Health economics最新文献

In the English National Health Service, most patients can use an online platform to send a written request to the practice, in addition to calling or visiting the practice in person. However, there are concerns that the availability of an online access route to primary care can adversely impact healthcare provision for older or lower socioeconomic groups. To examine those concerns, we explore the differential timing of online platforms' implementation between 2019 and 2020 across 289 practices covering over 2.5 million patients in North West London. We find no evidence of an impact of the online access route on age and socioeconomic-related inequity in synchronous interactions in primary care, but observe an increase in all interactions in this setting and in some cases, a small reduction (worst case, no changes) in unplanned hospital care. These findings suggest that having an online access route to primary care can improve the provision of healthcare services, at no detriment to patients from older and lower socioeconomic groups.

This study investigates if local walkability helped mitigate the well-documented mental health impacts of the COVID-19 pandemic. Walkability may improve mental health by facilitating walking (which our data suggest occurred during the pandemic), as well as through other avenues such as time spent outdoors and improved social ties. However, estimating the causal effects of walkability is challenged by its lack of exogenous time variation. Our empirical approach uses the pandemic as a geographically-variable and arguably-random shock to mental health which, when combined with Census tract measures of walkability and mental health, sheds light on the possible impact of local walkability on mental health resiliency. Focusing on within-county, over-time variation in mental health and controlling for a wide set of local factors, results suggest that those living in a more walkable community experienced smaller declines in mental health. The magnitudes are reasonable; increasing walkability by one standard deviation is associated with a 4 percent reduction in the average pandemic-related deterioration in mental health. These findings are robust to many sensitivity checks and falsification tests. Although the pandemic is the random shock studied here, this research has implications for the potential role of walkability in diminishing the mental health effects of other stressors.

Parents of children with disabilities may face higher labor-market penalties given the extra care and support required. Using Swedish administrative data, we focus on first-born children with Cerebral Palsy (CP) to estimate impacts on parental labor-market outcomes. We apply an event study approach to identify effects up to 10 years after the birth of the child. Our results show that employment and earnings of mothers decrease in the short run and increase in the long run whereas for fathers, a marginal decrease is observed in the short run. The effects differ by severity of the disability, with mothers of children with severe impairments driving the increases in the long run, whilst mothers of children with mild impairments appear to experience a penalty. Further, transfers and benefits from the Swedish social insurance system compensate parents for some of the potential costs associated with caring for a child with CP.

Recent research has found that health risk values elicited using Discrete Choice Experiments (DCEs) may be inadequately sensitive to the magnitude of the risk reduction, a phenomenon referred to as insensitivity to scope. This paper investigates the use of DCEs to estimate the value of a statistical life (VSL) under different experimental conditions. In particular, we use an experimental design where in one experimental arm we carry out a standard unincentivised DCE as in the existing literature, while in the other experimental arm we carry out an incentivized version of the DCE with real payments. Our findings suggest that the incentive has an impact on the results, in the sense that the VSL estimates are higher in the unincentivised arm of the experiment. However, we find evidence of external insensitivity to scope in both experimental arms and only weak evidence of stronger internal sensitivity to scope in the incentivized arm. Hence, our results suggest that a lack of scope sensitivity is unrelated to the hypothetical nature of the payments in stated-preference valuations of health risks.

We examine how the earlier introduction of compulsory school grades affects the likelihood of receiving a mental disorder diagnosis among Swedish adolescents. We exploit a school reform that shifted the introduction of grades from grade 8 to grade 6, resulting in first exposure to grading at different ages between cohorts. Our results show that girls exposed to earlier grading are more likely to be diagnosed with internalizing disorders, such as depression and anxiety, by the end of compulsory school. This effect is particularly pronounced among students with low to moderate academic achievement. We also find suggestive evidence that both girls and boys exposed to earlier grading face an increased risk of being diagnosed with alcohol-related disorders. These findings highlight that early exposure to grading may have unintended adverse effects on adolescent mental health. Education systems should acknowledge these potential risks and consider implementing complementary mental health support when revising grading policies.

This paper studies how the introduction of industrial robots affects sickness absence among workers in the manufacturing sector in Norway. We use data on the imports of industrial robots at the firm level, combined with employee-firm linked register data, to investigate the impact of robotization on the duration of sick leave (SL). We find that robotization leads to a statistically significant increase in SL duration of approximately 1.7 days. Workers in blue-collar occupations are especially negatively affected, and among this group those with routine tasks experience even higher levels of SL following robotization, with an average increase of around 5 days. We conduct additional analyses looking at different categories of diagnoses across various occupation groups and find heterogeneous effects. Our results suggest that for blue-collar and routine workers robotization leads to increased musculoskeletal SL, while we only observe an increase in injuries for STEM workers, with maintenance engineers especially negatively affected. Our findings suggest several mechanisms that differ by type of occupation, ranging from musculoskeletal diagnoses caused by repetitive strain to an increase in injuries resulting from working directly with the newly installed industrial robots.

During the Great Recession, monetary stimulus had asymmetric impacts on mortgages with different interest rate structures, leading to a significant and unexpected reduction in mortgage payments for adjustable-rate mortgage (ARM) borrowers, which in turn increased their disposable income. Leveraging this quasi-experimental setup, our analysis reveals that healthcare expenditures and medical service utilization increased in counties with a higher prevalence of ARMs. The heterogeneity between ARM and fixed-rate mortgage (FRM) borrowers, combined with the more pronounced economic decline observed in counties densely populated with ARMs, allows our study to provide conservative lower bound estimates of the effects of income shocks on household healthcare consumption.

The stated preference literature on equity in health aims to enhance our understanding of the public's preferences for allocation of health resources to promote fairness and justice in the distribution of healthcare. This paper explores how different elicitation approaches impact on the elicited distributional preferences in the context of health. We randomly allocated respondents to one of two elicitation approaches: the ex post social decision maker perspective and the private ex ante insurance perspective. Respondents were asked to make choices between healthcare resource allocation distributions that follow different priority rules regarding maximization and equality. We find that preferences differ across the two approaches with the health maximization objective receiving less support under the ex ante perspective. The contribution of this paper is to demonstrate that option value, in addition to inequality aversion, provides an important argument for average citizens' distributional preferences, and that both sets of preferences may represent important inputs to policy making.