months of life are a sensitive period for later obesity, as this is the period when infants rapidly gain weight and adipose tissue develops. |
| Keywords: | childhood obesity, prevention, vitamin D |
| JEL: | I18 I12 |
| Date: | 2023–01 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2023-002&r=hea |
| By: | Qiren Liu; Sen Luo; Robert Seamans |
| Abstract: | The rising adoption of industrial robots is radically changing the role of workers in the production process. Robots can be used for some of the more physically demanding and dangerous production work, thus reducing the possibility of worker injury. On the other hand, robots may replace workers, potentially increasing worker anxiety about their job safety. In this paper, we investigate how individual physical health and mental health outcomes vary with local exposure to robots for manufacturing workers in China. We find a link between robot exposure and better physical health of workers, particularly for younger workers and those with less education. However, we also find that robot exposure is associated with more mental stress for Chinese workers, particularly older and less educated workers. |
| Date: | 2023–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2301.10675&r=hea |
| By: | Jarvis, Stephen; Deschenes, Olivier; Jha, Akshaya |
| Abstract: | Many countries have phased out nuclear power in response to concerns about nuclear waste and the risk of nuclear accidents. This paper examines the shutdown of more than half of the nuclear production capacity in Germany after the Fukushima accident in 2011. We use hourly data on power plant operations and a machine learning approach to estimate the impacts of the phase-out policy. We find that reductions in nuclear electricity production were offset primarily by increases in coal-fired production and net electricity imports. Our estimates of the social cost of the phase-out range from €3 to €8 billion per year. The majority of this cost comes from the increased mortality risk associated with exposure to the local air pollution emitted when burning fossil fuels. Policymakers would have to significantly overestimate the risk or cost of a nuclear accident to conclude that the benefits of the phase-out exceed its social costs. We discuss the likely role of behavioral biases in this setting, and highlight the importance of ensuring that policymakers and the public are informed about the health effects of local air pollution. |
| JEL: | C53 Q41 Q53 |
| Date: | 2022–06–14 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113634&r=hea |
| By: | Stefan Flagner; Piet Eichholtz; Nils Kok; Guy Plasqui; Maartje Willeboordse |
| Abstract: | Primary and secondary education are of critical importance to the future life of children, determining their future in the labour market. Thus, pupils should be provided with an optimal learning environment to work at their highest cognitive capacity, including the indoor quality of classrooms. However, school buildings are often old, poorly ventilated, and in urgent need of renovation. Past studies have shown that being in a poorly ventilated classroom can have negative effects on the learning outcomes of pupils. The question remains, however, if children with an unhealthy lifestyle are more susceptible to a poor indoor environment. This study aims to investigate the role of the pupil’s health status when being exposed to high levels of indoor carbon dioxide (CO2) in classrooms. It is hypothesised that among the students with healthy dietary behaviour and high physical activity level, despite being exposed to a high concentration of CO2 during the time they study for a test and during the time of conducting the test, they are more resilient towards the negative effects of indoor CO2 on learning outcomes, compared to students with a less healthy lifestyle. For this purpose, data from a quasi-experimental study was used, including indoor air sensor data for each classroom, data of the health behaviour of students, and the exam grades of an annual nationwide test. The sensors measure the concentration of CO2, fine particular matter, temperature and humidity levels, and noise levels in classrooms. Preliminary results from linear mixed model analysis have shown that an unhealthy diet and a higher BMI negatively affects test scores. Additionally, the effect of dietary behaviour on test scores interacts with the level of CO2 in the classroom. The next steps will be to examine this effect further by including confounders such as socioeconomic status, sick leave, and minutes spend in the classroom. |
| Keywords: | Academic Performance; Cognition; Health Behaviour; indoor environment |
| JEL: | R3 |
| Date: | 2022–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:2022_86&r=hea |
| By: | Ravaska, Terhi |
| Abstract: | I examine the effects of reduced working hours on various health outcomes. I focus on individuals close to retirement and exploit a reform in part-time pension rules. Using detailed register data on health and job spells together with a difference-in-differences approach, I find that an earlier eligibility age for part-time pension program increased purchases of prescription drugs by approximately 1.0 percentage point over the following 6 years. In relative terms, this effect is small, around 2%, but is economically significant as drug purchases are largely subsidized by the state. However, looking at the long-term effects I do not find effects on mortality or severe health diagnoses. I also look at labour market exits and find that the reform did not reduce the risk of early withdrawal from the labour market. |
