Health economics最新文献

This study examines spillovers from a 2014 New York Medicaid policy change that increased reimbursement for immediate postpartum long-acting reversible contraceptive (LARC) insertion. Using administrative data on hospital deliveries from 2011 through 2019, we analyze whether physicians who inserted immediate postpartum LARCs for Medicaid patients following the policy change were more likely to subsequently perform the procedure on non-Medicaid patients. We find significant spillovers, as physicians who first perform an immediate postpartum Medicaid LARC insertion following the 2014 payment reform are 9.3 percentage points more likely to perform immediate postpartum non-Medicaid LARC insertions; an association that increases with the physician's share of Medicaid deliveries. To distinguish between physician-specific and hospital-specific factors driving spillovers, we compare physicians within the same hospital-year. Results indicate approximately half the spillover is due to physician-specific factors and half to hospital-specific factors. Our findings highlight how targeted reimbursement policies can have broader impacts beyond the intended population and demonstrate the influence of both individual physician behavior and institutional factors in shaping clinical practice patterns. Understanding these spillover dynamics is important for policymakers and healthcare providers aiming to promote effective and equitable contraceptive care across patient populations.

Oregon Ballot Measure 110 (BM 110) reduced the penalties for non-commercial possession of a controlled substance, downgrading them from a felony or misdemeanor to a new Class E violation, punishable by a maximum $100 fine. In this paper, we investigate whether BM 110 was associated with changes in drug-related fatal traffic crashes in Oregon after its implementation in February 2021. To do so, we used Fatality Analysis Reporting System (FARS) data from 2018 to 2021 to calculate population-adjusted state-level drug-related fatal traffic crashes. We also employed a modified synthetic control method to create a "synthetic" Oregon, designed to closely resemble the state's pre-policy sociodemographic characteristics and outcome trends while correcting for time-invariant pre-policy differences. The findings show that BM 110 was not associated with changes in drug-related fatal traffic crashes per 100,000 population (0.114, 95% CI: -0.106, 0.334). These results suggest that the implementation of BM 110 did not change drug-related fatal traffic crashes in Oregon in the early period following its adoption.

We study the effects of general practitioners' (GPs') resignations on their patients' healthcare utilization and diagnoses in an event-study setting. Using claims data from a large German statutory health insurance, we find that after physicians leave, their former patients persistently reduce their primary care utilization, only partially substituting it with specialist visits and hospital care. Because patients find a new GP already 1.1 quarters after the old resigns, on average, the persistent effects must be explained through the new GP. Indeed, the new GP serves more patients but performs less diagnostic testing. Our results reveal a substantial decrease in diagnoses of many relevant chronic conditions (such as congestive heart failure and diabetes), suggesting that disruptions may have adverse consequences for the efficiency of the healthcare system. This indicates that continuity in primary care is pivotal and shows that the GP has an essential role in healthcare delivery, particularly in healthcare systems such as Germany, where GPs often have a high workload and little consultation time.

The hidden value of adult informal care (IC) refers to the unaccounted value of informal care in overall costs of long-term care (LTC) estimates. This paper estimates the net value of adult IC in Europe, drawing on a well-being-based methodology. We use an instrumental variable strategy and a longitudinal and cross-country dataset to estimate the causal effect of the extensive and intensive margin of caregiving on subjective well-being. We estimate the so-called compensating surplus (CS), namely the income equivalent transfer, to compensate for the net disutility of caregiving. We show that IC reduces average subjective well-being by about 1% compared to the mean (6% among co-residential caregivers). Relative to a country's Gross Domestic Product (GDP), the value of IC ranges between 4.2% in France and 0.85% in Germany. Such relative value declines as the country's share of formal LTC spending increases. These results call for a reconsideration of the existing classifications of LTC regimes. We estimate that the average CS per hour for IC is 9.55€, with a range from 22€ per hour in Switzerland to 5€ per hour in Spain. Additionally, we estimate that the long-term CS (estimated using an individual's permanent income) tends to be lower than short-term CS (estimated using an individual's current income).

Under the evidence that the Daylight Saving Time (DST) regime does not accomplish its primary goal of saving energy, I analyze one of the main side effects, automobile accidents in Chile between 2002 and 2018. I use a Regression Discontinuity Design (RDD) exploiting the discrete nature of the transition into DST and a Difference-in-Difference (DID) approach, taking advantage of the changes in dates that the policy starts and ends over the years. I find a 2.7% reduction in automobile accidents under the DST regime. I isolate the two main mechanisms: sleep disruption and the reallocation of light. I find suggestive evidence that the sleep disruption effect plays a relevant role at both transitions: it increases automobile accidents by 6% the first week following the transition into DST and decreases them by 3.9% the first week following the transition into Standard Time (ST). I also find evidence that ambient light reduces serious and fatal accident risk.

We investigate whether the severity of lifestyle-related health shocks affects the response in dietary patterns. Using data from official patient registers in Denmark, we analyze the effects from strong health shock (SHS) occurrences (cardiovascular disease) and mild health shock (MHS) occurrences (arterial hypertension and hypercholesterolemia). These data are combined with scanner data on food purchases obtained from a consumer panel. Our analysis examines dietary effects stemming from these health shocks, including various nutrients, food groups, and overall adherence to dietary guidelines. Our findings reveal immediate dietary responses to both severe and mild health shocks, with a larger effect observed for SHS compared to MHS. However, among individuals previously exposed to mild health shocks, we observe minimal to no alteration in food consumption after experiencing a SHS. We argue that failing to account for this potential self-selection may lead to a misconception that severe health shocks do not result in dietary improvements.

Understanding the behavior of populations of drug consumers has been and remains a topic of keen interest. Using a unique dataset on 25 districts from Bengal, India, from 1911 to 1925, we analyze whether populations of consumers treat alcohol, cannabis, and opium as economic substitutes or complements in a legal regime. Additionally, we examine responsiveness to prices and income. Our analysis has three main findings. First, we find evidence of substitution between alcohol and cannabis bud. Second, cannabis leaf is a complement for alcohol but a substitute for cannabis bud. Third, we find negative income elasticity for alcohol, cannabis bud, and opium consumption. These findings on the link between consumption patterns and economic factors can guide harm reduction strategies.

The Northeast region of Brazil is characterized by long periods of drought. However, the region is also frequently affected by floods. The socioeconomic characteristics of the locality make the population more vulnerable to the impacts of these disasters. Therefore, the aim of this article is to investigate the short to long-term impacts of hydrological disasters in northeastern Brazil on morbidity and mortality rates, by age groups. For this purpose, the difference-in-differences method proposed by Callaway and Sant'Anna was applied to a monthly panel data spanning the period from 2000 to 2012. The results indicate that in the short term there is an increase in the mortality rate associated with drowning. In the medium term, there are effects particularly on morbidity rates, with emphasis on leptospirosis and acute respiratory diseases. For the long-term diseases analyzed, no effects of hydrological disasters were observed.

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.