American Journal of Health Economics最新文献

英文中文

The Effect of Extended Unemployment Insurance Generosity on Population Mental Health 延长失业保险宽裕度对人口心理健康的影响

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-09-19 DOI: 10.1086/722556

Jie Chen, Xiaohui Guo, Lizhong Peng, M. Qian

This study contributes to a small but growing literature on the health effects of unemployment insurance (UI) by examining the impact of extended benefit generosity during the Great Recession on population mental health. Using data from the 2003–13 Behavioral Risk Factor Surveillance System as well as cross-state and time series variation in UI policies, we estimate that a one standard deviation (or $1,000) increase in UI generosity is associated with a 5.1 (0.5) percent improvement in self-reported mental health among the unemployed. We also provide evidence for the validity of our research design through an event study model and supplementary regressions that incorporate county or county-by-time fixed effects. However, we find no definitive evidence that UI affects general/physical health, health insurance, access to care, or health behaviors.

这项研究通过研究大衰退期间延长福利慷慨对人口心理健康的影响，为失业保险对健康影响的少量但不断增长的文献做出了贡献。利用2003-13年行为风险因素监测系统的数据以及UI政策的跨州和时间序列变化，我们估计UI慷慨度的一个标准差（或1000美元）增加与失业者自我报告的心理健康改善5.1%（0.5%）有关。我们还通过事件研究模型和补充回归为我们的研究设计的有效性提供了证据，补充回归包含了县或县的时间固定效应。然而，我们没有发现明确的证据表明UI会影响一般/身体健康、健康保险、获得护理或健康行为。

引用次数: 0

The Effect of a Free Family Planning Program on Fertility 免费计划生育计划对生育率的影响

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-09-19 DOI: 10.1086/722557

Aaron M. Gamino

In this paper, I estimate the effect of access to family planning clinics on birth rates. The Louisiana Family Planning Program opened more than 140 clinics between 1965 and 1970. By 1971, a family planning clinic was operating in each Louisiana county. Exploiting the variation in dates when clinics began operating in each county, I employ two-way fixed effects and staggered difference-in-differences designs to assess the impact of family planning access on birth rates. I find that clinic openings led to a 5 to 7 percent decrease in birth rates.

在本文中，我估计了获得计划生育诊所对出生率的影响。路易斯安那州计划生育项目在1965年至1970年间开设了140多家诊所。到1971年，一个计划生育诊所在路易斯安那州的每个县运作。利用每个县诊所开始运营日期的差异，我采用双向固定效应和交错差异设计来评估计划生育对出生率的影响。我发现开设诊所导致出生率下降了5%到7%。

引用次数: 0

Do Class Size Reductions Protect Students from Infectious Diseases? 缩减班级规模能保护学生免受传染病的侵害吗？

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-09-01 DOI: 10.1086/719354

M. Oikawa, Ryuichi Tanaka, S. Bessho, H. Noguchi

We evaluate the causal effect of class size (number of students in a classroom) on incidence of class closure due to the flu, as an outcome of an infectious disease epidemic. For identification of causal effects, we apply a regression discontinuity design using discontinuous variation of class sizes, around the class size cap set by regulation, to administrative data of public primary and middle school students in one of the largest municipalities within the Tokyo metropolitan area from 2015 to 2017. Most classrooms in Japan are constructed in accordance with a standard of classroom area, 63 square meters; class size reduction improves social distancing among students in a classroom. We find that class size reduction is effective in reducing class closures due to the flu: a one-unit reduction of class size decreases class closure by about 5 percent. Additionally, forming small classes with 27 students at most, satisfying the social distancing of 1.5 meters recommended to prevent droplet infection including influenza and COVID-19, reduces class closure by about 90 percent. Moreover, we find that the older the students, the larger the effects of class size reduction. Our findings provide evidence for the effectiveness of social distancing policy in primary and middle schools to protect students from droplet infectious disease spread, including COVID-19.

