Health economics最新文献

We investigate how disability insurance (DI) generosity affects DI take-up and labor market participation in a setting where benefits can be cumulated with substantial labor earnings. Using rich administrative data on Italian private-sector workers and a Regression Discontinuity in Time design, we find a large behavioral response to DI generosity, with an elasticity of 1.26 in DI take-up, while employment effects are minor and concentrated among immigrants. Our identification strategy exploits a major social security reform that reduced the expected DI replacement rate and generated a clear income effect. To address unobserved heterogeneity and the unobservability of underlying disability, we focus on individuals affected by acute cardiovascular shocks whose DI eligibility is plausibly exogenous. Overall, our results suggest that when earnings cumulability is extensive, DI is widely perceived as a complement to labor income. This has important implications for the design of labor-inclusive DI schemes.

This paper quantifies physician agency in China's prescription drug market by exploiting the structural shift created by the Zero-Markup Drug Policy. We find that physicians' prescribing decisions are about three times more sensitive to the hospital's profit margin than to the retail price faced by patients. The study provides several key findings. First, government policy exerts a strong influence on drug prices. Second, branded drugs are generally preferred over generics and display lower price elasticity. Third, the policy accounts for more than half of the observed decline in average wholesale prices. Finally, while the policy improves patient welfare, it reduces pharmaceutical firms' sales and profits, and a partial restoration of drug markups could increase overall social welfare.

Annually, countries allocate hundreds of millions of dollars to subsidize fossil fuels, often at the expense of public health and environmental sustainability. This undermines progress toward Sustainable Development Goals (SDG) 3 (Good Health and Well-Being) and 13 (Climate Action). Despite this, the impact of fossil fuel subsidies (FFS) on social protection expenditure, including health, remains poorly quantified. This study aimed to determine whether FFS crowd out health expenditure globally, using panel data from 126 countries covering the period 2015-2019. An instrumental variable approach, relying on countries' exposure to international energy trade and fluctuations in crude oil price, was employed to capture exogenous variation in FFS and estimate a causal relationship. The analyses revealed that in 2019, 17 countries spent more than five percent of GDP on FFS, with FFS expenditure exceeding health expenditure in 15 of those countries. Specifically, a 1% increase in FFS per capita, driven by rising international oil prices and weighted by countries' exposure to international energy trade, led to a 0.05% (95% CI -0.08% to -0.02%) decrease in domestic health expenditure per capita. These findings underscore the detrimental impact of FFS on health expenditure, presenting another reason to eliminate FFS to achieve SDG3 in addition to avoiding further dangerous climate heating.

This study estimates the effects on perinatal mental health of the state's minimum wage and earned income tax credit (EITC), controlling for other policies and state-level factors. Using data from the Pregnancy Risk Assessment Monitoring System for 2012-2018 births we find robust evidence that minimum wages and EITC levels reduce depression before pregnancy and suggestive evidence of minimum wages reducing postpartum depression, at least for married respondents. Our estimates suggest that a one dollar increase in the minimum wage ($100 increase in the state EITC) reduces pre-pregnancy depression by roughly 8.5% (1.5%). These findings stand up to standard robustness and falsification tests, including event study analyses, a wide array of alternative specifications, and finding no effect for those unlikely to benefit (e.g., college-educated respondents). A supplementary analysis using data from the Behavioral Risk Factor Surveillance System suggests that state EITC levels may reduce mental distress during pregnancy. We investigate possible mechanisms by providing a descriptive analysis of the income and work behavior of such households, which shows the wide reach of these policies, and investigating a broad set of outcomes from the PRAMS, such as financial stressors, health insurance and birth outcomes.

In France, the Couverture Maladie Universelle Complémentaire (CMU-C) scheme is a means-tested, state-financed, complementary health insurance program that fully covers healthcare. Using administrative claims data and a staggered difference-in-differences approach, we estimate the impact of enrollment in the program on healthcare utilization. To address selection into the program, we use health shocks at the family level to exogenize individual enrollment. The findings indicate that access to free healthcare significantly increases healthcare utilization at both intensive and extensive margins. This effect is driven primarily by individuals who are uninsured before enrolling in the CMU-C. Moreover, individuals with severe or chronic illnesses, who already receive additional public coverage for their conditions, experience significant gains from the CMU-C coverage. Finally, these effects persist throughout the coverage period.

