|
on Health Economics |
| By: | Hanming Fang; King King Li; Peiyao Shen |
| Abstract: | Coal heating in residential homes is an important source of indoor air pollution, leading to detrimental health effects. We conduct a randomized field experiment in northern China using three types of SMS campaigns targeting three potential biases that may hinder the adoption of electric heating: a Cost SMS campaign, designed to address the overestimation of electricity expenses; a Health SMS campaign, aimed at addressing the underestimation of health damage associated with coal heating; and a Social Comparison SMS campaign, intended to inform households about the popularity of electric heating. We find that the Cost SMS backfires: it instead leads to a substantial reduction in electric heating, which can be attributed to salience bias induced by the Cost SMS, which drew heightened attention to the cost of electricity. The Health SMS is ineffective for households that underestimate the health damage of coal heating and even backfires for those who expressed little concern about the health consequences. Social Comparison SMS is only effective for a small proportion of households who were concerned about their neighbors' heating choices. Overall, our findings suggest that SMS campaigns targeting these biases are largely ineffective, and caution should be exercised when applying plausible nudge interventions. The findings also suggest that households may be motivated to maintain their beliefs and resist paternalistic interventions. |
| JEL: | C93 D91 Q50 Q58 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31841&r=hea |
| By: | Leonardo Bursztyn; Jonathan Kolstad; Aakaash Rao; Pietro Tebaldi; Noam Yuchtman |
| Abstract: | We study how the politicization of policies designed to correct market failures can undermine their effectiveness. The Patient Protection and Affordable Care Act (ACA) was among the most politically divisive expansions of the US government. We examine whether partisanship distorted enrollment and market outcomes in the ACA insurance marketplaces. Controlling for observable characteristics and holding fixed plans and premiums available, Republicans enrolled less than Democrats and independents in ACA marketplace plans. Selection out of the ACA marketplaces was strongest among Republicans with lower expected healthcare costs, generating adverse selection. Computing enrollment and average cost with and without partisan differences, we find that this political adverse selection reduced enrollment by around three million people and raised average costs in the marketplaces, increasing the level of public spending necessary to provide subsidies to low-income enrollees by around $105 per enrollee per year. Lower enrollments and higher costs are concentrated in more Republican areas, potentially contributing to polarized views of the ACA. |
| Keywords: | politicization, policies, marketplace, adverse |
| Date: | 2022–07–12 |
| URL: | http://d.repec.org/n?u=RePEc:cep:poidwp:034&r=hea |
| By: | Martin Gaynor; Adam Sacarny; Raffaella Sadun; Chad Syverson; Shruthi Venkatesh |
| Abstract: | Despite the continuing US hospital merger wave, it remains unclear how mergers change, or fail to change, hospital behavior and performance. We open the "black box" of hospital practices through a mega-merger between two for-profit chains. Benchmarking the merger's effects against the acquirer's stated aims, we show they achieved some of their goals, harmonizing electronic medical records and sending managers to target hospitals. Post-acquisition managerial processes were similar across the merged chain. However, these interventions failed to drive detectable gains in performance. Our findings demonstrate the importance of organizations for merger research in health care and the economy more generally. |
| Keywords: | health care, hospital mergers, US |
| Date: | 2022–03–31 |
| URL: | http://d.repec.org/n?u=RePEc:cep:poidwp:030&r=hea |
| By: | Bai, Liang; Handel, Benjamin; Miguel, Edward; Rao, Gautam |
| Abstract: | Self-control problems constitute a potential explanation for the underinvestment in preventive health in low-income countries. Behavioral economics offers a tool to solve such problems: commitment devices. We conduct a field experiment to evaluate the effectiveness of different types of theoretically motivated commitment contracts in increasing preventive doctor visits by hypertensive patients in rural India. Despite achieving high take-up of such contracts in some treatment arms, we find no effects on actual doctor visits or individual health outcomes. A substantial number of individuals pay for commitment but fail to follow through on the doctor visit, losing money without experiencing health benefits. We develop and structurally estimate a prespecified model of consumer behavior under present bias with varying levels of naiveté. The results are consistent with a large share of individuals being partially naive about their own self-control problems: sophisticated enough to demand some commitment but overly optimistic about whether a given level of commitment is sufficiently strong to be effective. The results suggest that commitment devices may in practice be welfare diminishing, at least in some contexts, and serve as a cautionary tale about their role in health care. |
