Health economics最新文献

When judging the distributional impact of unhealthy food taxes, what matters is not just how much low income people would pay but how much the such taxes would benefit or harm them overall. In this paper, we assess the consumer welfare impact of a fat tax net of its expected benefits computed as savings from weight loss. Using Italian data, we estimate a censored Exact Affine Stone Index (EASI) incomplete demand system for food groups, simulating changes in purchases, calorie intake, consumer welfare, and the monetary value of short-run health benefits. While the Italian government has proposed a sugar tax, we show that there is no significant excess consumption of added sugars among Italian adults. Instead, excessive fat consumption is more prevalent, making a fat tax a more compelling and effective solution to address diet-related health risks. Our results suggest costs from fat taxation are larger than benefits at all income levels. As a fraction of income, the net impact would be slightly regressively distributed.

This study investigates the effects of diverse payment methods within long-term care insurance (LTCI) on the well-being of elderly individuals, encompassing both in-kind and cash payments. Utilizing panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we leverage a generalized difference-in-differences (DID) approach and the LTCI pilots across various Chinese cities to identify the impacts of different LTCI payment methods. Our findings indicate that an in-kind LTCI policy significantly decreases the one-year mortality of older adults, with significant improvements on ADL-related care receipt as well as health status. Conversely, no significant impacts are observed under the framework of a cash LTCI policy. We term the weaker effects regarding older adults in cash LTCI policy versus in-kind LTCI policy as "the cash-out puzzle". Our findings emphasize the critical importance of developing right incentives of LTCI payment schemes thoughtfully worldwide.

For over 3 decades, the Centers for Medicare & Medicaid Services (CMS) has provided a bonus payment for outpatient physician services provided to beneficiaries under Medicare Part B in areas designated as Primary Care Health Professional Shortage Areas (HPSAs) during the previous calendar year. Despite the longstanding existence of the program, no studies have explicitly evaluated how previously established physicians practicing in areas subject to an HPSA designation respond to the bonus payments. Using 2012-2019 physician-level data with stacked event study models that control for several characteristics, including the underlying criteria used to construct HPSA scores, I find little to no statistically significant changes in access to care (as measured through total annual beneficiaries treated or services delivered to Medicare beneficiaries) in the years leading up to HPSA designation. However, once physicians become eligible for a 10% bonus payment, their annual number of beneficiaries treated and volume of services decline, consistent with recent empirical work and CMS's actuarial assumptions about how physicians respond to changes in reimbursement.

Existing evidence on whether e-cigarettes are substitutes or complements to combustible cigarettes is limited and mixed. We revisit this question using nationally-representative Canadian survey data over 14 years (2004-2017) and difference-in-differences methods that exploit the staggered adoption of e-cigarette Minimum Legal Age (MLA) laws in Canadian provinces between 2015 and 2017. We study the laws' effects not only on youth smoking but also on smoking initiation and cessation to shed light on the mechanisms through which these laws affect youth smoking. We find that the relationship between e-cigarette use and combustible cigarette use depends on smoking status of youths. While the MLA laws reduced smoking initiation among youth non-smokers, they made existing youth smokers less likely to quit smoking. Our results highlight the tradeoffs between lower smoking initiation and lower smoking cessation associated with policies that aim to reduce youth e-cigarette use.

This paper examines the causal impacts of rising housing costs on individual health and satisfaction with life circumstances, using a fixed-effects instrumental variable approach and individual-level panel data from Australia. Relying on the historical patterns of immigrant settlement, we construct an instrumental variable that exploits exogenous variation in housing costs driven by foreign investments that flow differentially into localities. We find that rising housing costs-as measured by composite housing costs faced by homeowners and renters living in an area-have a significant positive impact on individuals' self-assessed physical health and a significant negative impact on satisfaction ratings, but no significant impact on self-assessed emotional health. Heterogeneity analysis suggests that the positive effects on physical health are mainly concentrated among homeowners, the well-educated, and older individuals.