| Keywords: | part-time pension, health, eligibility age reform, work hours, Social security, taxation and inequality, J26, I10, fi=Sosiaaliturva|sv=Social trygghet|en=Social security|, fi=Terveyspalvelut|sv=Hälsovårdstjänster|en=Healthcare services|, fi=Työmarkkinat|sv=Arbetsmarknad|en=Labour markets|, |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:fer:wpaper:153&r=hea |
| By: | Michaela Paffenholz |
| Abstract: | I provide evidence on the causal effects of a student’s relative socioeconomic status during high school on their mental health and human capital development. Leveraging data from representative US high schools, I utilize between-cohort differences in the distributions of socioeconomic status within schools in a linear fixed effects model to identify a causal rank effect. I find that a higher rank during high school improves a student’s depression scores, cognitive ability, self-esteem and popularity. The rank effects are persistent with long-lasting consequences for adult depression and college attainment. Additional analyses emphasize the role of inequality in exacerbating these rank effects. |
| Keywords: | rank, mental health, higher education |
| JEL: | I14 I23 I24 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10248&r=hea |
| By: | Antonio Abatemarco (University of Salerno and CELPE); Massimo Aria (Università di Napoli Federico II); Sergio Beraldo (Università di Napoli Federico II and CSEF); Michela Collaro (Università di Napoli Federico II) |
| Abstract: | We propose an approach for the measurement of health care inequalities inspired by the ideal of equal universal access. The approach assesses the chances of access to health treatments of appropriate quality, for any given realization of socially relevant characteristics an individual may have. It allows to assess supply-side (cost-specific) and demand-side (resource-specific) determinants of health care inequality. An empirical exercise using Italian data shows that the methodology can be employed to improve the design of policies addressing health care inequalities. |
| Keywords: | health care, equality of opportunity, factor-decomposition, health policy |
| JEL: | I14 I18 D63 |
| Date: | 2023–02–03 |
| URL: | http://d.repec.org/n?u=RePEc:sef:csefwp:666&r=hea |
| By: | Hai-Anh Dang (World Bank); Trong-Anh Trinh (Monash University); Paolo Verme (World Bank) |
| Abstract: | Hardly any evidence exists on the effects of mental illness on refugee labor outcomes. We offer the first study on this topic in the context of Australia, one of the host countries with the largest number of refugees per capita in the world. Analyzing the Building a New Life in Australia longitudinal survey, we exploit the variations in traumatic experiences of refugees interacted with post-resettlement time periods to causally identify the impacts of refugee mental health. We find that worse mental health, as measured by a one-standard-deviation increase in the Kessler mental health score, reduces the probability of employment by 14.1% and labor income by 26.8%. We also find some evidence of adverse impacts of refugees’ mental illness on their children’s mental health and education performance. These effects appear more pronounced for refugees that newly arrive or are without social networks, but they may be ameliorated with government support. |
| Keywords: | refugees, mental health, labor outcomes, Australia |
| JEL: | I15 J15 J21 J61 O15 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:mhe:chemon:2023-02&r=hea |
| By: | Kapoor, Rati; Singh, Nishmeet; Nguyen, Phuong Hong; Singh, S. K.; Dwivedi, L. K.; Pedgaonkar, Sarang; Puri, Parul; Chauhan, Alka; Khandelwal, Shweta; Chamois, Sylvie |
| Abstract: | A set of global nutrition targets for maternal and child nutrition together with diet related non communicable diseases ( to be achieved by 2025 was endorsed by the World Health Assembly in 2013 These targets provide goals against which progress towards ending malnutrition in all its forms can be measured and contribute to the Sustainable Development Goals This data note describes trends in multiple forms of malnutrition and NCD outcomes at the national, state, and district levels for India using survey data from NFHS 3 2005 06 NFHS 4 2015 2016 and NFHS 5 2019 2021 Insights on other malnutrition targets such as anemia and breastfeeding will be forthcoming. |
| Keywords: | INDIA; SOUTH ASIA; ASIA; data; data analysis; diabetes; diet; hypertension; malnutrition; maternal and child health; maternal nutrition; nutrition; stunting; wasting disease (nutritional disorder); non-communicable diseases (NCDs) |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:poshdn:92&r=hea |
| By: | Silke Daals; Wabbe de Vries; Laumé Buitenwerf; Loraine Scholten |
| Abstract: | Due to the COVID-19 pandemic, the indoor air quality of school buildings is a much-discussed topic. It is important to know whether indoor climate of buildings influences the physical and mental situations of users in these buildings, and with that, performance of users. The aim of this study is to establish a direct link between users’ health, well-being and performances, and indoor air quality in a case study that focuses on the ‘Marie Kamphuisborg, ’ a building owned and used by the Hanze University of Applied Sciences in the Netherlands. The study was conducted by using a mixed methods approach, consisting of a literature review, surveys among students and teachers, and interviews with facility management staff. It has tried to measure the degree of well-being of users related to the indoor air quality in this building. Results of the literature review showed that poor indoor climate leads to a negative influence on concentration of users due to discomfort and weakened physical and mental health of students, in the end leading to lower performances of users.The survey showed that students as well