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on Health Economics |
By: | Sunny Karim; Matthew D. Webb; Nichole Austin; Erin Strumpf |
Abstract: | In this study, we identify and relax the assumption of data "poolability" in difference-in-differences (DID) estimation. Poolability, or the combination of observations from treated and control units into one dataset, is often not possible due to data privacy concerns. For instance, administrative health data stored in secure facilities is often not combinable across jurisdictions. We propose an innovative approach to estimate DID with unpoolable data: UN--DID. Our method incorporates adjustments for additional covariates, multiple groups, and staggered adoption. Without covariates, UN--DID and conventional DID give identical estimates of the average treatment effect on the treated (ATT). With covariates, we show mathematically and through simulations that UN--DID and conventional DID provide different, but equally informative, estimates of the ATT. An empirical example further underscores the utility of our methodology. The UN--DID method paves the way for more comprehensive analyses of policy impacts, even under data poolability constraints. |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:arx:papers:2403.15910&r=hea |
By: | Enzo Brox; Michael Lechner |
Abstract: | This article shows how coworker performance affects individual performance evaluation in a teamwork setting at the workplace. We use high-quality data on football matches to measure an important component of individual performance, shooting performance, isolated from collaborative effects. Employing causal machine learning methods, we address the assortative matching of workers and estimate both average and heterogeneous effects. There is substantial evidence for spillover effects in performance evaluations. Coworker shooting performance, meaningfully impacts both, manager decisions and third-party expert evaluations of individual performance. Our results underscore the significant role coworkers play in shaping career advancements and highlight a complementary channel, to productivity gains and learning effects, how coworkers impact career advancement. We characterize the groups of workers that are most and least affected by spillover effects and show that spillover effects are reference point dependent. While positive deviations from a reference point create positive spillover effects, negative deviations are not harmful for coworkers. |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:arx:papers:2403.15200&r=hea |
By: | Rahi Abouk; John S. Earle; Johanna Catherine Maclean; Sungbin Park |
Abstract: | We study the effect of mandates requiring COVID-19 vaccination among healthcare industry workers adopted in 2021 in the United States. There are long-standing worker shortages in the U.S. healthcare industry, pre-dating the COVID-19 pandemic. The impact of COVID-19 vaccine mandates on shortages is ex ante ambiguous. If mandates increase perceived safety of the healthcare industry, marginal workers may be drawn to healthcare, relaxing shortages. On the other hand, if marginal workers are vaccine hesitant or averse, then mandates may push workers away from the industry and exacerbate shortages. We combine monthly data from the Current Population Survey 2021 to 2022 with difference-in-differences methods to study the effects of state vaccine mandates on the probability of working in healthcare, and of employment transitions into and out of the industry. Our findings suggest that vaccine mandates may have worsened healthcare workforce shortages: following adoption of a state-level mandate, the probability of working in the healthcare industry declines by 6%. Effects are larger among workers in healthcare-specific occupations, who leave the industry at higher rates in response to mandates and are slower to be replaced than workers in non-healthcare occupations. Findings suggest trade-offs faced by health policymakers seeking to achieve multiple health objectives. |
JEL: | H70 I1 I11 J20 |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32286&r=hea |
By: | Kosonen, Tuomas; Jysmä, Sami; Savolainen, Riikka |
Abstract: | This paper studies the relationship between substitutability of taxed and nontaxed goods and the price elasticity of demand. We organize the paper through a simple model that yields as a result a highly convex relationship between the demand elasticity and how close non-taxed substitutes are available. Empirically we analyze a Finnish sin tax scheme for sweets, soda and ice cream providing us with quasi-experimental variation through multiple reforms. We have product and storelevel data on sales and prices containing hundreds of millions of observations. We also develop survey evidence on substitution preferences across categories of goods. Our estimated consumption elasticity is close to zero for sweets and ice cream that have intermediate non-taxed substitute: cookies. In a stark contrast, when the tax rate was doubled for sugary soft drinks but not for their close substitute non-sugary soft drinks, consumption elasticity is close to unity. These estimates align well with our theory framework wherein even with intermediate non-taxed substitutes available the demand elasticity is close to zero, while it is close to unity when very close substitutes are available. We also provide evidence that the quasiexperimental price elasticity estimates in the previous literature align with our theory framework. |
