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on Health Economics |
| By: | Bergvall, Sanna (Department of Economics, University of Gothenburg); Fernström, Clara (Stockholm Business School, Stockholm University); Ranehill, Eva (Department of Economics, Lund University); Sandberg, Anna (Swedish Institute for Social Research, Stockholm University) |
| Abstract: | Recent self-reported and cross-sectional survey evidence documents high levels of mental health problems among PhD students. We study the impact of PhD studies on mental health care uptake using Swedish administrative records of prescriptions for psychiatric medication for the full population of PhD students. First, we provide descriptive evidence that PhD students collect psychiatric medication at a higher rate than a matched sample of individuals holding a master’s degree, but at a lower rate than a matched sample from the general population. Second, we implement an event study analysis and document that, in the years preceding their PhD studies, prospective students collect psychiatric medication at a rate similar to that of a matched sample of individuals holding a master’s degree. However, following the start of PhD studies, the use of psychiatric medication among PhD students increases substantially. This upward trend continues throughout the course of PhD studies, with estimates showing a 40 percent increase by the fifth year compared to pre-PhD levels. After the fifth year, which represents the average duration of PhD studies in our sample, we observe a notable decrease in the utilization of psychiatric medication. |
| Keywords: | Mental health; PhD studies; psychiatric medication |
| JEL: | I10 I23 |
| Date: | 2024–09–04 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:lunewp:2024_007 |
| By: | Philipp Ager; Viktor Malein |
| Abstract: | The paper evaluates the long-run impact of charity nurseries for disadvantaged children in early 20th-century New York. Access to charity nurseries with kindergarten instruction raised children’s years of education and reduced their likelihood of working in low-skilled jobs later in life. Instead, exposed children were more likely to work in jobs requiring higher cognitive and language skills. The effects were strongest for children from the most disadvantaged immigrant groups at that time. Our findings suggest that kindergarten instruction in charity nurseries helped immigrant children better understand teachers’ instructions and learning materials which improved their economic outcomes in adulthood. |
| Keywords: | Age of Mass Migration; Charity Nurseries; Child Care; Disadvantaged Children; Kindergarten Instruction; New York City |
| JEL: | I21 I26 J13 J15 N31 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2024_596 |
| By: | Majlesi, Kaveh; Molin, Elin; Roth, Paula |
| Abstract: | We examine the effect of fatal and nonfatal health shocks on household debt defaults. Fatal shocks significantly cause defaults, especially among surviving spouses lacking sufficient resources, namely housing wealth. Our findings suggest that this behavior is not due to inattention. These shocks also have intergenerational consequences, as children of resource-poor surviving spouses become more likely to face debt collection. These findings in a country with a relatively generous welfare system manifest the graveness of background risks among poorer households and suggest the potential for improving social insurance programs. Nonfatal health shocks lead to an immediate but temporary increase in default likelihood. |
| Keywords: | financial distress, health shocks, household debt, household saving, JEL classification: I12, G51, G22 |
| Date: | 2024–10–08 |
| URL: | https://d.repec.org/n?u=RePEc:ajt:wcinch:82497 |
| By: | Sebastian Becker; Annica Gehlen; Johannes Geyer; Peter Haan |
| Abstract: | We provide novel evidence about the incentive and welfare effects of an increase in the generosity of disability benefits. Importantly, a unique policy variation in Germany allows us to isolate the income effect of a change in benefit generosity. We leverage this quasi-experimental policy variation using an RD design to estimate the effect of increasing disability benefits on employment, earnings, labor market transitions, and mortality outcomes using administrative data on the universe of new disability benefit recipients. Contrary to previous literature, our analysis reveals no significant impact on the employment and earnings of DI recipients due to the increased benefits. However, we find a sizable effect of the probability of returning to the labor market. We find no effects on recipient mortality six years after benefit award, but estimates imply a notable reduction in poverty risk, highlighting meaningful welfare implications of increased generosity. |
| Keywords: | disability insurance, pension reform, wealth effect, labor supply, mortality, RDD |
| JEL: | H55 I12 J22 J26 |
| Date: | 2024–09–23 |
| URL: | https://d.repec.org/n?u=RePEc:bdp:dpaper:0050 |
| By: | McNamara, Cici (Georgia Institute of Technology); Pineda-Torres, Mayra (Georgia Institute of Technology) |
