In this study, we document the effect of food stamp access on adult health-care utilization. While the Food Stamp Program is one of the largest safety net programs in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this issue, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in physician visits due to food stamps may offset some of the program’s impact on the overall government budget because of the existence of government-provided health insurance programs such as Medicaid.
{"title":"An Apple a Day? Adult Food Stamp Eligibility and Health Care Utilization Among Immigrants","authors":"Chloe N. East, Andrew I. Friedson","doi":"10.1086/709368","DOIUrl":"https://doi.org/10.1086/709368","url":null,"abstract":"In this study, we document the effect of food stamp access on adult health-care utilization. While the Food Stamp Program is one of the largest safety net programs in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this issue, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in physician visits due to food stamps may offset some of the program’s impact on the overall government budget because of the existence of government-provided health insurance programs such as Medicaid.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"29 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138540228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
By favoring early diagnosis, mammography screening decreases breast cancer mortality and treatment costs. However, participation in public screening programs is low in many countries. We ran a randomized field experiment to assess whether costless manipulations of the informational content (restricted or enhanced information) and the framing (gain or loss framing) of the invitation letter to the breast cancer screening program in Messina (Italy) affects participation. We show that giving enhanced loss-framed information about the risks of not having a mammography increases the take-up. This manipulation is most effective among subgroups with lower baseline take-ups, thereby reducing inequalities in screening. Finally, subjects exposed to this manipulation are much less likely to postpone the screening conditional on participation, revealing enhanced awareness about the risks related with delayed participation.
{"title":"The Good Outcome of Bad News","authors":"Marco Bertoni, L. Corazzini, S. Robone","doi":"10.1086/708930","DOIUrl":"https://doi.org/10.1086/708930","url":null,"abstract":"By favoring early diagnosis, mammography screening decreases breast cancer mortality and treatment costs. However, participation in public screening programs is low in many countries. We ran a randomized field experiment to assess whether costless manipulations of the informational content (restricted or enhanced information) and the framing (gain or loss framing) of the invitation letter to the breast cancer screening program in Messina (Italy) affects participation. We show that giving enhanced loss-framed information about the risks of not having a mammography increases the take-up. This manipulation is most effective among subgroups with lower baseline take-ups, thereby reducing inequalities in screening. Finally, subjects exposed to this manipulation are much less likely to postpone the screening conditional on participation, revealing enhanced awareness about the risks related with delayed participation.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"6 1","pages":"372 - 409"},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/708930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47069628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How do exogenous changes in the macroeconomic environment affect workers’ perceived job security, and consequently, their mental and physical health? To answer this question, we exploit variation in world commodity prices over the period 2001–17 and analyze panel data that include detailed classifications of mining workers. We find that commodity price increases cause increases in perceived job security, which in turn, significantly and substantively improves the mental health of workers. In contrast, we find no effects on physical health. Our results imply that the estimated welfare costs of recessions are much larger when the effects of job insecurity, and not only unemployment, are considered.
{"title":"Macroeconomic Shocks, Job Security, and Health","authors":"D. Johnston, M. Shields, Agne Suziedelyte","doi":"10.1086/708929","DOIUrl":"https://doi.org/10.1086/708929","url":null,"abstract":"How do exogenous changes in the macroeconomic environment affect workers’ perceived job security, and consequently, their mental and physical health? To answer this question, we exploit variation in world commodity prices over the period 2001–17 and analyze panel data that include detailed classifications of mining workers. We find that commodity price increases cause increases in perceived job security, which in turn, significantly and substantively improves the mental health of workers. In contrast, we find no effects on physical health. Our results imply that the estimated welfare costs of recessions are much larger when the effects of job insecurity, and not only unemployment, are considered.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"116 ","pages":"348 - 371"},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/708929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41283718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Sears, J. M. Villas-Boas, Vasco Villas-Boas, S. Villas-Boas
The recent spread of COVID-19 across the United States led to concerted efforts by states to “flatten the curve” through the adoption of stay-at-home mandates that encouraged individuals to reduce travel and maintain social distance. Combining data on changes in travel activity and human encounter rates with state policy adoption timing, we first characterize the overall changes in mobility patterns that accompanied the spread of COVID-19. We find evidence of dramatic nationwide declines in mobility and human encounters prior to adoption of any statewide mandates. Then, using difference-in-differences along with weighted and unweighted event study methods, we isolate the portion of those reductions directly attributable to statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines of between 2.1 and 7.0 percentage points relative to pre-COVID-19 baseline levels. While residents of mandate states soon returned to prior business visitation patterns, the impacts on distances traveled and human encounter rates persisted throughout the observed mandate periods. Our estimates of early mobility reductions and the responses to statewide stay-at-home policies convey important policy implications for the persistence of mobility behavior changes and states’ future reopenings.