Keywords: | excise taxes, sin tax, consumption, substitution, sweets, soda, Social security, taxation and inequality, H2, I18, fi=Verotus|sv=Beskattning|en=Taxation|, |
Date: | 2024 |
URL: | http://d.repec.org/n?u=RePEc:fer:wpaper:164&r=hea |
By: | Chiara Malavasi; Han Ye |
Abstract: | We estimate the effect of additional pension income on mortality outcomes by exploring the eligibility criteria of a German program subsidizing the pensions of low-wage workers. Using novel administrative data, we find that eligibility leads to a 2-month delay in age at death (censored at 75). Survey evidence suggests that additional pension income improves both mental and physical health. In addition, individuals feel less financially constrained and are more optimistic about their future. Heterogeneity analysis indicates that the results are mainly driven by men. |
Keywords: | Mortality, Health, Income, Pension subsidy, Retirement |
JEL: | I10 I12 J14 J26 |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2024_514v2&r=hea |
By: | Emre Oral; Simon Rabaté; Arthur Seibold |
Abstract: | We study the influence of family members, neighbors and coworkers on retirement behavior. To estimate causal retirement spillovers between individuals, we exploit a pension reform in the Netherlands that creates exogenous variation in peers’ retirement ages, and we use administrative data on the full Dutch population. We find large spillovers in couples, primarily due to women reacting to their husband’s retirement choices. Consistent with homophily in social interactions, the influence of the average sibling, neighbor and coworker is modest, but sizable spillovers emerge between similar individuals in these groups. Additional evidence suggests both leisure complementarities and the transmission of social norms as mechanisms behind retirement spillovers. Our findings imply that pension reforms have a large social multiplier, amplifying their overall impact on retirement behavior by 40%. |
Keywords: | retirement, pension reform, social networks, spillover, peer effects |
JEL: | D91 H55 J26 |
Date: | 2024 |
URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10999&r=hea |
By: | Monge-Navarro, Daniela; Monge, Andrea N |
Abstract: | Public insurers face trade-offs between the individual and collective benefits they can provide given limited resources. Drug expenditure is one of the largest components of health spending and it is not clear cut what should be readily available. We study litigation as a safety valve using data from cancer drug requests filed in court in Costa Rica, a country with a universal healthcare system. As a standard, decisions on rationing are based on economic evaluations of health care, but a probit model to predict lawsuit success shows that higher benefit drugs do not have higher success probabilities even if this would be the desired outcome from the individual’s perspective. Marginal costs, which approximate cost-benefit ratios, do show a significant effect but of a smaller magnitude, making the Court differ from the public insurer’s rationing rule. Regarding social determinants of health, variables such as education, income and region don’t appear to generate a bias from judges. Moreover, as prevalence and mortality are commonly used to characterize diseases and their severity, we examine the types of cancers involved in litigation and assess whether healthcare coverage explains any patterns. Overall, no clear patterns emerge, indicating that the Court’s role in drug access complements the population-level rationing rules, addressing individual heterogeneity. For judges, the findings do not suggest a cautious approach for prevalent diseases, but they do place a high value on the probability of survival. So far this last factor appears the most relevant for Court rulings. Finally, an event study model shows that no drug or diagnosis guarantees lawsuit success, and past decisions do not significantly influence future ones, which is a common concern according to public opinion. This research sheds light on the complex decision-making process regarding drug access under a universal healthcare system and highlights the importance of balancing individual and collective well-being in resource allocation. |
