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on Health Economics |
| By: | Balia, S.;; Brau, R.;; Pau, S.; |
| Abstract: | This paper studies the population health effects of Italian Local Health Authorities' consolidation. The reform centralized administrative functions and expanded the scale of health service provision, creating entities with larger catchment areas. Using an event-study Difference-in Differences design, we estimate the policy's impact on municipal mortality rates, accounting for heterogeneous treatment effects. Results reveal a significant increase in mortality rates starting four years after implementation, with an average 1.8% rise in total mortality observed over the following five years. Deaths from preventable conditions among individuals aged 0-74 disproportionately explain this increase. The adverse effects were primarily concentrated in municipalities within absorbed LHAs. Evidence indicates that expected economies of scale failed to improve health outcomes; instead, the reform imposed considerable health costs, particularly in municipalities belonging to larger LHDs and those with more extensive catchment area expansions. Moreover, we document that the effects were unevenly distributed, creating new vulnerable areas. |
| Keywords: | consolidation policy; local healthcare units; national health system; mortality; event-study; |
| JEL: | I11 I18 L38 G34 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:yor:hectdg:25/02 |
| By: | Lanfiuti Baldi, Giacomo; Nigri, Andrea; Trias-Llimos, Sergi; Barbi, Elisabetta |
| Abstract: | The term ”Deaths of Despair” (DoD) refers to mortality due to alcohol consumption, drug use, and suicides. While the concept has predominantly been studied in the United States, where these deaths have increased significantly, this analysis examines its application to Italy, a country with comparatively lower DoD rates. This work aims to analyse the magnitude of these causes of death in Italy and examine both their joint and independent trends to determine whether they can be treated as a single group of causes. We employ the Potential Gain in Life Expectancy to assess the impact of these causes on overall mortality in Italy, then investigate the identified time series leveraging Cointegration Analysis. Utilizing ISTAT data from 1983 to 2018, aggregated by gender and age groups at the NUTS1 level, the study reveals a decline in DoD mortality in Italy, driven mainly by a reduction in alcohol-related deaths. The magnitude and trajectory of the analysed causes offer valuable insights into the unique dynamics of DoD in Italy and its regional variations. Cointegration Analysis indicates that there is no significant dependency structure between these causes or across regions, with only a few exceptions. These findings suggest that in Italy, DoD should not be treated as a homogeneous group, but rather as distinct outcomes of despair that require separate consideration in public health interventions. |
| Date: | 2025–01–09 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:jnq2e_v1 |
| By: | Cameron, Corey; Jungkyu Rhys Lim; Michelle Dugas; Ellen Elizabeth Moscoe; Mohamad Chatila; Renos Vakis; Zeina Afif; Victor Hugo Orozco Olvera; Daniel Alejandro Pinzon Hernandez |
| Abstract: | During the COVID-19 pandemic, low- and middle-income countries struggled with lower vaccination rates compared to wealthier countries, posing challenges to reducing virus transmission, mitigating healthcare system pressures, and promoting economic recovery. Communications campaigns offer low-cost opportunities to overcome such challenges by strengthening vaccine confidence and intentions to get vaccinated, but empirical testing is needed to identify which messages will be most effective in different contexts. To support policy-making efforts to design effective communication rapidly during the pandemic, a global research program of 28 online experiments was conducted by recruiting respondents (123, 270 individuals) through social media between January 2021 and June 2022 across 23 mostly low- and middle-income countries and territories. An individual participant data (IPD) meta-analysis of these data summarizes the results of this research program testing the impact of behaviorally informed messaging on vaccine intentions. Results from the meta-analysis show that among unvaccinated survey respondents, behaviorally informed messages significantly increased the odds of vaccination intention by 1.28 times overall and up to 1.93 times in individual studies (safety messages in Papua New Guinea). Significant pooled effects of specific framings ranged from increasing the odds of vaccination intention by 1.16 times (variant framing) to 1.45 times (experts and religious leaders framing). This research underscores the importance of communication tailored to address different drivers of vaccine hesitancy and offers insights for handling future health crises with behavioral communication strategies leveraging rapid insights afforded by social media. |
| Date: | 2024–11–19 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10981 |
| By: | Rinner, Claus (Toronto Metropolitan University); Uda, Mariko; Manwell, Laurie |
