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on Health Economics |
| By: | Hackmann, Martin B.; Pohl, R. Vincent; Ziebarth, Nicolas R. |
| Abstract: | How do patient and provider incentives affect the provision of long-term care? Our analysis of 551 thousand nursing home stays yields three main insights. First, Medicaid-covered residents prolong their stays instead of transitioning to community-based care due to limited cost-sharing. Second, when facility capacity binds, nursing homes shorten Medicaid stays to admit more profitable out-of-pocket private payers. Third, providers react more elastically to financial incentives than patients. Thus, targeting provider incentives through alternative payment models, such as episode-based reimbursement, is more effective than increasing patient cost-sharing in facilitating transitions to community-based care and generating long-term care savings. |
| Keywords: | Long-Term Care, Nursing Homes, Patient Incentives, Provider Incentives, Cost-Sharing, Episode-Based Reimbursement, Medicaid |
| JEL: | H51 H75 I11 I13 I18 J14 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:280928&r=hea |
| By: | Michael E. Darden; Mario Macis |
| Abstract: | We present results from a nationally representative survey of American adults, guided by a simple theoretical model expressing health care-seeking behavior as a function of economic and behavioral fundamentals and highlighting the role of trust. We report several findings. First, we document a strong association between higher levels of trust in the health care system and reported care-seeking behavior, both retrospective and anticipated. This relationship holds across several care scenarios, from routine check-ups to vaccinations. Second, the impact of trust on health care utilization is similar in magnitude to that of factors such as income and education, long recognized as crucial in the existing literature. Third, the relationship between trust and care-seeking behavior appears to be mediated by key mechanisms from our theoretical framework, notably individuals’ beliefs about the system's effectiveness in managing their health and their personal disutility tied to medical visits. Fourth, we ask respondents about trust in specific health care system sectors, and we find important heterogeneity in the associations between trust and care-seeking behavior, notably between trust in the Centers for Disease Control and Prevention and the likelihood to receive flu and COVID-19 vaccinations. Finally, we find no differential relationship between trust and care-seeking for Black respondents, but we find important differences by age and political affiliation. Our findings hold significant implications for policy, particularly given that trust in medical and, more broadly, scientific expertise is increasingly difficult to establish. |
| JEL: | I11 I12 I14 I18 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32028&r=hea |
| By: | Packham, Analisa (Vanderbilt University); Slusky, David (University of Kansas) |
| Abstract: | We estimate the causal impact of access to means-tested public health insurance coverage (Medicaid) on health outcomes and recidivism for those recently released from incarceration. To do so, we leverage a policy change in South Carolina that allowed simplified Medicaid re-enrollment for previously incarcerated eligible individuals. Using linked administrative data on criminal convictions and health insurance claims, we find that reducing barriers in access to Medicaid for vulnerable populations increases enrollment and utilization of health care services. However, we do not find that this improved health care insurance access reduces 1-year or 3-year recidivism, suggesting that effectiveness of such policies is context dependent. |
| Keywords: | Medicaid, health care utilization, recidivism |
| JEL: | I38 I18 K42 |
| Date: | 2023–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16665&r=hea |
| By: | Lavetti, Kurt; DeLeire, Thomas C.; Ziebarth, Nicolas R. |
| Abstract: | The Affordable Care Act requires insurers to offer cost sharing reductions (CSRs) to low-income consumers on the Marketplaces. We link 2013-2015 All-Payer Claims Data to 2004-2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the actuarial value of CSR plans that are solely determined by income. This allows us to examine the effect of cost sharing on medical spending among low-income individuals. We find that enrollees facing lower levels of cost sharing have higher levels of health care spending, controlling for past health care use. We estimate demand elasticities of total health care spending among this low-income population of approximately -0.12, suggesting that demand-side price mechanisms in health insurance design work similarly for low-income and higher-income individuals. We also find that cost sharing subsidies substantially lower out-of-pocket medical care spending, showing that the CSR program is a key mechanism for making health care affordable to low-income individuals. |
| Keywords: | demand elasticities, health insurance, moral hazard, ACA, marketplaces, AV-variants, low-value care, lifestyle drugs, value-based CSRs, Utah |
| JEL: | H24 H41 H43 H51 I11 I18 J32 J33 J68 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:280989&r=hea |
| By: | Michael J. Dickstein; Jihye Jeon; Eduardo Morales |
| Abstract: | Health insurance plans in the U.S. increasingly use price mechanisms to steer demand for prescription drugs. The effectiveness of these incentives, however, depends both on physicians' price sensitivity and their knowledge of patient prices. We develop a moment inequality model that allows researchers to identify agents' preferences without fully specifying their information. Applying this model to diabetes care, we find that physicians lack detailed price information and are more price-elastic than full-information models imply. We predict that providing physicians detailed information on prices at the point of prescribing can save patients 12-23% of their out-of-pocket costs for diabetes treatment. |