Keywords: | litigation, healthcare, drug-access, cost-effectiveness, prevalence, mortality |
JEL: | D61 H40 I11 I13 I18 K41 |
Date: | 2023 |
URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120493&r=hea |
By: | Yun taek Oh; Morris M. Kleiner |
Abstract: | Ways of leaving the labor force has been an understudied aspect of labor market outcomes. Labor market institutions such as occupational licensing may influence how individuals transition to retirement. When and how workers transition from career jobs to full retirement may contribute to pre- and post-retirement well-being. Previous investigations of retirement pathways focused on the patterns and outcomes of retirement transitions, yet the influence of occupational licensing on retirement transition has not been analyzed. In this study, we use the Current Population Survey and Survey of Income and Program Participation to investigate how occupational licensing influences American later-career workers’ choice of retirement pathways. Our results show that licensed workers are less likely to choose to change careers but more likely to reduce work hours in transitioning out of the workforce. These results are consistent with the findings that licensed workers receive more benefits in the form of preferable retirement options, suggesting that these workers tend to have higher wages, benefits, and flexibility even toward the end of their careers. |
JEL: | J0 J26 J3 J30 J32 J33 J40 J44 |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32292&r=hea |
By: | Mora-Garcia, Claudio A (INCAE Business School); Prem, Mounu (Einaudi Institute for Economics and Finance, and CEPR); Rodriguez-Lesmes, Paul (Facultad de Economía Universidad del Rosario); Vargas, Juan F. (University of Turin (ESOMAS); Collegio Carlo Alberto) |
Abstract: | Healthcare workers are in great deficit worldwide, especially in rural and vulnerable areas of developing countries. By leveraging a permanent ceasefire that ended over five decades of armed conflict between the Colombian government and the FARC insurgency, we study the extent to which conflict termination affected the health workforce gap between areas more exposed to FARC violence and other places. Based on individual-level administrative records of all healthcare workers in Colombia and a difference-in differences strategy, we find that the ceasefire caused a differential 11.4% decrease in the share of employed healthcare workers per 1, 000 people in places more exposed to FARC violence relative to the rest of the country. We find a stronger decrease among healthcare workers with less human capital levels and open-ended labor contracts. We show that this effect is likely explained by lifting mobility restrictions in previously violent areas, and document that, because the net reduction in healthcare workers increased the within-municipality share of (more productive) physicians, it did not translate into a deterioration of mortality rates or healthcare service provision. |
Keywords: | healthcare workers; armed conflict; violence |
JEL: | I12 I15 |
Date: | 2024–04–10 |
URL: | http://d.repec.org/n?u=RePEc:col:000092:021124&r=hea |
By: | Zhu, Ge |
Abstract: | In the context of an increasingly aging population, this paper examines the economic incentives of long-term care insurance policies for women to disengage from informal care responsibilities within the household. Through constructing both theoretical analytical frameworks and empirical identification strategies, we seek to comprehend the causal relationship between women benefiting from long-term care insurance policy pilot programs and their entry or re-entry into the labor market. Our findings indicate that long-term care insurance policies significantly stimulate female employment. This discovery implies that aiding women in shifting family responsibilities to the market contributes to enhancing female labor participation. Robustness checks corroborate our findings, and the outcomes of competitive hypotheses demonstrate that alleviating family care burdens is more conducive to promoting female employment than providing care job opportunities. Further analysis suggests that long-term care insurance policies may also potentially undermine China's "raising children to support old age" mechanism and the preference for sons over daughters. However, there exist heterogeneities concerning enhancing women's bargaining power in both the household and society. |
Keywords: | Long-term Care insurance policy; Women employment; Informal care; China; Competing hypotheses; Bargaining power of women |
JEL: | I1 J2 |
Date: | 2024–01–24 |
URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120472&r=hea |
By: | Yoko Ibuka (Faculty of Economics, Keio University); Junya Hamaaki (Faculty of Economics, Hosei University) |