我们评估了班级规模（教室里的学生人数）对流感导致的停课发生率的因果影响，流感是传染病流行的结果。为了确定因果效应，我们将回归不连续设计应用于2015年至2017年东京都内最大城市之一的公立中小学生的行政数据，该设计使用了班级规模的不连续变化，围绕法规设定的班级规模上限。日本的大多数教室都是按照63平方米的教室面积标准建造的；班级人数的减少提高了学生在课堂上的社交距离。我们发现，减少班级规模可以有效地减少流感导致的班级关闭：减少一个单元的班级规模可以减少约5%的班级关闭。此外，组建最多27名学生的小组，满足预防包括流感和新冠肺炎在内的飞沫感染所建议的1.5米社交距离，将停课减少约90%。此外，我们发现年龄越大的学生，班级规模缩小的影响越大。我们的研究结果为中小学保持社交距离政策保护学生免受包括新冠肺炎在内的飞沫传染病传播的有效性提供了证据。

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引用次数: 0

The Value of an Additional Day of Post-acute Care in a Skilled Nursing Facility 在专业护理机构额外进行一天急性期后护理的价值

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-07-22 DOI: 10.1086/721706

R. Werner, Norma B. Coe, Mingyu Qi, R. Konetzka

With ongoing efforts to improve the value of health care in the United States and reduce wasteful spending, we examine empirically the value trade-offs involved in an additional day in a skilled nursing facility (SNF) after hospital discharge. To control for potential endogeneity, we use the percentage of Medicare beneficiaries enrolled in Medicare Advantage in each county-year as an instrument for individuals’ SNF length of stay among Traditional Medicare beneficiaries, as local Medicare Advantage penetration puts downward pressure on SNF length of stay for all SNF patients but does not directly affect utilization management of those enrolled in Traditional Medicare. We also test for heterogeneity in treatment effect across patients by clinical complexity and two non-health-related factors, marital status and nursing home profit status. We find that one additional day in a SNF lowers short-term readmission rates, but this effect is small and heterogeneous across patient types. The most clinically complex patients (those with the longest predicted SNF stays) benefit the most from an additional SNF day, as do patients whose stays are shorter because of non-health-related factors. The cost savings from reduced readmission rates are small and do not offset the additional SNF costs.

随着不断努力提高美国医疗保健的价值和减少浪费的支出，我们从经验上考察了出院后在熟练护理机构(SNF)多呆一天所涉及的价值权衡。为了控制潜在的内生性，我们使用每个县每年参加医疗保险优势的医疗保险受益人的百分比作为传统医疗保险受益人中个人SNF停留时间的工具，因为当地医疗保险优势的渗透对所有SNF患者的SNF停留时间施加了下行压力，但并不直接影响那些参加传统医疗保险的人的利用管理。我们还通过临床复杂性和两个非健康相关因素(婚姻状况和养老院盈利状况)检验了患者治疗效果的异质性。我们发现在SNF多住一天会降低短期再入院率，但这种影响很小，而且在不同类型的患者中存在差异。临床最复杂的患者(预测SNF停留时间最长的患者)从额外的SNF日中获益最多，因为非健康相关因素而停留时间较短的患者也是如此。减少再入院率所节省的成本很小，不能抵消额外的SNF成本。

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引用次数: 1

Childhood Health Conditions and Lifetime Labor Market Outcomes 儿童健康状况与终身劳动力市场结果

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-06-29 DOI: 10.1086/721573

M. Flores, B. Wolfe

We explore the influence that different dimensions of early life health, such as the experience of epilepsy or a significant mental, physical, or general health problem, have on numerous lifetime labor market outcomes and patterns of life cycle employment. The data we use include over 81,000 males and females from the 29 countries in the Survey of Health, Ageing, and Retirement in Europe. Our results show that for men, all four dimensions of early life health impose a penalty for nearly all the lifetime labor market outcomes we consider, but those with childhood mental health problems tend to do worst. These penalties are often only somewhat larger than those of men with epilepsy but more than twice and five times larger than those with, respectively, poor general or adverse physical health during childhood. Women appear less affected by adverse early life health, although we find evidence of similar employment penalties for those with epilepsy and poor general health during childhood. Our life cycle analysis is consistent but provides more insight into the timing of reduced employment and full-time employment, thereby extending earlier studies in this literature. Overall, our results highlight the potential lifetime work gains for public health policies that help to prevent or comprehensively treat poor general health, mental health problems, or epilepsy during childhood.

我们探讨了早期生命健康的不同维度，如癫痫的经历或重大的心理、身体或一般健康问题，对许多终身劳动力市场结果和生命周期就业模式的影响。我们使用的数据包括欧洲健康、老龄化和退休调查中来自29个国家的81000多名男性和女性。我们的研究结果表明，对于男性来说，早期健康的所有四个维度都会对我们考虑的几乎所有终身劳动力市场结果产生影响，但那些有儿童心理健康问题的人往往表现最差。这些惩罚通常只比患有癫痫的男性略大，但分别是儿童时期身体健康状况不佳或不良的男性的两倍和五倍多。尽管我们发现有证据表明，儿童时期患有癫痫和总体健康状况不佳的女性受到类似的就业惩罚，但女性似乎较少受到不良早期健康的影响。我们的生命周期分析是一致的，但对减少就业和全职就业的时间提供了更多的见解，从而扩展了本文献中早期的研究。总的来说，我们的研究结果突出了公共卫生政策的潜在终身工作收益，这些政策有助于预防或全面治疗儿童时期的总体健康状况不佳、心理健康问题或癫痫。

