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on Health Economics |
| By: | Krauss, Alexander |
| Abstract: | What drives groundbreaking research in economics? Nobel-prize-winning work has had an important impact on public policies, but we still do not understand well what drives such breakthroughs. We collect data on all nobel-prize discoveries in economics to address this question. We find that major advances in the field of economics are brought about by methodological innovation: by developing new and improved research methods. We find that developing for example econometrics in 1933, randomised controlled trials in 1948 and new game theory methods in 1950 were essential to opening the new fields of corporate finance, experimental economics and information economics, respectively. We identify the development of new methods as the main mechanism driving new discoveries and research fields. Fostering this general mechanism (generating novel methods) holds the potential to greatly increase the rate at which we make new breakthroughs and fields. We also show that many of the main methods of economics – such as randomised controlled trials, natural experiments, regression discontinuity, instrumental variables and other statistical methods – had been developed and used in other fields like public health, before economists adopted them. This shift towards more powerful empirical methods in the field has important implications on developing new and better methods and adopting them from related fields to make new advances more rapidly. |
| Keywords: | economic breakthroughs; economic discoveries; economic methods; economics of science; Nobel prize; scientific discovery; scientific innovation |
| JEL: | J1 |
| Date: | 2024–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:123039&r= |
| By: | Katherine B Coffman (Harvard Business School); Lucas Coffman (Boston College); Keith Marzilli Ericson (Boston University Questrom School of Business) |
| 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. |
| Keywords: | Gender differences, Non-binary gender, Experiments, Labor |
| JEL: | C90 D10 J10 |
| Date: | 2024–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:boc:bocoec:1074&r= |
| By: | Anirban Basu |
| Abstract: | I demonstrate that to achieve dynamic efficiency, the optimal share of total surplus that a social payer should transfer to an innovating industry for a current asset depends on the marginal product of investment and the share of profits invested by the industry on the current asset and not on returns from future innovations. This insight arises from using a dynamic multi-period model of optimal transfers rather than a static two-period model with one optimal transfer, as used in the literature. I delve into the implications for alternative pricing of healthcare innovations - value-based prices using cost-effectiveness analysis, monopoly prices under the social demand curve, and monopoly profit preserving prices under insurance – for surplus appropriation by the innovating industry. I also explore how alternative financing mechanisms used by social payers and the demand uncertainty that innovators face impact this appropriation share. I illustrate these concepts with a substantive example of pricing gene therapy for sickle cell disease in the United States |
| JEL: | I11 I13 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32480&r= |
| By: | Ziyi Wang; Lijia Wei; Lian Xue |
| Abstract: | This study evaluates the effectiveness of Artificial Intelligence (AI) in mitigating medical overtreatment, a significant issue characterized by unnecessary interventions that inflate healthcare costs and pose risks to patients. We conducted a lab-in-the-field experiment at a medical school, utilizing a novel medical prescription task, manipulating monetary incentives and the availability of AI assistance among medical students using a three-by-two factorial design. We tested three incentive schemes: Flat (constant pay regardless of treatment quantity), Progressive (pay increases with the number of treatments), and Regressive (penalties for overtreatment) to assess their influence on the adoption and effectiveness of AI assistance. Our findings demonstrate that AI significantly reduced overtreatment rates by up to 62% in the Regressive incentive conditions where (prospective) physician and patient interests were most aligned. Diagnostic accuracy improved by 17% to 37%, depending on the incentive scheme. Adoption of AI advice was high, with approximately half of the participants modifying their decisions based on AI input across all settings. For policy implications, we quantified the monetary (57%) and non-monetary (43%) incentives of overtreatment and highlighted AI's potential to mitigate non-monetary incentives and enhance social welfare. Our results provide valuable insights for healthcare administrators considering AI integration into healthcare systems. |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2405.10539&r= |
| By: | Maynou, Laia; McGuire, Alistair; Serra-Sastre, Victoria |
