|
on Health Economics |
| By: | Breitkopf, Laura (Max Planck Institute for Research on Collective Goods); Chowdhury, Shyamal (University of Sydney); Priyam, Shambhavi (World Bank); Schildberg-Hörisch, Hannah (Heinrich Heine University Düsseldorf); Sutter, Matthias (Max Planck Institute for Research on Collective Goods) |
| Abstract: | We use novel data on nearly 6, 000 children and adolescents aged 6 to 16 that combine incentivized measures of social, time, and risk preferences with rich information on child behavior and family environment to study whether children's economic preferences predict their behavior. Results from standard regression specifications demonstrate the predictive power of children's preferences for their prosociality, educational achievement, risky behaviors, emotional health, and behavioral problems. In a second step, we add information on a family's socio-economic status, family structure, religion, parental preferences and IQ, and parenting style to capture household environment. As a result, the predictive power of preferences for behavior attenuates. We discuss implications of our findings for research on the formation of children's preferences and behavior. |
| Keywords: | social preferences, time preferences, risk preferences, experiments with children, origins of preferences, human capital, behavior |
| JEL: | C91 D01 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16834&r=hea |
| By: | Ashvin Gandhi; Andrew Olenski |
| Abstract: | This study examines “tunneling” practices through which health care providers covertly extract profit by making inflated payments for goods and services to commonly-owned related parties. While incentives to tunnel exist across sectors, health care providers may find it uniquely advantageous to do so. Masking profits as costs, thereby obscuring true profitability, may dissuade regulators from imposing stricter quality standards and encourage public payers to increase reimbursement rates. Likewise, tunneling effectively “shields” assets from malpractice liability risk, by moving them off the firm’s balance sheet. Using uniquely detailed financial data on the nursing home industry, we apply a difference-in-differences approach to study how firms’ stated costs change when they start transacting with a related party, allowing us to infer by how much these payments are inflated. We find evidence of widespread tunneling through inflated rents and management fees paid to related parties. Extrapolating these markups to all firms’ related party transactions, our estimates suggest that in 2019, 63% of nursing home profits were hidden and tunneled to related parties through inflated transfer prices. |
| JEL: | G3 I10 I11 L24 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32258&r=hea |
| By: | R. Anton Braun; Karen A. Kopecky |
| Abstract: | One in three 50-year-old Americans will spend over 90 days in a nursing home, with roughly one in ten facing out-of-pocket expenses exceeding $200, 000. Yet, only about 10 percent of individuals aged 65 or older possess private long-term care insurance (LTCI). While Medicaid provides benefits for those with minimal assets (about $2, 000 or less) and low income, its stringent means-test and private market frictions result in many retirees paying for long-term care (LTC) expenses out-of-pocket. As the American population ages, policymakers anticipate a rise in state and federal Medicaid expenditures. This chapter examines reforms to both public and private LTCI provision using a structural model of the US LTCI market. Three policies are considered: universal public LTCI, no public LTCI coverage, and a policy that exempts asset holdings from the Medicaid asset test on a dollar-for- dollar basis with private LTCI coverage. We find that this third reform enhances social welfare and creates a vibrant private LTCI market while preserving the safety- net provided by Medicaid to low-income individuals. |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:cnn:wpaper:24-005e&r=hea |
| By: | Marika Cabral; Marcus Dillender |
| Abstract: | Little is known about how pollution impacts worker health and workplace safety. This paper leverages high-frequency, plausibly exogenous variation in wildfire smoke to estimate the impact of pollution on workplace injuries. Our analysis draws on unique data we construct through linking information on smoke plumes and pollution to comprehensive administrative data on workers’ compensation injury claims from Texas. We first document that wildfire smoke increases ambient air pollution—with our estimates indicating that a day of smoke coverage is associated with an average increase in PM₂.₅ of 18.6%. We find that an additional day of smoke coverage leads to a 2.8% increase in workplace injury claims. Similar percent increases in workplace injuries are found across different types of injuries and workers. However, because of large variation in baseline injury risk, the incidence of these pollution-induced injuries is concentrated among workers in high-risk occupations, and supplemental analysis illustrates potential opportunities for improving the targeting of costly mitigation. Our estimates indicate that pollution—and wildfire smoke in particular—substantially harms worker health, even at pollution levels well below current and proposed regulatory standards. Overall, our findings suggest workers face unique risks from pollution and provide insights for policy aiming to address these risks. |