Abstract: | Studies suggest that mortality increases after income receipt. To examine whether the adverse effect of income on health is induced by economic activities and how certain economic activities are related to specific health conditions, we investigate withinmonth cycles in ambulance transport, utilizing detailed information on the locations of the origin and timing of the transports. Our analysis exploits the difference in the number of patients on the same day between payment and non-payment months, using the Japanese National Pension for the elderly that is distributed bi-monthly. We observe a 4.5% increase in ambulance transports on the day of pension payment, primarily attributed to heightened economic activities such as gambling or amusement, shopping, and dining out. We have suggestive evidence indicating that this increase in transport is linked to a relaxation in liquidity. These findings have implications for healthcare system preparedness and the optimal design of public benefit payment. |
Keywords: | Emergency Medical Services, Social Security Payment, Time Stamp, Excess sensitivity |
JEL: | H55 H75 I12 |
Date: | 2024–03–25 |
URL: | http://d.repec.org/n?u=RePEc:keo:dpaper:2024-006&r=hea |
By: | Weder, Rolf; Bentele, Riccardo |
Abstract: | Real-world data (RWD) are an increasingly important input into the pharmaceutical R&D process as shown by countries like the USA or Finland. As the availability of and access to Swiss RWD is rather limited, the question arises whether this creates a burden for pharmaceutical R&D in Switzerland. We build on the economics of data and ideas as well as the home-market effect to analyze the importance of local RWD in the three stages of pharmaceutical R&D (pre-clinical, clinical, and post-approval re-search) as well as in the field of personalized medicine. We find qualitative support for a home-market effect and conclude that there is an urgent need to improve the current RWD situation in Switzerland, from the perspective of both Swiss patients and pharmaceutical R&D in Switzerland. |
Keywords: | Patient Data, Real-World Data, Pharmaceutical R&D, Data and Innovation, Home-Market Effects, International Trade, Location of R&D |
JEL: | F1 O3 L65 |
Date: | 2024 |
URL: | http://d.repec.org/n?u=RePEc:bsl:wpaper:2024/02&r=hea |
By: | Raquel Carrasco; Diego González-González |
Abstract: | This study examines the impact of childhood obesity on the academic performance and human capital accumulation of high school students using data from Spain. To address potential endogeneity issues, we exploit the exogenous variation in obesity within peer groups. Specifically, we use the prevalence of obesity by gender in students’ classes as an instrumental variable for individual obesity. The results indicate that obesity has a negative impact on academic achievement, particularly on general scores for girls, cognitive abilities as measured by CRT scores, financial abilities, and English grades for both boys and girls. In addition, we found a negative impact of obesity on girls’ mathematics scores, while boys experienced a positive impact. We identify several key drivers of these effects, including teacher bias, psychological well-being, time preferences, and expectations related to labor market discrimination. Our analysis sheds light on the multiple influences of childhood obesity on academic outcomes and highlights the need for targeted interventions. |
Date: | 2024–04 |
URL: | http://d.repec.org/n?u=RePEc:fda:fdaddt:2024-03&r=hea |
By: | Simpson, Julija (Newcastle University); Wildman, John (Newcastle University); Bambra, Clare (Newcastle University); Brown, Heather (Lancaster University) |
Abstract: | Single mothers have experienced increasing work requirements both in the UK and in other developed countries. Little is known how increasing working hours may have affected their mental health. We investigate the impact of increasing working hours on mental health of single mothers, and compare this relationship to that for partnered mothers. We used 13 waves of the UKHLS (2009-2023) to estimate the relationship between changing working hour categories (1-16 hour per week vs. 17-25; 26-35; 36-40; and 41+) and mental health using fixed-effects models. We also investigated the role of potential mechanisms linking higher working hours and mental health, including role strain and additional income. Our findings suggest that increasing working hours from low (1-16 hours per week) to higher categories has a negative and progressively worsening relationship with the mental health of single mothers. Increasing hours to 17-25, 26-35, 36-40, and 41+ is associated with lower GHQ-12 scores by -0.7, -0.5, -0.8, and -1.1 respectively. For partnered mothers, there is no significant relationship with mental health across any of the higher working hour categories. Further analyses suggest increased role strain for single mothers as a mechanism helping explain these differences. We have found that higher working hours relative to part-time may be contributing to the worsening mental health of single mothers, at least in part due to increased role strain of having to balance work and family responsibilities. Such effects should be considered when developing future welfare policies for single mothers, to ensure that greater work requirements do not undermine the mental health of the already vulnerable population group. |
