Andrew Friedson, Moyan Li, Katherine Meckel, D. Rees, Daniel W. Sacks
Medical experts have argued forcefully that using cigarettes harms health, prompting the adoption of myriad anti-smoking policies. The association between smoking and mortality may, however, be driven by unobserved factors, making it difficult to discern the underlying long-term causal relationship. In this study, we explore the effects of cigarette taxes experienced as a teenager, which are arguably exogenous, on adult smoking participation and mortality. A one-dollar increase in teenage cigarette taxes is associated with an 8 percent reduction in adult smoking participation and a 6 percent reduction in mortality. Mortality effects are most pronounced for heart disease and lung cancer.
{"title":"Cigarette Taxes, Smoking, and Health in the Long Run","authors":"Andrew Friedson, Moyan Li, Katherine Meckel, D. Rees, Daniel W. Sacks","doi":"10.3386/w29145","DOIUrl":"https://doi.org/10.3386/w29145","url":null,"abstract":"Medical experts have argued forcefully that using cigarettes harms health, prompting the adoption of myriad anti-smoking policies. The association between smoking and mortality may, however, be driven by unobserved factors, making it difficult to discern the underlying long-term causal relationship. In this study, we explore the effects of cigarette taxes experienced as a teenager, which are arguably exogenous, on adult smoking participation and mortality. A one-dollar increase in teenage cigarette taxes is associated with an 8 percent reduction in adult smoking participation and a 6 percent reduction in mortality. Mortality effects are most pronounced for heart disease and lung cancer.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"27 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72570890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Becher, Daniel Stegmueller, S. Brouard, E. Kerrouche
Objective: We measure the prevalence of non-compliance with public health guidelines in the COVID-19 pandemic and examine how it is shaped by political ideology across countries. Methods: A list experiment of non-compliance and a multi-item scale of health-related behaviors were embedded in a comparative survey of 11,000 respondents in nine OCED countries. We conduct a statistical analyses of the list experiment capturing degrees of non-compliance with social distancing rules and estimate ideological effect heterogeneity. A semiparametric analysis examines the functional form of the relationship between ideology and the propensity to violate public health guidelines. Results: Our analyses reveal substantial heterogeneity between countries. Ideology plays an outsized role in the United States. No association of comparable magnitude is found in the majority of the other countries in our study. In many settings, the impact of ideology on health-related behaviors is non-linear. Conclusion: Our results highlight the importance of taking a comparative perspective. Extrapolating the role of ideology from the United States to other advanced industrialized societies might paint an erroneous picture of the scope of possible non-pharmaceutical interventions. Heterogeneity limits the extent to which policy-makers can learn from experiences across borders.
{"title":"Ideology and Compliance With Health Guidelines During the COVID-19 Pandemic: A Comparative Perspective","authors":"Michael Becher, Daniel Stegmueller, S. Brouard, E. Kerrouche","doi":"10.2139/ssrn.3887261","DOIUrl":"https://doi.org/10.2139/ssrn.3887261","url":null,"abstract":"Objective: We measure the prevalence of non-compliance with public health guidelines in the COVID-19 pandemic and examine how it is shaped by political ideology across countries. Methods: A list experiment of non-compliance and a multi-item scale of health-related behaviors were embedded in a comparative survey of 11,000 respondents in nine OCED countries. We conduct a statistical analyses of the list experiment capturing degrees of non-compliance with social distancing rules and estimate ideological effect heterogeneity. A semiparametric analysis examines the functional form of the relationship between ideology and the propensity to violate public health guidelines. Results: Our analyses reveal substantial heterogeneity between countries. Ideology plays an outsized role in the United States. No association of comparable magnitude is found in the majority of the other countries in our study. In many settings, the impact of ideology on health-related behaviors is non-linear. Conclusion: Our results highlight the importance of taking a comparative perspective. Extrapolating the role of ideology from the United States to other advanced industrialized societies might paint an erroneous picture of the scope of possible non-pharmaceutical interventions. Heterogeneity limits the extent to which policy-makers can learn from experiences across borders.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84980053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper we analyze the role of access to health insurance plays in the widely documented, sharp fall in mother's labor supply following childbirth. Our analysis exploits variation created by the Affordable Care Act (ACA), which substantially expanded access to health insurance within the U.S., and richly detailed administrative tax data. We find that mother's relative post-childbirth employment increases by 12% for births that occur after the insurance expansion. This labor supply response is pervasive across mother's pre-birth characteristics, and across the varied impact of the ACA expansion. Our analysis suggests that this response is likely driven by a combination of improved access to maternal health care, increased participation by mothers who do not work before birth, reduced exits among mothers who do work before birth, and a compositional changes in who gives birth following the ACA health insurance expansion.
