Health economics最新文献

Economic evaluations carried out from a societal perspective ought to account for the opportunity cost of a range of resources, including those committed by care recipients. People's time is such a resource: it is limited, valuable and it has an opportunity cost that should be reflected in cost calculations. Yet, when it comes to children and young people (CYP), there are few suggestions on how to value their time and include it in economic evaluations. Despite repeated calls for research, this remains a persistent gap in our methodology "playbook". In this paper, we look at the topic by bringing together seminal literature and recent research findings. We discuss key uncertainties that need to be resolved for the topic to move forwards, outline challenges and "frequently asked questions", offer our views on possible answers and solutions, and sketch out a roadmap for future research.

The COVID-19 pandemic placed exceptional strain on essential services, raising urgent concerns about the mental well-being of workers in critical sectors. This study examines the short- and medium-term effects of the COVID-19 pandemic on the mental health of health and social care (HSC) workers in the UK relative to other occupational groups. Using data from the UK Household Longitudinal Study and measuring mental health via the General Health Questionnaire (GHQ), we apply a difference-in-differences strategy, where both groups could be treated only in the second period (a pre-post design), to investigate whether HSC workers experienced distinct mental health trajectories compared to other key workers (KWs) and workers in non-essential sectors (non-KWs). The results for the immediate post-pandemic period (April-November 2020) show no significant differences in mental health for HSC workers compared with either comparator worker groups. Medium-term outcomes remained statistically insignificant across occupational comparisons. Additional analyses of individual GHQ items and potential mechanisms (financial stability and social isolation) suggest limited heterogeneous effects for each worker group using yearly data. While all studied groups exhibited some deterioration in mental health after 2020, HSC workers' trajectories largely mirrored those of other KWs and non-KWs, suggesting that factors such as stable employment and financial security may have cushioned the psychological impact for this sector.

Medicare Advantage (MA) enrollment more than doubled from 2013 to 2023, raising concerns about risk selection, spending, and the continued use of traditional Medicare (TM) spending as a benchmark for MA payment. This study examines trends in selection into MA from 2009 to 2020 using administrative and survey data from the Medicare Current Beneficiary Survey. For each survey year, we estimate a regression model of Part A and B spending among TM enrollees based on demographic characteristics, self-reported health status, limitations in activities of daily living, and enrollee group type (e.g., dual eligible, institutionalized, disabled). We apply this model to MA enrollees to estimate their predicted TM spending. We find that since 2017, MA enrollees have had higher predicted costs than TM enrollees-5-6% higher from 2017 to 2020-driven largely by the growing share of dual eligibles in MA. Within enrollee group type, however, we observe little evidence of differential selection. We further use the model results from just our baseline year, 2009, to predict both MA and TM spending in each subsequent year. We find that although MA enrollee characteristics did not trend observably healthier or sicker over this period, TM enrollees' characteristics appear to have shifted in ways associated with lower predicted spending over time. These findings suggest that the nature of selection into MA has qualitatively shifted over recent years and raises further questions about how well the current risk adjustment system reflects appropriate differences in risk as the enrollee characteristics in these groups continue to diverge.

The fiscal sustainability of healthcare systems is increasingly strained by aging populations with two competing hypotheses dominating the literature. The Red Herring Hypothesis suggests that healthcare expenditures are driven more by proximity to death than by chronological age, while the Steepening Hypothesis examines whether expenditures increase faster for older individuals over time. Nevertheless, these two frameworks have traditionally been studied independently rather than in conjunction. This paper offers a unified econometric model, allowing for a rigorous assessment of their concurrent validity and interaction. Using comprehensive register-based monthly somatic hospital expenditure data for the entire Danish population from 2002 to 2017, we provide robust evidence that both Red Herring and Steepening effects operate simultaneously. Although Red Herring effects modestly mitigate the expenditure burden of an increasingly older population, they are substantially outweighed by pronounced Steepening effects, which account for nearly 60% of hospital expenditure growth during the observation period. Through a novel decomposition method, we identify a previously unrecognized interaction between these phenomena, a Red Herring Steepening effect, which accelerates expenditure growth in the final years of life for older individuals. Our findings suggest that healthcare systems face considerably greater fiscal challenges from population aging than previously recognized under the Red Herring Hypothesis alone.

This study investigated the impact of providing feedback to respondents on a dominance-structured choice task on subsequent choice behavior in a discrete choice experiment (DCE). The DCE was conducted among 626 patients with heart failure. Respondents were given a dominance-structured choice task in which two devices (Device A and Device B) offered no benefits but carried risks compared to a "No Device" option. Among those who selected a device option (N = 340), half received feedback and an opportunity to revise their choice, while the other half did not. The effect of feedback on preference for the "No Device" option and choice consistency was examined using multinomial, heteroscedastic multinomial logit, and heteroscedastic latent-class logit models. Among those who received feedback (N = 170), 71% continued to choose the device options. Feedback recipients were more likely to choose the "No Device" option in subsequent questions (p < 0.01). Feedback led to a 25% reduction in choice consistency (p < 0.01) and an increased likelihood of choosing the "No Device" option. Impact on consistency varied across latent classes: feedback decreased consistency in the risk-sensitive class but increased consistency in the anti-device class, highlighting potential unintended consequences. Further research is needed to understand its effects in different contexts and samples.