| Abstract: | This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on-going maintenance costs. Using data from Hospital Episode Statistics for the period 2000–2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic-assisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference-in-difference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in post-LoS and 44% and 46% decrease in postoperative visits after 1 year and 2 years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the large-scale hospital investments in such costly technology. |
| Keywords: | efficiency gains; labor productivity; robotic surgery; staggered difference-in-differences; total factor productivity |
| JEL: | J1 |
| Date: | 2024–05–11 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:123635&r= |
| By: | Nakazawa, Katsuyoshi |
| Abstract: | This study adopts a quasi-experimental approach to empirically identify the discretion exercised by municipalities in conducting eligibility assessments for Japan’s Long-Term Care Insurance (LTCI) program. It leverages the municipal merger phenomenon in the first half of the 2000s as a significant factor in creating an extrapolation shock. Prior to the merger, municipalities had a clear incentive to enhance their eligibility ratios as they could transfer eligible recipients to the merged municipalities. This study’s difference-in-difference regression analysis provides concrete evidence that pre-merger municipalities did, indeed, escalate their eligibility ratios immediately before the merger, underscoring discretionary conduct in eligibility assessments. Moreover, it suggests that pre-merger municipalities tended to upgrade the eligibility status of insured residents from “Support needs” to “Long-term care needs I.” These findings not only highlight the deviation of the Japanese LTCI system from its institutional design but also point towards potential mismanagement within the system. Understanding these dynamics is crucial for improving the efficacy and fairness of LTCI programs. |
| Keywords: | Long-term care insurance; Eligibility assessment; Municipal merger; Free-rider behavior; Difference-in-difference |
| JEL: | H51 H73 H75 I13 I18 R51 |
| Date: | 2024–04–25 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120911&r= |
| By: | Hjalmarsson, Linn; Schmid, Christian P.R.; Schreiner, Nicolas (University of Basel) |
| Abstract: | Markets require informed participants to function efficiently. This paper examines the impact of providing targeted information directly to patients on their purchasing-decisions regarding pharmaceutical drugs. We analyze the effect of informational letters sent by a Swiss health insurer to clients who had recently purchased a brand-name drug, informing them of available generic alternatives and potential savings. Utilizing the quasi-randomized timing of the letter dispatch, we employ an event study design with staggered treatment adoption to estimate the causal effect of patient information on generic substitution probability. Based on 540, 000 drug purchases by 60, 000 patients we find that the probability of switching to a generic alternative increases by almost 30 percentage points immediately after receiving the informational letter, representing nearly a fourfold rise in the substitution likelihood among previous brand-name drug buyers. Furthermore, the effect does not substantially depend on whether patients face a copayment for their drug purchase and thus personally financially benefit from switching. Our results highlight the limits of healthcare policies that rely solely on financial incentives, particularly if patients lack sufficient information in their decision-making. |
| Keywords: | Generic substitution, Pharmaceuticals, Patient information |
| JEL: | D12 D83 D90 I11 I12 I18 |
| Date: | 2024–05 |
| URL: | https://d.repec.org/n?u=RePEc:bsl:wpaper:2024/05&r= |
| By: | Peter Q. Blair; Bobby W. Chung |
| Abstract: | Licensed workers could be shielded from unemployment during recession since occupational licensing laws are asymmetric—making unlicensed workers an illegal substitute for licensed workers but not the reverse. We test our hypothesis using a difference-in-differences event study research design that exploits cross-state variation in licensing laws to compare the unemployment rate between licensed and unlicensed workers before and after the COVID-19 recession and the Great Recession. Controlling for worker ability, we find that licensing shields workers from a recession-induced increase in the unemployment rate of 0.82 p.p. during COVID-19 and 1.11 p.p. during the Great Recession. |
| JEL: | E02 E24 J08 J23 J24 J44 J64 K31 L31 M51 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32486&r= |
| By: | Claire Borsenberger; Helmuth Cremer; Denis Joram; Jean-Marie Lozachmeur; Estelle Malavolti |