在本文中，我们分析了获得医疗保险的作用，在广泛记录的，在分娩后母亲的劳动力供应急剧下降。我们的分析利用了《平价医疗法案》(Affordable Care Act, ACA)带来的差异，该法案大幅扩大了在美国获得医疗保险的机会，以及丰富详细的行政税收数据。我们发现，在保险扩大后出生的母亲的相对产后就业增加了12%。这种劳动力供给反应在母亲出生前的特征中普遍存在，并在ACA扩大的各种影响中普遍存在。我们的分析表明，这一反应可能是由以下因素共同推动的:获得孕产妇保健的机会增加，出生前不工作的母亲参与的增加，出生前工作的母亲退出的减少，以及ACA健康保险扩大后生育人数的构成变化。
{"title":"Inducing Labor: the Impact of Health Insurance on Post-Natal Labor Supply","authors":"I. Lurie, Elena S. Patel, Shanthi P. Ramnath","doi":"10.2139/ssrn.3882237","DOIUrl":"https://doi.org/10.2139/ssrn.3882237","url":null,"abstract":"In this paper we analyze the role of access to health insurance plays in the widely documented, sharp fall in mother's labor supply following childbirth. Our analysis exploits variation created by the Affordable Care Act (ACA), which substantially expanded access to health insurance within the U.S., and richly detailed administrative tax data. We find that mother's relative post-childbirth employment increases by 12% for births that occur after the insurance expansion. This labor supply response is pervasive across mother's pre-birth characteristics, and across the varied impact of the ACA expansion. Our analysis suggests that this response is likely driven by a combination of improved access to maternal health care, increased participation by mothers who do not work before birth, reduced exits among mothers who do work before birth, and a compositional changes in who gives birth following the ACA health insurance expansion.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81403600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Concerning the economic losses associated with the COVID-19 outbreak and other recent large catastrophes, and given that in a connected world the economic losses have a larger impact, we aim to revisit the fundamental insurance paradigms, in particular, pooling and valuation in the presence of systematic risk. We consider a pool of policyholders whose losses can be widely correlated through common shock. We have observed that from a mathematical standpoint, insurance as a pooling approach can manage the risk if the principle of insurance (POI), that is to keep the systematic risk secure, holds. Our study suggests that valuation cannot be independent of the risk pool, and the premium needs to be adjusted according to the systematic safety loading. This also motivates the introduction of ex-post policies that can vanish the systematic safety loading by introducing contingent premiums. In addition, we look at the upper bounds for the pool valuation when the pool is influenced by a common shock. In the end, we make an assessment of our theory with two examples, first the UK Coronavirus job retention case and second catastrophe events in the agricultural sector. This way we propose a novel way to analyze events with large economic losses.