{"title":"Are We #Stayinghome to Flatten the Curve?","authors":"James Sears, J. M. Villas-Boas, Vasco Villas-Boas, S. Villas-Boas","doi":"10.1086/721705","DOIUrl":"https://doi.org/10.1086/721705","url":null,"abstract":"The recent spread of COVID-19 across the United States led to concerted efforts by states to “flatten the curve” through the adoption of stay-at-home mandates that encouraged individuals to reduce travel and maintain social distance. Combining data on changes in travel activity and human encounter rates with state policy adoption timing, we first characterize the overall changes in mobility patterns that accompanied the spread of COVID-19. We find evidence of dramatic nationwide declines in mobility and human encounters prior to adoption of any statewide mandates. Then, using difference-in-differences along with weighted and unweighted event study methods, we isolate the portion of those reductions directly attributable to statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines of between 2.1 and 7.0 percentage points relative to pre-COVID-19 baseline levels. While residents of mandate states soon returned to prior business visitation patterns, the impacts on distances traveled and human encounter rates persisted throughout the observed mandate periods. Our estimates of early mobility reductions and the responses to statewide stay-at-home policies convey important policy implications for the persistence of mobility behavior changes and states’ future reopenings.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"71 - 95"},"PeriodicalIF":3.7,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46623533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent economic literature on child development has underscored the importance of giving babies a healthy start. Despite the widespread use of prenatal care, whether this early investment improves infant health is not well understood. This study provides new causal evidence on this crucial issue using 1.4 million sibling births. The baseline within-family analysis shows a modest effect of prenatal care on the mean birth weight but large effects on adverse outcomes at the lower end of the birth weight distribution, where two channels are preventing low maternal weight gain and promoting prenatal smoking cessation. Similar results hold when we examine different subperiods or subgroups, consider multiple dimensions of care utilization, or use additional birth-varying controls. Overall, this study shows that adequate prenatal care has a significant payoff in terms of newborn health stock. From a policy perspective, it is important to improve prenatal care access for childbearing women.
{"title":"Healthy Babies","authors":"Ji Yan","doi":"10.1086/707831","DOIUrl":"https://doi.org/10.1086/707831","url":null,"abstract":"The recent economic literature on child development has underscored the importance of giving babies a healthy start. Despite the widespread use of prenatal care, whether this early investment improves infant health is not well understood. This study provides new causal evidence on this crucial issue using 1.4 million sibling births. The baseline within-family analysis shows a modest effect of prenatal care on the mean birth weight but large effects on adverse outcomes at the lower end of the birth weight distribution, where two channels are preventing low maternal weight gain and promoting prenatal smoking cessation. Similar results hold when we examine different subperiods or subgroups, consider multiple dimensions of care utilization, or use additional birth-varying controls. Overall, this study shows that adequate prenatal care has a significant payoff in terms of newborn health stock. From a policy perspective, it is important to improve prenatal care access for childbearing women.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"6 1","pages":"199 - 215"},"PeriodicalIF":3.7,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/707831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48270749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper studies the effects of changes in states’ scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States.
{"title":"The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses","authors":"Sara Markowitz, Kathleen Adams","doi":"10.1086/716545","DOIUrl":"https://doi.org/10.1086/716545","url":null,"abstract":"This paper studies the effects of changes in states’ scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"65 - 98"},"PeriodicalIF":3.7,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43672206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study provides the first quasi-experimental evidence on the effects of nonbinding vaccine recommendations targeted at high school–aged adolescents. Using data from the National Immunization Survey–Teen and the Centers for Disease Control’s disease surveillance system, I find that these simple recommendations significantly increased meningococcal vaccination rates among the targeted population by 21 percentage points, or 133 percent relative to the baseline mean, and substantially reduced meningococcal disease incidence in the population. I also provide evidence that the recommendations primarily affected vaccination rates through changes in provider behavior, and show that they exacerbated preexisting disparities in receipt of preventive care. In particular, groups with lower socioeconomic status, which had lower rates of vaccination and provider contact prior to the recommendation, were also less responsive to the policy.
{"title":"Giving Teens a Boost?","authors":"Emily C. Lawler","doi":"10.1086/707834","DOIUrl":"https://doi.org/10.1086/707834","url":null,"abstract":"This study provides the first quasi-experimental evidence on the effects of nonbinding vaccine recommendations targeted at high school–aged adolescents. Using data from the National Immunization Survey–Teen and the Centers for Disease Control’s disease surveillance system, I find that these simple recommendations significantly increased meningococcal vaccination rates among the targeted population by 21 percentage points, or 133 percent relative to the baseline mean, and substantially reduced meningococcal disease incidence in the population. I also provide evidence that the recommendations primarily affected vaccination rates through changes in provider behavior, and show that they exacerbated preexisting disparities in receipt of preventive care. In particular, groups with lower socioeconomic status, which had lower rates of vaccination and provider contact prior to the recommendation, were also less responsive to the policy.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"6 1","pages":"251 - 287"},"PeriodicalIF":3.7,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/707834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43819720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effects of the minimum wage on labor market outcomes have been extensively debated and analyzed. Less studied, however, are other consequences of the minimum wage that stem from changes in a household’s income and labor supply. We examine effects of the minimum wage on child health. To obtain estimates, we use data from the National Survey of Children’s Health and a difference-in-differences design. We find that an increase in the minimum wage throughout childhood is associated with improvement in child health. Much of the benefit of a higher minimum wage is associated with the period between birth and age 5.
