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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 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。
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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 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。
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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 3.1 2区 经济学 Q1 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 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。
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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 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。
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引用次数: 5
The Demand for Individual Insurance 个人保险需求
IF 3.7 2区 经济学 Q1 ECONOMICS Pub Date : 2021-11-11 DOI: 10.1086/718161
Conor Ryan, R. Feldman, Stephen L. Parente
We use a novel data set from a private online marketplace to estimate the demand for individual health insurance among a set comprising many high-income households across 18 states. Households earning more than four times the federal poverty level (FPL) are willing to pay $30 to $135 per month to increase the actuarial value of their insurance by 10 percentage points, much less than households earning less than 2.5 times FPL. Higher-income households are also less likely to forgo insurance because of a premium increase. These results are important for understanding the effect of health reform proposals targeting higher-income populations.
我们使用一个来自私人在线市场的新数据集来估计18个州的许多高收入家庭对个人健康保险的需求。收入超过联邦贫困水平四倍的家庭愿意每月支付30至135美元,以将其保险的精算价值提高10个百分点,远低于收入低于联邦贫困水平2.5倍的家庭。高收入家庭也不太可能因为保费上涨而放弃保险。这些结果对于理解针对高收入人群的卫生改革提案的效果非常重要。
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引用次数: 0
Does Particulate Matter Affect Cognitive Performance? 颗粒物会影响认知能力吗?
IF 3.7 2区 经济学 Q1 ECONOMICS Pub Date : 2021-11-01 DOI: 10.1086/717922
Hyunkuk Cho
This study analyzes the effect of test-hour particulate matter (PM10) on the college entrance test performance of 290,000 high school seniors. The data are drawn from Seoul, the capital city of South Korea, where each of the 25 districts has at least one PM10 monitoring station. The study finds that reading test scores decrease when the test-hour PM10 concentration increases. Specifically, when the one-hour average PM10 concentration is ≥75 μg/m3, reading test scores decrease by 0.13 standard deviations relative to when the concentration is lower than 25 μg/m3. The effect size is equivalent to increasing class size by six or seven students. In addition, the one-hour average concentrations measured before and after the reading test have no significant effects on the test scores, meaning that it is unlikely that other factors drive the result.
本研究分析了考试时颗粒物(PM10)对29万名高三学生高考成绩的影响。这些数据来自韩国首都首尔,那里的25个区都至少有一个PM10监测站。研究发现,当考试时间PM10浓度增加时,阅读考试成绩会下降。其中,当PM10一小时平均浓度≥75 μg/m3时,阅读测试成绩较浓度低于25 μg/m3时下降0.13个标准差。这种效应相当于班级规模增加6到7个学生。此外,阅读测试前后测量的一小时平均浓度对测试成绩没有显著影响,这意味着不太可能是其他因素造成的结果。
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引用次数: 0
Economic Hardship, Sleep, and Self-Rated Health 经济困难、睡眠和自我评价的健康
IF 3.7 2区 经济学 Q1 ECONOMICS Pub Date : 2021-10-26 DOI: 10.1086/717811
Helmut Farbmacher, Maximilian C. Hartmann, Heinrich Kögel
The Supplemental Nutrition Assistance Program (SNAP) distributes vouchers for grocery shopping to around 43 million individuals across the United States to counteract food insecurity. In this study, we take advantage of the random interview day assignment of the American Time Use Survey (ATUS) and the variation in voucher issuance dates across states to identify changes in self-rated health and sleep over the monthly SNAP payment cycle. We find that the economic hardship experienced at the end of the payout period causes a significant and sizable negative effect on self-assessed physical health and sleep quality. SNAP recipients were 18 percent more likely to report fair or poor physical health at the end of the payment cycle compared with the rest of the month. During this period of scarcity, recipients were also 50 percent more likely to report sleeplessness, with the number of minutes being sleepless more than doubling while total sleep duration remained unchanged. Drawing upon information on time use in the ATUS, we discuss evidence suggesting that higher levels of stress, changed eating patterns, and reduced sleep quality may be potential mechanisms of the adverse health effects. Our findings extend the literature on sleep quality as a mediator between low socioeconomic status and self-rated health in the short run.