{"title":"Pooling and Valuation Revisited","authors":"H. Assa","doi":"10.2139/ssrn.3880095","DOIUrl":"https://doi.org/10.2139/ssrn.3880095","url":null,"abstract":"Concerning the economic losses associated with the COVID-19 outbreak and other recent large catastrophes, and given that in a connected world the economic losses have a larger impact, we aim to revisit the fundamental insurance paradigms, in particular, pooling and valuation in the presence of systematic risk. We consider a pool of policyholders whose losses can be widely correlated through common shock. We have observed that from a mathematical standpoint, insurance as a pooling approach can manage the risk if the principle of insurance (POI), that is to keep the systematic risk secure, holds. Our study suggests that valuation cannot be independent of the risk pool, and the premium needs to be adjusted according to the systematic safety loading. This also motivates the introduction of ex-post policies that can vanish the systematic safety loading by introducing contingent premiums. In addition, we look at the upper bounds for the pool valuation when the pool is influenced by a common shock. In the end, we make an assessment of our theory with two examples, first the UK Coronavirus job retention case and second catastrophe events in the agricultural sector. This way we propose a novel way to analyze events with large economic losses.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87253761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4018/IJSST.2021070101
R. Cohen-Almagor
This paper is concerned with the social ills of bullying and cyberbullying that might lead to suicide especially when adolescents are involved. First, the author explains the two concepts. It is noted that people with monoamine oxidase-A (MAOA) have a propensity to antisocial behaviour and that they cannot relieve themselves of responsibility for their conduct. We all need to think of the consequences of our actions, and we need to ensure that internet abusers are held accountable for their wrongdoing. It is argued that parental responsibility is paramount. Parents, and society at large, need to exhibit zero tolerance to bullying and cyberbullying. Parents need to take active steps to tackle both phenomena, and, in this context, healthy communication with children and other stakeholders is key for success. Disregard for consequences of both activity and inactivity when facing all forms of bullying is immoral.
本文关注欺凌和网络欺凌可能导致自杀的社会弊病，特别是当青少年参与其中时。首先，作者对这两个概念进行了解释。值得注意的是，患有单胺氧化酶- a (MAOA)的人有反社会行为的倾向，并且他们不能减轻自己对自己行为的责任。我们都需要考虑我们行为的后果，我们需要确保互联网滥用者对他们的不法行为负责。有人认为父母的责任是最重要的。家长和整个社会需要对欺凌和网络欺凌表现出零容忍。家长需要采取积极措施来解决这两种现象，在这种情况下，与儿童和其他利益攸关方的健康沟通是成功的关键。在面对各种形式的欺凌时，无视活动和不活动的后果是不道德的。
{"title":"Bullying, Cyberbullying and Parental Responsibility","authors":"R. Cohen-Almagor","doi":"10.4018/IJSST.2021070101","DOIUrl":"https://doi.org/10.4018/IJSST.2021070101","url":null,"abstract":"This paper is concerned with the social ills of bullying and cyberbullying that might lead to suicide especially when adolescents are involved. First, the author explains the two concepts. It is noted that people with monoamine oxidase-A (MAOA) have a propensity to antisocial behaviour and that they cannot relieve themselves of responsibility for their conduct. We all need to think of the consequences of our actions, and we need to ensure that internet abusers are held accountable for their wrongdoing. It is argued that parental responsibility is paramount. Parents, and society at large, need to exhibit zero tolerance to bullying and cyberbullying. Parents need to take active steps to tackle both phenomena, and, in this context, healthy communication with children and other stakeholders is key for success. Disregard for consequences of both activity and inactivity when facing all forms of bullying is immoral.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72720873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In our study, we individually forecast 26 metal prices one-month ahead and outperform the predefined benchmark model, a random-walk (with drift) in 18 (18) cases. These forecasts are based on an overview over a large set of potential predictors for mineral commodities, originating from studies which only consider a selection of attributes and apply them to predict specific commodities or commodity indices. We pre-select the relevant, commodity-specific, individual factors through a correlation analysis, followed by a BIC based regression selection.
The results of our out-of-sample, one-month ahead forecasts show a significant outperformance for 18 of the 26 commodities considered, especially those in the minor metals sector. The differences in predictability between the metal groups are remarkable, as we are able to forecast 13 of 17 minor metals, 5 of 6 industrial metals, but no precious metal, highlighting the heterogeneity in metal commodity markets. Focusing on the influential factors, the value factor has a dominating, highly significant, negative effect in the prediction and determination of prices.
