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on Health Economics |
| By: | Hirani, Jonas Cuzulan (VIVE - The Danish Centre for Applied Social Science); Wüst, Miriam (University of Copenhagen) |
| Abstract: | A major policy concern across public vaccination programs is non-compliance. Exploiting Danish population data and three national reforms in regression discontinuity designs, we document the effects of reminders for childhood vaccination coverage. Retrospective reminders are primarily effective for families with small children and when sent out close to the recommended vaccination age. Digital and postal reminders are equally effective. Prospective reminders increase timely vaccinations in later childhood and help reaching high coverage for new vaccines in increasingly complex vaccination programs. While reminders prompt additional preventive care for focal children, we find no spillovers to other health behaviors or relatives. |
| Keywords: | vaccination, child health, public policy, reminder, Denmark |
| JEL: | I1 I12 I18 |
| Date: | 2023–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15877&r=hea |
| By: | Sevim, Dilek (University of Basel); Baranov, Victoria (University of Melbourne); Bhalotra, Sonia R. (University of Warwick); Maselko, Joanna (University of North Carolina, Chapel Hill); Biroli, Pietro (University of Bologna) |
| Abstract: | We study the formation of social and emotional skills in the first three years of life, and investigate the impact of a cluster-randomized peer-led psychosocial intervention targeting perinatally depressed mothers in rural Pakistan. The intervention significantly improved maternal mental health, especially among mothers of boys. It resulted in imprecisely estimated increases in parental investment, without any discernible impacts on the child's socioemotional skills or on indicators of their development in the cognitive and physical health domains. A descriptive analysis of mechanisms reveals that the intervention modified the production function of children's skills, by lowering the productivity of maternal mental health in the first 12 months of life. It moved outcomes for depressed women closer to outcomes for women not depressed during pregnancy. |
| Keywords: | mental health, stress, socioemotional, RCT, child development, technology of skill formation, gender |
| JEL: | D1 I1 J1 O2 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15925&r=hea |
| By: | Claudia Senik (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, SU - Sorbonne Université); Guglielmo Zappalà (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); Carine Milcent (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); Chloé Gerves-Pinquié (IRSRPL - Institut Recherche en Santé Respiratoire des Pays de la Loire); Patricia Dargent-Molina (INSERM - Institut National de la Santé et de la Recherche Médicale) |
| Abstract: | Happier Elderly Residents The positive impact of physical activity on objective and subjective health condition of elderly people in nursing homes. Evidence from a multi-site randomized controlled trial. We explore the effects of adapted physical exercise programs in nursing homes, in which some residents suffer from dementia and/or physical limitations and other do not. We use data from 452 participants followed over 12 months in 32 retirement homes in four European countries. Using a difference-in-difference with individual random effects model, we show that the program has exerted a significant impact on the number of falls and the self-declared health and health-related quality of life of residents (EQ-5D). The wide scope of this study, in terms of sites, countries, and measured outcomes, brings generality to previously existing evidence. A simple computation, in the case of France, suggests that such programs are highly cost-efficient. |
| Keywords: | Physical activity, Retirement homes, Impact study, Falls, Subjective health |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:hal:psewpa:halshs-03966677&r=hea |
| By: | Juliana Sanchez-Ariza |
| Abstract: | We examine the effect of the exposure (or reduction in the exposure) to conflictrelated violence on parental mental health, caregivers' parenting stress and responsive caregiving, and early childhood mental health. We use data collected from the impact evaluation of a psychosocial group intervention in Tumaco, Colombia, a community chronically affected by the armed conflict. Using an Instrumental Variables approach, we use the program's randomization into cohorts and staggered design of the data collection to exploit a natural experiment in which the armed groups in the municipality agreed to a Truce and municipal violence rates dropped between data collections. We find that the exposure to recent conflict-related violence had negative effects across the four main dimensions: increased parental mental health problems in 0.68 sd (SE=0.342 ; q-value=0.074), increased parenting stress in 0.76 sd (SE=0.389 ; q-value=0.074), reduced responsive caregiving in -1.023 sd (SE=0.434 ; q-value=0.074) and increased child mental health problems in 0.556 sd (SE=0.343 ; q-value=0.074). By providing causal evidence on the direct effect of conflict-related violence on parenting outcomes, we conduct an exploratory mediation analysis to assess whether parental mental health, parenting stress and responsive caregiving behaviors may partially account for the association between violence and child mental health. Yet, correlational links between violence and parental mental health and parenting behavior outcomes as mediators suggest important associations for understanding children's mental health vulnerability in conflict settings. |