| JEL: | I18 J28 J3 Q53 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32232&r=hea |
| By: | Shooshan Danagoulian; Monica Deza |
| Abstract: | Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the role of transitory health shocks or situational factors at explaining variations in fatal traffic accidents has been understudied. Exploring daily variation in city-specific pollen counts, this study finds novel evidence that traffic fatalities increase on days in which the local pollen count are particularly high. We find that the effects are present in accidents involving private vehicles and occur most frequently on the weekends, suggesting potentially the missed opportunity to avoid these fatalities. We do not find similar effects for fleet vehicles. These findings remain robust to alternative specifications and alternative definitions of high pollen count. Taken together, this study finds evidence that a prevalent and transitory exogenous health-shock, namely pollen allergies, increases traffic fatalities. Given our lack of evidence of avoidance, these effects are not mechanical and are likely driven by cognitive impairments that arise as a result of seasonal allergies. |
| JEL: | I1 I12 R4 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32233&r=hea |
| By: | Bütikofer, Aline (Norwegian School of Economics); Coy, Deirdre (Irish Government Economic and Evaluation Service); Doyle, Orla (University College Dublin); Ginja, Rita (University of Bergen) |
| Abstract: | Pregnancy loss is often a traumatic event which may impact both parents and subsequent children. Using Norwegian registry data, we exploit the random nature of single, early miscarriages to examine the impact of pregnancy loss on parental investment and family outcomes. We find that pregnancy loss improves maternal health investments in the subsequent pregnancy regarding supplement use, smoking, preventative healthcare, and physician choice. While a miscarriage negatively affects labor market attachment, it has limited effects on children born after the loss. This suggests that investment in the next pregnancy may offset the negative consequences of stress associated with pregnancy loss. |
| Keywords: | miscarriage, parental investment, healthcare use, household labor supply |
| JEL: | I12 J13 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16858&r=hea |
| By: | Jiayi Wen; Zixi Ye; Xuan Zhang |
| Abstract: | Justification bias, wherein retirees may report poorer health to rationalize their retirement, poses a major concern to the widely-used measure of self-assessed health in retirement studies. This paper introduces a novel method for testing the presence of this bias in the spirit of regression discontinuity. The underlying idea is that any sudden shift in self-assessed health immediately following retirement is more likely attributable to the bias. Our strategy is facilitated by a unique high-frequency data that offers monthly, in contrast to the typical biennial, information on employment, self-assessed health, and objective health conditions. Across a wider post-retirement time frame, we observe a decline in self-assessed health, potentially stemming from both justification bias and changes in actual health. However, this adverse effect diminishes with shorter intervals, indicating no evidence of such bias. Our method also validates a widely-used indirect testing approach. |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2403.06368&r=hea |
| By: | Christopher Roth (University of Cologne); Peter Schwardmann (Carnegie Mellon University); Egon Tripodi (Hertie School) |
| Abstract: | While psychotherapy has been shown to be effective in treating depression, take-up remains low. In a sample of 1, 843 depressed individuals, we document that effectiveness concerns are top-of-mind when respondents consider the value of therapy. We then show that the average respondent underestimates the effectiveness of therapy and that an information treatment correcting this misperception increases participants’ incentivized willingness to pay for therapy. Information affects therapy demand by changing beliefs rather than by shifting attention. Our results suggest that information interventions that target the perceived effectiveness of therapy are a potent tool in combating the ongoing mental health crisis. |
| Keywords: | mental health; depression; psychotherapy; beliefs; effectiveness; information policy; |
| Date: | 2024–03–24 |
| URL: | http://d.repec.org/n?u=RePEc:rco:dpaper:500&r=hea |
| By: | Christopher Roth (University of Cologne); Peter Schwardmann (Carnegie Mellon University); Egon Tripodi (Hertie School) |
| Abstract: | Throughout history, people with mental illness have been discriminated against and stigmatized. Our experiment provides a new measure of perceived depression stigma and then investigates the causal effect of perceived stigma on help-seeking in a sample of 1, 844 Americans suffering from depression. A large majority of our participants overestimate the extent of stigma associated with depression. In contrast to prior correlational evidence, lowering perceived social stigma through an information intervention leads to a reduction in the demand for psychotherapy. A mechanism experiment reveals that this information increases optimism about future mental health, thereby reducing the perceived need for therapy. |
| Keywords: | depression; stigma; information; psychotherapy; |