{"title":"Factors of predictive power for mineral commodities","authors":"P. Papenfuß, A. Schischke, A. Rathgeber","doi":"10.2139/ssrn.3860107","DOIUrl":"https://doi.org/10.2139/ssrn.3860107","url":null,"abstract":"In our study, we individually forecast 26 metal prices one-month ahead and outperform the predefined benchmark model, a random-walk (with drift) in 18 (18) cases. These forecasts are based on an overview over a large set of potential predictors for mineral commodities, originating from studies which only consider a selection of attributes and apply them to predict specific commodities or commodity indices. We pre-select the relevant, commodity-specific, individual factors through a correlation analysis, followed by a BIC based regression selection.<br><br>The results of our out-of-sample, one-month ahead forecasts show a significant outperformance for 18 of the 26 commodities considered, especially those in the minor metals sector. The differences in predictability between the metal groups are remarkable, as we are able to forecast 13 of 17 minor metals, 5 of 6 industrial metals, but no precious metal, highlighting the heterogeneity in metal commodity markets. Focusing on the influential factors, the value factor has a dominating, highly significant, negative effect in the prediction and determination of prices. <br>","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86888547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Social trust is often thought to be adversely affected by mental health problems. However, rigorous causal evidence required to substantiate this thought is scarce. Here I examine the causal effect of individuals' mental health on social trust using data from the European Social Survey. Estimating the causal effect, however, is a formidable task since the relationship between mental health and social trust is endogenous due to reverse causality and unmeasured confounding. I circumvent these difficulties by using a recently developed econometric technique that does not rely on valid exclusion restriction for identification. I find strong evidence that mental ill health has a significant negative effect on social trust. Further, I provide suggestive evidence which shows that the adverse effect of mental ill health on social trust arises due to reductions in individuals' level of optimism and hope, and participation in social networks caused by mental ill health. Overall, the results suggest that for achieving a durable increase in social trust - which often is one of the fundamental objectives of policy makers - interventions to promote mental health of individuals could be extremely useful.
{"title":"Too Unwell to Trust? The Effect of Mental Health on Social Trust in Europe","authors":"Punarjit Roychowdhury","doi":"10.2139/ssrn.3857864","DOIUrl":"https://doi.org/10.2139/ssrn.3857864","url":null,"abstract":"Social trust is often thought to be adversely affected by mental health problems. However, rigorous causal evidence required to substantiate this thought is scarce. Here I examine the causal effect of individuals' mental health on social trust using data from the European Social Survey. Estimating the causal effect, however, is a formidable task since the relationship between mental health and social trust is endogenous due to reverse causality and unmeasured confounding. I circumvent these difficulties by using a recently developed econometric technique that does not rely on valid exclusion restriction for identification. I find strong evidence that mental ill health has a significant negative effect on social trust. Further, I provide suggestive evidence which shows that the adverse effect of mental ill health on social trust arises due to reductions in individuals' level of optimism and hope, and participation in social networks caused by mental ill health. Overall, the results suggest that for achieving a durable increase in social trust - which often is one of the fundamental objectives of policy makers - interventions to promote mental health of individuals could be extremely useful.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73157790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A safe and effective COVID-19 vaccine is the holy grail of our generation, necessary to resurrect our societies, save millions of lives, and protect our economies from collapse. Patent protection is the primary legal mechanism for ensuring timely development of such a vaccine. The patent system is designed to create the necessary incentives for private parties to invest in developing the vaccine, knowing they will enjoy the fruits of their success. Indeed, patent protection is necessary to promote human knowledge generally as well as a quick, safe, and effective COVID-19 vaccine.Yet in reality, patent law may be obstructing the very goal it is intended to achieve. Patent law grants exclusive rights to inventors, enabling them to charge supracompetitive prices, delaying the distribution and dissemination of emerging technologies. In the context of the COVID-19 vaccine, patent protection means that vaccines will be financially out of reach for many. This produces a paradoxical result: rather than promote technological advancement for the public good, patent protection impedes it. Since universal immunity is necessary in the fight against the pandemic, delays in vaccine distribution can be catastrophic, costing millions of lives and carrying devastating economic consequences.This Article therefore proposes a novel, alternative patent regime, designed to overcome this paradox at the heart of patent law. We propose a mechanism that will eliminate the problem of over-protection of patent rights that exists under current patent law, while still providing sufficient incentive for inventors to invest in innovative efforts. Under our proposed regime, the developer of a new vaccine will be granted a patent protecting its invention, but this patent will expire once the patentee has recouped its investment, plus a handsome profit. This regime, which we term “recoupment patent,” ensures that inventors are rewarded appropriately—but not excessively—for their innovative efforts. The result is a structure that encourages innovation while minimizing the time it takes for life-saving inventions to reach the public domain. We compare the proposed regime with other suggestions for reforming the patent system, including compulsory licensing, government incentives such as grants, subsidies, and prizes, and altruistic initiatives such as private-public partnerships, patent pools, and patent pledges, and we highlight the recoupment patent model’s advantages over these alternatives.