| JEL: | I11 I13 L0 L15 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32014&r=hea |
| By: | Rowland, Neil; McVicar, Duncan; Vlachos, Stavros; Jahanshahi, Babak; McGovern, Mark E.; O’Reilly, Dermot |
| Abstract: | Extensive evidence shows exposure to ambient PM2.5 is associated with a wide range of poor health outcomes. But few studies examine genuinely long-run pollution exposures in nationally representative data. This study does so, exploiting longitudinally-linked Census data for Northern Ireland, linked to annual average PM2.5 concentrations at the 1km grid-square level from 2002-2010, exploiting complete residential histories. We show strong unconditional associations between PM2.5 exposure, self-rated general health, disability, and all available (eleven) domain-specific health measures in the data. Associations with poor general health, chronic illness, breathing difficulties, mobility difficulties, and deafness are robust to extensive conditioning and to further analysis designed to examine sensitivity to unobserved confounders. |
| Keywords: | Long-term exposure to ambient air pollution, PM2.5, population health, linked Census data, neighbourhood fixed effects, Oster method for unobserved confounding |
| JEL: | I10 I18 Q53 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:qmsrps:202401&r=hea |
| By: | Adamopoulou, Effrosyni; Olivieri, Elisabetta; Triviza, Eleftheria |
| Abstract: | This study explores the long-run effects of a temporary scarcity of a consumption good on preferences towards that good once the shock is over. Specifically, we focus on individuals who were children during World War II and assess the consequences of the temporary drop in meat availability they experienced early in life. To this end, we combine new hand-collected historical data on the number of livestock at the local level with microdata on eating habits, health outcomes, and food consumption expenditures. By exploiting cohort and regional variation in a difference-in-differences estimation, we show that individuals who as children were more exposed to meat scarcity tend to consume relatively more meat and spend more on food during late adulthood. Consistent with medical studies on the side effects of meat overconsumption, we also find that these individuals have a higher probability of being obese, having poor self-perceived health, and developing cancer. The effects are larger for women and persist intergenerationally, as the adult children of mothers who experienced meat scarcity similarly tend to overconsume meat. Our results point towards a behavioral channel, where early-life shocks shape eating habits, food consumption, and adult health. |
| Keywords: | preferences, food consumption, early life experiences, gender differences |
| JEL: | D12 I10 N44 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:zewdip:280927&r=hea |
| By: | Olivier Guillot |
| Abstract: | Based on individual-level data from military registers, this paper explores the trajectories of French conscripts during the Great War. The sample studied consists of more than 20, 000 men of the recruitment classes of 1900 to 1914. Besides a descriptive analysis, which aims at providing both a statistical portrait of conscripts and an insight into their wartime paths, regression analyses are carried out to identify factors influencing, or associated with, (1) fitness for armed service, (2) assignment to a civilian rather than military position, (3) infantry assignment, and (4) war mortality. The main focus is on whether there were inequalities in combat exposure and mortality in relation to socioeconomic status (as measured by family background, education, and occupation). The results of these analyses suggest that some social groups were more exposed to war violence than others. In particular, it appears that conscripts employed as farmers in civilian life were more likely to be considered fit to fight than industry/craft workers and (most of) men working in the tertiary sector. They were also more likely to join the war as infantry soldiers and had a lower probability to be recalled from the front and assigned to a civilian position. All this partly explains why mortality was higher in this group. Similarly, the analysis of deaths reveals that conscripts from disadvantaged family backgrounds (i.e. who were born out of wedlock and/or placed in public care during childhood) had a higher risk of dying during the conflict. The differences in mortality risk according to family background and occupation were, however, of lower magnitude than those associated with military characteristics (recruitment class, assignment and rank). |
| Keywords: | World War 1; French Army; war mortality; social stratification; archival data. |
| JEL: | N34 N44 Z13 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ulp:sbbeta:2023-39&r=hea |
| By: | Alberto Prati; Charlotte Saucet |
| Abstract: | The paper estimates the causal effect of a health treatment on patients’ beliefs, preferences and memories about the treatment. It exploits a natural experiment which occurred in the United Kingdom during the COVID-19 vaccination campaign. UK residents could choose to opt into the vaccination program, but not which vaccine they received. The assignment to a vaccine offered little objective information for learning about its qualities, but triggered strong psychological demand for reassuring beliefs. We surveyed a sample of UK residents about their beliefs on the different COVID-19 vaccines before and after receiving their jab. Before vaccination, individuals exhibit similar prior beliefs and stated preferences about the different vaccines. After vaccination, however, they update their beliefs overly optimistically about the safety and effectiveness of the vaccine they received, state that they would have chosen it if they could, and have distorted memories about their past beliefs. These results cannot be explained by conventional experience effects. At the aggregated level, they show that random assignment to a health treatment predicts a polarization of opinions about its quality. At the individual level, these findings provide evidence in line with the predictions of motivated beliefs and over-inference from weak signals in a real-world health setting. |