| Date: | 2024–03–24 |
| URL: | http://d.repec.org/n?u=RePEc:rco:dpaper:499&r=hea |
| By: | Oparina, Ekaterina (CEP, London School of Economics); Krekel, Christian (London School of Economics); Srisuma, Sorawoot (University of Surrey) |
| Abstract: | Common mental health problems impose significant costs on individuals and societies, yet healthcare systems often overlook them. We provide the first causal evidence on the effectiveness of a pioneering, nationwide mental health service for treating depression and anxiety disorders in England using non-experimental data and methods. We exploit variations in waiting times to identify treatment effects, based on a novel dataset of over one million patients that well represent the English population. Our findings show that treatment improved mental health and reduced impairment in work and social life. We also provide suggestive evidence of enhanced employment. However, effects vary across patients, services, and areas. The programme is cost-effective and provides a blueprint for treating mental health in other countries. |
| Keywords: | policy evaluation, mental health, psychological therapies, quasi- natural experiment, machine learning, cost-benefit analysis |
| JEL: | C31 C32 D61 I12 I38 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16839&r=hea |
| By: | Malani, Anup (University of Chicago); Kinnan, Cynthia (NBER); Conti, Gabriella (University College London); Imai, Kosuke (Harvard University); Miller, Morgen (University of Chicago); Swaminathan, Shailender (Sai University); Voena, Alessandra (Stanford University); Woda, Bartosz (Amazon) |
| Abstract: | Universal health coverage is a widely shared goal across lower-income countries. We conducted a large-scale, 4-year trial that randomized premiums and subsidies for India's first national, public hospital insurance program, RSBY. We find roughly 60% uptake even when consumers were charged premiums equal to the government's cost for insurance. We also find substantial adverse selection into insurance at positive prices. Insurance enrollment increases insurance utilization, partly due to spillovers from use of insurance by neighbors. However, many enrollees attempted to use insurance but failed, suggesting that learning is critical to the success of public insurance. We find very few statistically significant impacts of insurance access or enrollment on health. Because there is substantial willingness-to-pay for insurance, and given how distortionary it is to raise revenue in the Indian context, we calculate that our sample population should be charged a premium for RSBY between INR 500-1000 rather than a zero premium to maximize the marginal value of public funds. |
| Keywords: | health insurance, adverse selection, spillovers, marginal value of public funds |
| JEL: | D1 I13 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16861&r=hea |
| By: | Ana Costa-Ramón (University of Zurich); N. Meltem Daysal (University of Copenhagen); Ana Rodriguez-González (Lund University) |
| Abstract: | What is the impact of the oral contraceptive pill on the mental health of adolescent girls? Using administrative data from Denmark and exploiting the variation in the timing of pill initiation in an event study design, we find that the likelihood of a depression diagnosis and antidepressant use increases shortly after pill initiation. We then uncover substantial variation in primary care providers' tendency to prescribe the pill to adolescents, unrelated to patient characteristics. Being assigned to a high prescribing physician strongly predicts pill use by age 16 and leads to worse mental health outcomes between ages 16-18. |
| Keywords: | Contraceptive pill, mental health, adolescents, prescribing practices. |
| JEL: | I12 J13 |
| Date: | 2023–08–29 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kucebi:2305&r=hea |
| By: | Bruna Guidetti; Paula Pereda; Edson R. Severnini |
| Abstract: | How responsive to health shocks are healthcare systems in the developing world? Developing countries are known to have both lower levels of hospital infrastructure and serious health shocks driven by air pollution. These shocks are transitory and may be marginal relative to other health demands, so healthcare systems might be able to manage them. On the other hand, with limited capacity hospitals may not be able to respond rapidly, possibly exacerbating health damages from pollution. In this study, we examine the consequences of health shocks induced by air pollution in a megacity in the developing world: Sao Paulo, Brazil. Using daily data on pediatric hospitalizations from 2015-2017, an instrumental variable approach based on wind speed, and a plausibly exogenous measure of hospital capacity constraints, we show that such transitory health shocks can disrupt healthcare services due to limited capacity, including for conditions seemingly unrelated to air pollution. Also, we cannot rule out severe deterioration of health outcomes. |
| JEL: | I15 O13 Q53 Q56 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32224&r=hea |
| By: | Sylvia Hristakeva; Julie Holland Mortimer; Eric Yde |