补充营养援助计划(SNAP)向全美约4300万人分发食品杂货购物券,以解决粮食不安全问题。在本研究中,我们利用美国时间使用调查(ATUS)的随机访谈日分配和各州代金券发行日期的变化来确定每月SNAP支付周期中自评健康和睡眠的变化。我们发现,在支付期结束时经历的经济困难对自我评估的身体健康和睡眠质量产生了显著而可观的负面影响。与当月剩余时间相比,SNAP接受者在支付周期结束时报告身体健康状况一般或较差的可能性高出18%。在这段时间内,接受者报告失眠的可能性也增加了50%,失眠的分钟数增加了一倍多,而总睡眠时间保持不变。根据ATUS中关于时间使用的信息,我们讨论了表明压力水平升高、饮食模式改变和睡眠质量下降可能是不良健康影响的潜在机制的证据。我们的研究结果扩展了睡眠质量作为低社会经济地位和短期自我评估健康之间中介的文献。
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引用次数: 2
Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability 阿片类药物相关政策对阿片类药物使用、医疗性质和残疾持续时间的影响
IF 3.7 2区 经济学 Q1 ECONOMICS Pub Date : 2021-10-01 DOI: 10.1086/722981
D. Neumark, Bogdan Savych
We examine the effects of must-access prescription drug monitoring programs (PDMPs) and recent regulations limiting the duration of initial opioid prescriptions on care received by patients with work-related injuries, focusing on opioid utilization and medical care related to pain management. We find that must-access PDMPs contributed to declines in opioid utilization, while regulations limiting duration of initial opioid prescriptions had little effect on whether workers receive opioids, but reduced opioid use among those with prescriptions. We find some evidence that must-access PDMPs affected utilization of other medical care—most interestingly, in light of high opioid use, towards non-opioid pain medication and interventional pain management services for neurologic spine pain. We find that must-access PDMPs and limits on initial prescriptions had little impact on the duration of temporary disability benefits captured at 12 months of maturity.
我们研究了必须获得的处方药监测计划(PDMP)和最近限制首次阿片类药物处方持续时间的法规对工伤患者接受护理的影响,重点关注阿片类物质的使用和与疼痛管理相关的医疗护理。我们发现,必须获得PDMP导致了阿片类药物使用率的下降,而限制首次阿片类处方持续时间的规定对工作人员是否接受阿片类物质几乎没有影响,但减少了处方人员的阿片类药品使用。我们发现了一些必须获得PDMP的证据,这些证据影响了其他医疗护理的利用——最有趣的是,鉴于阿片类药物的高使用率,非阿片类止痛药和神经性脊椎疼痛的介入性疼痛管理服务。我们发现,必须获得PDMP和初始处方的限制对12个月到期时获得的临时残疾福利的持续时间几乎没有影响。
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引用次数: 1
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits 平价医疗法案扩大对阿片类药物相关急诊就诊的影响
IF 3.7 2区 经济学 Q1 ECONOMICS Pub Date : 2021-09-01 DOI: 10.1086/722928
Sandra L. Decker, M. Dworsky, T. Gibson, R. Henke, K. McDermott
Amid rising opioid-related deaths and hospital use, the 2010 Patient Protection and Affordable Care Act (ACA) was signed into law, with the central coverage provisions implemented in 2014. We leverage these ACA coverage expansions (including Medicaid expansion and Marketplaces) to study the impact of health insurance on opioid-related emergency department (ED) visits while accounting for potentially confounding changes in relevant state-level policies. We use zip code–level ED utilization data from the 2010–18 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. In difference-in-difference-in-differences (DDD) models that compared low- and high-uninsurance areas within states, we found evidence of a dose-response relationship between pre-ACA uninsurance and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsurance rates prior to the ACA saw larger reductions in opioid-related ED visits after the ACA took effect. Effects were also time-varying, with no significant dose-response relationship emerging until the third year of ACA implementation. These estimates suggest that increasing insurance coverage among the uninsured may help mitigate harms of the opioid crisis.
在阿片类药物相关死亡人数和医院使用人数不断增加的情况下,2010年《患者保护和平价医疗法案》(ACA)签署成为法律,中央覆盖条款于2014年实施。我们利用ACA覆盖范围的扩大(包括医疗补助计划的扩大和市场)来研究医疗保险对阿片类药物相关急诊科(ED)就诊的影响,同时考虑到相关州级政策的潜在混淆变化。我们使用来自2010-2018年医疗成本和利用项目(HCUP)的29个州的州住院患者数据库(SID)和州急诊科数据库(SEDD)的邮政编码级ED利用率数据。在比较各州内低保险和高保险地区的差异-差异(DDD)模型中,我们发现有证据表明,ACA前的保险与扩张州和非扩张州ED就诊率的变化之间存在剂量-反应关系:ACA前保险率较高的地区在ACA生效后阿片类药物相关ED就诊率大幅减少。影响也是时变的,直到ACA实施的第三年才出现显著的剂量-反应关系。这些估计表明,增加未参保人群的保险范围可能有助于减轻阿片类药物危机的危害。
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引用次数: 0
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American Journal of Health Economics
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