| Abstract: | We study the design of optimal (private and/or social) insurance schemes for formal home care and institutional care. We consider a three period model. Individuals are either in good health, lightly dependent or heavily dependent. Lightly dependent individuals can buy formal home care which reduces the severity of dependency and reduces the probability to become severely dependent in the next period. Severely dependent individuals pay for nursing home care. In both states of dependency individuals can receive a (private or public) insurance benefit (transfers). These benefits can be flat or depend on the formal care consumed (or a combination of the two). These benefits are financed by a premium (or a tax). Individuals may be alive until the end of period 2 or die at the beginning of periods 1 or 2 with a certain probability which may depend on their state of health. The laissez faire is inefficient because individuals consume a too low level of formal home care and are not insured. The first-best insurances scheme requires a transfer to lightly dependent individuals that, (under some conditions) increases with the amount of formal home care consumed. Severely dependent individuals, on the other hand, must receive a flat transfer (from private or social insurance). The theoretical analysis is illustrated by a calibrated numerical example which show that the expressions have the expected sings under plausible conditions. |
| Keywords: | long-term care insurance, formal home care, nursing home care |
| JEL: | I13 I18 H51 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11112&r= |
| By: | Bachner, Florian (Austrian National Public Health Institute (GÖG)); Halla, Martin (WU Vienna University of Economics and Business); Pruckner, Gerald J. (University of Linz) |
| Abstract: | We examine how the number of beds available in a maternity ward affects the likelihood of cesarean delivery and maternal health. Our analysis is based on administrative data from Austria. We exploit idiosyncratic daily variation in the occupancy of maternity hospital beds. We find that empty beds increase the probability of cesarean delivery, hospitalization, and readmission. A one standard deviation decrease in maternity bed occupancy increases the probability of cesarean delivery by 4.0% and subsequent hospitalization by 5.8%. Expectant mothers may benefit from a crowded hospital, even at unfavorable patient-staff ratios, because it may lead to less harmful overtreatment. |
| Keywords: | capacity, hospital crowding, supplier-induced demand, cesarean delivery, cesarean section, overtreatment, maternal health |
| JEL: | I12 J13 J11 J22 J21 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16981&r= |
| By: | Meiyi Zhuang; Xinyi Zhang; Hisahiro Naito |
| Abstract: | Health is one of the most critical factors that affects retirement behavior, and poor health may lead to early retirement among middle-aged and older adults. In China, where the population is aging rapidly, early retirement has significant implications for the economy. Recent studies have shown that air pollution, particularly PM2.5, can cause various illnesses, such as respiratory diseases, cardiovascular diseases, high blood pressure, and diabetes. In this paper, we analyze the effects of PM2.5 on the retirement and health of middle-aged and elderly people, assuming that the effects of air pollution on retirement are highly nonlinear and different for farmers and non-farmers. To control for potential endogeneity, we use 2SLS estimation. The regression results for non-farmers show that higher PM2.5 concentrations increase the probability of heart-related diseases and early retirement behavior. Specifically, we found that a 10 microgra per cubic meters(about one standard deviation) per cubic meter increase in PM2.5 concentration is associated with a 58% increase in the probability of heart-related diseases and a 57% increase in early retirement. This implies that roughly 12.1 million people could continue participating in the labor market if the government can reduce PM2.5 concentration by 10 microgram per cubic meter across the country. For farmers, we found that higher PM2.5 concentration is associated with a higher probability of lung-related diseases, but we did not find evidence that it increases early retirement. For both non-farmers and farmers, we did not find evidence that a higher PM2.5 concentration decreases financial wealth. These findings suggest that higher air pollution deteriorates the health of non-farmers, increases the disutility of work, and induces early retirement but does not affect the financial wealth of farmers and non-farmers. |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:tsu:tewpjp:2024-001&r= |
| By: | Provenzano, Sandro; Roth, Sefi; Sager, Lutz |
| Abstract: | Recent research suggests that short-term exposure to air pollution is associated with an elevated prevalence of respiratory infectious disease. In this paper, we examine the relationship between the air quality index and weekly cases of COVID-19 and influenza-like illnesses (ILI) in the United States. We address potential bias from omitted variables and measurement error with an instrumental variable approach using atmospheric temperature inversions. Unlike other recent studies, we find no relationship between air quality and either COVID-19 or ILI cases. |
| Keywords: | air pollution; respiratory disease; influenza; COVID-19; ES/P000622/1 |
| JEL: | I18 Q51 Q53 |
| Date: | 2024–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:122154&r= |
| By: | Hasager, Linea (University of Copenhagen); Jørgensen, Mia (Danmarks Nationalbank) |