| Abstract: | Immediately following the emergency use authorizations of COVID-19 vaccines, governments around the world made these products available to their populations and later started implementing differential rules for vaccinated and unvaccinated citizens regarding mobility and access to venues and services. The Oxford COVID-19 Government Response Tracker (OxCGRT) is a time series database that reflects the extent of public health measures in each country. On the basis of the OxCGRT Containment and Health Index, we calculated a corresponding discrimination index by subtracting the daily index values for vaccinated and unvaccinated individuals. The resulting metric provides a cursory quantification of the discrimination experienced by unvaccinated individuals throughout 2021 and 2022. Patterns in the index data show a high degree of discrimination with great numeric and temporal differences between jurisdictions. Around 90% of countries in Europe and North and South America discriminated against their unvaccinated citizens at some point during the pandemic. The least amount of discrimination was found for countries in Central America and Africa. In order to move towards sustainable post-pandemic recovery and prevent discriminatory public health policies in the future, we recommend that human rights protections be expanded and the prohibition of discrimination be extended beyond a limited list of grounds. |
| Date: | 2025–01–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:h4djv_v1 |
| By: | Proudfoot, Andrew John; Duffy, Sarah; Sinclair, Justin; Mezyk, Robert; Armour, Mike |
| Abstract: | People with endometriosis in Australia predominantly use delta-9 tetrahydrocannabinol cannabis flower and oil products, and cannabidiol preparations, to manage their symptoms, reporting reductions in use of other drugs. It is known that lower rates of systematic disclosure of risk factors in life insurance settings, particularly of smoked tobacco, can have an impact on customer premiums, contract terms and claims outcomes, however less is known about cannabis (such as ‘smoker’ or other loadings, exclusions and coverage refusals). This article examines positive and negative risks around disclosure of cannabis use for endometriosis management, from insureds to insurers, when purchasing or increasing life, disability or trauma insurance, in a cohort of Australians. Better condition management and reduced alcohol, tobacco and other drug consumption suggested improved insurability outcome factors relevant to endometriosis and these insurances. Disclosure behaviour however, suggested significant legal risks for insurers and insureds, as misrepresentations and fraudulent non-disclosure of cannabis use occurred. The study outcomes revealed important insurance medicine medico-legal and human rights considerations for insureds and life insurers in the context of certain disclosure behaviours and the legal basis to discriminate relevant to the limited actuarial or statistical data that exists about medical cannabis as an anodyne for endometriosis disease. |
| Date: | 2025–02–12 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:23ys9_v1 |
| By: | Chennai, Nishok; |
| Abstract: | In recent years mental health has become a prominent topic in society. Mental health has often been ignored or integrated very minimally within society. However, one place in society constantly finds itself within the spotlight and forefront of mental health, educational institutions. These places have always been a prevalent part of this field due to their ability to help society at large through primary and secondary prevention. Primary prevention involves providing interventions to stop mental health issues from arising in the first place. This form of prevention teaches students healthy habits for their mental health and helps prevent illnesses. Secondary prevention involves preventing the further growth of mental health issues through prevention after the issue has already been diagnosed. Both prevention methods are utilized across the broad spectrum of students schools carry. Due to this broad spectrum, schools have been the grounds for many famous studies conducted by many famous scientists. In recent years, more and more money has been put into furthering mental health resources at schools. Legislation such as the Mental Health Services Grant Program provided 144 million to schools for mental health resources. However, the question becomes, how are these mental health resources being utilized? This correlational study aims to address the current gap in research for a need for data that is not diluted due to many confounding variables and provides information on trends of utilization of resources provided by school districts. To accomplish this we utilized vast surveys with each high school's Ohio State University clinician and Social Worker. This study collected responses from each staff member each time they met with a student on topics discussed and general demographics. This data was finally analyzed and tested to find general trends within the central Ohio school district. Some of the major findings and trends included that sophomores are most likely to go to the staff for help, the number of students that made a certain number of staff visits decreases exponentially for each increasing visit, women are more likely to go for help, and Caucasians are most likely to go for mental health. Further analysis by the school’s OSU Clicican and Social worker revealed more data such as Asians almost always are the least represented in mental health cases despite their proportion of the student body. Further anxiety and stress are the most commonly discussed topics between staff and students. This data provides a basic understanding of the relationship between mental health and high school students. This could be the gateway to the effective application of solutions presented in primary and secondary prevention studies. Furthermore, a better understanding of how mental health issues affect the student body can result in more efficient utilization of funding and resources by school districts and allow for more targeted interventions. Further research could be conducted on how mental health affects high school students who are first-generation immigrants compared to those not. This could provide insight into how culture and societal norms impact the mental health of developing minds. |