| Keywords: | Economics, Applied Economics, Prevention, Clinical Research, Good Health and Well Being, Econometrics, Banking, finance and investment, Applied economics |
| Date: | 2021–12–02 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:econwp:qt3w3154kb&r=hea |
| By: | Bart Cockx (Department of Economics, Ghent University. CESifo (Munich), IRES (UCLouvain), IZA (Bonn), ROA (Maastricht University).); Jinkai Li (Department of Economics, Ghent University.); Erga Luo (Department of Agricultural Economics and Management, Zhejiang University.) |
| Abstract: | In 2015, 15% of all children in China were left behind in the countryside because at least one of their parents migrated to a city. We implement an event study analysis between 2010 and 2018 on five waves of the China Family Panel Studies (CFPS) to investigate the dynamic effects of parental migration on the health of left behind young children (LBC). While we find a gradual increase in medical expenditures, we do not detect any significant impact on the incidence of sickness. Furthermore, the analysis shows that the incidence of overweight declines gradually since their parents’ first migration and reports suggestive evidence for mental health improvement. We argue that these long-term positive effects on health and health consumption can be explained by the transitory nature of migration, the high-quality substitution of the caregiver role by grandparents, and by a reorientation in family expenditures, partly induced by government policy. |
| Keywords: | young left-behind children; parental migration; Hukou system; long-term impact on health; event study analysis; mechanisms analysis |
| JEL: | I15 J10 J61 |
| Date: | 2023–11–12 |
| URL: | http://d.repec.org/n?u=RePEc:ctl:louvir:2023019&r=hea |
| By: | Muhammad Fawdy Renardi Wahyu (Department of Economics, Faculty of Economics and Business, Universitas Gadjah Mada); Ardyanto Fitrady (Department of Economics, Faculty of Economics and Business, Universitas Gadjah Mada) |
| Abstract: | We analyze the optimal cigarette excise tax rate based on the optimal tax theory. We find that the optimal tax is different when there is an illegal production of cigarettes. We find that, without illegal production of cigarettes, the government can achieve the first best optimum condition by fully internalizing externality. The government can optimally choose the amount of tax on legal cigarettes that is equal to the marginal cost of health care. When there is an illegal production of cigarettes, we find that the rate of cigarette excise tax is not equal to the marginal cost of health care. Therefore, the government need more policy instruments to achieve the optimal tax rate in this case. We also find that an increase in the work hours of a legal cigarette production reduces illegal cigarette productions. Policymakers can use marginal income tax policy as an incentive to reduce illegal production of cigarettes. |
| Keywords: | Optimal Tax, Excise Tax, Indonesia Cigarettes Excise Tax |
| JEL: | D11 H2 H21 |
| Date: | 2023–03 |
| URL: | http://d.repec.org/n?u=RePEc:gme:wpaper:202303001&r=hea |
| By: | Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany); Torsten Santavirta |
| Abstract: | We study the long-run effect of early adulthood prison camp exposure on mortality using an examiner design and data on 6, 961 former prisoners during the Finnish Civil War of 1918. Our descriptive analysis shows a statistically significant adverse association and a dose response between prison sentence length and old-age mortality. Our instrumental variable design exploits the variation in judge sentence tendency across quasi-randomly assigned judges. We document an effect of sentence length on old-age mortality that is five times larger than the estimated associations. We show that our causal estimates have a local average treatment effect interpretation for the compliers. Keywords: Civil war, Ageing, Mortality, Examiner design |
| JEL: | J1 Z0 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2023-045&r=hea |
| By: | Ferdi Botha (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne); Jan Kabátek (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne); Jordy Meekes (Department of Economics, Leiden University, Netherlands); Roger Wilkins (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne) |