| Abstract: | We study the effect of price caps on the provision of costly effort by pharmaceutical firms using variation in drug discounts generated by a price regulation program that allows eligible hospitals to purchase outpatient drugs at steep discounts. These discounts directly affect drug manufacturers’ markups, and may change firms’ incentives to exert promotional effort targeted towards physicians at these hospitals. We find that the effects of price regulation on pharmaceutical firm effort depend crucially on the design of the regulations. Using detailed data on marketing payments from pharmaceutical firms to physicians, we observe that physicians receive 12% fewer promotional payments after their hospitals take up the program. The design of the price caps imply that discounts tend to increase with a drug’s age. Consistent with theoretical predictions, we find that pharmaceutical firms shift promotional payments away from older drugs and towards newer drugs, which are less affected by the price caps. |
| JEL: | I1 I11 L0 L2 M30 M37 M39 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32249&r=hea |
| By: | Chun Yee Wong (IUJ Research Institute, International University of Japan); Shugo Shinohara (Keio University) |
| Abstract: | This study investigates the effects of increased copayment on health behaviours among older people in Japan. Utilizing data from the Comprehensive Survey of Living Conditions (CSLC), our analysis focuses on the impacts on positive and negative health behaviours including having regular meals, balanced diet, regular sleep, doing exercise, smoking, and drinking alcohol. While augmented cost sharing is associated with increased positive health behaviours, its impact on negative behaviours is complex, with smoking rates declining but alcohol consumption showing a mild upward trend, particularly among highly educated individuals and males. Notably, higher educated individuals exhibit a greater propensity towards positive health behaviours. This research contributes to understanding the complex interplay between health insurance coverage and health behaviours among older adults, providing insights for policymakers aiming to promote healthy aging and mitigate adverse health outcomes resulting from policy reforms. |
| Keywords: | Copayment, Health Insurance, Health Behaviours, Older Adults, Japan |
| JEL: | I12 I15 I18 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iuj:wpaper:ems_2024_03&r=hea |
| By: | Szklo, Michel (São Paulo School of Economics-FGV); Clarke, Damian (University of Chile); Rocha, Rudi (São Paulo School of Business Administration) |
| Abstract: | We examine the link between public spending in health and health outcomes by leveraging differential exposure to a health spending reform prompted by Brazil's 29th Constitutional Amendment, which mandated municipalities to spend at least 15% of their budget on health. We map dynamic effects on health care spending, inputs, access, outputs and outcomes. For municipalities initially spending below the 15% threshold, we find (a) large increases in health spending specifically, driven by administrative spending, infrastructure investment, and human resources; (b) a resulting greater supply of personnel, primary care coverage, and municipal hospitals; and (c) reductions in infant mortality rates, in particular for deaths during the neonatal period. While we find substantial cost increases and lower mortality elasticities compared with previous correlational parameters, benefits still exceed costs provided any VSL greater than US$764 thousand. Our results contribute to the literature by providing one of the first well-identified causal parameters of the relationship between public spending in health and health outcomes, by documenting the links in the chain connecting government health expenditure to health outcomes, and by considering spillovers across space and sectors. |
| Keywords: | health spending, public spending, health care provision, health outcomes |
| JEL: | I1 I3 O5 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16829&r=hea |
| By: | Johan Saeverud (Dept. of Economics, University of Copenhagen) |
| Abstract: | I investigate a Danish policy reform that postpones social security eligibility tied to an increase in life expectancy. The reform creates sharp discontinuities based on exact birth dates, allowing for the identification of causal effects. Using both administrativeand survey data, I document a substantial increase in labor force participation of 20 percentage points as a result of postponing social security eligibility. The effect isstrongest among individuals with low pension wealth. This pattern is consistent across multiple retirement age thresholds and cohorts, including both individuals who havealready retired and in expectation for younger cohorts who are not yet retired. This research offers new insights into the impacts of life expectancy-based adjustments tosocial security eligibility. Welfare assessments show overall gains, but also that welfare effects are unequally distributed. Individuals with low pension wealth show the largestincreases in labor supply, but also face the largest personal costs in terms of foregone consumption smoothing. |
| Keywords: | retirement, social security, labor supply |
| JEL: | J26 H55 |
| Date: | 2024–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kucebi:2405&r=hea |
| By: | Bancalari, Antonella; Berlinski, Samuel; Buitrago, Giancarlo; García, María Fernanda; Mata, Dolores de la; Vera-Hernández, Marcos |
