Health economics最新文献

Prompt access to cancer care is a policy priority in several OECD countries, because delayed access can exacerbate deleterious health outcomes. Access to care based on need remains a key pillar of publicly-funded health systems. This study tests for the presence of inequalities in waiting times by socioeconomic status for patients receiving breast cancer surgery (mastectomy or breast conserving surgery) in England using the Hospital Episode Statistics. We investigate separately the pre-COVID-19 period (April 2015–January 2020), and the COVID-19 period (February 2020–March 2022). We use linear regression models to study the association between waiting times and income deprivation measured at the patient's area of residence. We control for demographic factors, type and number of comorbidities, past emergency admissions and Healthcare Resource Groups, and supply-level factors through hospital fixed effects. In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient's area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7 days (given a mean waiting time of 20.6 days).

Taxes on sweetened beverages have become an important policy response to growing obesity rates and the prevalence of type 2 diabetes in the U.S. and other nations. Since 2015, eight U.S. cities have implemented these taxes, but so far direct evidence of their impacts on household purchasing behavior is scarce. Of particular interest to many researchers and policy makers is the response of lower-income consumers to these taxes, both because they have higher sweetened beverage consumption on average and because of concerns that sweetened beverage taxes are regressive. This project investigates the income-stratified household response to SSB taxes using a data set containing the purchasing behavior of approximately 400 households in the cities of Seattle, San Francisco, Oakland, and Philadelphia, all of which have recently introduced beverage taxes. Using doubly-robust estimation of dynamic and heterogeneous treatment effects relative to a propensity-matched set of households in three comparison cities, we find that households in taxed cities experience increased prices and reduce their purchases of those beverages, with no evidence of cross-border shopping. We further find differential tax impacts by income level, with lower-income households (households with income <200% of the federal poverty line for their size) reducing their purchases of taxed beverages by nearly 50% — more than double the 18% reduction found in higher-income households (households with income >400% of the federal poverty line for their size). Our finding that lower-income households decrease their consumption more than twice as much as higher-income households suggests that these taxes may reduce health disparities and promote population health.

The Medicaid coverage “cliff” occurs when Medicare beneficiaries with household income exceeding 100% of the federal poverty level lose eligibility for supplemental Medicaid coverage. Using a regression discontinuity design with data from Medical Expenditure Panel Survey and National Health and Nutrition Examination Survey for 2007–2019, we demonstrate that the cliff increases out-of-pocket spending by 25% and the probability of experiencing problems paying medical bills by 44.4% without decreases in overall health care spending. However, there is evidence that near-poor Medicare beneficiaries changed behavior in response to the cliff, increasing the use of high-value diagnostic and preventive testing by 8.8% and enrollment in a more affordable plan by 12.2%. The cliff does not encourage healthy behavior.

Methods have been developed for transporting evidence from randomised controlled trials (RCTs) to target populations. However, these approaches allow only for differences in characteristics observed in the RCT and real-world data (overt heterogeneity). These approaches do not recognise heterogeneity of treatment effects (HTE) according to unmeasured characteristics (essential heterogeneity). We use a target trial design and apply a local instrumental variable (LIV) approach to electronic health records from the Clinical Practice Research Datalink, and examine both forms of heterogeneity in assessing the comparative effectiveness of two second-line treatments for type 2 diabetes mellitus. We first estimate individualised estimates of HTE across the entire target population defined by applying eligibility criteria from national guidelines (n = 13,240) within an overall target trial framework. We define a subpopulation who meet a published RCT's eligibility criteria (‘RCT-eligible’, n = 6497), and a subpopulation who do not (‘RCT-ineligible’, n = 6743). We compare average treatment effects for pre-specified subgroups within the RCT-eligible subpopulation, the RCT-ineligible subpopulation, and within the overall target population. We find differences across these subpopulations in the magnitude of subgroup-level treatment effects, but that the direction of estimated effects is stable. Our results highlight that LIV methods can provide useful evidence about treatment effect heterogeneity including for those subpopulations excluded from RCTs.

This paper theoretically investigates externalities and policy interventions in travel during a pandemic. We develop a tractable static model of two regions from a short-run perspective. The model shows that the externalities can be both negative and positive, depending on regional asymmetry. Thus, even when infectious diseases are widespread, travel restrictions do not necessarily reduce infections and do not necessarily improve social welfare. A formula for the optimal policy intervention is derived and shown to be the weighted average of four types of externalities defined by the direction of travel and the epidemiological status of a traveler.

