Using the staggered implementation of telehealth parity laws in the U.S. Healthcare industry, we find causal evidence that virtual competition affects U.S. hospitals' cost of capital through a credit risk channel. Financial statements indicate that rural hospitals lose patients to urban hospitals in the same state after states require equivalent reimbursement of remote and in-person services. These effects increase rural hospital bankruptcy risk indicated by leverage and Z-Score. This increased financial stress translates into lower credit ratings and a higher cost of capital for rural hospitals. Controlling for bond characteristics, we find that affected rural hospitals' new bond costs rise by 20 - 38 bps relative to urban hospital bonds issued in the same state and in the same year. Secondary market yields of outstanding rural bonds increase by a significant 8 - 17 bps. Overall, this paper implies that virtual competition creates financial distress for rural healthcare providers.
{"title":"Virtual Competition and Cost of Capital: Evidence from Telehealth","authors":"K. Cornaggia, Xuelin Li, Zihan Ye","doi":"10.2139/ssrn.3833193","DOIUrl":"https://doi.org/10.2139/ssrn.3833193","url":null,"abstract":"Using the staggered implementation of telehealth parity laws in the U.S. Healthcare industry, we find causal evidence that virtual competition affects U.S. hospitals' cost of capital through a credit risk channel. Financial statements indicate that rural hospitals lose patients to urban hospitals in the same state after states require equivalent reimbursement of remote and in-person services. These effects increase rural hospital bankruptcy risk indicated by leverage and Z-Score. This increased financial stress translates into lower credit ratings and a higher cost of capital for rural hospitals. Controlling for bond characteristics, we find that affected rural hospitals' new bond costs rise by 20 - 38 bps relative to urban hospital bonds issued in the same state and in the same year. Secondary market yields of outstanding rural bonds increase by a significant 8 - 17 bps. Overall, this paper implies that virtual competition creates financial distress for rural healthcare providers.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131123467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We offer a comprehensive picture of the rural economy in Bangladesh during the first three months of the lockdown period in comparison with the pre-COVID-19 situation. Using a nationally representative sample (of 2,312 rural households from 62 villages in 56 districts) known as the Mahbub Hossain Survey sample, we conducted a telephone survey in June 2020. Our descriptive and regression analyses suggest that, during the survey period, the rural economy experienced several adverse impacts from the containment measures, such as a delayed harvest, difficulty in selling farm produce, labor and material input disruptions and cost increases, and reductions in remittance receipts and non-farm business sales. Rural households had to reduce their food consumption and receive food support from the government and cash support from the private sector. Vulnerability was especially apparent in households with a head who was female, less educated, young, or casual labor. Livelihoods varied significantly among geographic areas according to the concentration of the infection and less significantly according to the stringency of the lockdown measures. We also found that rural households preferred cash or product support, rural work or employment support, and cash assistance or soft loans for farm inputs and business inputs at the time of the survey.
{"title":"Changes in the Rural Economy in Bangladesh under COVID-19 Lockdown Measures: Evidence from a Phone Survey of Mahbub Hossain Sample Households","authors":"M. A. Malek, Tetsushi Sonobe, H. Truong","doi":"10.2139/ssrn.3912353","DOIUrl":"https://doi.org/10.2139/ssrn.3912353","url":null,"abstract":"We offer a comprehensive picture of the rural economy in Bangladesh during the first three months of the lockdown period in comparison with the pre-COVID-19 situation. Using a nationally representative sample (of 2,312 rural households from 62 villages in 56 districts) known as the Mahbub Hossain Survey sample, we conducted a telephone survey in June 2020. Our descriptive and regression analyses suggest that, during the survey period, the rural economy experienced several adverse impacts from the containment measures, such as a delayed harvest, difficulty in selling farm produce, labor and material input disruptions and cost increases, and reductions in remittance receipts and non-farm business sales. Rural households had to reduce their food consumption and receive food support from the government and cash support from the private sector. Vulnerability was especially apparent in households with a head who was female, less educated, young, or casual labor. Livelihoods varied significantly among geographic areas according to the concentration of the infection and less significantly according to the stringency of the lockdown measures. We also found that rural households preferred cash or product support, rural work or employment support, and cash assistance or soft loans for farm inputs and business inputs at the time of the survey.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116136903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to theory, “sin taxes” are welfare improving if consumers with low self-control respond at least as much to the tax as consumers with high self-control. We investigate empirically if demand response to soft drink and fat tax variations in Denmark depends on consumers’ self-control. We use a unique home-scan panel that includes a survey measure of self-control. When taxes increase, consumers with low self-control reduce purchases less strongly than consumers with high self-control. When taxes decrease, both groups increase their purchases similarly. The results show an asymmetry in price elasticities by self-control that is more pronounced when taxes increase. (JEL D12, D91, H25, H31, I12, I18, L66)