| Abstract: | The present paper outlines measures of disparity in healthcare access and health outcomes, drawing from the standardized metrics introduced in one related study (Bancalari et al., 2023). Beveridge countries seem to be less unequal than Bismarckian countries. Yet, there is no strong pattern in inequalities across our taxonomy, indicating certain unobserved variables of the health system might wield more influence over health and health care disparities than the overarching features defining our health system taxonomy. Finally, it will be analyzed how differences in healthcare use and health outcomes within countries are related to whether individuals benefit from either the contributory or the non-contributory subsystems and assess main factors explaining such differences by means of Oaxaca decompositions. |
| Keywords: | Health Insurance;Public and Private;Health and Inequality;Health and Economic Development |
| JEL: | I13 I14 I15 |
| Date: | 2023–10 |
| URL: | http://d.repec.org/n?u=RePEc:idb:brikps:13196&r=hea |
| By: | Lenka Slegerova (Charles University, Faculty of Social Sciences, Institute of Economic Studies, Czechia) |
| Abstract: | This study evaluates the accessibility of primary care for children in Czechia in light of the declining numbers of general practitioners and the rising numbers of children without a practitioner. We show that children largely receive primary care outside their district of administrative residence, that the average number of children registered per practitioner is increasing, and that the share of children without a practitioner was over 6% in 2022. This study further challenges the use of hospital admissions for ambulatory care sensitive conditions as a measure of the accessibility and quality of primary care. We build a fixed-effects model for district-level data on paediatric hospital admissions and the utilisation of primary care between 2010 and 2019 in Czechia. Our focus is on the effect that the number of registered and treated children per primary-care physician has on the composition of paediatric hospital admissions. We find no significant relationship between the variables of our interest. Therefore, we suggest that hospital admissions for ambulatory care sensitive conditions are not a good measure of the accessibility and quality of primary care for the child population in Czechia, a country with compulsory health insurance and no gatekeeping of primary care. |
| Keywords: | accessibility of primary care, paediatric hospital admissions, ambulatory care sensitive conditions |
| JEL: | I10 I11 I18 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:fau:wpaper:wp2024_13&r=hea |
| By: | Valerie Gilbert Ulep (Philippine Institute for Development Studies); Miharu Kimwell (University of the Philippines Diliman); Romelei Camiling-Alfonso (Philippine Society of Public Health Physicians); Denese de Guzman (Philippine Society of Public Health Physicians); Arianna Amit (ACERD); Ida Marie Pantig (ACERD); Alex Herrin (HREP-ADMU Senior Adviser) |
| Abstract: | The study assesses the state of primary care (PC) in the Philippines, considering outcomes and various sectoral inputs like financing, service delivery, and governance. Based on this assessment and adhering to established health financing principles, we made recommendations to address challenges. PC plays a leading role in the ongoing Universal Health Care reform in the Philippines, highlighting the importance of such assessments to inform policy and legislative agenda. Analyzing data from various sources and examining existing policies, we assessed the performance of PC in the country, benchmarking progress with regional and aspirational peers. Our findings suggest that health outcomes of Filipinos have improved over the years, but progress has been modest and marked with inequities and fast-changing disease patterns. These challenges result from various issues, including chronic underinvestment, challenges in financing arrangements, supply-side constraints such as limited capital investments and health human resources, and governance and organizational problems. We argue that addressing these challenges can be achieved by leveraging health financing strategies and reforms. Our recommendations revolve around refining the health financing system to better align incentives, allocate resources efficiently, and enhance governance and organizational structures. |
| Keywords: | primary care, financing, health systems |
| JEL: | I10 I14 I18 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:agy:dpaper:202403&r=hea |
| By: | Piero Ronzani (ISDC – International Security and Development Center, Berlin, Germany); Wolfgang Stojetz (ISDC – International Security and Development Center, Berlin, Germany); Nadine Stammel (Freie Universität Berlin, Berlin, Germany); Maria Boettche (Freie Universität Berlin, Berlin, Germany); Diego Zardetto (World Bank, Washington DC, USA); Sarah Fenzl (ISDC – International Security and Development Center, Berlin, Germany); Maen Salhab (Palestinian Central Bureau of Statistics, Ramallah); Jessica M. Anderson (World Bank, Washington DC, USA); Arden Finn (World Bank, Washington DC, USA); Alia Aghajanian (World Bank, Washington DC, USA); Tilman Brück (ISDC – International Security and Development Center, Berlin, Germany, Humboldt University of Berlin, Berlin, Germany, Leibniz Institute of Vegetable and Ornamental Crops, Großbeeren, Germany) |