| Date: | 2023–01–08 |
| URL: | http://d.repec.org/n?u=RePEc:oxf:wpaper:1031&r=hea |
| By: | Fane Groes; Anna Houstecka; Daniela Iorio; Raül Santaeulàlia-Llopis |
| Abstract: | Using Danish administrative data, we show that IVF success is associated with maternal education: College-educated women have a 9% higher live birth chance than high school-educated women and 25% higher than dropouts. We exclude infertility causes, health, clinics, finances, and partner attributes as drivers. Instead, we focus on latent factors like ability and psychological traits. First, we show how proxies for these factors like Grade Point Average (GPA) shape IVF success. Second, we build a dynamic model of post-IVF-failure dropout where women differ in latent ability and psychological costs. Our model counterfactuals imply that ability explains 87% of the education gradient in IVF success, prompting a policy discussion. |
| Keywords: | in-vitro fertilization, success, inequality, infertility, education, ability, administrative data, endogenous dropouts |
| JEL: | I00 J13 E00 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:bge:wpaper:1421&r=hea |
| By: | Karen Eggleston |
| Abstract: | Nonprofits supply many tax-financed services like healthcare and education. Yet nonprofits are absent from the canonical property rights theory of ownership. Extending the government “make or buy” decision to nonprofits and ex post frictions based on contracts as reference points suggests that contracting out to a nonprofit can be optimal when “mission” alignment credibly signals adherence to the spirit and not just the letter of the contract in unforeseen contingencies. The model sheds light on differential nonprofit presence across the spectrum of basic services, as illustrated by an application to the health sector. |
| JEL: | H1 H4 H44 I0 I11 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32020&r=hea |
| By: | Jean-Christophe Lapouble (LAM - Les Afriques dans le monde - IEP Bordeaux - Sciences Po Bordeaux - Institut d'études politiques de Bordeaux - IRD - Institut de Recherche pour le Développement - Institut d'Études Politiques [IEP] - Bordeaux - UBM - Université Bordeaux Montaigne - CNRS - Centre National de la Recherche Scientifique, LéP - Laboratoire d'économie de Poitiers - Université de Poitiers) |
| Abstract: | The fight against doping is organized at the global level under the aegis of the World Anti-Doping Agency (WADA) in application of the 2005 UNESCO convention which made the application of the World Anti-Doping Code mandatory for all countries wishing to participate and organize international sports competitions. In fact, it appears that for a variety of reasons, the application of the World Anti-Doping Code is largely theoretical in Africa. Indeed, if most African countries adhere to the system set up by WADA, it appears that very few are able to apply it effectively. The numerous difficulties that African countries may experience due to a degraded socioeconomic context confine anti-doping policies to the rank of non-priority public policies. Thus, the difficulties experienced by different countries in terms of development, structuring of the sports movement through associations, public administration, public health and corruption must lead us to consider that the fight against doping in Africa cannot be free of the socioeconomic context and must therefore be adapted accordingly. This adaptation must be based on the reality of the functioning of sports organizations in the countries and not on theoretical considerations that are far removed from reality. |
| Keywords: | Corruption development doping public administration public health, Corruption, Development, Doping, Public administration, Public health |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04348227&r=hea |
| By: | Ana L. Abeliansky (Department of Economics, Vienna University of Economics and Business); Klaus Prettner (Department of Economics, Vienna University of Economics and Business); Roman Stoellinger (Department of Economics, Vienna University of Economics and Business) |
| Abstract: | We propose a model of production featuring the trade-off between employing workers versus employing robots and analyze the extent to which this trade-off is altered by the emergence of a highly transmissible infectious disease. Since workers are - in contrast to robots - susceptible to pathogens and also spread them at the workplace, the emergence of a new infectious disease should reduce demand for human labor. According to the model, the reduction in labor demand concerns automatable occupations and increases with the viral transmission risk. We test the model's predictions using Austrian employment data over the period 2015-2021, during which the COVID-19 pandemic increased the infection risk at the workplace substantially. We find a negative effect on occupation-level employment emanating from the higher viral transmission risk in the COVID years. As predicted by the model, a reduction in employment is detectable for automatable occupations but not for non-automatable occupations. |
| Keywords: | Automation, robots, pandemics, viral transmission risk, occupational employment, shadow cost of human labor |
| JEL: | I14 J21 J23 J32 O33 |
| Date: | 2023–12 |