{"title":"Sin Taxes and Self-Control","authors":"Renke Schmacker, Sinne Smed","doi":"10.2139/ssrn.3661144","DOIUrl":"https://doi.org/10.2139/ssrn.3661144","url":null,"abstract":"According to theory, “sin taxes” are welfare improving if consumers with low self-control respond at least as much to the tax as consumers with high self-control. We investigate empirically if demand response to soft drink and fat tax variations in Denmark depends on consumers’ self-control. We use a unique home-scan panel that includes a survey measure of self-control. When taxes increase, consumers with low self-control reduce purchases less strongly than consumers with high self-control. When taxes decrease, both groups increase their purchases similarly. The results show an asymmetry in price elasticities by self-control that is more pronounced when taxes increase. (JEL D12, D91, H25, H31, I12, I18, L66)","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126425815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In early 2020, many states issued stay-at-home orders to slow the spread of COVID-19. I analyze Google Mobility data to consider the extent to which state-level stay-at-home orders induced people to stay at home. I find that much of the change in residential, retail and recreational, park, workplace, transit station, and, to a lesser extent, grocery and pharmacy activity preceded state-level stay-at- home orders.
{"title":"Behavioral and Policy Responses to COVID-19: Evidence from Google Mobility Data on State-Level Stay-at-Home Orders","authors":"William J. Luther","doi":"10.2139/ssrn.3596551","DOIUrl":"https://doi.org/10.2139/ssrn.3596551","url":null,"abstract":"In early 2020, many states issued stay-at-home orders to slow the spread of COVID-19. I analyze Google Mobility data to consider the extent to which state-level stay-at-home orders induced people to stay at home. I find that much of the change in residential, retail and recreational, park, workplace, transit station, and, to a lesser extent, grocery and pharmacy activity preceded state-level stay-at- home orders.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127831132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Innes, P. Randad, Anton Korinek, Meghan F. Davis, L. Price, A. So, C. Heaney
Antimicrobial use (AMU) in animal agriculture contributes to antimicrobial resistance (AMR) in humans, which imposes significant health and economic costs on society. Economists call these costs negative externalities, societal costs that are not properly reflected in market prices. We review the relevant literature and develop a model to quantify the external costs of AMU in animal agriculture on AMR in humans. Parameters required for this estimate include (a) the health and economic burden of AMR in humans, (b) the impact of AMU in animal agriculture on AMR in animals, (c) the fraction of AMR in humans attributable to animal agriculture, and (d) AMU in animals. We use a well-documented historic case to estimate an externality cost of about US$1,500 per kilogram of fluoroquinolones administered in US broiler chicken production. Enhanced data collection, particularly on the third and fourth parameters, is urgently needed to quantify more fully the externalities of AMU in animal agriculture. Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
{"title":"External Societal Costs of Antimicrobial Resistance in Humans Attributable to Antimicrobial Use in Livestock","authors":"G. Innes, P. Randad, Anton Korinek, Meghan F. Davis, L. Price, A. So, C. Heaney","doi":"10.3386/w26189","DOIUrl":"https://doi.org/10.3386/w26189","url":null,"abstract":"Antimicrobial use (AMU) in animal agriculture contributes to antimicrobial resistance (AMR) in humans, which imposes significant health and economic costs on society. Economists call these costs negative externalities, societal costs that are not properly reflected in market prices. We review the relevant literature and develop a model to quantify the external costs of AMU in animal agriculture on AMR in humans. Parameters required for this estimate include (a) the health and economic burden of AMR in humans, (b) the impact of AMU in animal agriculture on AMR in animals, (c) the fraction of AMR in humans attributable to animal agriculture, and (d) AMU in animals. We use a well-documented historic case to estimate an externality cost of about US$1,500 per kilogram of fluoroquinolones administered in US broiler chicken production. Enhanced data collection, particularly on the third and fourth parameters, is urgently needed to quantify more fully the externalities of AMU in animal agriculture. Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126003997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Dionne, D. Desjardins, M. Lebeau, S. Messier, A. Dascal
The ability and willingness of health care workers to report for work during a pandemic are essential to pandemic response. The main contribution of this article is to examine the relationship between risk perception of personal and work activities and willingness to report for work during an influenza pandemic. Data were collected through a quantitative Web-based survey sent to health care workers on the island of Montreal. Respondents were asked about their perception of various risks to obtain index measures of risk perception. A multinomial logit model was applied for the probability estimations, and a factor analysis was conducted to compute risk perception indexes (scores). Risk perception associated with personal and work activities is a significant predictor of intended presence at work during an influenza pandemic. This means that correcting perceptual biases should be a public policy concern. These results have not been previously reported in the literature. Many organizational variables are also significant.
