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 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.

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.

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.

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.

While the direct health impacts of air pollution are widely discussed, its indirect effects, particularly during pandemics, are less explored. Utilizing detailed individual-level data from all designated hospitals in Wuhan during the initial COVID-19 outbreak, we examine the impact of air pollution exposure on treatment costs and health outcomes for COVID-19 patients. Our findings reveal that patients exposed more intensively to air pollution, identified by their residence in downwind areas of high-polluting enterprises, not only had worsened health outcomes but also consumed more medical resources. This increased demand is primarily due to their heightened vulnerability to cardiopulmonary conditions. Using a causal machine learning method called Causal Forests to estimate individual treatment effects, we uncover significant heterogeneity across demographic and socioeconomic characteristics, with older and economically disadvantaged patients showing particular vulnerability. These findings highlight the importance of considering environmental factors in pandemic preparedness and suggest the value of targeted interventions that account for demographic and socioeconomic variations in vulnerability.

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.

The discussion on tackling childhood obesity is often centered around fostering physical activity. A potential relationship yet overlooked could run from providing the proper environment for healthy lifestyles to reduced weight problems. A unique quasi-experimental setting of transforming former airport grounds to a large urban green space allows me to apply a difference-in-differences approach within an intention-to-treat framework, comparing several weight outcomes of residential children to children living further away before and after park opening. I use new administrative data on the Berlin district level from mandatory school entrance examinations and provide robust evidence of a lower probability by 4.3% points for treated children to be overweight (BMI > 90 P.), driven entirely by girls, mainly by children from foreign cultural backgrounds and children with less childcare exposure. My results are robust to corrective methods of inference, including synthetic controls, and may open a new perspective for obesity policy action and prevention.

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.

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.