{"title":"Recalibrating Patent Protection for COVID-19 Vaccines: A Path to Affordable Access and Equitable Distribution","authors":"Miriam Marcowitz-Bitton, Yotam Kaplan","doi":"10.2139/ssrn.3855033","DOIUrl":"https://doi.org/10.2139/ssrn.3855033","url":null,"abstract":"A safe and effective COVID-19 vaccine is the holy grail of our generation, necessary to resurrect our societies, save millions of lives, and protect our economies from collapse. Patent protection is the primary legal mechanism for ensuring timely development of such a vaccine. The patent system is designed to create the necessary incentives for private parties to invest in developing the vaccine, knowing they will enjoy the fruits of their success. Indeed, patent protection is necessary to promote human knowledge generally as well as a quick, safe, and effective COVID-19 vaccine.Yet in reality, patent law may be obstructing the very goal it is intended to achieve. Patent law grants exclusive rights to inventors, enabling them to charge supracompetitive prices, delaying the distribution and dissemination of emerging technologies. In the context of the COVID-19 vaccine, patent protection means that vaccines will be financially out of reach for many. This produces a paradoxical result: rather than promote technological advancement for the public good, patent protection impedes it. Since universal immunity is necessary in the fight against the pandemic, delays in vaccine distribution can be catastrophic, costing millions of lives and carrying devastating economic consequences.This Article therefore proposes a novel, alternative patent regime, designed to overcome this paradox at the heart of patent law. We propose a mechanism that will eliminate the problem of over-protection of patent rights that exists under current patent law, while still providing sufficient incentive for inventors to invest in innovative efforts. Under our proposed regime, the developer of a new vaccine will be granted a patent protecting its invention, but this patent will expire once the patentee has recouped its investment, plus a handsome profit. This regime, which we term “recoupment patent,” ensures that inventors are rewarded appropriately—but not excessively—for their innovative efforts. The result is a structure that encourages innovation while minimizing the time it takes for life-saving inventions to reach the public domain. We compare the proposed regime with other suggestions for reforming the patent system, including compulsory licensing, government incentives such as grants, subsidies, and prizes, and altruistic initiatives such as private-public partnerships, patent pools, and patent pledges, and we highlight the recoupment patent model’s advantages over these alternatives.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89962619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We study patient mobility in the Italian National Health System, using patient-episode level data on elective Percutaneous Transluminal Coronary Angioplasty procedures over the years 2008-2011. We examine how patients’ choice of the hospital is affected by changes in waiting times and clinical quality within hospitals over time. We estimate mixed-logit specifications and show the importance of jointly controlling for time-invariant and time varying clinical quality to identify the effect of waiting times. Conversely, failure to capture variations in clinical quality over time does not affect the estimate of the discouraging effect of travel distance. We provide evidence that patients are responsive to changes in waiting times and clinical quality: average demand elasticity with respect to own waiting times and mortality is estimated to be – 0.17 and – 1.38, respectively. Patients’ personal characteristics significantly influence how they trade off distance and waiting times with quality of care. We find a higher Willigness-To-Wait and Willingness-to-Travel to seek higher quality care for patients in the younger age groups and who are more severely ill. The results convey important policy implications for highly regulated healthcare markets.