{"title":"Health Care Workers’ Risk Perceptions and Willingness to Report for Work During an Influenza Pandemic","authors":"G. Dionne, D. Desjardins, M. Lebeau, S. Messier, A. Dascal","doi":"10.3390/RISKS6010008","DOIUrl":"https://doi.org/10.3390/RISKS6010008","url":null,"abstract":"The ability and willingness of health care workers to report for work during a pandemic are essential to pandemic response. The main contribution of this article is to examine the relationship between risk perception of personal and work activities and willingness to report for work during an influenza pandemic. Data were collected through a quantitative Web-based survey sent to health care workers on the island of Montreal. Respondents were asked about their perception of various risks to obtain index measures of risk perception. A multinomial logit model was applied for the probability estimations, and a factor analysis was conducted to compute risk perception indexes (scores). Risk perception associated with personal and work activities is a significant predictor of intended presence at work during an influenza pandemic. This means that correcting perceptual biases should be a public policy concern. These results have not been previously reported in the literature. Many organizational variables are also significant.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133717841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We study the impact of mandatory calorie posting on consumers' purchase decisions, using detailed data from Starbucks. We find that average calories per transaction falls by 6%. The effect is almost entirely related to changes in consumers' food choices--there is almost no change in purchases of beverage calories. There is no impact on Starbucks profit on average, and for the subset of stores located close to their competitor Dunkin Donuts, the effect of calorie posting is actually to increase Starbucks revenue. Survey evidence and analysis of commuters suggest the mechanism for the effect is a combination of learning and salience.
{"title":"Calorie Posting in Chain Restaurants","authors":"B. Bollinger, Phillip Leslie, Alan T. Sorensen","doi":"10.1257/POL.3.1.91","DOIUrl":"https://doi.org/10.1257/POL.3.1.91","url":null,"abstract":"We study the impact of mandatory calorie posting on consumers' purchase decisions, using detailed data from Starbucks. We find that average calories per transaction falls by 6%. The effect is almost entirely related to changes in consumers' food choices--there is almost no change in purchases of beverage calories. There is no impact on Starbucks profit on average, and for the subset of stores located close to their competitor Dunkin Donuts, the effect of calorie posting is actually to increase Starbucks revenue. Survey evidence and analysis of commuters suggest the mechanism for the effect is a combination of learning and salience.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129649801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper reviews the public sector role in the provision of health care. A first role of the government is to use tax policy to correct externalities associated with individual behaviors. Estimates suggest that the external effects of many `sins' such as alcohol consumption are greater than current taxes on these goods. A second role of the government is to correct distortions in markets for medical care and health insurance. Markets for health insurance have traditionally not offered a choice between cost and the generosity of benefits. As a result, there have been incentives for excessive technological development, particularly technologies that increase spending. Once technologies have diffused widely, they are overutilized. Policies to increase choice in insurance markets could increase welfare, provided they limit segmentation on the basis of risk.
{"title":"Public Policy for Health Care","authors":"D. Cutler","doi":"10.3386/W5591","DOIUrl":"https://doi.org/10.3386/W5591","url":null,"abstract":"This paper reviews the public sector role in the provision of health care. A first role of the government is to use tax policy to correct externalities associated with individual behaviors. Estimates suggest that the external effects of many `sins' such as alcohol consumption are greater than current taxes on these goods. A second role of the government is to correct distortions in markets for medical care and health insurance. Markets for health insurance have traditionally not offered a choice between cost and the generosity of benefits. As a result, there have been incentives for excessive technological development, particularly technologies that increase spending. Once technologies have diffused widely, they are overutilized. Policies to increase choice in insurance markets could increase welfare, provided they limit segmentation on the basis of risk.","PeriodicalId":119641,"journal":{"name":"HEN: Public Health (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131371376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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