Physician adoption of new information about a medical procedure can affect patient outcomes. Medical malpractice law may influence physician use of such information. We analyze how physician reactions to information shocks regarding vaginal births after cesarean sections (VBACs) in the 1990s were mediated by tort reform and the standard used in malpractice claims to determine a physician's duty of care to patients. Differentiating states according to whether they capped non-economic damages in malpractice claims (Caps) and whether they defined the duty of care using a national or a local reference point, we analyze how physicians under the four legal regimes reacted to a series of adverse information shocks regarding VBACs over the period. Our results suggest that physicians whose duty of care is determined by standard practices nationwide are less likely to adopt innovations which have not yet been incorporated into those practices and more likely to adopt innovations once they are incorporated into those practices. Caps may moderate these effects. Our results also suggest intuitive heterogeneity in the effects of legal regime on physician decisions.

This paper examines the impact of Targeted Regulation of Abortion Providers (TRAP) laws on the supply and composition of maternal healthcare providers, particularly obstetrician-gynecologists (OB/GYNs). We exploit the staggered enactment of TRAP laws across U.S. states from 2010 to 2021 using a propensity score matching and stacked difference-in-differences approach. Our analytic sample includes physician-, county- and state-level measures of OB/GYN supply, newly graduated OB/GYNs, medical school and residency program applicants, nurse practitioners (NPs) and physician assistants (PAs) who practice women's healthcare, as well as advanced practice nurse midwives. TRAP law enactment is associated with a statistically significant reduction of 2.09 in OB/GYN supply per 100,000 females aged 15-44 (6.6% relative to the baseline). This decline is particularly pronounced among OB/GYNs aged 55-64. For OB/GYNs under 34, the estimates suggest a decline but this finding should be interpreted cautiously given pre-trends. TRAP laws also are associated with a reduction in the supply of newly graduated OB/GYNs from lower-ranked medical schools. We find no evidence that NPs, PAs, or midwives substitute for the decline in OB/GYNs. Mechanism analyses provide suggestive evidence that the supply contraction operates through exit rather than relocation. These findings highlight unintended consequences of abortion restrictions on broader maternal healthcare provision.

Payments to healthcare providers are often based on the number of patients with a particular diagnosis or treatment with well known limitations. Payment based on health outcomes, a form of pay-for-performance, has long been advocated as a possible solution. We use a contract theory approach and illustrate how it can inform practical implementation of pay-for-performance schemes that reward health outcomes. The pricing rule suggests that the bonus should be set to reflect the difference between the provider's marginal cost of a health improvement before the policy intervention and the provider's marginal cost evaluated at the target health set by the purchaser. We provide estimates of the optimal bonus for hip and knee replacement under a range of assumptions about provider cost functions and the value of health improvements.

We examine whether a universal drug subsidy for seniors in Poland provided effective financial protection and whether it induced ex ante moral hazard. The policy eliminated out-of-pocket costs for prescription medications while leaving all other healthcare coverage unchanged. Using detailed household expenditure data and a sharp age-based eligibility threshold, we implement a difference-in-discontinuities design to estimate causal effects. The reform reduced average medication spending and lowered the incidence of catastrophic drug expenditures by 62%, with gains concentrated in the upper tail of the spending distribution-consistent with insurance against large health shocks. On the non-medical margin, we find suggestive evidence of a modest increase in spending on a category of unhealthy goods-consistent with reduced precautionary behavior at the household level. These results highlight that while public subsidies can meaningfully reduce financial risk, they may also induce behavioral responses that partially offset intended health benefits.

This paper examines the impacts of maternal education on her children's nutritional status in Kenya, utilizing six waves of nationally representative data from KDHS. To mitigate potential endogeneity issues and derive a causal relationship, we employ a change in the educational regime in 1985 as an instrument variable. The key findings can be summarized as follows. First, women under the new structure enhance their education by an average of 1.8 years. Second, an additional year of education attained by a mother is shown to have an impact on reducing the likelihood of her child experiencing stunting, underweight, and wasting by approximately 3.8, 2.6, and 1.2 percentage points, respectively. These findings withstand rigorous testing through a battery of robustness checks. Finally, to elucidate the underlying mechanisms behind these results, our study delves into various factors, encompassing women's fertility, female labor force engagement, women's information exposure, and their involvement in decision-making.