{"title":"Effects of the Minimum Wage on Child Health","authors":"G. Wehby, R. Kaestner, W. Lyu, Dhaval M. Dave","doi":"10.1086/719364","DOIUrl":"https://doi.org/10.1086/719364","url":null,"abstract":"Effects of the minimum wage on labor market outcomes have been extensively debated and analyzed. Less studied, however, are other consequences of the minimum wage that stem from changes in a household’s income and labor supply. We examine effects of the minimum wage on child health. To obtain estimates, we use data from the National Survey of Children’s Health and a difference-in-differences design. We find that an increase in the minimum wage throughout childhood is associated with improvement in child health. Much of the benefit of a higher minimum wage is associated with the period between birth and age 5.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"412 - 448"},"PeriodicalIF":3.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43087110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among the elderly population that is hospitalized, about 20 percent are discharged to skilled nursing facilities (SNFs), at a cost of over $30 billion annually. SNFs provide high-level care in an outpatient setting with the intent of reducing individuals’ time in the hospital and preventing readmissions. I leverage a Medicare policy that induces a discontinuity in the probability of being transferred to a SNF to estimate the effectiveness of SNF care. I find that SNF care reduces the probability of readmission to the hospital within 30 days by 33 percent, suggesting that SNF care substantially improves patient outcomes.
{"title":"The Effects of Skilled Nursing Facility Care","authors":"Liam Rose","doi":"10.1086/706864","DOIUrl":"https://doi.org/10.1086/706864","url":null,"abstract":"Among the elderly population that is hospitalized, about 20 percent are discharged to skilled nursing facilities (SNFs), at a cost of over $30 billion annually. SNFs provide high-level care in an outpatient setting with the intent of reducing individuals’ time in the hospital and preventing readmissions. I leverage a Medicare policy that induces a discontinuity in the probability of being transferred to a SNF to estimate the effectiveness of SNF care. I find that SNF care reduces the probability of readmission to the hospital within 30 days by 33 percent, suggesting that SNF care substantially improves patient outcomes.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"6 1","pages":"39 - 71"},"PeriodicalIF":3.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/706864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43923339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We study the effect of Medicare on financial strain, measured by annual changes in medical debt in collections, using credit bureau data. We exploit the program’s eligibility age at 65 and compare the experiences of those just under and over age 65 using a regression discontinuity design. We find that during our baseline study period Medicare reduced the annual probability of large medical collections, above $1,000, by 0.31 percentage points, a 19 percent reduction relative to the probability for those aged 60–64, and reduced new medical collections by approximately $380 at the 99th percentile, a 23 percent decrease. We hypothesize that Medicare mainly decreases medical collections among those who transition from uninsured to Medicare. Under that hypothesis we estimate a “treatment on the treated” average reduction of about $250 in new medical collections. We find support for our hypothesis by comparing discontinuities for those in zip codes with different uninsured rates pre-age 65, and comparing discontinuities before and after implementation of the main health insurance provisions of the Affordable Care Act. Our findings complement recent work on the role of Medicare in reducing risk of out-of-pocket medical expenditures and of health insurance in reducing medical collections.
{"title":"Does Medicare Reduce Medical Debt?","authors":"Kyle J. Caswell, J. Goddeeris","doi":"10.1086/706623","DOIUrl":"https://doi.org/10.1086/706623","url":null,"abstract":"We study the effect of Medicare on financial strain, measured by annual changes in medical debt in collections, using credit bureau data. We exploit the program’s eligibility age at 65 and compare the experiences of those just under and over age 65 using a regression discontinuity design. We find that during our baseline study period Medicare reduced the annual probability of large medical collections, above $1,000, by 0.31 percentage points, a 19 percent reduction relative to the probability for those aged 60–64, and reduced new medical collections by approximately $380 at the 99th percentile, a 23 percent decrease. We hypothesize that Medicare mainly decreases medical collections among those who transition from uninsured to Medicare. Under that hypothesis we estimate a “treatment on the treated” average reduction of about $250 in new medical collections. We find support for our hypothesis by comparing discontinuities for those in zip codes with different uninsured rates pre-age 65, and comparing discontinuities before and after implementation of the main health insurance provisions of the Affordable Care Act. Our findings complement recent work on the role of Medicare in reducing risk of out-of-pocket medical expenditures and of health insurance in reducing medical collections.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"6 1","pages":"72 - 103"},"PeriodicalIF":3.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/706623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46615602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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