| Abstract: | Mental health risks are high in conflict settings, but mental health research mostly focuses on non-conflict settings. Survey data from active conflict settings often suffer from low response rates, unrepresentative samples, and a lack of detailed information on the roots and implications of poor mental health. We overcome these challenges by analyzing nationally representative evidence on the prevalence, sources, and socio-economic correlates of depression, a highly disabling and costly public health issue, in an active conflict setting. We analyze nationally and sub-nationally representative geocoded survey data from the Palestinians’ Psychological Conditions Survey, collected from 5, 877 Palestinian individuals in West Bank and Gaza in 2022. We calculate representative depression statistics, disaggregate by sub-areas and across socio-demographic groups, and estimate the associations with geocoded violent conflict event data as well as survey-based trauma exposure across conflict types and socio-economic outcomes. 58 percent (SE=2·21) of adults in Palestine exhibit depressive symptoms. Prevalence is highest in Gaza (71 percent, SE=2·70), increases with exposure to violent conflict and traumatic events, and is associated with worse socio-economic outcomes. The associated losses for 2022 are equivalent to 732, 555 Years Lost in Disability, representing 8·9 percent of Palestine’s GDP. Those exposed to violence and traumatic events are disproportionately affected by depression in conflict settings, which may fuel poverty and instability. Scalable investments in mental health in conflict settings promise to not only support well-being but also strengthen productivity and social cohesion for a given level of violence. |
| Keywords: | Depression, Conflict, Trauma, Mental health, Disability-adjusted life years, Socio-economic outcomes, Palestine, Burden of disease |
| JEL: | I12 I14 I15 I31 J14 J17 O10 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:hic:wpaper:410&r=hea |
| By: | Miriam Gensowski (Rockwool Foundation, CEBI (U. of Copenhagen), and IZA); Mette Goertz (University of Copenhagen, Dep. of Economics and CEBI and IZA) |
| Abstract: | Is the education-health gradient inflated because both education and health are associated with unobserved socio-emotional skills? Revisiting the literature, we find that the gradient is reduced by 30-45% by fine-grained personality facets and Locus of Control. Traditional aggregated Big-Five scales, in contrast, have a much smaller and mostly insignificant contribution to the gradient. We decompose the gradient into its components with an order-invariant method, and use sibling-fixed effects to address that much of the observed education-health gradient reflects associations rather than causal relationships. There are education-health gradients even within sibling pairs; personality facets reduce these gradients by 30% or more. Our analyses use an extraordinarily large survey (N=28, 261) linked to high-quality administrative registers with information on SES background and objective health outcomes. |
| Keywords: | Inequality; Health-Education Gradient; Personality; Big Five-2 Inventory; Sibling Fixed Effects. |
| JEL: | I14 I12 I24 I31 |
| Date: | 2023–08–29 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kucebi:2304&r=hea |
| By: | Aravena, José M. (Yale University); Chen, Xi (Yale University); Levy, Becca R. (Yale University) |
| Abstract: | Low healthcare quality has been found to predict the development of several illnesses in older adults, while the evidence on dementia is still lacking. This study assesses whether and to what extent experiencing low healthcare quality can be associated with developing dementia in people 60-years-old and greater. Participants in the Health and Retirement Study (HRS), without dementia and 60-years-old and greater at baseline, were followed 2006 through 2019. Experiencing low healthcare quality was assessed at baseline through healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression is used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. Experiencing low healthcare quality is associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27 - 2.21, p-value |
| Keywords: | dementia, patient satisfaction, perceived discrimination, social determinants of health, healthcare quality, Alzheimer's Disease |
| JEL: | I11 I18 J14 J15 J18 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16838&r=hea |
| By: | Alberto Prati (University of Oxford, UCL - University College of London [London], LSE - London School of Economics and Political Science); Charlotte Saucet (UP1 UFR02 - Université Paris 1 Panthéon-Sorbonne - École d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne, CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique) |
| 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. |
| Keywords: | COVID-19, Motivated beliefs, Motivated memory, Over-inference, Natural experiment, Behavioral health economics |
| Date: | 2024–02–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:cesptp:hal-04512861&r=hea |
| By: | Pierre Dubois (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Thierry Magnac (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | We study intertemporal tradeoffs that health authorities face when considering the control of an epidemic using innovative curative medical treatments. We set up a dynamically controlled susceptible–infected–recovered (SIR) model for an epidemic in which patients can be asymptomatic, and we analyze the optimality conditions of the sequence of cure expenses decided by health authorities at the onset of the drug innovation process. We show that analytical conclusions are ambiguous because of their dependence on parameter values. As an application, we focus on the case study of hepatitis C, the treatment for which underwent a major upheaval when curative drugs were introduced in 2014. We calibrate our controlled SIR model using French data and simulate optimal policies. We show that the optimal policy entails some front loading of the intertemporal budget. The analysis demonstrates how beneficial intertemporal budgeting can be compared to non-forward-looking constant budget allocation. |
