Health economics最新文献

We provide novel evidence on the role of social comparisons in shaping adolescent body misperception. Using an instrumental variables approach leveraging variation in relative age generated by school entry cutoff months and data from the Health Behaviour in School-Aged Children study, we show that relatively younger students are more likely to describe their bodies as lighter than the clinically relevant BMI category implied by their reported heights and weights compared to their same-age counterparts who are relatively older within their respective classrooms. This result is driven by relatively younger students who are classified as normal weight for their age describing themselves as “too thin.” We then show that relatively younger students are more likely to desire to gain weight, consume more calorie-dense foods, and report lower levels of physical activity. Overall, our results suggest that relatively younger students base their weight-related expectations and behaviors on their older peers.

Despite well-established econometric theory, less attention is paid to the type of treatment effects being estimated using alternate instrumental variable (IV) approaches and the support for IV in the health literature. We illustrate this case using a commonly used IV—differential distance (DD). We summarize the literature and find that DD was used as an IV in various forms and approaches in the literature, leading to the estimation of different identified parameters, which were not always explained. We illustrate the sources of these differences using theoretical reasoning and a case study to evaluate the causal effects of going to a for-profit (FP) hospital versus a not-for-profit (NFP) hospital on the total cost of psychiatric inpatient stay. We find that estimates of treatment effects differ considerably when using two-stage least squares with binary versus continuous DD. In contrast, two-stage residual inclusion (2SRI) approaches using binary or continuous DD yield similar estimates of the treatment effects when we adequately model the control function. Both the 2SRI estimates are close to the average treatment effect estimate generated by local IV approaches, which can illustrate the extent of selection into FP versus NFP hospitals through marginal treatment effect heterogeneity.

Using Norwegian administrative register data, we assess the impact of unexpected health shocks hitting lone parents on offspring's labor market outcomes and well-being. We use first-time hip fractures or strokes as indicators of parental health shocks and estimate both the overall effects and the heterogeneous impacts by the survival time of the affected parent. We identify small, but significant, immediate responses in terms of an increase in physician-certified sickness absences and a higher risk of diagnosed mental disorders. The short-term effects are larger for offspring whose parents die shortly after the shock. Most of the effects fade out quickly, and the negative impacts on subsequent employment and earnings are small and only borderline statistically significant. In general, our results suggest that the responses to the deteriorating health of a parent tend to be short-lived and mostly manifest as temporary absences from work rather than complete detachment from the labor market.

Rates of severe maternal morbidity (SMM) are related to maternal, hospital, and residential factors, but the contribution of these factors to racial disparities in SMM within Medicaid and private insured groups is largely unknown. Linked Georgia vital records/hospital discharge data for 2016–2020 are used to identify SMM during delivery or within 42 days postpartum for Medicaid and private insured. The Oaxaca-Blinder decomposition is used to describe the percentage of the Black-White SMM gap explained, based on linear probability models without and with hospital fixed-effects. While the rate of SMM is higher for Medicaid than private insured, the Black-White SMM gap is lower within Medicaid than private insured (1.15 vs. 1.40 per 100 deliveries). Including hospital fixed-effects increased the explained gap by 29.1 percentage points (from 13.8% to 42.9%) within Medicaid and by 9.4 percentage points (from 20.0% to 29.4%) within private insured. Residential factors significantly reduced the Black-White gap explained for Medicaid (−19.6%) but were insignificant (∼0%) for privately insured. According to the Oaxaca-Blinder algebraic calculation, differences in within-hospital processes by race contribute a large portion of the discriminatory Black-White SMM gap among Georgia deliveries while residential areas with greater provider access tends to reduce the gap among Medicaid insured.

This study investigates the spillover effects of a city-wide global budget and case-based payment reform (known as the DIP reform) on non-resident patients from another city in the same province. By developing a theoretical model, I hypothesize that nontrivial deviation costs from reform-driven standard patient journeys could lead to reduced charges for patients who seek care in the reform city but are not subject to its payment reform policies. To test this hypothesis, I employ a difference-in-differences approach using discharge records to compare outcomes between patients from a non-reform outbound city hospitalized in the reform city, where DIP was implemented, and those hospitalized in other non-reform cities within the same province. The results indicate that the DIP reform significantly reduced total hospital charges for non-resident patients, without compromising care quality as measured by readmission rates. Notably, high-cost hospitals experienced more pronounced charge reductions compared to low-cost hospitals, highlighting the need to manage heterogeneous impacts on different healthcare providers to ensure equitable healthcare delivery.