| Abstract: | In this study, we quantify the causal effects of commuting time and working from home (WFH) arrangements on the mental health of Australian men and women. Leveraging rich panel-data models, we first show that adverse effects of commuting time manifest only among men. These are concentrated among individuals with pre-existing mental health issues, and they are modest in magnitude. Second, we show that WFH arrangements have large positive effects on women’s mental health, provided that the WFH component is large enough. The effects are once again concentrated among individuals with pre-existing mental health issues. This effect specificity is novel and extends beyond Australia: we show that it also underlies the adverse effects of commuting time on the mental health of British women. Our findings highlight the importance of targeted interventions and support for individuals who are dealing with mental health problems. |
| Keywords: | mental health, commuting, working from home, unconditional quantile regression |
| JEL: | D1 I1 R41 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2023n15&r=hea |
| By: | Marcelo Cajias; Rebecca Restle |
| Abstract: | Knowledge of emission sources is essential to take measures in time to mitigate the subsequent effects on health and the environment. In general terms, substances that are harmful to health and the environment are called air pollutants. The World Health Organization (WHO 2022b) estimated ~ 37.000 premature deaths related to ambient air pollution in Germany in 2016. Air pollution is a concern for everyone, but its effects are not compensated, and the originator is not required to cover the costs. Several methods have been developed to determine these costs. In the context of air pollution, the revealed-preference method is considered as it "involves determining the value that consumers hold for an environmental good by observing their purchase of goods in the market that directly – or indirectly – relate to environmental quality". Based on a semiparametric hedonic regression this paper evaluates the impact of air quality on the asking rents in Berlin between 2018 and 2021. The rental income of apartments located in areas with low pollution was 2% higher than market average. Assets in areas with high pollution were offered at a discount between –2% and -6% in comparison with average assets. |
| Keywords: | Air pollution; Geostatistics; Residential Real Estate; semiparametric geographic hedonic models |
| JEL: | R3 |
| Date: | 2023–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:eres2023_50&r=hea |
| By: | Claire Lepault (CIRED - Centre International de Recherche sur l'Environnement et le Développement - Cirad - Centre de Coopération Internationale en Recherche Agronomique pour le Développement - EHESS - École des hautes études en sciences sociales - AgroParisTech - ENPC - École des Ponts ParisTech - Université Paris-Saclay - CNRS - Centre National de la Recherche Scientifique, 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) |
| Abstract: | In developing countries, untreated sewage exposes people to alarming water pollution levels, yet there is limited knowledge about the effectiveness of wastewater treatment investments. I leverage the national inventory of sewage treatment plants in India and various granular datasets on river water quality measures, as well as geo-localized information on child births and deaths, to identify robust effects of wastewater treatment installations. To do so, I use estimators robust to staggered adoption within a difference-indifferences design and compare urban areas that started wastewater treatment from 2010 onwards and urban areas where such treatment was planned or under construction in 2020. I show that after starting wastewater treatment, levels of fecal coliforms decreased by 50%, and downstream mortality under the age of six months declined by 20%. A back-of the-envelope calculation suggests that starting wastewater treatment earlier-from 2010 onwards-in urban areas later selected into treatment-after 2020-would have prevented over 40, 000 child deaths in downstream sub-basins. |
| Keywords: | infrastructure, wastewater treatment, water quality, infant mortality, India |
| Date: | 2023–10–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:ciredw:hal-04232407&r=hea |
| By: | Axel Ockenfels; Alvin Roth |
| Abstract: | The European Commission is considering new ways to regulate the ‘substances of human origin’ –including blood, plasma, and cells – used in medical procedures from transfusions andtransplants to assisted reproduction. This column argues that such legislation jeopardises theinterests of both donors and recipients. While sympathetic to the intentions behind the proposals–which aim to ensure that donations are voluntary and to protect financially disadvantageddonors – the authors believe such rules overlook the effects on donors, on the supply of suchsubstances, and on the health of those who need them. |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:ajk:ajkpbs:055&r=hea |
| By: | Angelique Acquatella; Keith Marzilli Ericson; Amanda Starc |