Using 43,817 parent-child pairs from 23 waves of the HILDA Survey, I study the intergenerational transmission of alcohol use within a rational model of trait transmission. Transmission is predominantly same-sex: the mother-daughter elasticity is 0.10 and the father-son elasticity is 0.09; there is no father-daughter effect. Influence peaks at ages 15-17 and re-emerges at 28-37 when offspring become parents; mothers also affect sons at both junctures. Comparisons with non-birth (adoptee-style) dyads show similar mother-daughter transmission, indicating norm-based rather than biological channels. Identification concerns are addressed with placebo reshuffling and copula-based corrections; estimates are robust across specifications. Men who remain childless are more likely to mirror maternal drinking, which-together with declining fertility and earlier alcohol-control policies-helps explain cohort declines in male drinking. The interpretation is that parental norms anchor behavior at identity-forming and role-transition ages, with strong persistence thereafter. Policy should target these windows with gender-specific, couple-level interventions alongside population levers on price, availability and marketing.

There are large health inequalities between neighborhoods in many cities of the world. This paper studies individuals' sorting based on health amenities and exposes an important connection between health preferences and the housing market. I estimate a neighborhood choice model using geolocated data from a health survey in New York City and neighborhood characteristics from different data sources. I find that individuals with higher preferences for being healthy are more likely to choose neighborhoods close to health amenities such as parks, and this sorting explains a large part of observed geographical inequalities in health behaviors. Moreover, the model predicts that a higher demand for health amenities capitalizes into house prices and displaces poor individuals to neighborhoods further from these amenities. This implies that health awareness campaigns might actually worsen the inequality in access to public health amenities.

Some patients prescribed opioid pills fail to properly dispose of their unused pills, posing a risk for others. We report results from a pre-registered field experiment testing whether behaviorally informed reminder cards increase participation in a financial incentive program for returning unused opioid pills among U.S. Veterans. The cards incorporate principles from behavioral economics, including timely reminders, implementation intention prompts, and loss framing. Relative to a cash incentive alone, the reminder cards increase both the likelihood that patients return unused pills (the extensive margin) and the number of pills returned (the intensive margin). The intervention also improves cost-effectiveness, reducing both the cost per pill returned and the cost per participant who returns pills. These findings show that low-cost behavioral messaging can meaningfully enhance the effectiveness of existing financial incentive programs for safe opioid disposal.

Public funding for pharmaceuticals often follows repeated negotiation between manufacturers and a public agency, yet little empirical work examines how the timing of agreement reflects the economic structure of these interactions. Using a duration model of negotiations in Australia from 2005 to 2018, we assess whether observed patterns of delay and agreement align with dynamic bargaining theory under incomplete information. Agreements from 634 submissions for 400 therapies required a median of 16 months, and 71% of negotiation rounds ended without agreement. Therapies with lower expected value to the agency-reflected in higher incremental cost per QALY, greater budget impact, or evidence uncertainty-experienced longer delays and lower agreement rates, while those with strong clinical importance, perceived need, or elevated public interest were listed more quickly. Delays also varied across therapeutic classes and with a therapy's position in the sequencing of available treatments. The observed patterns point to a systematic listing rule in which therapies are funded when expected health gains justify their opportunity costs. They also support the view that the timing of agreement reflects strategic negotiation under uncertainty, not simply procedural delay.

Previous research documents a strong association between gambling and substance use, suggesting that these seemingly distinct behaviors may share similar environmental, neurobiological, and genetic causes. However, there is a dearth of credible empirical evidence on whether gambling has a causal impact on substance use or vice versa. This paper estimates the impact of gambling on substance use making use of the rapid roll-out of sports betting laws across US states. Using data from the Behavioral Risk Factor Surveillance System and a difference-in-difference (DID) estimation strategy to assess the impact of legalizing sports betting on smoking and drinking behavior among adults, we find that the legalization of online sports betting has increased binge drinking frequency-at the intensive margin among young men by approximately 10 percent, but find no discernible impact on smoking. The results are consistent across traditional two-way fixed effects models as well as more recently developed DID methods designed for staggered treatment adoption.