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on Health Economics |
| By: | Amelia A. Hawkins; Christopher A. Hollrah; Sarah Miller; Laura R. Wherry; Gloria Aldana; Mitchell D. Wong |
| Abstract: | This paper examines whether a generous cash intervention early in life can "undo" some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27%of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings. |
| JEL: | H0 H53 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:cen:wpaper:24-10&r=hea |
| By: | Gordon B. Dahl; Anne Gielen |
| Abstract: | Can participation in safety net programs have long-lasting negative effects across multiple generations? Prior work shows a 1993 Dutch disability insurance reform which tightened requirements and lowered benefits for participants resulted in better outcomes for their children. We study the third generation, finding that grandchildren of individuals whose DI eligibility and benefits were reduced are less likely to be born premature, have low birthweight, or experience complicated deliveries. They also have better health and schooling outcomes during early childhood. These early-life improvements are consequential, as they have been linked to better health, education, and labor market outcomes in adulthood. |
| JEL: | H53 I38 J62 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32212&r=hea |
| By: | Achyuta Adhvaryu (UC San Diego, NBER, BREAD, J-PAL, Good Business Lab); N. Meltem Daysal (University of Copenhagen, CEBI, CESifo, IZA); Snaebjorn Gunnsteinsson (Independent Researcher); Teresa Molina (University of Hawaii at Manoa, IZA); Herdis Steingrimsdottir (Copenhagen Business School) |
| Abstract: | How do parents contend with threats to the health and survival of their children? Can the social safety net mitigate negative economic effects through transfers to affected families? We study these questions by combining the universe of cancer diagnoses among Danish children with register data for affected and matched unaffected families. Parental income declines substantially for 3-4 years following a child' cancer diagnosis. Fathers' incomes recover fully, but mothers' incomes remain 3% lower 12 years after diagnosis. Using a policy reform that introduced variation in the generosity of targeted safety net transfers to affected families, we show that such transfers play a crucial role in smoothing income for these households and, importantly, do not generate work disincentive effects. The pattern of results is most consistent with the idea that parents' preferences to personally provide care for their children during the critical years following a severe health shock drive changes in labor supply and income. Mental health and fertility effects are also observed but are likely not mediators for impacts on economic outcomes. |
| Keywords: | child health, income, labor supply, safety net, cash transfers, disincentive effects, long-run effects, mental health, childhood cancers, Denmark |
| JEL: | I10 J13 J22 |
| Date: | 2023–05–11 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kucebi:2302&r=hea |
| By: | Monica Deza; Thanh Lu; Johanna Catherine Maclean; Alberto Ortega |
| Abstract: | We study the impact of losing health insurance on criminal activity by leveraging one of the most substantial Medicaid disenrollments in U.S. history, which occurred in Tennessee in 2005 and lead to 190, 000 non–elderly and non–disabled adults without dependents unexpectedly losing coverage. Using police agency–level data and a difference–in–differences approach, we find that this mass insurance loss increased total crime rates with particularly strong effects for non–violent crime. We test for several potential mechanisms and find that our results may be explained by economic stability and access to healthcare, in particular mental healthcare. |
| JEL: | I1 I12 I13 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32227&r=hea |
| By: | Gregory Clark (University of Southern Denmark, LSE); Neil Cummins (LSE) |
| Abstract: | Children early in the birth order get more parental care than later children. Does this significantly affect their life chances? An extensive genealogy of 428, 280 English people 1680-2024, with substantial sets of complete families, suggests that birth order had little effect on social outcomes either for contemporary outcomes, or in earlier centuries. For a small group of elite families in the nineteenth century and earlier, the oldest son was advantaged in terms of wealth, education, and occupational status. But even in this elite group, among later sons, birth order had no effect. We consider in the paper how the absence of birth order effects in England can be reconciled with reports of substantial negative birth order effects for modern Nordic countries. |
| Keywords: | Human Capital Formation, Birth Order, Intergenerational Mobility |
| JEL: | J24 J62 N33 N34 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:hes:wpaper:0254&r=hea |
| By: | Ohler, Johann |
| Abstract: | This paper studies the individual-level assumptions of the Malthusian model in pre-industrial Germany. By exploiting demographic records for 150, 000 individuals from the historical county of Wittgenstein, I test for status gradients in child mortality (the Malthusian positive check) and marital fertility (preventive check). While I find no evidence for a status gradient in child mortality, I find strong evidence for a status gradient in fertility. The richest families had, on average, one extra child when compared to their poorer compatriots. Turning to the mechanics of the preventive check, this appears to have been driven mostly by an earlier age of marriage amongst high status families. Disaggregating my dataset into six periods reveals that this fertility differential began to disintegrate around 1800. Ergo, I conclude that prior to 1800, the German population was subject to some Malthusian forces, albeit it was not stuck in a rigid Malthusian equilibrium, as conceptualised by some neo Malthusian scholars. |