| Keywords: | Early childhood mental health, parental mental health, violence, parenting, conflict, early childhood development, responsive caregiving. |
| JEL: | I1 I3 J13 D91 |
| Date: | 2022–09–22 |
| URL: | http://d.repec.org/n?u=RePEc:col:000089:020639&r=hea |
| By: | Barker, Nathan; Bryan, Gharad; Karlan, Dean; Ofori-Atta, Angela L.; Udry, Christopher |
| Abstract: | We study the impact of group-based cognitive behavioral therapy (CBT) for individuals selected from the general population of poor households in rural Ghana (N = 7, 227). Results from one to three months after the program show strong impacts on mental and perceived physical health, cognitive and socioemotional skills, and economic self-perceptions. These effects hold regardless of baseline mental distress. We argue that this is because CBT can improve well-being for a general population of poor individuals through two pathways: reducing vulnerability to deteriorating mental health and directly increasing cognitive capacity and socioemotional skills. |
| Keywords: | mental health; poverty; cognitive behavioral therapy; scarcity |
| JEL: | D12 I12 I31 I32 O12 O18 |
| Date: | 2022–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114397&r=hea |
| By: | Julia Hatamyar; Noemi Kreif |
| Abstract: | Machine learning (ML) estimates of conditional average treatment effects (CATEs) can be used to inform policy allocation rules, such as treating those with a beneficial estimated CATE ("plug-in policy"), or searching for a decision tree that optimises overall outcomes. Little is known about the practical performance of these algorithms in usual settings of policy evaluations. We contrast the performance of various policy learning algorithms, using synthetic data with varying outcome prevalence (rare vs. not rare), positivity violations, extent of treatment effect heterogeneity and sample size. For each algorithm, we evaluate the performance of the estimated treatment allocation by assessing how far the benefit from a resulting policy is from the best possible ("oracle") policy. We find that the plug-in policy type outperforms tree-based policies, regardless of ML method used. Specifically, the tree-based policy class may lead to overly-optimistic estimated benefits of a learned policy; i.e., the estimated advantages of tree-based policies may be much larger than the true possible maximum advantage. Within either policy class, Causal Forests and the Normalised-Double-Robust Learner performed best, while Bayesian Additive Regression Trees performed worst. Additionally, we find evidence that with small sample sizes or in settings where the ratio of covariates to samples is high, learning policy trees using CATEs has a better performance than using doubly-robust scores. The methods are applied to a case study that investigates infant mortality through improved targeting of subsidised health insurance in Indonesia. |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2302.05260&r=hea |
| By: | Lin, Zhuoer (Yale University); Fu, Mingqi (Wuhan University); Chen, Xi (Yale University) |
| Abstract: | Cognitive misperception contributed to poor decision-making; yet their impact on health-related decisions is less known. We examined how self-perceived memory was associated with chronic disease awareness among older Chinese adults. Data were obtained from the China Health and Retirement Longitudinal Study. Nationally representative blood biomarkers identify participants' dyslipidemia and diabetes status. Among participants with biomarker identified dyslipidemia or diabetes, disease awareness was defined as self-reported diagnosis of the conditions. The proportions of disease awareness were lower for individuals with better self-perceived memory and those with more impaired cognitive ability, showing opposite patterns. Controlling for cognitive ability and covariates, self-perceived memory was negatively associated with the dyslipidemia and diabetes awareness. In particular, older adults with the highest level of self-perceived memory had significantly lower disease awareness as compared to those with the lowest level of self-perceived memory. Our findings were robust to alternative cognitive measures and were stronger for less educated rural residents or those living without children. Cognitive misperception poses great challenges to chronic disease management. Targeted interventions and supports are needed, particularly for the disadvantaged. |
| Keywords: | cognitive impairment, self-perceived memory, chronic disease awareness, dyslipidemia, diabetes |