Keywords: | mental health, working hours, single mothers, partnered mothers, inequalities |
JEL: | J13 J16 J22 |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16875&r=hea |
By: | Nguyen, Ha; Zubrick, Stephen; Mitrou, Francis |
Abstract: | Children and adolescents spend more than one-third of their time sleeping. Yet, we know little about the causal impact of sleeping on their development. This paper is the first to exploit variation in local daily daylight duration measured on pre-determined diary dates across the same individuals through time as an instrument in an individual fixed effects regression model to draw causal estimates of sleep duration on a comprehensive set of child development indicators. Applying this model to about 50 thousand time use diaries from two cohorts of Australian children spanning over 16 years, we first document that children sleep substantially less on days with longer daylight duration. Our results show that sleeping longer improves selected general developmental, behavioural and health outcomes in children and adolescents. By contrast, sleeping more statistically significantly increases the BMI scores, mainly by increasing the risk of being overweight. Moreover, while the impact of sleep duration on general and behavioural outcomes is more pronounced for females or older individuals, the effect on BMI is largely driven by males. The results indicate a null or relatively small positive impact of sleeping longer on cognitive skills. |
Keywords: | Sleep; Time Allocation; Circadian Rhythms; Human Capital; Child Development |
JEL: | I00 I12 J22 J24 |
Date: | 2024 |
URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120562&r=hea |
By: | Ian Brownwood; Gaétan Lafortune |
Abstract: | The pandemic has stimulated growing interest in using advanced practice nurses such as Nurse Practitioners (NPs) to address growing primary care needs linked to population ageing and more people living with chronic conditions, although not all countries are moving at the same speed. This OECD Health Working paper reviews recent developments in advance practice nursing (APN) in primary care in OECD countries. It focusses on NPs in those countries that are recognising this category of nurses, but also describes the emergence of other categories of nurses taking on new roles such as family and community nurses in some European countries. In those countries that have achieved decisive breakthroughs in new forms of task sharing between primary care doctors (GPs) and nurses, increasing the number of APNs in primary care is seen as a real opportunity to respond to primary care needs and reduce pressures on GPs and hospitals. |
Date: | 2024–04–15 |
URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:165-en&r=hea |
By: | Matthew P Hamilton; Caroline Gao; Jonathan Karnon; Luis Salvador-Carulla; Sue M Cotton; Cathrine Mihalopoulos |
Abstract: | Most health economic analyses are undertaken with the aid of computers. However, the research ethics of implementing health economic models as software (or computational health economic models (CHEMs)) are poorly understood. We propose that developers and funders of CHEMs should adhere to research ethics principles and pursue the goals of: (i) socially acceptable user requirements and design specifications; (ii) fit for purpose implementations; and (iii) socially beneficial post-release use. We further propose that a transparent (T), reusable (R) and updatable (U) CHEM is suggestive of a project team that has largely met these goals. We propose six criteria for assessing TRU CHEMs: (T1) software files are publicly available; (T2) developer contributions and judgments on appropriate use are easily identified; (R1) programming practices facilitate independent reuse of model components; (R2) licenses permit reuse and derivative works; (U1) maintenance infrastructure is in place; and (U2) releases are systematically retested and deprecated. Few existing CHEMs would meet all TRU criteria. Addressing these limitations will require the development of new and updated good practice guidelines and investments by governments and other research funders in enabling infrastructure and human capital. |
Date: | 2024–03 |
URL: | http://d.repec.org/n?u=RePEc:arx:papers:2403.17798&r=hea |
By: | José María Durán-Cabré (Universitat de Barcelona & IEB); Alejandro Esteller-Moré (Universitat de Barcelona & IEB); Leonzio Rizzo (Università degli Studi di Ferrara & IEB); Riccardo Secomandi (University of Ferrara) |