| Abstract: | We quantify the impact of federal subsidies for graduate medical education on primary care physician (PCP) supply by examining the impact of Section 5503 of the Affordable Care Act, which increased the number of residents that teaching hospitals in rural and high-need areas could receive subsidies for training. Instrumenting for selection into the program using its eligibility and allocation criteria, we find that the provision increased both the recruitment of residents into primary care and time spent at teaching hospitals in high-need areas, resulting in an increase in PCP supply in treated counties of 5.2 percent. |
| Keywords: | Medicare, Affordable Care Act, primary care |
| JEL: | I18 I28 J24 |
| Date: | 2024–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17263 |
| By: | Abdel Ghany, Jasmin; Wilde, Joshua K.; Dimitrova, Anna; Kashyap, Ridhi; Muttarak, Raya |
| Abstract: | Human sex ratios at birth (SRBs) shape population composition and are closely linked to maternal health and gender discrimination. In the context of climate change, SRBs may theoretically be skewed by physiological or behavioral responses to exposure to global warming. However, evidence for this is limited. In this study, we estimate the effect of prenatal exposure to temperature on birth sex by linking survey data on 5 million live births in 33 sub-Saharan African countries and India with high-resolution temperature data. To distinguish between spontaneous and induced abortions, we exploit sociodemographic differentials, exposure timing, and regional differences in son preference. We find that days with a maximum temperature above 20°C are negatively associated with male births in both regions. In sub-Saharan Africa, we observe fewer male births after high first trimester temperature exposure, consistent with increased spontaneous abortions from maternal heat stress. This is particularly true for births by mothers in rural areas, with little formal education, and for higher birth orders. By contrast, in India we find second trimester temperature exposure is associated with fewer male births, consistent with reductions in induced sex-selective abortions against girls. As expected, these reductions are concentrated in higher birth orders and older mothers. We also find large reductions in male births by sonless mothers in northern Indian states, where son preference is greater. These findings demonstrate that climate change harms maternal health, increases prenatal mortality, and reduces engagement with the health system, leading to a complex effect on sex ratios at birth. |
| Date: | 2024–09–18 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:wj7ke |
| By: | Lagarde, Mylène; Riumallo Herl, Carlos |
| Abstract: | In a field experiment with 400 groups of informal entrepreneurs in El Salvador, we compare the impact of group incentives (linked to compliance of all members) to equivalent individual ones to encourage cardiovascular check-ups. We test two incentive designs: small rewards and lotteries. Group incentives are as effective as individual ones at increasing demand for prevention, but, unlike individual incentives, they fail to target those with potentially higher health risks. The equal effectiveness of group incentives is linked to more communication, coordination between members and, to some extent, peer pressure. These social dynamics contribute to reduce uncertainty about other group members’ decisions and enhance the perceived net benefit of prevention. Although the preventive check-ups do not induce short-term lifestyle changes, they substantially increase the detection of new risk factors, making all incentives highly cost-effective interventions in this population. |
| JEL: | C93 D91 I12 |
| Date: | 2025–01–01 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:125349 |
| By: | Hall, Caroline (IFAU - Institute for Evaluation of Labour Market and Education Policy); Kotakorpi, Kaisa (Tampere University); Liljeberg, Linus (IFAU - Institute for Evaluation of Labour Market and Education Policy); Pirttilä, Jukka (University of Helsinki) |
| Abstract: | We examine the health effects of a labor market activation policy, the Youth Job Guarantee, implemented in Sweden in 2007. To estimate the causal effects of this policy on health, we implement an RD-design using the age-eligibility threshold of the policy, together with detailed administrative data on health outcomes including measures of mental health. Health effects could arise indirectly via effects on employment, or directly, e.g., via an improved daily routine. In contrast to most of the existing literature on the health effects of ALMPs, our results indicate that the activation policy did not have clear positive effects on health one year after the start of the unemployment spell, measured by prescribed medication or healthcare visits. |
| Keywords: | Labor market programs; activation; youth unemployment; mental health |
| JEL: | H51 I12 I18 J68 |
| Date: | 2024–09–27 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:ifauwp:2024_015 |
| By: | Scervini, Francesco; Trucchi, Serena (Cardiff Business School) |
