Health economics最新文献

Taxes on sweetened beverages have become an important policy response to growing obesity rates and the prevalence of type 2 diabetes in the U.S. and other nations. Since 2015, eight U.S. cities have implemented these taxes, but so far direct evidence of their impacts on household purchasing behavior is scarce. Of particular interest to many researchers and policy makers is the response of lower-income consumers to these taxes, both because they have higher sweetened beverage consumption on average and because of concerns that sweetened beverage taxes are regressive. This project investigates the income-stratified household response to SSB taxes using a data set containing the purchasing behavior of approximately 400 households in the cities of Seattle, San Francisco, Oakland, and Philadelphia, all of which have recently introduced beverage taxes. Using doubly-robust estimation of dynamic and heterogeneous treatment effects relative to a propensity-matched set of households in three comparison cities, we find that households in taxed cities experience increased prices and reduce their purchases of those beverages, with no evidence of cross-border shopping. We further find differential tax impacts by income level, with lower-income households (households with income <200% of the federal poverty line for their size) reducing their purchases of taxed beverages by nearly 50% - more than double the 18% reduction found in higher-income households (households with income >400% of the federal poverty line for their size). Our finding that lower-income households decrease their consumption more than twice as much as higher-income households suggests that these taxes may reduce health disparities and promote population health.

The Medicaid coverage "cliff" occurs when Medicare beneficiaries with household income exceeding 100% of the federal poverty level lose eligibility for supplemental Medicaid coverage. Using a regression discontinuity design with data from Medical Expenditure Panel Survey and National Health and Nutrition Examination Survey for 2007-2019, we demonstrate that the cliff increases out-of-pocket spending by 25% and the probability of experiencing problems paying medical bills by 44.4% without decreases in overall health care spending. However, there is evidence that near-poor Medicare beneficiaries changed behavior in response to the cliff, increasing the use of high-value diagnostic and preventive testing by 8.8% and enrollment in a more affordable plan by 12.2%. The cliff does not encourage healthy behavior.

Methods have been developed for transporting evidence from randomised controlled trials (RCTs) to target populations. However, these approaches allow only for differences in characteristics observed in the RCT and real-world data (overt heterogeneity). These approaches do not recognise heterogeneity of treatment effects (HTE) according to unmeasured characteristics (essential heterogeneity). We use a target trial design and apply a local instrumental variable (LIV) approach to electronic health records from the Clinical Practice Research Datalink, and examine both forms of heterogeneity in assessing the comparative effectiveness of two second-line treatments for type 2 diabetes mellitus. We first estimate individualised estimates of HTE across the entire target population defined by applying eligibility criteria from national guidelines (n = 13,240) within an overall target trial framework. We define a subpopulation who meet a published RCT's eligibility criteria ('RCT-eligible', n = 6497), and a subpopulation who do not ('RCT-ineligible', n = 6743). We compare average treatment effects for pre-specified subgroups within the RCT-eligible subpopulation, the RCT-ineligible subpopulation, and within the overall target population. We find differences across these subpopulations in the magnitude of subgroup-level treatment effects, but that the direction of estimated effects is stable. Our results highlight that LIV methods can provide useful evidence about treatment effect heterogeneity including for those subpopulations excluded from RCTs.

Despite a growing interest in the impacts of prenatal factors on adulthood quality of life, economists have not estimated the income effects of sunlight exposures by mothers during pregnancy. This paper estimates such effects using data from China General Social Survey and China National Meteorological Data Service Center. The results show that the income effects of prenatal sunlight exposure in the second trimester are significantly positive. The effects differ for individuals born in different months and the effects are larger for female employees, older employees, those born in rural areas, in the pre-reform period, or whose mothers are less-educated. Finally, we investigate the possible mechanisms via the human capital pathway, discovering that fetuses with longer sunlight exposure in the second trimester are healthier and do more exercises in adulthood. It is suggested that families, communities, policymakers should pay attention to prenatal sunlight exposure, especially for pregnant women in the developing world who are less educated or live in rural areas.

This paper theoretically investigates externalities and policy interventions in travel during a pandemic. We develop a tractable static model of two regions from a short-run perspective. The model shows that the externalities can be both negative and positive, depending on regional asymmetry. Thus, even when infectious diseases are widespread, travel restrictions do not necessarily reduce infections and do not necessarily improve social welfare. A formula for the optimal policy intervention is derived and shown to be the weighted average of four types of externalities defined by the direction of travel and the epidemiological status of a traveler.

This study investigates the impacts of health shocks among older individuals on the dynamics of their living arrangements in Europe and the United States. Exploiting unpredicted health shocks, we use an event-study difference-in-differences approach to demonstrate that health shocks increase difficulties with activities of daily living and instrumental activities of daily living, thereby increasing the need for care. Our findings indicate that health shocks raise the probability of nursing home residency and co-residence with adult children by 0.7 and 1.4 percentage points in Europe, and by 2.1 and 1.8 percentage points in the U.S., respectively. Further analyses reveal that more generous long-term care public policies correlate with a higher probability of nursing home residency and a lower probability of co-residing with adult children, highlighting the significant role of public policies in household responses to health shocks. Additionally, we find that health shocks negatively impact adult children's labor supply, particularly in the U.S.

This paper empirically investigates the impact of public long-term care insurance (LTCI) on the utilization of inpatient services and associated expenditures among disabled Chinese individuals, using data from the China Health and Retirement Longitudinal Study from 2011 to 2018. Employing a staggered difference-in-difference approach within a propensity score matching framework (PSM-DID), the study finds that the introduction of LTCI significantly reduces the likelihood of inpatient service usage by 4.2%, the annual number of inpatient admissions by 10.2%, the annual inpatient cost by 16.2%, the out-of-pocket expenses by 20.7%, and the reimbursement expenditure by the public medical insurer by 9.9%. The study further explores the mechanisms underlying these effects and identifies that the Substitution Effect, where care services in community healthcare centers and nursing homes replace hospitalizations, outweighs the Income Effect generated by LTCI benefits. By leveraging the quasi-natural experimental setting of diverse LTCI policies across cities, the study also examines the heterogeneous impacts of LTCI based on household income, eligibility criteria, and reimbursement methods. The findings underscore the positive role of LTCI in controlling medical expenses and alleviating congestion in urban hospitals, offering valuable insights for promoting "Healthy Aging".