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引用次数: 0

Student Aid, Higher Education, and Long-Run Health 学生资助、高等教育与长期健康

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-06-29 DOI: 10.1086/721567

Barton Willage

Financial aid lowers the cost of higher education and improves educational attainment. Based on the correlation between education and health, one might expect aid to improve health, but little evidence exists. I use a shock in Social Security benefits that occurred in 1981 to test the relationship between aid, education, and health. Minor children of retired, disabled, or deceased parents are eligible for their own Social Security benefits, and until 1981 college-aged recipients could continue to receive these benefits conditional on college enrollment. Using difference-in-differences, I show that aid reduced women’s long-run body mass index and general health, but had no effect on men. I find that financial aid improved educational attainment for beneficiaries, which is the plausible mechanism between aid and health. Consistent with the effects on health, the educational effects are concentrated in women. Finally, I use Social Security benefits as an instrument for attending college to estimate the effect of education on long-run weight and general health.

经济援助降低了高等教育的成本，提高了受教育程度。根据教育和健康之间的相关性，人们可能期望援助能改善健康，但几乎没有证据存在。我用1981年社会保障福利的冲击来检验援助、教育和健康之间的关系。退休、残疾或去世父母的未成年子女有资格享受他们自己的社会保障福利，直到1981年，大学年龄的受助人可以继续享受这些福利，条件是上大学。通过差异中的差异，我表明援助降低了女性的长期体重指数和总体健康状况，但对男性没有影响。我发现，财政援助提高了受益者的受教育程度，这是援助与健康之间看似合理的机制。与对健康的影响一致，对教育的影响主要集中在妇女身上。最后，我用社会保障福利作为上大学的工具来估计教育对长期体重和一般健康的影响。

引用次数: 0

Paying Adolescents for Health Screenings Works 支付青少年健康检查费用

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-06-29 DOI: 10.1086/721571

M. Halla, G. Pruckner, T. Schober

With regard to their future health, adolescents are at a critical stage. Previous evaluations have shown that health screenings, counseling, and other intervention programs during this phase of life are important, particularly for those with a low socioeconomic background. Unfortunately, adolescents tend to have little interest in preventive programs. We designed a field experiment to evaluate the effectiveness of financial incentives to promote participation in health screenings. Our study comprises more than 10,000 participants, observed via high-quality administrative data from Austria. The treatment group received a €40 shopping voucher if they participated in an age-specific health screening. On average, the financial incentive increased the likelihood of participation by 280 percent. Treatment effects are comparably larger for children in families with a higher socioeconomic status, and of parents with a revealed preference for secondary health prevention.

关于他们未来的健康，青少年正处于一个关键阶段。先前的评估表明，在生命的这一阶段，健康筛查、咨询和其他干预计划很重要，尤其是对那些社会经济背景较低的人来说。不幸的是，青少年往往对预防计划不感兴趣。我们设计了一个实地实验来评估促进参与健康筛查的经济激励措施的有效性。我们的研究包括10000多名参与者，通过奥地利的高质量行政数据进行观察。如果治疗组参加了特定年龄段的健康筛查，他们将获得40欧元的购物券。平均而言，经济激励使参与的可能性增加了280%。社会经济地位较高的家庭中的儿童和明显倾向于二级健康预防的父母的治疗效果相对较大。

引用次数: 0

INFORMATION GAPS AND HEALTH INSURANCE ENROLLMENT: Evidence from the Affordable Care Act Navigator Programs. 信息差距和健康保险登记

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-01-01 Epub Date: 2022-09-22 DOI: 10.1086/721569

Rebecca Myerson, Honglin Li

We studied the impact of Affordable Care Act navigator programs on health insurance coverage, using the 80 percent cut in program funding under the Trump administration as a natural experiment. Our study design exploited county-level differences in the program prior to funding cuts. We did not find that cuts to the program significantly decreased rates of marketplace coverage or any health insurance coverage by 2019; however, our estimates could not rule out marketplace coverage declines of up to 2.7 percent (point estimate -1.3 percent, 95 percent CI: 2.7 percent to 0.1 percent), or total coverage declines of up to 1.8 percentage points (point estimate -0.8 percentage points or -1.2 percent, 95 percent CI: -1.8 to 0.2). Cuts to the navigator program significantly decreased marketplace coverage and total coverage among lower-income adults, and significantly decreased total coverage among adults under age 45, Hispanic adults, and adults who speak a language other than English at home. We found no significant impact of the cuts on Medicaid enrollment (95 percent CI: -1.9 percentage points to 0.5 percentage points); most uninsured people in the states we studied lived in locations that had not implemented Medicaid eligibility expansions. These findings suggest that before the funding cuts, navigators were helping underserved consumers obtain coverage.