| Abstract: | Does living in a low-income neighborhood have negative health consequences? We document causal neighborhood effects on health by exploiting a Spatial Dispersal Policy that quasi-randomly resettled refugees across neighborhoods from 1986 to 1998. Refugees allocated to low-income neighborhoods had a 12 percent higher risk of having developed a lifestyle related disease 8 to 15 years after immigration compared with those allocated to high-income neighborhoods. Our results suggest that interaction with neighbors and the characteristics of the immediate environment are important determinants for health outcomes. Differences in health care access, ethnic networks, and individual labor market outcomes cannot explain our findings. |
| Keywords: | health inequality, Refugee Dispersal Policy, lifestyle related diseases, neighborhood effects |
| JEL: | J15 I12 I14 I31 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16949&r= |
| By: | Ahmad, Saba |
| Abstract: | Water, essential for all life, is abundantly present in nature and crucial for the environmental health of communities. Pakistan, ranking ninth among countries with limited access to clean water, has 21 million people out of 207 million facing this challenge. The study focuses on analyzing drinking water quality and health impacts in Havelian district. Twenty-one samples from eleven locations were examined for various physical and chemical parameters. Respondents overwhelmingly favored bottled water as safest, while solutions like filters and pipeline upgrades were suggested to address water quality issues. Few health issues were reported due to overall better water quality, with typhoid and diarrhea being most common. The study offers insights valuable for policymakers and researchers, discussed along with recommendations in subsequent sections. |
| Keywords: | Drinking water; quality; chemical properties; consumer health; consumer decisions. |
| JEL: | Q53 |
| Date: | 2024–04–20 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:120870&r= |
| By: | Pascaline Dupas; Seema Jayachandran; Adriana Lleras-Muney; Pauline Rossi |
| Abstract: | We conducted a randomized trial among 14, 545 households in rural Burkina Faso to test the oft-cited hypothesis that limited access to contraception is an important driver of high fertility rates in West Africa. We do not find support for this hypothesis. Women who were given free access to medical contraception for three years did not have lower birth rates; we can reject even modest effects. We cross-randomized additional interventions to address possible inefficiencies leading to low demand for free contraception, specifically misperceptions about the child mortality rate, limited exposure to opposing views about family size and contraception, and social pressure. Free contraception did not influence fertility even in combination with these other interventions. |
| JEL: | J13 J18 O12 |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32427&r= |
| By: | Wattal, Vasudha; Checkland, Katherine; Sutton, Matt; Morciano, Marcello |
| Abstract: | We study the long-term effects on hospital activity of a three-year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites. These effects were heterogeneous across sites, with greater reductions in care home Vanguard sites and concentrated among the older population. Care home Vanguards showed significant reductions beginning early in the programme but falling away more rapidly after programme discontinuation. Moreover, there were greater reductions for sites performing poorly before the programme. Overall, this suggests the effects of the integration programme might have been lagged but transitory, and more reliant on continued programme support. |
| Keywords: | integrated care; England; Vanguard; new care models; hospital admissions |
| JEL: | D00 H51 I11 I18 |
| Date: | 2024–03–09 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:123604&r= |
| By: | Debora Di Gioacchino; Emanuela Ghignoni; Laura Sabani |
| Abstract: | Healthcare typologies are valuable instruments for comparing the similarities and discrepancies in how nations finance, deliver, and structure their healthcare systems. This study concentrates on three distinct aspects of healthcare systems: (1) the overall level of healthcare expenditure; (2) the distribution between public and private funding; (3) the emphasis on primary care versus secondary care. We examine 25 European countries to investigate empirically how these nations cluster based on these three features. To accomplish this goal, we undertake a cluster analysis combining data on healthcare expenditure with metrics on the public-private funding mix and indicators of healthcare sectional orientation, predominantly utilizing OECD Health Data and WHO country reports. The results suggest the identification of at least five distinct healthcare system types. Subsequently, we employ these typologies to examine cross-national differences in health outcomes and health inequalities. Consistent with expectations, our findings show a robust association between healthcare expenditure, particularly public expenditure, and health outcome metrics, alongside a negative correlation with socio-economic health disparities. Primary care emphasis does not appear to correlate with improved health outcomes, nor with reduced health disparities. Finally, our findings challenge the purported decongestion effect associated with voluntary health insurance |