| JEL: | I12 J14 D91 I18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15934&r=hea |
| By: | Yinan Liu; Emma Zai (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | Medicaid aging waivers incentivize older adults who need long-term care to stay at home rather than move into a nursing facility. However, this policy may inadvertently shift care burdens onto informal caregivers. Using data on state-level waiver expenditure from 1998 to 2014 linked with the restricted access Health and Retirement Study (HRS), this paper investigates whether program funding is associated with the probability that an HRS respondent provides informal care to her older parents. Changes to state-level policy funding produce a quasi-experiment, which allows us to use two-way fixed effects models to estimate a causal relationship between the program and informal caregiving. The findings show that a 10 percent increase in aging waiver expenditure increases the overall likelihood that an adult child becomes an informal caregiver to her parents by 0.1 percentage points (0.3 percent). The overall estimate is composed of differential effects on different types of care. The results show that the Medicaid aging waiver funding is positively associated with the likelihood of being an errands caregiver and a non-intensive caregiver who spends fewer hours providing care, but unrelated to the likelihood of providing personal care and intensive care. The findings are mainly driven by the mechanism that aging-at-home is more attractive supported by the aging waivers. |
| JEL: | J1 Z0 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2023-006&r=hea |
| By: | Silvia Loi (Max Planck Institute for Demographic Research, Rostock, Germany); Peng Li (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | The weathering hypothesis implies that there is an interaction between age and race or ethnicity that results in disadvantaged groups experiencing a more rapid decline in health than other groups. While the weathering hypothesis has been tested based on racial or ethnic identity, less is known about weathering by immigration status, and about weathering as viewed from an intersectional perspective. We contribute to the literature on weathering by addressing three research questions: Are immigrants, and especially immigrant women, ageing in poorer health? Does education protect immigrants from a faster health decline with age? How do income and marital status affect the health trajectories of immigrants and natives? We focus on Germany and estimate trajectories of declining health at the intersection of age, sex, and nativity, and evaluate the role of education. We estimate the ages at immigrant-native crossover across the health trajectories, and the corresponding health levels. We find that immigrants, and especially immigrant women, age in poorer health than natives. Furthermore, we show that high education explains the differential relationship between age, nativity, and health. We also find that employment and marital status only partly account for the observed gaps, as differences persist even after these factors are considered. |
| JEL: | J1 Z0 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2023-005&r=hea |
| By: | María Noel Pi Alperin; Magali Perquin; Gastón A. Giordana |
| Abstract: | This paper uses long-term population projections to study the evolution of dementia in Luxembourg through 2070, as well as its impact on public expenditure through healthcare and long-term care. We extend the Giordana and Pi Alperin (2022) model by adding an algorithm to identify individuals suffering from dementia. This allows us to simulate dementia prevalence among individuals aged 50 and more in several scenarios incorporating alternative hypotheses about risk factors, new treatments and comorbidities (including long-run effects of COVID-19). Public health policies reducing stroke and hypertension risk could lower dementia prevalence by 17% and public expenditure on healthcare for dementia patients by a similar amount. A new treatment extending the mild dementia phase could nearly double prevalence and possibly triple the associated healthcare costs. Finally, past exposure to COVID-19 could raise prevalence by 12% to 24% in the medium term and public expenditure on dementia healthcare by 6% to 12%. Public expenditure on long-term care for dementia patients would increase even more, generally doubling by 2070. |
| Keywords: | Dementia, Dynamic micro-simulation, Healthcare, Health-related public expenditure, Long-term care, Luxembourg, SHARE |
| JEL: | D3 H30 I10 I12 I13 I18 |
| Date: | 2023–01 |
| URL: | http://d.repec.org/n?u=RePEc:bcl:bclwop:bclwp170&r=hea |
| By: | Marjorie Pierrette (INRS ( Vandoeuvre lès Nancy) - Institut national de recherche et de sécurité (Vandoeuvre lès Nancy)); Aude Cuny-Gerrier (INRS ( Vandoeuvre lès Nancy) - Institut national de recherche et de sécurité (Vandoeuvre lès Nancy)) |