| Keywords: | German Economic History; Malthus; Demographic History; European Marriage Pattern; Unified Growth Theory |
| JEL: | J12 J13 N33 N93 O40 |
| Date: | 2024–01–17 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120451&r=hea |
| By: | Arntz, Melanie; Findeisen, Sebastian; Maurer, Stephan; Schlenker, Oliver |
| Abstract: | This study quantifies the relationship between workplace digitalization, i.e., the increasing use of frontier technologies, and workers' health outcomes using novel and representative German linked employer-employee data. Based on changes in individual-level use of technologies between 2011 and 2019, we find that digitalization induces similar shifts into more complex and service-oriented tasks across all workers, but exacerbates health inequality between cognitive and manual workers. Unlike more mature, computer-based technologies, frontier technologies of the recent technology wave substantially lower manual workers' subjective health and increase sick leave, while leaving cognitive workers unaffected. We provide evidence that the effects are mitigated in firms that provide training and assistance in the adjustment process for workers. |
| Keywords: | health, inequality, technology, machines, automation, tasks, capital-labor substitution |
| JEL: | I14 J21 J23 J24 O33 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cexwps:289440&r=hea |
| By: | Reeves, Aaron; Fransham, Mark; Stewart, Kitty; Reader, Mary; Patrick, Ruth |
| Abstract: | In this paper, we examine the labour market effects of lowering the UK's benefit cap in 2016. This policy limits the total amount a working-age non-disabled household with no-one in employment can receive in social security. We treat the sharp reduction in this benefit cap as a natural experiment, comparing those at risk of being capped and those who were not before and after the cap was lowered. Drawing on data from ~500, 000 individuals, we find that this reform reduced unemployment compared to those not at risk of being capped. The reform also increased economic inactivity, partly because the cap harmed mental health but also because those at risk of being capped were eligible to claim disability-related welfare payments that made them exempt. Limiting total monthly welfare payments of low-income families may increase employment for some but it can also push others out of the labour market altogether. |
| Keywords: | welfare reform; disability; economic inactivity; mental health; FR-23208 |
| JEL: | R14 J01 |
| Date: | 2024–02–20 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122338&r=hea |
| By: | Pinka Chatterji; Chun-Yu Ho; Tao Jin; Yichuan Wang |
| Abstract: | Since the inception of Medicare Part D in 2006, mergers and acquisitions (M&A) and regulatory changes have led to increased concentration and reduced plan variety in the standalone prescription drug plan (PDP) portion of the market. We examine how this industry consolidation affects Medicare beneficiaries’ enrollment in PDPs and their out-of-pocket (OOP) drug expenditures using individual-level data from the 2006-2018 waves of the Health and Retirement Study (HRS) merged with PDP market-level characteristics. Overall, we find that lower plan variety in the PDP market decreases the likelihood that elderly individuals enroll in PDPs, and higher PDP market concentration increases OOP drug expenditures. Our main results are robust to considering possible effects of unobserved individual-level heterogeneity, region-specific time trends, and entry/exit of insurers, as well as to the use of an alternative identification scheme based on a quasi-experimental design. Further, we find that younger, more advantaged, and healthier individuals respond differently to industry consolidation compared to their older, less advantaged, and sicker counterparts. The former groups are more likely to adjust their PDP enrollment in response to reduced PDP variety and have higher OOP drug expenditures in response to increased PDP market concentration compared to the latter groups. Finally, we find that not only do lower PDP variety and greater PDP market concentration directly affect PDP enrollment and OOP drug expenditures, but these changes also affect Medicare beneficiaries indirectly through impacting PDP characteristics. |
| JEL: | I1 I11 I13 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32267&r=hea |
| By: | Katherine B. Coffman; Lucas C. Coffman; Keith Marzilli Ericson |
| Abstract: | Economics research has largely overlooked non-binary individuals. We aim to jump-start the literature by providing data on several economically-important beliefs and preferences. Among many results, non-binary individuals report more gender-based discrimination and express different career and life aspirations, including less desire for children. Anti-non-binary sentiment is stronger than anti-LGBT sentiment, and strongest among men. Non-binary respondents report lower assertiveness than men and women, and their social preferences are similar to men’s and less prosocial than women’s, with age an important moderator. Elicited beliefs reveal inaccurate stereotypes as people often mistake the direction of group differences or exaggerate their size. |