as lecturers experienced a lower performance in situations of a poor indoor climate in classrooms. Both indicated that they develop physical complaints during a lecture in a classroom with poor indoor air quality. Lecturers tended to give a lower and insufficient grade to the indoor climate of the Marie Kamphuisborg compared students, who rated the building sufficient. Expert interviews showed that complaints about indoor climate only have to do with classrooms without windows in the inner circle, the so called M-wing, of the building. Outcomes from the interviews show that complaints, both from teachers and students are related mainly to high temperatures, high Carbon dioxide and low oxygen levels. These complaints mainly occur in the warmer season. Complaints about noise levels and light intensity are very rare. In addition, the experts argued that other aspects can influence the well-being for users in buildings, such as green walls, wall decorations with recognizable sceneries, colors, friendly staff at front offices and a proper canteen. We can conclude that both teachers and students assess classrooms in the M-wing as negative for their well-being and, with that, for their performances. This is in line with the findings of facility staff members of the Marie Kamphuisborg and confirmed by prior research. |
| Keywords: | Classrooms; Indoor climate quality; User performance; Ventilation |
| JEL: | R3 |
| Date: | 2022–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:2022_35&r=hea |
| By: | Christian Leuz; Anup Malani; Maximilian Muhn; Laszlo Jakab |
| Abstract: | Financial ties between drug companies and medical researchers are thought to bias studies published in medical journals. To enable readers to account for such bias, most medical journals require authors to disclose potential conflicts of interest. We examine whether disclosure reduces article citations, indicating a discount. A challenge to estimating this effect is selection as drug companies may seek out higher quality authors. Our analysis confirms this positive association. Including observable controls for article and author quality attenuates but does not eliminate this relation. We perform three tests. First, we show that the positive association is weaker for review articles, which are more susceptible to bias. Second, we examine article recommendations to family physicians among articles that are a priori more homogenous in quality. We find a significantly negative association between disclosure and expert recommendations, consistent with discounting. Third, we conduct an analysis within author and article, exploiting journal policy changes that result in conflict disclosure by an author. We examine the effect of this disclosure on citations to a previously published article by the same author. This analysis reveals a negative citation effect. Overall, our evidence is consistent with the notion that other researchers discount articles with disclosed conflicts. |
| JEL: | D83 D84 G18 K20 L51 M40 O31 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30927&r=hea |
| By: | Bellani, Luna; Bertogg, Ariane; Kulic, Nevena; Strauß, Susanne |
| Abstract: | The increase in inequalities during the ongoing COVID-19 pandemic has been the topic of intense scholarly and public debate. School closures are one of the containment measures that have been debated most critically in this regard. What drives support for school and daycare/kindergarten closures during a public health crisis such as the current COVID-19 pandemic? More specifically, do inequality concerns affect this support? To identify causal linkages between awareness of inequalities and support for school and daycare/kindergarten closures, we use a survey experiment with information treatment, in which we randomly assign information designed to prime the respondents to think about either education inequality, gender inequality, or both. Based on an original survey experiment involving more than 3, 000 respondents, conducted in spring 2021 at the end of a long lockdown in Germany, our findings show that concerns about education inequality and gender inequality are equally important for decreasing support for preschool and primary school closures, while they do not seem to matter regarding secondary school closures. |
| Keywords: | Childcare Policy, COVID-19, School Closures, Survey Experiment, Information Treatment, Policy Support, Educational Inequality, Gender Inequality, Germany |
| JEL: | D13 I24 J16 H4 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cexwps:11&r=hea |
| By: | Bratsberg, Bernt (Ragnar Frisch Centre for Economic Research); Godøy, Anna (University of Oslo); Hart, Rannveig Kaldager (Norwegian Institute of Public Health); Raaum, Oddbjørn (Ragnar Frisch Centre for Economic Research); Reme, Bjørn-Atle (Norwegian Institute of Public Health); Wörn, Jonathan (Norwegian Institute of Public Health) |
| Abstract: | We study the impact of work loss on mental health during the COVID-19 pandemic. Combining data on work loss and health care consultations from comprehensive individual-level register data, we define groups of employees delineated by industry, region, age, and gender. With these groups, we use a difference-in-differences framework to document significantly increased rates of consultations for psychological conditions among workers with higher exposure to work loss. The increases, and their persistence, were markedly higher for consultations in specialist (vs. primary) care, indicating that the deterioration of mental health was more than a widespread increase in lighter symptoms. Overall, our findings suggest that the economic disruptions of the COVID-19 pandemic adversely affected the mental health of workers most exposed to loss of work. |