| Keywords: | Pharmaceuticals, SIR model, Controlled epidemic dynamics, Optimal intertemporal policies, Hepatitis C |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04501256&r=hea |
| By: | Lucinda Dalzell; Victoria Udalova; Alice Zawacki; Dennis Linders |
| Abstract: | The National Ambulatory Medical Care Survey (NAMCS) is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. The survey is conducted by the National Center for Health Statistics (NCHS) and the U.S. Census Bureau is the data collection agent. The survey was initially designed from 1967-1972 and first began collecting data in 1973. The sample is comprised of physicians classified by the American Medical Association (AMA) and American Osteopathic Association (AOA) as providing office-based care; not federally employed and not in the specialties of anesthesiology, radiology, or pathology. Changes in the health care landscape since the survey was initially designed many decades ago are impacting the response rates and out-of-scope rates of the survey. This report begins with background on NAMCS including the need and recommendations for a redesign. The second part of this report describes data sources from the Census Bureau, other Federal agencies, and non-government sources for developing an ambulatory medical care survey frame that more accurately targets in-scope providers at the outset of data collection. |
| Keywords: | NAMCS |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:cen:tnotes:24-03&r=hea |
| By: | Tinasti, Khalid; Zhang, Yong-An |
| Abstract: | The history, policies and practice of drug control in Asia have been historically multifaceted, particularly concerning substances like opium, cannabis, and various indigenous psychoactive plants. The opium trade, notably in the 19th and early 20th centuries, significantly impacted Asian societies, triggering conflicts, influencing international relations, and altering the socio-economic fabric. Yet, the history of drug control across different parts of Asia reflects a complex interplay of factors and a stark regional diversity. This special issue serves as a platform for interdisciplinary studies that link Asian drug trafficking with collaborative legal responses across the region. The primary objective is to compile an overview of the history, current practices, and policies addressing drug production, trafficking, and usage in a continent that houses 60% of the global population. This is done by sampling articles that encompass the large geographical scope of Asia, from Northeast Asia to the Middle East. The special issue focuses on three key dimensions of drug control that affect Asian countries: Historical landmarks, including milestones of drug control policy developments at the national level, which shaped the international regime over the last two centuries; public health and history of local responses with the analysis of the burden of infectious diseases, and the state of access to controlled essential medicines; and, criminal justice and historical landmarks of its development through legal responses and punishments. |
| Keywords: | history; Asia; drug control; China; Lebanon; Azerbaijan; Phillipines |
| JEL: | N0 |
| Date: | 2024–02–27 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122170&r=hea |
| By: | Nguyen, Ha Trong; Zubrick, Stephen R.; Mitrou, Francis |
| Abstract: | This study explores the allocation of time, particularly to sleep, among children and adolescents in response to daily solar cycles. Utilizing a dataset of over 50, 000 time-use diaries from two Australian cohorts spanning 16 years and employing an individual fixed effects estimator, we uncover a significant correlation between daylight duration and sleep patterns. Our findings reveal that days with longer daylight hours are associated with a decrease in total sleep duration, driven primarily by later sleep onset and earlier wake times. Additionally, longer daylight hours correspond to reduced time spent on personal care and media activities, with increased dedication to school and physical activities. Furthermore, we identify socio-demographic factors moderating these effects, such as older age and weekdays exerting a stronger influence on sleep duration, while children of mothers with lower education or unemployment exhibit a subtle impact. These insights contribute to our understanding of how environmental factors shape daily routines and offer implications for designing schedules that promote positive developmental outcomes in young individuals. |
| Keywords: | Sleep, Time Allocation, Circadian Rhythms, Solar Cycles, Children |
| JEL: | I00 I12 J22 J24 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1410&r=hea |
| By: | Kamanzi, Collins; Matsiko, Eric; Rugema, Lawrence; Umubyeyi, Aline; Kanya, Lucy |