| Date: | 2024–08–23 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:gdbjf_v1 |
| By: | Daniel P. Gross; Bhaven N. Sampat |
| Abstract: | During World War II, the U.S. Committee on Medical Research (CMR) undertook an integrated, cross-sectoral effort to develop medical science and technology for war, representing the U.S. government's first substantial investment in medical research. Using data on all CMR research contracts, we show that although it had mixed results during the war, it left a large imprint on the postwar U.S. biomedical innovation system. Research areas it supported experienced rapid growth in postwar science, especially in new subjects. It also stimulated the U.S. pharmaceutical industry's adoption of modern science-based drug discovery, fueled new postwar drug development, influenced medical practice, and shaped extramural research funding at the National Institutes of Health. Contemporary accounts of individual CMR programs point to specific ways these investments enabled old and new subjects to grow. The evidence documents the long-run effects coordinated, application-oriented biomedical research can have on science and technology and challenges the influential 'linear model' paradigm in research policy. |
| JEL: | H51 H56 N42 N72 O31 O32 O33 O38 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33457 |
| By: | Nicholas K.W. Jones; Asmita Tiwari; Natsuko Kikutake; Takacs, Sacha; Souverijns, Niels |
| Abstract: | Although deaths and economic losses due to extreme heat are rising globally, heatwaves remain a "hidden hazard" whose impacts are underrecognized due to measurement and valuation challenges. Cities in India are developing Heat Action Plans that combine physical cooling measures (such as urban greening and reflective roofs) with public health measures (such as heat-health early warning systems). However, there is a key knowledge gap on the relative efficacy of these actions. To inform debate on how scarce public funds could most efficiently be allocated to reduce deaths and productivity loss due to extreme heat, this paper develops spatially explicit heat risk maps for Lucknow, Chennai, and Surat under climate scenarios; models future health and economic losses under a “no intervention” scenario; and estimates the costs and benefits of alternative sets of heat mitigation actions. The modeling suggests that by 2050, the number of heat-related deaths could rise by one-third for the case study cities, while labor productivity losses could affect between 2 and 4 percent of their economic output. Among the interventions typically considered in city Heat Action Plans, benefit-to-cost ratios are favorable but vary significantly. Urban greening investments more than cover their costs based on the health and labor productivity benefits of the heat stress reduction they yield (benefit-cost ratio of 3:1). However, heat-health early warning systems offer the greatest harm reduction per dollar invested (benefit-cost ratios exceeding 50:1), suggesting that they are “low-hanging fruit” whose wider implementation across Indian and global cities should be prioritized. |
| Date: | 2024–10–28 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:10960 |
| By: | Karen Clay; Edson R. Severnini; Xiao Wang |
| Abstract: | This paper uses U.S. Toxic Release Inventory data on air lead emissions to provide IV estimates of the effects of air lead concentration on infant mortality. The causal effect of lead on infant mortality is identified by annual variation in air fugitive lead emissions interacted with wind speed near reporting plants, which together determine local ambient lead concentration. Unlike stack emissions, which occur routinely and may prompt avoidance behavior, fugitive emissions are intermittent and influenced by both historical and current factors, such as wind speed variation, making them difficult to avoid. The paper has two main findings. First, higher air lead concentration causes higher infant mortality in the first month and in the first year, suggesting that both in utero and environmental exposures matter. Second, higher lead concentration increases deaths from low birthweight, sudden unexplained infant death (SUID), and respiratory and nervous system causes, which is consistent with findings from animal studies, even when accounting for behavioral responses. Back of the envelope calculations indicate that declines in fugitive lead emissions prevented 34-59 infant deaths per year, generating benefits of $380-$670 million annually in 2023 dollars. |
| JEL: | I14 Q51 Q53 |
| Date: | 2025–02 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33447 |