| Abstract: | We examine cost-plus lagged-price reimbursement contracts, focusing on Medicare Part B's payment for physician-administered drugs. Our theoretical model shows that lagged-price reimbursement can raise launch prices but lower prices in later periods. While previous research showed Part B increased launch prices, we estimate its effect on later prices (net of rebates). Drugs more exposed to Medicare have lower price growth. A drug with above median Part B exposure has a 10% lower price after 3 years than a below median exposure drug that launched at the same price, with a larger effect for newly approved molecules. |
| JEL: | H57 I11 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31834&r=hea |
| By: | Pieter Bakx; Eddy Van Doorslaer; Bram Wouterse |
| Abstract: | We describe the financing and use of long-term care in the Netherlands. Public long-term care insurance is universal and comprehensive; user fees are low compared to other countries. We use linked survey and administrative data to document the distribution of the need for long-term care in the 65+ population, long-term care costs and how they are paid for. The findings reveal that no other country spends more per capita on publicly financed formal care than The Netherlands. A potential reason is that the threshold to receive formal care appears to be lower in the Netherlands than in other countries. Still, a considerable share of the adult population provides informal care. Caregiving is concentrated in specific demographic groups. The costs of informal care provision are considerable, but as a share of total spending on long term care they are smaller than in most developed countries. Adding the costs of informal care to formal care expenditures changes the view on who bears the costs of long-term care. |
| JEL: | I10 I13 I18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31823&r=hea |
| By: | Joan Costa-Font; Sergi Jimenez-Martin; Cristina Vilaplana-Prieto; Analía Viola |
| Abstract: | Spain together with Scotland are two countries that exhibit the largest expansions in long term care (LTC) in the last two decades, universalizing subsidies and supports. This paper is part of a global effort to provide a snapshot of the trends in LTC use and access, as well as the financing, and organization of the LTC system compared to other higher-income countries. The passage of Act 39/2006 on the Promotion of Personal Autonomy and Care for Dependent Persons (SAAD in Spanish) on December 14th, 2006, universalized coverage for care subsidies and supports, allowing access to care conditioned only on individuals’ assessment of care needs. As a consequence, LTC spending as a percentage of GDP has risen from 0.5% in 2003 to nearly 0.9% in 2019, despite private LTC insurance playing a minor role. Still today, LTC remains heavily reliant on informal care, which is now partially subsidized by a caregiving subsidy as part of SAAD. Long-term care spending in Spain amounts to between 1.27% (conservative estimates) and 1.70% (flexible estimation) of GDP. Finally, the system reveals significant gender imbalances in the provision of care, with women accounting for most caregivers in both formal (87%) and informal (58%) care. |
| JEL: | D14 G22 I18 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31825&r=hea |
| By: | Rong Fu; Toshiaki Iizuka; Haruko Noguchi |
| Abstract: | Japan, renowned for its significantly aged population, presents a distinctive landscape in elderly care. Notably, there exists no apparent correlation between the economic well-being of the elderly and the limitations they experience in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). In response to the escalating demand for elderly care, Japan introduced the public Long-Term Care Insurance (LTCI) system in 2000. This comprehensive program offers a wide spectrum of long-term care services, aiming to facilitate aging in place for seniors and alleviate the burdens on informal caregivers. Nevertheless, the LTCI system faces substantial challenges, predominantly related to financial sustainability and a shortage of human resources. Ongoing discussions center on achieving cost-effective service delivery, potential adjustments to premium rates and copayments, especially for individuals with ample financial resources or minimal care needs. Furthermore, debates surround the reduction of the age of eligibility for LTCI, with opposition stemming from intricate financial and structural considerations. Japan grapples with a deficiency of social security contributors and skilled care workers, necessitating endeavors to enhance labor force participation and foster innovation in the long-term care sector. Japan's LTCI system offers invaluable insights for countries grappling with akin demographic and care-related predicaments. |
| JEL: | I10 I13 I18 I19 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31829&r=hea |
| By: | James Banks; Eric French; Jeremy McCauley |