| JEL: | C90 D10 J16 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32222&r=hea |
| By: | Mette Goertz (University of Copenhagen, CEBI); Vibeke Myrup Jensen (The Danish Center for Social Science Research - VIVE); Sarah Sander (University College London - Social Research Institute) |
| Abstract: | A large share of young mothers return to work before their child turns one year. Exploiting exogenous variation in daycare vacancy rates, we estimate the causal effects of enrollment age in universal daycare on child development for children younger than two years. We find modest effects of postponing daycare enrollment on early childhood outcomes. Children who enroll later have fewer visits to their primary care physician in their first years of daycare, but the effects vanish before preschool. Children who enroll later are also more likely to have insufficient language proficiency at age five and thus need additional language support. |
| Keywords: | Daycare, child development, health, cognitive skills |
| JEL: | I00 J13 J24 |
| Date: | 2023–01–08 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kucebi:2226&r=hea |
| By: | Christian Posso; Jorge Tamayo; Arlen Guarin; Estefania Saravia |
| Abstract: | Identifying the impact of physicians on health outcomes is a challenging task due to the nonrandom sorting between physicians, hospitals, and patients. We overcome this challenge by exploiting a Colombian government program that randomly assigned 2, 126 physicians to 618 small hospitals. We estimate the impact on the 256, 806 children whose mothers received care in those hospitals during their pregnancy, using administrative data from the program, hospitals’ vital statistics records, and physicians’ records from mandatory health-specific graduation exams. We find that more-skilled physicians improve health at birth outcomes. That is, being assigned a physician with a one standard deviation higher performance in the health graduation exam scores decreases the probability of giving birth to an unhealthy baby by 6.31 percent. We present evidence that an underlying mechanism includes improving the targeting of care toward the more vulnerable mothers. **** La asignación de médicos, hospitales y pacientes no suele ser aleatorio, por lo que identificar la importancia de los médicos en la salud de sus pacientes no resulta trivial. En este documento aprovechamos la asignación aleatoria de 2.126 médicos a 618 hospitales pequeños, que se realizó en Colombia a través del Servicio Social Obligatorio (SSO), para estimar el impacto de las habilidades de los médicos en la salud al nacer de los 256.806 bebés cuyas madres recibieron atención en dichos hospitales durante su embarazo. Para este análisis, utilizamos datos administrativos del programa SSO de los años 2013 y 2014, registros de estadísticas vitales y los puntajes en la prueba de medicina de la prueba estandarizada Saber Pro. El resultado principal muestra que los médicos más hábiles mejoran la salud de los niños al nacer. Específicamente, la asignación de un médico que obtuvo un puntaje en la prueba de medicina (Saber Pro) una desviación estándar superior a la media, disminuye la probabilidad de dar a luz a un bebé no sano en un 6, 31%. Adicionalmente, encontramos que este resultado es explicado por una mejor focalización de los controles prenatales hacía las madres más vulnerables. |
| Keywords: | physicians’ health skills, health at birth outcomes, experimental evidence, habilidades de los médicos, salud al nacer, evidencia de experimentos aleatorios |
| JEL: | H51 I14 I15 I18 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:bdr:borrec:1269&r=hea |
| By: | Jihye Lee; Elena Tosetto |
| Abstract: | Existing well-being measurement initiatives in the region, such as the Quality of Life Indicators in Korea, Bhutan’s Gross National Happiness Index and Quality of Life Index in the Philippines, shed some insight on dimensions that should be considered for measuring well-being beyond GDP in Asia. Dimensions of housing, health, education, environment and civic engagement recur across several Asian well-being measurement frameworks, as well as dimensions such as family and culture which are more characteristic of the region. Identifying vulnerable population groups and securing better evidence on social mobility are also necessary to better measure progress in the region. Going forward, it would be helpful for countries to exchange knowledge on how well-being data available can be used for policy making in a more concrete way, for example, by including it in national development plans or budgeting processes. |
| Keywords: | happiness, quality of life, sustainable development, well-being |
| JEL: | I30 I31 I38 |
| Date: | 2024–04–02 |
| URL: | http://d.repec.org/n?u=RePEc:oec:wiseaa:22-en&r=hea |
| By: | Macchia, Lucía |