| Abstract: | Alcohol consumption among older adults has been drawing public health interest due to the rising use of alcohol in the growing elderly population. This paper adds to the understanding of alcohol consumption in later life by investigating the impact of a specific life event: the transition to an empty nest, when adult children leave the parental home. Our findings show a significant increase in alcohol consumption in an empty nest, equivalent to approximately one additional drink every one to three weeks. This change is characterised by more regular drinking patterns and a modest rise in daily intake. The groups most affected by this change include couples, individuals with high income, those actively employed, and respondents aged 45-60. We also provide evidence on the mechanisms underlying this relationship, supporting a key role of relaxation and changes in time use. |
| Keywords: | Empty nest, alcohol consumption, longitudinal data. |
| JEL: | D1 I12 J14 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:cdf:wpaper:2024/20 |
| By: | Nanna Fukushima; Stephanie von Hinke; Emil N. S{\o}rensen |
| Abstract: | This paper investigates the effects of the staggered roll-out of a pollution reduction programme introduced in the UK in the 1950s. The policy allowed local authorities to introduce so-called Smoke Control Areas (SCAs) which banned smoke emissions. We start by digitizing historical pollution data to show that the policy led to an immediate reduction in black smoke concentrations. We then merge data on the exact location, boundary and month of introduction of SCAs to individual-level outcomes in older age using individuals' year-month and location of birth. We show that exposure to the programme increased individuals' birth weights as well as height in adulthood. We find no impact on their years of education or fluid intelligence. |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2409.11839 |
| By: | Ichimura , Hidehiko (University of Arizona and University of Tokyo); Lei , Xiaoyan (Peking University.); Lee , Chulhee (Seoul National University); Lee , Jinkook (University of Southern California); Park , Albert (Asian Development Bank); Sawada , Yasuyuki (University of Tokyo) |
| Abstract: | East Asia is undergoing a rapid demographic transition and “super” aging. As a result of steadily decreasing fertility and increasing life expectancy, older people’s proportion of the population and the old-age dependency ratio is rising across all countries in East Asia, particularly in the People’s Republic of China (PRC), Japan, and the Republic of Korea (ROK). In this paper, we empirically investigate the well-being of older people in these three countries, using comparable microlevel data from the China Health and Retirement Longitudinal Study (CHARLS), the Japanese Study of Aging and Retirement (JSTAR), and the Korean Longitudinal Study on Aging (KLoSA). Specifically, we examine the depressive symptom scale as a measure of well-being and estimate the impact of four broad categories—demographic, economic, family-social, and health. The decomposition and simulation analysis reveals that although much of the difference in mean depression rates among countries can be explained by differences in the characteristics of older people in the three countries, there remain significant differences across countries that cannot be explained. In particular, even after accounting for a multitude of factors, older people in the ROK are more likely to be depressed than in the PRC or Japan. |
| Keywords: | aging; well-being; depression; suicide; panel data |
| JEL: | D10 I30 J14 |
| Date: | 2024–10–15 |
| URL: | https://d.repec.org/n?u=RePEc:ris:adbewp:0745 |
| By: | Bibata Wassonguema (ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité, ACF - Action Contre la Faim); Dieynaba S N’diaye (ACF - Action Contre la Faim); Morgane Michel (ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité); Laure Ngabirano (ACF - Action Contre la Faim); Severine Frison (ACF - Action Contre la Faim); Matar Ba; Françoise Siroma (ACF - Action Contre la Faim); Antonio V Brizuela (AAH - Action Against Hunger); Martine Audibert (CERDI - Centre d'Études et de Recherches sur le Développement International - IRD - Institut de Recherche pour le Développement - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne); Karine Chevreul (ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables - INSERM - Institut National de la Santé et de la Recherche Médicale - AP-HP Hôpital universitaire Robert-Debré [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UPCité - Université Paris Cité) |
| Abstract: | Severe acute malnutrition (SAM) is a high-fatality condition that affected 13.7 million children under five years of age worldwide in 2022, with complicated cases requiring extensive inpatient stay with an accompanying caregiver. Our objective was to assess the costs of inpatient treatment for complicated SAM in children aged 6 to 59 months in Northern Senegal and identify cost predictors. We performed a retrospective cost analysis, including 140 children hospitalized from January to December 2020 in five SAM inpatient treatment facilities. We adopted a societal perspective, including direct medical and non-medical costs and indirect costs. We extracted patients' sociodemographic and clinical data from medical records and conducted semi-structured interviews with healthcare staff to capture information on time allocation and care management. A multivariable generalized