We estimated the monetary value of informal care from the perspectives of informal caregivers and care recipients in China using the contingent valuation method. Data were obtained from a specially designed survey of 1458 informal caregivers and 972 care recipients. The mean for caregivers' willingness to pay (WTP) for reducing informal care by 1 h per week was CNY32.37 (€4.11), while the mean for willingness to accept (WTA) increasing informal care by 1 h was CNY46.21 (€5.87). The mean for care recipients' WTP (WTA) values for increasing or reducing informal care by 1 h per week were CNY28.74 (€3.65) and CNY44.78 (€5.69), respectively. The WTP and WTA values varied according to care hours and tasks, kinship, and living arrangements, and correlated with the characteristics of both caregivers and care recipients. The WTP and WTA values were also sensitive to a broad range of factors such as health, level of education, employment status, and household income. We highlight the contribution made by informal caregivers to elderly care and recommend the promotion of informal care activities to support and incentivize them.

We study the effect of education on vaccination against COVID in Germany in a sample of individuals above the age of 60. In ordinary least squares regressions, we find that, in this age group, one more year of education goes along with a 0.7 percentage point increase in the likelihood to get a COVID vaccination. In two stage least squares regressions where changes in compulsory schooling laws are used as exogenous variation for education, the effect of an additional year of education is estimated to be zero. The results hold for the compliers to the policy change which are older individuals at the lowest margin of education.

Urban environments are thought to improve food security, by offering enhanced access to markets and income opportunities. Yet this idea is hard to test empirically due to an abundance of confounding factors and selection issues. This study leverages a resettlement program in China to provide the first quasi-experimental estimate of city life on food consumption and nutrition among low-income households. Lottery-determined timing of resettlement enables causal inference. We base our empirics on a 3-year panel and a range of difference-in-differences and matching methodologies. We find that those who were resettled to towns significantly increased both food consumption and diet variety, with increased intake of several macro- and micro-nutrients. Diet quality mostly improved, but we also found signs of over-consumption, notably of carbohydrates. Our evidence further suggests that our impacts are primarily due to improved market access. This stands in contrast to recent literature that finds little or no effect of living environments on food consumption. Instead, we reveal a significant impact of urban environments in shaping diets, bolstering the notion that supply-side channels do matter in some contexts.

Policymakers can use cost-effectiveness analysis to set value-based prices (VBP) for new pharmaceuticals. However, the uncertainty of investigational drug benefits complicates this pricing strategy. Such complexity stems from decision-makers' risk aversion and the potential change in the estimated value with emerging evidence. The recent surge in drugs approved via the Accelerated Approval (AA) pathway in the U.S. has made incorporating uncertainty into VBP crucial. We propose to estimate risk-adjusted VBP (rVBP) for drugs with uncertain benefits via integrating value of information and expected utility theory. Our approach involves two assessment points: an initial assessment with existing evidence; and a reassessment with new evidence that reduces uncertainty. This approach enables decision-makers to set rVBP in the initial assessment such that the expected utility, from the exisiting evidence, aligns with the benchmark uncertainty. We evaluate two benchmarks: one with no uncertainty, and one with a decision-maker's acceptable uncertainty level. We show in a case study of a hypothetical AA drug that rVBP may be lower than traditional VBP, especially under high risk aversion or low acceptable uncertainty. Our methodology adjusts VBP to account for uncertainty, supporting decision-makers in balancing timely market access with the risks associated with uncertainty in the benefits of new pharmaceuticals.

In this research we show that ambitious increases in tobacco tax rates can substantially reduce tobacco consumption, increase fiscal revenue, and provide net positive social benefits even in contexts of low consumption prevalence and intensity. Low nicotine intake still constitutes a grave disease risk factor, and the effectiveness of tax increases might be questioned if income effects are small. We adapt spatial variation of price methodologies to deal with low prevalence and intensity, censored data, and small samples using the Bolivian case as an illustration. We find an average price elasticity of demand of $-0.69$ to $-0.76$ . Using our estimates of elasticities, we develop a simulation to anticipate the effects of a 35% yearly increase of the Bolivian specific excise on tobacco starting in 2025. Our estimates show that by 2030, this reform could reduce the consumption of cigarettes by 52.6%, diminish the prevalence of smoking by 30.6%, and increase fiscal revenue by $123 million over six years. Moreover, we estimate that the abated direct medical costs of reduced consumption net of the deadweight loss associated with a tax increase would generate a net social gain of over $100 million in five years.