| Abstract: | Investment in the health system is essential for effective pandemic response: Despite Rwanda’s rapid implementation of control measures to manage the COVID-19 pandemic, the country faced several challenges in the early stages, due to inadequate infrastructure and a shortage of trained staff. A home-based care approach alleviated the facility-based care burden during the pandemic: Implemented in September 2020, this key strategy engaged community health workers (CHWs) to provide health education and monitor patients with mild COVID-19 symptoms. The integration of medical doctors (MDs) into home-based care teams strengthened the COVID-19 response in Rwanda: Operation Save the Neighbour, launched in 2021, integrated MDs into home-based care teams. This improved the quality of care provided to COVID-19 patients, enhanced patient monitoring, and offered additional support to CHWs at household level. The provision of continuous support to CHWs contributed to overcoming challenges in implementing home-based care models: CHWs played a critical role in community mobilization and surveillance. However, they faced significant challenges, including fear, anxiety, and overwhelming workloads. To support these frontline workers, ongoing training and an adequate supply of resources, including personal protective equipment (PPE), are required. |
| Keywords: | Covid-19; coronavirus |
| JEL: | R14 J01 |
| Date: | 2024–02–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122391&r=hea |
| By: | MERADEE, Tangvatcharapong |
| Abstract: | The increasing amount of misinformation, especially during the Covid-19 pandemic, has generated significant debate about the proper role of government and media platforms in combating it. However, little is known about whether and to what extent misinformation can actually change health behavior. This paper addresses this question by examining how parents responded to the unexpected surge in media coverage in 2007 of the verifiably false claim that the MMR vaccine caused autism. Specifically, I use a difference-in-differences approach to compare the vaccination rates of children whose parents were most and least likely to be affected by the news over time. Results indicate that susceptible parents were 3.3 percentage points less likely to vaccinate their children with an MMR shot by the recommended age of 15 months and 4.1 percentage points less likely to do so by 29 months. |
| Keywords: | vaccination, immunization, misinformation, news |
| JEL: | I12 I18 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:hit:hitcei:2023-07&r=hea |
| By: | Jang, Youngook (KOREA INSTITUTE FOR INTERNATIONAL ECONOMIC POLICY (KIEP)); Joe, Donghee (JEONBUK NATIONAL UNIVERSITY) |
| Abstract: | In this paper, we investigate the relationship between COVID-19 entry restrictions and dependence on immigrants. In response to the global COVID-19 pandemic, countries worldwide implemented international travel restrictions to reduce the entry of infected individuals. These measures included entry and exit bans, mandatory quarantine of travelers, and vaccination requirements, significantly altering global mobility patterns. Despite their proven effectiveness, entry restrictions also impose substantial economic costs, particularly evident in the form of reduced immigration and subsequent labor shortages in sectors reliant on immigrant labor. We introduce a theoretical framework to shed light on the factors influencing the determination of entry restrictions, encompassing both health and economic considerations. Empirical analyses reveal that countries heavily dependent on foreign labor are inclined to adopt less stringent border controls, balancing the economic costs associated with reduced immigrant workforce. Moreover, we argue that the strength of entry restrictions is determined by a government’s capacity to manage infection waves through means other than entry bans. Finally, we offer policy implications based on our research, on how to control the spread of infectious diseases while minimizing the costs imposed by reducing immigration and the cost imposed on the immigrants themselves. |
| Keywords: | India; Trade; Investment; Causality test; COVID-19; entry restrictions; immigration policy; immigrant workforce |
| JEL: | F22 I18 J61 |
| Date: | 2023–12–29 |
| URL: | http://d.repec.org/n?u=RePEc:ris:kiepwp:2023_004&r=hea |
| By: | Josselin Thuilliez (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique, UR - Université de Rennes); Nouhoum Touré (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, UP1 - Université Paris 1 Panthéon-Sorbonne) |
| Abstract: | High levels of vaccine hesitancy remain poorly understood during an epidemic. Using high-frequency data in France at departmental level and exploiting the Covid-19 vaccination campaign calendar, we observe that vaccination among the elderly influences vaccination among young adults. We then propose a simple epidemiological economic model with two partially vaccinated demographic groups – the young and the elderly – and two opinions on vaccination - "vaxxers" and "antivaxxers". The utility to get vaccinated for the young depends on the vaccination behavior of the elderly, their opinion of the vaccine and the epidemic environment. Our results suggest that mutual interactions between individuals' vaccination opinions and infection prevalence may lead to the emergence of oscillations and disease traps. The vaccination behavior of the elderly can be harnessed to promote vaccination. |
| Keywords: | Vaccination, Economic epidemiology, Opinion dynamics |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04490900&r=hea |