| Abstract: | Physical pain has been traditionally regarded as a body sensation. Most recently, physical pain has been considered an important human feeling. Subjective Well-Being (SWB) is a self-reported metric of well-being and involves different components including life satisfaction, positive and negative affect, and sense of fulfilment in life. This piece argues that physical pain should be considered a component of Subjective Well-Being. Physical pain and the current indicators of SWB have critical features in common that support the inclusion of physical pain in the conceptualization of SWB. Despite the similarities, none of the present measures of SWB are perfect proxies for pain. This underscores the potential of physical pain to capture aspects overlooked by the existing components of SWB. Considering physical pain a component of SWB can help researchers and policymakers to better understand individuals’ well-being and to advance the field in the coming decades. |
| Date: | 2024–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:fpsut&r=hea |
| By: | Goux, Dominique (CREST-INSEE); Maurin, Eric (Paris School of Economics) |
| Abstract: | Driven by new information technologies, working from home has experienced unprecedented growth since the COVID pandemic. We contribute to the debate on the consequences of this development by drawing on a French reform conducted in 2017, with the aim of facilitating telework agreements between employers and employees. We show that the reform was followed by a boom in working from home, particularly in mid-level occupations. On the other hand, employees in lower-level occupations were virtually unaffected. By comparing occupational groups before and after the reform, in firms that have signed telework agreements and in firms that have not, we find that the development of working from home coincides with a significant deterioration in the health status of mid-level employees, particularly men. Wages and number hours worked, on the other hand, remain largely unaffected. |
| Keywords: | occupational level, teleworking, health status, working from home |
| JEL: | J81 J53 I19 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16848&r=hea |
| By: | Eva M. Berger; Ernst Fehr; Henning Hermes; Daniel Schunk; Kirsten Winkel |
| Abstract: | Working memory capacity is a key component of executive functioning and is thought to play an important role for a wide range of cognitive and noncognitive skills such as fluid intelligence, math, reading, the inhibition of pre-potent impulses or more general self-regulation abilities. Because these abilities substantially affect individuals’ life trajectories in terms of health, education, and earnings, the question of whether working memory (WM) training can improve them is of considerable importance. However, whether WM training leads to spillover effects on these other skills is contested. Here, we examine the causal impact of WM training embedded in regular school teaching by a randomized educational intervention involving a sample of 6–7 years old first graders. We find substantial immediate and lasting gains in working memory capacity. In addition, we document positive spillover effects on geometry, Raven’s fluid IQ measure, and the ability to inhibit pre-potent impulses. Moreover, these spillover effects emerge over time and only become fully visible after 12–13 months. Finally, we document that three years after the intervention the children who received training have a roughly 16 percentage points higher probability of entering the academic track in secondary school. |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11010&r=hea |
| By: | Reitzinger, Stephanie; Reiss, Miriam; Czypionka, Thomas |
| Abstract: | Hypercholesterolemia is a major risk factor for atherosclerotic cardiovascular disease leading to reduced (healthy) life years. The aim of this study is to quantify the societal costs associated with hypercholesterolemia. We use epidemiologic data on the distribution of cholesterol levels as well as data on relative risks regarding ischemic heart disease, stroke, and other cardiovascular diseases. The analytical approach is based on the use of population-attributable fractions applied to direct medical, direct non-medical and indirect costs using data of Austria. Within a life-cycle analysis we sum up the costs of hypercholesterolemia for the population of 2019 and, thus, consider future morbidity and mortality effects on this population. Epidemiologic data suggest that approximately half of Austria’s population have low-density lipoprotein cholesterol (LDL-C) levels above the target levels (i.e., are exposed to increased risk). We estimate that 8.2% of deaths are attributable to hypercholesterolemia. Total costs amount to about 0.33% of GDP in the single-period view. In the life-cycle perspective, total costs amount to €806.06 million, €312.1 million of which are medical costs, and about €494 million arise due to production loss associated with hypercholesterolemia. The study points out that significant shares of deaths, entries into disability pension and care allowance, full-time equivalents lost to the labor market as well as monetary costs for the health system and the society could be avoided if LDL-C-levels of the population were reduced. |
| Keywords: | Austria; cardiovascular diseases; hypercholesterolemia; lifecycle; macrolevel data; societal costs |
| JEL: | C82 I10 I18 |
| Date: | 2024–03–22 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122526&r=hea |
| By: | Cristian Concha; Nathaly M. Rivera |