| URL: | http://d.repec.org/n?u=RePEc:wiw:wiwwuw:wuwp352&r=hea |
| By: | Ningyi Li |
| Abstract: | This paper examines the effects of daily exercise time on the academic performance of junior high school students in China, with an attempt to figure out the most appropriate daily exercise time for students from the perspective of improving students' test scores. By dividing the daily exercise time into five sections to construct a categorical variable in a linear regression model as well as using another model to draw intuitive figures, I find that spending both too little and too much time on physical activity every day would have adverse impacts on students' academic performance, with differences existing in the impacts by gender, grade, city scale, and location type of the school. The findings of this paper carry implications for research, school health and education policy and physical and general education practice. The results also provide recommendations for students, parents and teachers. |
| Date: | 2023–11 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2312.11484&r=hea |
| By: | Enza Simeone (Universitat de Girona) |
| Abstract: | To mitigate the spread of COVID-19, from March 2020 worldwide were adopted a series of policy interventions aimed at reducing interpersonal contact and implementing testing to identify infectious cases early.By comparing the evolution of the pandemic under policy intervention versus inaction by policymakers, it is possible to define the feasible cost bearing to reduce the death number and other negative effects of the COVID-19 by adopting two approaches: a cost-benefit analysis (CBA) and a social welfare function analysis (SWF).This paper aims at showing how the social welfare function and the cost-benefit analysis can be applied to assess the COVID-19 pandemic policies' impacts on wellbeing, also considering the heterogeneous effects by age and income groups. As a case study that compares both approaches, we refer to those conducted by Adler et al. (2020) and Ferranna et al. (2021) in the USA, implementing the COVID-19 pandemic simulator developed by Fleurbaey et al. (2020). Analysing various scenarios, the CBA approach endorses more costly policies than the SWF approach to remove the pandemic risk. Moreover, the findings consistently favour controlled policies (e.g., suppression or mitigation) over uncontrolled ones, regardless of the evaluation method used.Finally, as a potential theoretical contribution, we explore how the impact of an individual’s trust in different agents (i.e., social trust and political trust) and the risk perception may impact the level of adherence to control policies aimed at preventing the spread of the COVID-19 pandemic. |
| Keywords: | Cost-benefit analysis, Social welfare function, COVID-19, wellbeing, trust, policy evaluation |
| JEL: | D61 I18 I38 |
| Date: | 2024–01 |
| URL: | http://d.repec.org/n?u=RePEc:inq:inqwps:ecineq2024-662&r=hea |
| By: | Costa-Font, Joan; Fleche, Sarah; Pagan, Ricardo |
| Abstract: | Daylight Saving Time (DST) is a widely adopted practice implemented by over seventy countries to align sunlight with day-to-day activities and reduce energy demands. However, we do not have a clear knowledge of how it affects individuals’ welfare. Using a regression discontinuity design combined with a differences-indifferences approach, we find that the Spring DST transition 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. Using an event-study approach, we find that the effects persist for about six days after the DST transition. By contrast, we provide evidence that the Fall DST transition is associated with a significant increase in life satisfaction. We end the paper by a simple cost-benefit analysis and discuss the potential benefits of ending DST. |
| Keywords: | daylight saving time; wellbeing; health; sleep; time; stress; Wiley deal |
| JEL: | I18 K20 I31 |
| Date: | 2024–01–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:120819&r=hea |
| By: | Kosfeld, Reinhold; Mitze, Timo; Rode, Johannes; Wälde, Klaus |
| Abstract: | The paper studies the containment effects of public health measures to curb the spread of Covid‐19 during the first wave of the pandemic in spring 2020 in Germany. To identify the effects of six compound sets of public health measures, we employ a spatial difference‐in‐differences approach. We find that contact restrictions, mandatory wearing of face masks and closure of schools substantially contributed to flattening the infection curve. The significance of the impact of restaurant closure does not prove to be robust. No incremental effect is evidenced for closure of establishments and the shutdown of nonessential retail stores. |
| Date: | 2023–12–22 |
| URL: | http://d.repec.org/n?u=RePEc:dar:wpaper:142046&r=hea |
| By: | Costi, Chiara (University of Luxembourg); Clark, Andrew E. (Paris School of Economics); Lepinteur, Anthony (University of Luxembourg); D'Ambrosio, Conchita (University of Luxembourg) |
| Abstract: | We evaluate the effect of the COVID-19 pandemic on the life satisfaction of healthcare workers, as compared to the wider workforce, in five European countries. In ten waves of quarterly panel data, the life satisfaction of healthcare workers is always higher than that of other essential workers and non-essential workers. Life satisfaction follows a double humped pattern over time for all workers, which is largely explained by the COVID-19 death rate and policy stringency. The spread of the pandemic in terms of the death rate has twice as large an effect on healthcare workers' life satisfaction; on the contrary, the latter are the only workers whose satisfaction was not affected by the stringency of lockdown policies. |
| Keywords: | healthcare workers, life satisfaction, COVID-19, policy stringency |
| JEL: | H51 I18 I31 |
| Date: | 2023–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16680&r=hea |