| Keywords: | healthcare systems; public–private mix; primary vs secondary care; voluntary health insurance; health outcomes |
| JEL: | H42 I13 I14 C40 |
| Date: | 2024–06 |
| URL: | https://d.repec.org/n?u=RePEc:sap:wpaper:wp251&r= |
| By: | Wiebe, Michael |
| Abstract: | Gendron-Carrier et al. (2022) studies the effect of subway openings on urban air pollution. The authors find a null average effect, but a negative effect in cities with high initial pollution. In this comment, I perform several robustness checks on the negative effect for high-pollution cities, and repeat the main analyses for low-pollution cities. I show that the main finding for high-pollution cities is robust, and find mixed results for low-pollution cities. I implement an alternative back-of-the-envelope calculation for the effect of subway openings on infant mortality, and find a smaller number of averted deaths. |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:i4rdps:121&r= |
| By: | Zhang, Yuting (University of Melbourne); Zhao, Jin (Shanghai Jiao Tong University); Yu, Zhangsheng (Shanghai Jiao Tong University); Wang, Guanghai (Shanghai Jiao Tong University); Zhang, Jun (Shanghai Jiao Tong University); Jiang, Fan (Shanghai Jiao Tong University); Wu, Saishuang (Shanghai Jiao Tong University); Zhang, Yue (Shanghai Jiao Tong University); Zhang, Donglan (New York University); Chen, Xi (Yale University) |
| Abstract: | During the first wave of the COVID-19 pandemic, Shanghai implemented lockdown measures to stop transmission of the virus. Over 26 million residents, including 0.8 million children aged 3-6, were confined at home. This study leveraged a city-wide cohort of preschool children - the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool (SCHEDULE-P) - and used a quasi-experimental design to study the impact of lockdown on preschool children's mental health and changes in their home environment and lifestyles. Two cohorts - the pre-pandemic cohort and the pandemic cohort - were investigated and compared using the difference-in-differences approach. The Strengths and Difficulties Questionnaire was used to screen children who were at risk for mental health distress. The Index of Childcare Environment questionnaire was used to evaluate the quality and quantity of stimulation and support available to children in their family environment. Children's screen time, sleep duration, and household socioeconomic status were also queried. The results showed that having experienced lockdown and home confinement was associated with a 3.1% increase in the percentage of children at risk for mental health distress, was associated with 21.2 minutes/day longer screen time, 15.7 minutes/day longer sleep duration, and a less favorable family environment. Children of parents with lower levels of education were more likely to experience mental health challenges associated with the lockdown. |
| Keywords: | lockdown, preschoolers, mental health, home environment, lifestyle, China, COVID-19 |
| JEL: | I18 I12 H75 I28 C23 |
| Date: | 2024–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16971&r= |
| By: | Difang Huang; Ying Liang; Boyao Wu; Yanyi Ye |
| Abstract: | We identify the effectiveness of social distancing policies in reducing the transmission of the COVID-19 spread. We build a model that measures the relative frequency and geographic distribution of the virus growth rate and provides hypothetical infection distribution in the states that enacted the social distancing policies, where we control time-varying, observed and unobserved, state-level heterogeneities. Using panel data on infection and deaths in all US states from February 20 to April 20, 2020, we find that stay-at-home orders and other types of social distancing policies significantly reduced the growth rate of infection and deaths. We show that the effects are time-varying and range from the weakest at the beginning of policy intervention to the strongest by the end of our sample period. We also found that social distancing policies were more effective in states with higher income, better education, more white people, more democratic voters, and higher CNN viewership. |
| Date: | 2024–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2405.12180&r= |
| By: | Holger Strulik; Volker Grossmann |
| Abstract: | In this paper, we examine the effects of the Covid-19 pandemic on individual aging and longevity with special focus on socioeconomic disparities in health outcomes. We also explore the individual-specific effects of Long Covid. We develop and calibrate a health economic model based on principles of the biology of human aging that captures the interaction between infections and chronic health deficits. Our analysis suggests that neglecting this interaction leads to a gross underestimation of the long-term health impact of the pandemic. Our model also explains large socioeconomic health differences that can be attributed to infection protection behavior. |
| Keywords: | Covid-19, Long Covid, health behaviour, health deficits, health inequality, protection aversion, false beliefs, longevity |
| JEL: | D15 I10 I12 J24 J26 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_11104&r= |