Despite a growing interest in the impacts of prenatal factors on adulthood quality of life, economists have not estimated the income effects of sunlight exposures by mothers during pregnancy. This paper estimates such effects using data from China General Social Survey and China National Meteorological Data Service Center. The results show that the income effects of prenatal sunlight exposure in the second trimester are significantly positive. The effects differ for individuals born in different months and the effects are larger for female employees, older employees, those born in rural areas, in the pre-reform period, or whose mothers are less-educated. Finally, we investigate the possible mechanisms via the human capital pathway, discovering that fetuses with longer sunlight exposure in the second trimester are healthier and do more exercises in adulthood. It is suggested that families, communities, policymakers should pay attention to prenatal sunlight exposure, especially for pregnant women in the developing world who are less educated or live in rural areas.

Lower levels of education are associated with higher mortality. Lower levels of education are also associated with lower income, which is also associated with higher mortality. We investigate the impact of education on mortality and the extent to which this is mediated through income over the life course. We account for both selective educational attainment and selective income over the life course, through inverse propensity weighting (IPW) of the mortality hazard. We decompose the educational gain, that is, the decrease in mortality from more education, in the hazard into an indirect effect of education, running through changes in income and a direct effect of education, running through other factors. We use Swedish conscription data (men only), linked to parental information and individual annual income for the period 1968 till 2012. Our empirical results indicate large educational gains in mortality. We also find that this educational gradient runs through changes in income, especially for the more educated, and does not run through other factors related to education. We conduct several robustness and sensitivity checks that indicate that the results are robust.

The literature on health shocks finds that minor injuries have only short-term labor market impacts. However, mild traumatic brain injuries (mTBIs, commonly referred to as concussions) may be different as the medical literature highlights that they can have longer-term health and cognitive effects. Moreover, TBIs are one of the most common causes of disability globally, with the vast majority being mild. Thus, it is important to understand the impact of mTBIs on labor market outcomes. We use administrative data on all medically-diagnosed mild traumatic brain injuries (mTBIs) in New Zealand linked to monthly tax records to examine the labor market effects of a mTBI. We use a comparison group of those who suffer a mTBI at a later date to overcome potential endogeneity issues, and employ a doubly-robust difference-in-differences method. We find that suffering a mTBI has negative labor market effects. Rather than dissipating over time, these negative effects grow, representing a decrease in employment of 20 percentage points and earning losses of about a third after 48 months. Our results highlight the need for timely diagnosis and treatment to mitigate the effect of mTBIs to reduce economic and social costs.

Age is one of the most relevant observable risk attributes in determining the value of health insurance premiums. Empirical evidence indicates that the cost of health insurance is the leading cause of contract switching, which can compromise access to healthcare services and potentially result in treatment discontinuities. Using data from a Health Maintenance Organization in the Southern region of Brazil, we examined the effect of health plan price readjustment resulting from changes in the beneficiary's age group on disenrollment or switches to a more limited coverage plan. The estimates were obtained using the method of regression discontinuity. The main findings indicate that for age group transitions at 59 years old, the price readjustment effect led to an increase in contract cancellations and switching to cheaper plans. These findings highlight that an important consequence of the difference in premium sensitivity among age groups is that the exit of individuals from the health insurance sector is selective in age. The results of this paper can support policymaking to improve access to health insurance.

This study investigates the impacts of health shocks among older individuals on the dynamics of their living arrangements in Europe and the United States. Exploiting unpredicted health shocks, we use an event-study difference-in-differences approach to demonstrate that health shocks increase difficulties with activities of daily living and instrumental activities of daily living, thereby increasing the need for care. Our findings indicate that health shocks raise the probability of nursing home residency and co-residence with adult children by 0.7 and 1.4 percentage points in Europe, and by 2.1 and 1.8 percentage points in the U.S., respectively. Further analyses reveal that more generous long-term care public policies correlate with a higher probability of nursing home residency and a lower probability of co-residing with adult children, highlighting the significant role of public policies in household responses to health shocks. Additionally, we find that health shocks negatively impact adult children's labor supply, particularly in the U.S.