| Abstract: | This paper describes the state of Long-Term Care (LTC) in England, which is facing increasing strain due to population aging. We piece together microeconomic and aggregate data in order to give an overview of the demand and supply of LTC in England in a way that facilitates comparisons with other countries, and briefly discuss current LTC policy and recent reforms. |
| JEL: | H51 I1 |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31826&r=hea |
| By: | Jonathan Wood; Sotirios Thanos; Anupam Nanda |
| Abstract: | Alcohol outlets are ubiquitous in UK urban centres and play a significant role both in the development of the built environment and in how people interact with urban spaces. There is a well established literature focusing on the health and social outcomes of the density and distribution of alcohol outlet. However, there is a clear research gap in examining how socioeconomic and urban characteristics impact the density and distribution of alcohol outlets. Factors relevant to the study of the density and distribution of the alcohol outlet industry are diverse but can be fitted into two main categories: variations in the rate of change in alcohol outlets densities; and variations in the change in market share between alcohol outlet typologies. This research takes a longitudinal approach applying panel count regression analysis techniques to model adaptations in the alcohol market across two UK cities, Manchester and Nottingham. Manchester and Nottingham make representative study areas for the UK context, with wide variation in urban density and socioeconomic characteristics. A novel dataset is employed that contains spatio-temporal counts of alcohol outlets across the study areas for the years 2002 to 2020. A high specificity of alcohol outlet characteristics allows for the creation of niche outlet typologies, allowing for the granular analysis of the wide range of sub-markets reflecting the market heterogeneity. |
| Keywords: | Alcohol Outlets; Location Patterns |
| JEL: | R3 |
| Date: | 2023–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:eres2023_309&r=hea |
| By: | Miguel, Edward; Mobarak, Ahmed Mushfiq |
| Abstract: | The COVID-19 pandemic has upended health and living standards around the world. This article provides an interim overview of these effects, with a particular focus on low- and middle-income countries (LMICs). Economists have explained how the pandemic is likely to have different consequences for LMICs and demands distinct policy responses compared to those of rich countries. We survey the rapidly expanding body of empirical research that documents the pandemic's many adverse economic and noneconomic effects in terms of living standards, education, health, and gender equality, which appear to be unprecedented in scope and scale. We also review research on successful and failed policy responses, including the failure to ensure widespread vaccine coverage in many LMICs, which is needed to end the pandemic. We close with a discussion of implications for public policy in LMICs and for the institutions of international governance, given the likelihood of future pandemics and other major shocks (e.g., climate). |
| Keywords: | Economics, Applied Economics, Economic Theory, Prevention, Generic health relevance, COVID-19, pandemics, economic development, public health, low- and middle-income countries, LMICs, Applied economics, Economic theory |
| Date: | 2022–08–12 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:econwp:qt0191q2qs&r=hea |
| By: | Jose Maria Barrero; Nicholas Bloom; Steven J. Davis |
| Abstract: | Many working-age Americans say they will continue some forms of social distancing after the COVID-19 pandemic ends. We uncover this long social distancing phenomenon in our monthly Survey of Working Arrangements and Attitudes. It is stronger among older persons, the less educated, and those who live with or care for persons at high risk from infectious diseases. Regression models fit to individual-level data suggest that social distancing lowered labor force participation by 2.4 percentage points in 2022, 1.2 points on an earnings-weighted basis. Daily interactions with at-risk persons and long COVID experiences lead to larger drags on participation. When combined with simple equilibrium models, our results imply that the social-distancing drag on participation reduced U.S. output by $205 billion in 2022, shrank the college wage premium by 2.1 percentage points, and modestly steepened the cross-sectional age-wage profile. Our data also say that social distancing intentions overlap with, but are broader than, infection worries. Drawing on self-assessed causal effects in a separate analysis, we estimate that infection worries lowered participation by one percentage point as of late 2022. |
| Keywords: | Covid-19, social distancing, working from home, productivity |
| Date: | 2023–04–26 |
| URL: | http://d.repec.org/n?u=RePEc:cep:cepdps:dp1918&r=hea |