Health economics最新文献

Mandatory vaccination for COVID-19 has received intense political and ethical debates, while the literature on the causal effects of vaccination mandates on vaccination outcomes is very limited. In this study, we examine the effects of the announcement of vaccine mandates (VMs) for workers working in three sectors, including health, education, and state governments, on the uptake of first-dose and second-dose vaccination across 50 states in the United States of America. We show that VM announcements have heterogeneous effects; hence, standard two-way fixed effects and difference-in-differences estimators are biased. We present evidence for the heterogeneous treatment effects in single and two-treatment settings. In the setting of a single treatment, when treating all VM announcements equally, our results show that VM announcement was associated with an increase of 20.6% first-dose uptake from 1 July to 31 August 2021. In two-treatment settings, our results suggest that VM announcements for workers in health or state government sectors have significant causal effects on first-dose vaccination. Additionally, VM announcements do not have significant causal effects on second-dose uptake. Our results are robust to the choice of differing outcome variables and periods after controlling for state-level covariates, including COVID-19 death, unemployment, and cumulative two-dose vaccination.

This paper investigates the impact of a dependent coverage age-eligibility rule on young adults' health and healthcare utilisation under Indonesia's National Health Insurance (NHI) program. Employing a regression discontinuity design, analysis of the NHI administrative data documents a significant 14.6 to 20.9 percentage points drop in coverage among young adults at age 21, the age cut-off imposed by the rule. Using a large nationally representative household survey, this paper shows that the loss of insurance coverage does not change young adults' health status but markedly decreases the utilisation of outpatient care among those who are ill. Specifically, there is an abrupt 5.3 to 8.4 percentage points reduction in the probability of young adults having any outpatient visit in the past month, primarily driven by lower utilisation of primary care services. The study also finds an increased likelihood of self-treatment and the use of traditional healers, indicating a substitution effect. Further analysis shows a larger impact on those who are poor, less educated, and live in regions with higher healthcare costs.

We study a policy introducing diagnosis related payment for inpatient mental health care in Germany with rates decreasing over length of stay. Using data on all hospital cases, we first examine which hospitals voluntarily opt into the new scheme. We show that specialized hospitals that treat more complicated cases and are reimbursed more highly under the new scheme select into it. Second, we study the effect of diagnosis related payment on length of stay. We find that diagnosis related payment is associated with large reductions in length of stay but has no effect on mortality, post-acute care, or the ambulatory sector. We argue that the reductions in length of stay are driven by the fact that diagnoses related reimbursement is higher for more complex cases and by payment decreasing over length of stay. This novel evidence contributes to a scarce literature on the role of payment systems for inpatient mental health care and provides important insights for policymakers.

Waiting time is a rationing mechanism that is used in publicly funded healthcare systems as a mean to ensure equal access for equal need. However, several studies suggest that individuals with higher socioeconomic status wait less. These studies typically measure patients' socioeconomic status as an aggregate measure from patients' residential area and the results are hence vulnerable for aggregation biases. We shed light on the magnitude of the aggregation bias by analyzing socioeconomic gradients in waiting times when education and income are measured on three different levels: the individual level, the population cell level, and the municipal level. Our individual level socioeconomic gradient is modest compared with the literature. When socioeconomic status is measured on an aggregate level, we observe stronger associations with socioeconomic variables and less accurate estimates. A researcher who only has access to the aggregate data runs the risk of overstating the magnitude of the socioeconomic gradients.

After years of reductions in the rate of murder in the United States, the national murder rate has increased since 2015. The causes of this trend are generally unknown, though there is some evidence related to narcotic drugs. Arrests related to heroin and cocaine had been stable between 2010 and 2014 before a sudden increase in 2015. Likewise, the number of murders related to narcotic drugs has increased since 2013, with a jump in 2015. Increased rates of these crimes parallel recent dramatic growth in overdoses involving heroin. However, the causal relationship between the recent opioid crisis and the rise in murder rates is missing from the literature. I used OxyContin reformulation as an exogenous shock to illicit markets. OxyContin reformulation led some people who misused OxyContin to switch to illicit opioids. Previous work has shown that areas with higher rates of OxyContin misuse experienced faster growth in heroin overdoses post-reformulation. I tested whether this growth in illicit drug use caused an increase in crime. After reformulation, I find significantly greater relative increases in murder rates in states with high pre-reformulation rates of OxyContin misuse. The results support a causal link between the opioid epidemic and crime.