Abstract: | The Covid-19 vaccination campaign can be regarded as a public-sector success story. Given the shock caused by the pandemic, the visible and successful response of the public authorities regarding vaccination might have elicited an increase in the public’s trust. We test whether the vaccination process has increased the marginal willingness to pay taxes (MWTP). Taking advantage of the different paths of vaccination in Spain, we pursue a difference-in-difference empirical strategy, complemented by an event study, to infer causality running from vaccination to MWTP. We find an increase in MWTP caused by the good governance related to vaccination. |
Keywords: | Survey data, marginal willingness to pay, DiD, event study, Covid-19 |
JEL: | D72 H20 H26 H30 |
Date: | 2023 |
URL: | http://d.repec.org/n?u=RePEc:ieb:wpaper:doc2023-08&r=hea |
By: | Christopher F Baum (Boston College); Andrés Garcia-Suaza (Facultad de Economía, Universidad del Rosario); Miguel Henry (QuantEcon Research); Jesús Otero (Facultad de Economía, Universidad del Rosario) |
Abstract: | Since the initial outbreak of COVID-19 in the United States, researchers from a variety of scientific disciplines have sought to understand the factors influencing the evolu- tion of cases and fatalities. This paper proposes a two-stage econometric modeling approach to analyze a range of socioeconomic, demographic, health, epidemiological, climate, pollution, and political factors as potential drivers of the spread of COVID- 19 across waves and counties in the United States. The two-step modeling strategy allows us to (i) accommodate the observed heterogeneity across waves and counties in the transmissibility of the virus, and (ii) assess the relative importance of the cross- sectional measures. We leverage the availability of daily data on confirmed cases and deaths of COVID-19 in counties across the 48 contiguous states and the District of Columbia, spanning a two-year period from March 2020 to March 2022. We find that socioeconomic and demographic factors generally had the greatest influence on the transmissibility of the virus and the associated mortality risk, with health and climate factors playing a lesser role. |
Keywords: | COVID-19, coronavirus, geographic heterogeneity, covariate selection |
JEL: | C13 C21 R15 R23 |
Date: | 2024–04–13 |
URL: | http://d.repec.org/n?u=RePEc:boc:bocoec:1067&r=hea |
By: | Ebert, Cara; Steinert, Janina |
Abstract: | We study the impact of the COVID-19 pandemic on domestic violence against women in Germany in 2020. The analysis draws on three data sources: (1) longitudinal administrative data on the volume of help requests to helplines, shelters and counselling services, (2) cross-sectional survey data collected during the first wave of the pandemic, and (3) a qualitative online survey with counsellors and domestic violence experts. The number of violence-related requests at helplines increased significantly by 29% with the first physical distancing measures, whereas ambulatory care services such as shelters experienced a 19% increase in help requests only after physical distancing restrictions were lifted. Our results indicate that individuals substituted help services away from ambulatory care towards helplines. We do not observe exacerbated violence in states with greater mobility reductions, lower daycare capacity for childcare or higher COVID-19 infection numbers. Our findings highlight the importance of providing easily accessible online counselling offers for survivors of violence and governmental financial relief packages. |
Abstract: | Wir untersuchen die Auswirkungen der COVID-19-Pandemie auf die häusliche Gewalt gegen Frauen in Deutschland im Jahr 2020. Die Analyse stützt sich auf drei Datenquellen: (1) administrative Längsschnittdaten zum Umfang der Hilfeanfragen bei Hotlines, Frauenhäusern und Beratungsdiensten, (2) Querschnittsdaten, die während der ersten Welle der Pandemie erhoben wurden, und (3) eine qualitative Online-Befragung von Fachpersonal für häuslicher Gewalt. Die Zahl der Hilfeanfragen bei Hotlines stieg mit den ersten Socialdistancing-Maßnahmen signifikant um 29 %, während ambulante Dienste wie Notunterkünfte erst nach Aufhebung der Socialdistancing-Maßnahmen einen Anstieg der Hilfeanfragen um 19 % verzeichneten. Unsere Ergebnisse deuten darauf hin, dass Betroffene ambulante Hilfestellen durch Hotlines ersetzt haben. Wir beobachten keinen größeren Zuwachs an Gewalt in Staaten mit größeren Mobilitätseinschränkungen, geringeren Kinderbetreuungskapazitäten oder höheren COVID-19-Infektionszahlen. Unsere Ergebnisse unterstreichen die Bedeutung von leicht zugänglichen Telefon- oder Online-Hilfsangeboten und von finanziellen Entlastungsangeboten der Regierung. |
Keywords: | COVID-19, lockdown, violence against women, event study |
JEL: | J12 J16 J18 I18 |
Date: | 2024 |
URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:287763&r=hea |