linear model with gamma family and a log link was used to investigate the factors associated with direct costs. Costs are expressed in 2020 international USD using purchasing power parity. Mean length of stay was 5.3 (SD = 3.2) days and diarrhoea was the cause of the admission in 55.7% of cases. Mean total cost was USD 431.9 (SD = 203.9), with personnel being the largest cost item (33% of the total). Households' out-of-pocket expenses represented 45.3% of total costs and amounted to USD 195.6 (SD = 103.6). Costs were significantly associated with gender (20.3% lower in boys), diarrhoea (27% increase), anaemia (49.4% increase), inpatient death (44.9% decrease), and type of facility (26% higher in hospitals vs. health centre). Our study highlights the financial burden of complicated SAM in Senegal in particular for families. This underscores the need for tailored prevention and social policies to protect families from the disease's financial burden and improve treatment adherence, both in Senegal and similar contexts. |
| Keywords: | economic burden, cost analysis, severe acute malnutrition with complications, Northern Senegal, societal cost, health economics, cost drivers |
| Date: | 2024–07–10 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-04697869 |
| By: | Giacomo Buzzao (Dept. of Management, Venice School of Management, Yunus Social Business Centre, Università Ca' Foscari Venice); Francesco Rullani (Dept. of Management, Venice School of Management, Yunus Social Business Centre, Università Ca' Foscari Venice); Giovanni Putoto (Doctors with Africa, CUAMM); Marcello Mazzotta (Doctors with Africa, CUAMM) |
| Abstract: | We set out to estimate the cost-effectiveness of an ambulance-based referral system for emergencies, connecting primary care health centres to a central hospital in a sub-Saharan low-income context. We adopted an observational retrospective study design in the setting of the Beira District (Sofala Region, Mozambique) and classified effective referrals based on the triage emergency codes assigned during transfer. We focused solely on referral running costs required to run the ambulance and complete safe and effective transfer, including staff (nurses and drivers) and communication costs between health centres, ambulance operators and the central hospital. A total of 7849 referrals were included in the analysis, 6295 of which were deemed effective. The total running cost of the intervention (11 months) was $172.071. The cost-per-effective referral was $27, 33, which is below the acceptability benchmarks that can be considered “very attractive” ($58, 20) and that we defined as 1/10 of the national GDP per capita of Mozambique ($582). Sensitivity analysis corroborates our findings, which confirm and extend previous evidence on the high cost-effectiveness of ambulance-based referral systems for emergencies in sub-Saharan low-income countries. |
| Date: | 2024–04 |
| URL: | https://d.repec.org/n?u=RePEc:vnm:wpdman:211 |
| By: | Gietel-basten, Stuart; Chen, Shuang |
| Abstract: | Compared to other settings, COVID-19 infection and death rates in Hong Kong were very low until 2022, due to top-down interventions (e.g. quarantines, ‘mask mandates’) and community activation. However, in addition to these epidemiological circumstances, Hong Kong has also undergone significant social and political change stemming from the social movement beginning in 2019 through the enacting, and aftermath, of the National Security Law. We draw on registered birth and marriage data from 2015 through 2021 to explore how fertility and nuptiality changed after the social movement followed by the first four waves of the COVID pandemic. We describe how fertility and marriage rates have changed in Hong Kong and to what extent the changes are associated with the social movement and the COVID pandemic. We further disaggregate the fertility and nuptiality trends by Hong Kong-born and non-Hong Kong-born population, with a specific focus on migrants from the Mainland. |
| Keywords: | Covid-19; social movement; Hong Kong; fertility; nuptiality; coronavirus |
| JEL: | N0 |
| Date: | 2023–05–04 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:118543 |
| By: | Stephen Gibbons; Sandra McNally; Piero Montebruno |
| Abstract: | A high level of school absence has persisted across many countries since the COVID-19 pandemic. We use English data to investigate whether a student's absence during the pandemic had a causal impact on school attendance and academic progress in future years, using variation in local regulations during the pandemic (not aimed at schools). We find that more stringent regulations caused higher rates of school absence at that time, leading to lower attendance and rates of achievement in subsequent years. Our evidence suggests that the persistent effect is caused by changes in parents' and pupils' attitudes to attendance and not because of rules forcing students to stay at home when they had been in contact with others who had COVID-19. The effects of policy restrictions on contemporaneous and persistent absences was stronger for lower socio-economic groups. |
| Keywords: | student absence, COVID-19 pandemic |
| Date: | 2024–09–06 |
| URL: | https://d.repec.org/n?u=RePEc:cep:cepsps:47 |