| Abstract: | What were the consequences of the Covid-19 pandemic for the working conditions and the health of french nursing home care workers. This is an already fragile sector that has to deal with a significant and constantly increasing number of claims. A questionnaire was distributed between October and December 2020 to caregivers, nurses and nurse coordinators of private French nursing home. The results make it possible to identify factors, depending on the occupation, particularly predictive of health and to provide guidelines for practitioners in the sector on the adjustements to be proposed in connection with a pandemic situation. |
| Abstract: | Quelles conséquences la pandémie de Covid-19 a-t-elle eu sur le travail et la santé du personnel soignant dans les établissements d'hébergement pour personnes âgées dépendantes (Ehpad) privés en France ? Un secteur pourtant déjà fragile qui doit faire face à une sinistralité importante en constante augmentation. Un questionnaire a été diffusé entre octobre et décembre 2020 aux aides-soignants, infirmiers et infirmiers coordinateurs d'Ehpad privés français. Les résultats permettent également d'identifier certains facteurs particulièrement prédicteurs de la santé selon le métier et d'alimenter les réflexions des professionnels du secteur sur les aménagements à proposer en lien avec une situation pandémique et des conditions de travail transitoires et/ou pérennes en découlant. |
| Keywords: | Crise sanitaire, Personnel soignant, Milieu de soins, Organisation du travail, Conditions de travail, Risque psychosocial, RPS, Enquête |
| Date: | 2022–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03890326&r=hea |
| By: | Björkman Nyqvist, Martina (Mistra Center for Sustainable Markets (Misum)); Jayachandran, Seema (Princeton University); Zipfel, Céline (Mistra Center for Sustainable Markets (Misum)) |
| Abstract: | Building on prior evidence that mothers often have a stronger preference for spending on children than fathers do, we use a randomized experiment to evaluate the impacts of a communication training program for mothers on child health in Uganda. The hypothesis is that the training will enable women to better convey their knowledge and preferences to their husbands and, thereby, boost investments in children’s health. We find that the program increases spousal discussion about the family’s health, nutrition, and finances. However, this does not increase overall adoption of health-promoting behaviors or improve child anthropometrics. One exception is that the communication training increases women’s and children’s intake of protein-rich foods as well as household spending on these foods. |
| Keywords: | Spouse; Communication; Child health; Investments; Uganda |
| JEL: | I12 I15 J12 O15 |
| Date: | 2023–02–14 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:hamisu:2023_013&r=hea |
| By: | Coen van de Kraats (Erasmus University Rotterdam); Titus Galama (University of Southern California); Maarten Lindeboom (Vrije Universiteit Amsterdam and Monash University) |
| 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 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 substantially lower levels of mental well-being, comparable to, e.g., the detriment of being widowed. 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. |
| Keywords: | mental well-being, social norm of work, retirement institutions |
| JEL: | I10 I31 J60 D63 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:mhe:chemon:2023-03&r=hea |
| By: | Rácz, Olivér Miklós |
| Abstract: | Distancing policies became the primary preventive intervention during the COVID-19 pandemic. This paper estimates the effect of such interventions on the effective reproduction number (Rt) of this virus on a daily panel of 109 countries. Distancing interventions affect COVID infections indirectly through the regulation of social behaviors, which are also a function of voluntary decisions. The main contribution of this paper is the separation of policy-compliant and voluntary distancing effects. I identify the policy-compliant component of distancing behavior as rapid changes in social activity immediately after an intervention. This allows me to isolate the voluntary component as residual changes in activity. I use the isolated voluntary component as a control in the main estimation of distancing policy effects on Rt. I distinguish between (i) place restrictions: restricting destinations and (ii) mobility restrictions: regulations on inland movements. I find strong and permanent effects for both types of restrictions. Place restrictions that target specific destinations are found to be less effective than general mobility restrictions. The effect of voluntary distancing is also significantly negative but weaker than that of policy restrictions. These results suggest that governments can use distancing restrictions effectively in pushing the effective reproduction number below the containment threshold: Rt = 1. |
| Keywords: | COVID-19, non-pharmaceutical interventions, causal identification, reproduction number, regression-discontinuity-in-time |
| JEL: | C33 C43 C54 E65 H12 H39 H84 I12 I18 |
| Date: | 2023–02–20 |
| URL: | http://d.repec.org/n?u=RePEc:cvh:coecwp:2023/01&r=hea |