{"title":"Should I Wait or Should I Go? Travelling Versus Waiting for Better Healthcare","authors":"Matteo Lippi Bruni, C. Ugolini, Rossella Verzulli","doi":"10.2139/ssrn.3859184","DOIUrl":"https://doi.org/10.2139/ssrn.3859184","url":null,"abstract":"Abstract We study patient mobility in the Italian National Health System, using patient-episode level data on elective Percutaneous Transluminal Coronary Angioplasty procedures over the years 2008-2011. We examine how patients’ choice of the hospital is affected by changes in waiting times and clinical quality within hospitals over time. We estimate mixed-logit specifications and show the importance of jointly controlling for time-invariant and time varying clinical quality to identify the effect of waiting times. Conversely, failure to capture variations in clinical quality over time does not affect the estimate of the discouraging effect of travel distance. We provide evidence that patients are responsive to changes in waiting times and clinical quality: average demand elasticity with respect to own waiting times and mortality is estimated to be – 0.17 and – 1.38, respectively. Patients’ personal characteristics significantly influence how they trade off distance and waiting times with quality of care. We find a higher Willigness-To-Wait and Willingness-to-Travel to seek higher quality care for patients in the younger age groups and who are more severely ill. The results convey important policy implications for highly regulated healthcare markets.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80315404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper examines the evolution of consumer uncertainty about unemployment one year after the irruption of the covid-19 pandemic in European countries. Since uncertainty is not directly observable, we use two alternative methods to directly approximate it. Both approaches are based on qualitative expectations elicited form the consumer survey conducted by the European Commission. On the one hand, following Dibiasi and Iselin (2019), we use the share of consumers unable to formalize expectations about unemployment (Knightian-type uncertainty). On the other hand, we use the geometric discrepancy indicator proposed by Claveria et al. (2019) to quantify the proportion of disagreement in business and consumer expectations. We have used information from 22 European countries. We find that both uncertainty measures covary. Although we observe marked differences across countries, in most cases the perception of employment uncertainty peaked before the outbreak of the crisis, plummeted during the first months of the lockdown, and started rising again since the past few months. When testing for cointegration with the unemployment rate, we find that the discrepancy indicator exhibits a long- term relationship with unemployment in most countries, while the Knightian uncertainty indicator shows a purely short-run relationship. The impact of both indicators on unemployment is characterised by considerable asymmetries, showing a more intense reaction to decreases in the level of uncertainty. While this finding may seem counterintuitive at first sight, it somehow reflects the fact that during recessive periods, the level of disagreement in the employment expectations of consumers drops considerably.
{"title":"Employment Uncertainty a Year after the Irruption of the COVID-19 Pandemic","authors":"Petar Sorić, Oscar Claveria","doi":"10.2139/ssrn.3853110","DOIUrl":"https://doi.org/10.2139/ssrn.3853110","url":null,"abstract":"This paper examines the evolution of consumer uncertainty about unemployment one year after the irruption of the covid-19 pandemic in European countries. Since uncertainty is not directly observable, we use two alternative methods to directly approximate it. Both approaches are based on qualitative expectations elicited form the consumer survey conducted by the European Commission. On the one hand, following Dibiasi and Iselin (2019), we use the share of consumers unable to formalize expectations about unemployment (Knightian-type uncertainty). On the other hand, we use the geometric discrepancy indicator proposed by Claveria et al. (2019) to quantify the proportion of disagreement in business and consumer expectations. We have used information from 22 European countries. We find that both uncertainty measures covary. Although we observe marked differences across countries, in most cases the perception of employment uncertainty peaked before the outbreak of the crisis, plummeted during the first months of the lockdown, and started rising again since the past few months. When testing for cointegration with the unemployment rate, we find that the discrepancy indicator exhibits a long- term relationship with unemployment in most countries, while the Knightian uncertainty indicator shows a purely short-run relationship. The impact of both indicators on unemployment is characterised by considerable asymmetries, showing a more intense reaction to decreases in the level of uncertainty. While this finding may seem counterintuitive at first sight, it somehow reflects the fact that during recessive periods, the level of disagreement in the employment expectations of consumers drops considerably.","PeriodicalId":13563,"journal":{"name":"Insurance & Financing in Health Economics eJournal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91248973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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