As population aging will likely lead to an increasing number of people in need of care, the demand for informal care is expected to rise. In this context, it is often discussed whether financial incentives can motivate more individuals to assume caregiving responsibilities. We analyze the potential effect of financial incentives on the provision of informal care by estimating a structural model with endogenous labor supply and caregiving decisions. This allows us to investigate how both individual wages and financial compensations for caregiving affect the caregiving decision, while accounting for heterogeneous preferences. We find that wage increases are associated with a decreased willingness to care. Financially compensating potential carers for the opportunity costs from caregiving significantly increases the probability of providing care. However, across different subgroups, a large share of about 50% of potential carers remains unwilling to provide care despite the financial incentive. For these individuals, factors such as preferences and social norms outweigh financial considerations in their caregiving decision.

Despite being one of the most common surgical procedures in industrialized countries, there is limited causal evidence on the long-term consequences of Cesarean section (CS). We study the impacts of CS on health during ages 1-12 years and human capital outcomes at age 16 years, using exogenous variation in the probability of receiving a CS for breech births at term-a group with high CS risk. We use administrative data from Denmark, Norway, and Sweden to show that preventing complicated vaginal births benefits health at birth and reduces the number of all-cause hospital nights during childhood. Our findings for childhood diagnoses for asthma, allergies, diabetes mellitus type 1, and school outcomes are imprecise and do thus not lend strong support for prominent hypotheses on CS causing long-term immune dysfunction disorders and, thereby, worse human capital outcomes.

This study examines the impact of the Affordable Care Act (ACA) on health insurance coverage among rent-burdened households-those spending more than 30% of their income on rent-and non-rent-burdened households. Using data from American Community Survey, we find that Medicaid take-up rate increased 8.88 percentage points (pp) among rent-burdened households and 7.54 pp among non-rent-burdened households in expansion states. Conditional on household income and demographic characteristics, rent-burdened households exhibit a 1.5 pp higher likelihood of Medicaid enrollment, with an additional decline of 0.7 pp in employer-sponsored insurance and 1.0 pp in directly purchased insurance enrollment. These effects were more pronounced among individuals aged over 26 and those in states without state-run exchanges. The findings show the importance of tailored Medicaid policies to assist households facing housing burdens, especially for those ineligible for housing vouchers.

We estimate the effects of hospital-physician vertical integration on spending and utilization of physician-administered drugs for hematology-oncology, ophthalmology, and rheumatology. Using a 100% sample of Medicare fee-for-service medical claims from 2013 to 2017, we find that vertical integration shifts treatments away from physician offices and toward hospital outpatient departments. These shifts are accompanied by increases in physician-administered drug administration spending per procedure for all three specialties. Spending on Part B drugs also increases for hematologist-oncologists. At the same time, physician treatment intensity, as measured by the number of beneficiaries who receive drug infusions/injections and the number of drug infusions, decreases across all three specialties. These results suggest that the incentives of the Medicare reimbursement system, particularly site-of-care payment differentials and outpatient drug reimbursement rates, interact with vertical integration to lead to higher overall spending. Policies and merger guidelines should attempt to restrain spending increases attributed to vertical integration.

We trace the evolution of all-cause mortality rates in Brazilian regions with varying exposure to trade-induced economic shocks before, during, and after liberalization reforms in the 1990s. We find consistent evidence of pro-cyclical mortality, with areas more exposed to tariff reductions experiencing larger declines in mortality across varying time horizons. The observed decline in mortality rates is evident across sex, age groups, and for both internal and external causes of mortality. We falsify the observed relationship between mortality and tariff reductions with analyses of causes of death that are plausibly unrelated to economic activity. Concerning proximate mechanisms involved in our finding of pro-cyclical mortality, we show that healthcare infrastructure expanded in local economies more affected by the trade-induced economic shock. This expansion was characterized by the increased capital-intensity of care, facilitated by the import of diagnostic technologies that reduce mortality from internal causes. We also find supporting evidence for the idea that pro-cyclical mortality is partially caused by a decrease in transport and non-transport-related accidents. Overall, our findings highlight an underappreciated dimension of trade policy effects, namely public health.