我们研究了《平价医疗法案》导航项目对医疗保险覆盖率的影响，将特朗普政府削减80%的项目资金作为一项自然实验。我们的研究设计利用了该项目在资金削减之前的县级差异。到2019年，我们没有发现该计划的削减显著降低了市场覆盖率或任何健康保险覆盖率；然而，我们的估计不能排除市场覆盖率下降2.7%的可能性（点估计-1.3%，95%置信区间：2.7%至0.1%），或总覆盖率下降高达1.8个百分点（点估计值-0.8个百分点或-1.2%，95%置信区间：-1.8-0.2）。导航计划的削减显著降低了低收入成年人的市场覆盖率和总覆盖率，并显著降低了45岁以下成年人、西班牙裔成年人、，以及在家说英语以外语言的成年人。我们发现削减对医疗补助注册人数没有显著影响（95%置信区间：-1.9个百分点至0.5个百分点）；在我们研究的州中，大多数没有保险的人居住在没有扩大医疗补助资格的地区。这些发现表明，在资金削减之前，导航员正在帮助服务不足的消费者获得保险。

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引用次数: 0

Do opioid prescriptions lead to fatal car crashes? 阿片类药物处方会导致致命车祸吗?

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2022-01-01 DOI: 10.1086/718511

Michael R Betz, Lauren E Jones

Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis and Reporting System, we use two-way fixed effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25 to 34 year-olds.

广泛的阿片类药物滥用表明致命车祸可能会增加。然而，如果司机对阿片类药物的流行做出反应，不再使用酒精等更令人陶醉的麻醉剂，阿片类药物的使用可能并不一定会导致更多的撞车事故。结合来自死亡分析和报告系统的当地阿片类药物处方率和车祸数据，我们使用双向固定效应模型来检验2007年至2016年处方强度与车祸死亡人数之间的关联方向。我们估计，当地处方率每增加10%，机动车事故中司机死亡人数就会增加1%。这种关联在几个模型规格中都是稳健的，并且孤立于受阿片类药物危机影响最大的司机:男性和25至34岁的人。

引用次数: 3

Physician Competition And Low-Value Health Care 医师竞争和低价值医疗保健

IF 3.7 2区经济学 Q1 Economics, Econometrics and Finance

American Journal of Health Economics

Pub Date : 2021-12-13 DOI: 10.1086/718509

Anthony Scott, Jinhu Li, H. Gravelle, M. McGrail

Although countries have implemented pro-competitive reforms in health care to reduce costs and improve quality, there is limited evidence on the effect of competition on quality of care provided by physicians. We study the effect of competition on the provision of low-value—ineffective or harmful—health care by general practitioners (GPs). We use rich patient-level data on GP consultations in Australia and measure competition as distance to other GPs. Our study found that GPs facing more competition provide lower quality of care by ordering more imaging for low back pain and uncomplicated acute bronchitis. We find similar but smaller and insignificant effects of competition on prescribing antibiotics for coughs and colds. Competition can have mixed effects across different conditions because of differences in GPs’ beliefs and patient expectations about the effectiveness of care, as well as differences in demand, costs, and profit.

尽管各国在卫生保健方面实施了有利于竞争的改革，以降低成本和提高质量，但关于竞争对医生提供的护理质量的影响的证据有限。我们研究了竞争对全科医生提供低价值、无效或有害的医疗保健服务的影响。我们在澳大利亚的全科医生咨询中使用丰富的患者水平数据，并衡量与其他全科医生的距离。我们的研究发现，面对更多竞争的全科医生会为腰痛和非并发症的急性支气管炎安排更多的影像学检查，从而降低护理质量。我们发现，竞争对咳嗽和感冒抗生素处方的影响类似，但较小且不显著。由于全科医生的信念和患者对护理有效性的期望不同，以及需求、成本和利润的差异，竞争在不同情况下可能产生混合影响。

引用次数: 5

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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