| Abstract: | Despite the extensive evidence linking particulate matter exposure to adverse health effects, a significant portion of the global population, especially in low-income countries, continues to depend on highly polluting fuels like wood-burning for cooking and heating. This study evaluates the immediate effects of wood-burning restrictions, triggered by air quality warnings, on levels of fine and coarse particulate matter in the city of Los Angeles, Chile. Employing a regression discontinuity design, we derive plausible causal estimates indicating that wood-burning restrictions significantly reduce daily concentrations of PM10 and PM2.5 during the most severe air quality warning. A battery of additional estimations supports these findings. However, our empirical analysis suggests that, while effective, wood-burning restrictions may not be sufficient to lower air pollution concentrations to levels deemed safe for health. |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:udc:wpaper:wp557&r=hea |
| By: | Rodríguez-Pose, Andrés; Bartalucci, Federico; Kurmanov, Bakhytzhan; Rau, Genadiy; Nigmetov, Kaisar |
| Abstract: | Growing disparities in wealth, well-being, and access to services in Kazakhstan have raised serious concerns among policymakers, especially since the January 2022 protests. This paper evaluates these regional inequalities and presents the findings from Kazakhstan’s inaugural well-being survey. The survey, based on global best practices, involves 4, 032 face-to-face interviews with a diverse sample across all 20 regions, ensuring representation. The resulting indices—the Subjective Well-Being Index and the Regional Well-Being Index—highlight both within-region and between-region disparities. Notably, the indices reveal significant variations in well-being, with certain regions reporting notably lower satisfaction levels across dimensions like trust in institutions, satisfaction with financial and housing conditions, health care and education quality, and personal security perceptions. |
| Keywords: | well-being survey; inequality; Kazakhstan; regional development |
| JEL: | P25 P28 R58 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122341&r=hea |
| By: | Yutong Chen; Amalia R. Miller; Carmit Segal; Melissa K. Spencer |
| Abstract: | This chapter examines the impact of COVID-19 shutdowns on domestic violence (DV) in the United States. Despite widespread concerns that pandemic shutdowns could increase DV, initial studies found mixed evidence that varied across data sources and locations. We review the evolving literature on the effects of the pandemic and highlight results from studies that examine multiple measures of DV across a common set of large cities. These studies show that the conflicting early results are due to opposite effects of pandemic shutdowns on two measures of DV in police data: an increase in domestic violence 911 calls and a decrease in DV crime reports. In theory, this divergence can come from either higher DV reporting rates, possibly because of additional media attention to DV and greater third-party calling, or from lower policing intensity for DV crimes. Prior evidence from police data and other sources supports the conclusion that the increase in calls came from greater reporting, while the incidence of criminal DV decreased. Finally, we present new evidence drawing on police and hospitals records from across the state of California to show that DV crimes and hospital emergency department (ED) visits were both lower during pandemic shutdowns. |
| JEL: | I18 J12 J16 K42 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32259&r=hea |
| By: | Foster, Gigi; Frijters, Paul |
| Abstract: | In 2020 and 2021, the world witnessed policies that caused enormous net damage to most countries. We demonstrate the usefulness of the new WELLBY currency in gauging the costs and benefits of COVID policies and review the contributions of Australian economists to the scholarly and public debates about these policies. Our analysis documents the value of what was destroyed, the weak resistance mounted by the Australian economics profession during this period, and the role played by many Australian economists as apologists for what we view as Australia's most catastrophic peacetime economic policy failure. We close with ideas for working towards a better future. |
| Keywords: | Australia; Covid-19; economics profession; health policy; welfare; WELLBY; coronavirus |
| JEL: | N0 |
| Date: | 2024–03–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122384&r=hea |
| By: | Mauricio Acuña; Roberto Alvarez; Cristobal Avarca |
| Abstract: | In this paper we study the pandemic's effects on the academic results of a group of university level students in a Chilean School of Economics and Business. We ask whether students from better socio-economic conditions outperformed those from poorer families. The hypothesis is that higher resources in terms of studying and living conditions, internet connections, and computer access would have contributed to increasing the gap among students from dissimilar backgrounds. Results obtained are consistent with this hypothesis, especially for those students coming from public schools. Using a differences-in-differences approach with fixed effects, we find an increase of about 40-50% in course dropping-out rates and about 30% reduction in course passing rates compared with students from private schools. Given the fact that some policies, mostly benefitting poorer students were implemented during the period, we can conclude that the gap could have potentially been even larger during the pandemic. We also find evidence showing that, after controlling for socioeconomic status, women and students with lower admission scores were less affected, while no significant effect was found between regular and special admission types. |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:udc:wpaper:wp556&r=hea |