| Keywords: | COVID-19, layoffs, work loss, job loss, mental health |
| JEL: | I12 I14 I18 J65 |
| Date: | 2023–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15913&r=hea |
| By: | Seth M. Freedman; Kelli R. Marquardt; Dario Salcedo; Kosali I. Simon; Coady Wing |
| Abstract: | We study how the societal disruptions of the COVID-19 pandemic impacted diagnosis of a prevalent childhood mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). Using both nationwide private health insurance claims and a single state’s comprehensive electronic health records, we compare children exposed to the pandemic to same aged children prior to the pandemic. We find the pandemic reduced new ADHD diagnoses by 8.6% among boys and 11.0% among girls nationwide through February 2021. We further show that higher levels of in-person schooling in Fall 2020 dampened the decline for girls but had no moderating effect for boys. |
| JEL: | I0 I12 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30909&r=hea |
| By: | Dirk Foremny (Universitat de Barcelona & IEB); Pilar Sorribas-Navarro (Universitat de Barcelona & IEB); Judit Vall Castelló (Universitat de Barcelona & IEB & CRES-UPF) |
| Abstract: | This paper provides novel evidence of the mental health effects of the Covid-19 outbreak. Between April 2020 and April 2022, we run four waves of a large representative survey in Spain, which we benchmark against a decade of pre-pandemic data. We document a large and sudden deterioration of mental health at the beginning of the pandemic, as the share of people reporting being depressed increased from 16% before the pandemic to 46% in April 2020. This effect is persistent over time, which translates into important and irreversible consequences, such as a surge in suicides. The effect is more pronounced for women, younger individuals and those with unstable incomes. Finally, using mediation analysis, event studies and machine learning techniques, we document the role of the labor market as an important driver of these effects, as women and the young are more exposed to unstable income sources. |
| Keywords: | Mental health, Gender, Inequality, Labor markets, Pandemic, Covid-19 |
| JEL: | I14 H2 H12 E24 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ieb:wpaper:doc2022-07&r=hea |
| By: | Bonander, Carl; Chauca Strand, Gabriella; Jakobsson, Niklas |
| Abstract: | This report presents a replication of Altindag et al. (2022) performed at the Olso Replication Games in 2022. Altindag et al. (2022) estimate the effects of an age-specific lockdown on mental health outcomes and mobility among adults aged 65 and older in Turkey, using a regression discontinuity design. The authors find a decline in mobility with a one-day decrease in the number of days being outside and an increase in the probability of never going out by 30 percentage points. These point estimates are statistically significant at the 1% level. The mobility restrictions lead to a worsening in mental health outcomes of approximately 0.2 standard deviations, statisti-cally significant at the 10% level in their preferred specification. In this paper we accomplish two things. First, we successfully reproduce Altindag et al.'s main findings. Second, we test the ro-bustness of the results to a small number of changes to their preferred estimations by (1) not clustering the standard errors on the running variable, (2) not including control variables, and (3) calculating the optimal bandwidth using another technique. Point estimates for mobility outcomes are stable to all three manipulations, and standard errors only change marginally. Point estimates and standard errors for the mental health outcomes are somewhat more sensitive, especially to changing the optimal bandwidth selection method. However, the observed changes are reason-ably expected when applying data-driven model selection methods to noisy data (to avoid over-fitting, it is likely preferable to apply a less data-driven approach like the original authors did). Our general impression is that the original analyses and results are both theoretically plausible and credible, despite some defensible model dependencies. |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:i4rdps:16&r=hea |
| By: | Altindag, Onur; Erten, Bilge; Keskin, Pinar |
| Abstract: | In Altindag et al. (2022), we estimate the effects of an age-specific lockdown policy on mobility and mental health outcomes among adults aged 65 and older in Turkey using a regression discontinuity design. Bonander et al. (2023) successfully replicate all our main findings. They argue that the estimates for mobility outcomes are all robust to alternative sensitivity checks while some of the estimates for mental health-which were statistically significant around the 5-9 percent level-lose significance at the conventional level of 10 percent in the more conservative specifications. In this reply, we provide approximately 7, 000 additional estimates that comprise a near universe of RD estimates for all our outcomes, each possible monthly bandwidth, and each possible combination of covariate adjustment, kernel selection, estimation methodology, standard error adjustment, and kernel weighting selection. This comprehensive analysis shows that our original results are robust to these choices. We show that Bonander et al. (2023) rely on a selection of very narrow bandwidths that produce highly sensitive and uninformative estimates due to overfitting. We also show that Bonander et al. (2023) report imprecise estimates, which are outliers in the distribution of all estimates that can be reported. We conclude that broader statistical tests are more informative for robustness checks. |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:i4rdps:17&r=hea |