Pub Date : 2024-12-15DOI: 10.1016/j.jce.2024.12.001
Pei Li , Kaihao Liu , Yi Lu , Lu Peng
The effectiveness of environmental policies is often compromised by weak enforcement due to conflicts between local and national interests. We examine a novel institutional reform in China that centralizes the management authority of grassroots environmental bureaus to address the issue of local capture. By analyzing the staggered roll-out of this reform, we find that the Air Quality Index significantly decreased by 25.1%. We attribute this improvement to a reduction in the capture of front-line environmental regulators by local interest groups, alignment of interests between local regulators and their upper-level administrators, and increased efforts for environmental protection by local governments in a more independent and impartial regulatory environment. These results highlight the effectiveness of distributing management authority to different administrative levels, as it reshapes the incentives for local environmental regulators, strengthens enforcement efficiency, and facilitates the achievement of policy objectives.
{"title":"Organizing regulatory structure and local air quality: Evidence from the environmental vertical management reform in China","authors":"Pei Li , Kaihao Liu , Yi Lu , Lu Peng","doi":"10.1016/j.jce.2024.12.001","DOIUrl":"10.1016/j.jce.2024.12.001","url":null,"abstract":"<div><div>The effectiveness of environmental policies is often compromised by weak enforcement due to conflicts between local and national interests. We examine a novel institutional reform in China that centralizes the management authority of grassroots environmental bureaus to address the issue of local capture. By analyzing the staggered roll-out of this reform, we find that the Air Quality Index significantly decreased by 25.1%. We attribute this improvement to a reduction in the capture of front-line environmental regulators by local interest groups, alignment of interests between local regulators and their upper-level administrators, and increased efforts for environmental protection by local governments in a more independent and impartial regulatory environment. These results highlight the effectiveness of distributing management authority to different administrative levels, as it reshapes the incentives for local environmental regulators, strengthens enforcement efficiency, and facilitates the achievement of policy objectives.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"53 1","pages":"Pages 139-164"},"PeriodicalIF":2.8,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444984","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}
Pub Date : 2024-12-05DOI: 10.1016/j.jce.2024.11.003
Jiafu An , Shiqi Guo , Haicheng Jiang
This study examines the impact of Chinese infrastructure aid on local employment across ten African countries, surveying over 500,000 individuals from 2000 to 2014. Utilizing variations in proximity to aid projects and the timing of project construction relative to local surveys reveals that Chinese aid increases local employment by two percentage points in areas near project sites compared to those awaiting project commencement, contrasting with regions without such aid. Employment rises with the onset of construction, primarily benefiting individuals with lower educational attainment, and persists post-completion, sustained by the migration and employment of skilled workers. Various infrastructure projects temporarily boost local employment, with long-term benefits particularly pronounced for projects in education, healthcare, and water and power utilities. Cross-sectoral and spatial spillover effects are also identified, with results remaining robust after accounting for additional local development factors.
{"title":"Foreign-assisted infrastructure and local employment: Evidence from China's aid to Africa","authors":"Jiafu An , Shiqi Guo , Haicheng Jiang","doi":"10.1016/j.jce.2024.11.003","DOIUrl":"10.1016/j.jce.2024.11.003","url":null,"abstract":"<div><div>This study examines the impact of Chinese infrastructure aid on local employment across ten African countries, surveying over 500,000 individuals from 2000 to 2014. Utilizing variations in proximity to aid projects and the timing of project construction relative to local surveys reveals that Chinese aid increases local employment by two percentage points in areas near project sites compared to those awaiting project commencement, contrasting with regions without such aid. Employment rises with the onset of construction, primarily benefiting individuals with lower educational attainment, and persists post-completion, sustained by the migration and employment of skilled workers. Various infrastructure projects temporarily boost local employment, with long-term benefits particularly pronounced for projects in education, healthcare, and water and power utilities. Cross-sectoral and spatial spillover effects are also identified, with results remaining robust after accounting for additional local development factors.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"53 1","pages":"Pages 118-138"},"PeriodicalIF":2.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444983","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.008
Lewis Davis , Astghik Mavisakalyan , Clas Weber
This study establishes the influence of sex-based grammatical gender on gendered violence. We demonstrate a statistically significant relationship between speaking a gendered language and the incidence of intimate partner violence in a cross-section of countries. Motivated by this evidence, we conduct an individual-level analysis of the effect of speaking a gendered language on beliefs about the justifiability of intimate partner violence, controlling for a wide variety of individual level socioeconomic characteristics as well as country, religion, language family and ethnicity fixed effects. Speaking a gendered language is associated with the belief that intimate partner violence is justifiable. Our results are consistent with complementarity between the cultural and cognitive effects of language on the attitudes to intimate partner violence.
{"title":"Gendered language and gendered violence","authors":"Lewis Davis , Astghik Mavisakalyan , Clas Weber","doi":"10.1016/j.jce.2024.08.008","DOIUrl":"10.1016/j.jce.2024.08.008","url":null,"abstract":"<div><div>This study establishes the influence of sex-based grammatical gender on gendered violence. We demonstrate a statistically significant relationship between speaking a gendered language and the incidence of intimate partner violence in a cross-section of countries. Motivated by this evidence, we conduct an individual-level analysis of the effect of speaking a gendered language on beliefs about the justifiability of intimate partner violence, controlling for a wide variety of individual level socioeconomic characteristics as well as country, religion, language family and ethnicity fixed effects. Speaking a gendered language is associated with the belief that intimate partner violence is justifiable. Our results are consistent with complementarity between the cultural and cognitive effects of language on the attitudes to intimate partner violence.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 755-772"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.003
Marco Catola , Pietro Guarnieri , Veronica Pizziol , Chiara Rapallini
We use a multilevel public goods game to investigate attitudes towards national public budgets and a European public budget in six Member States of the European Union: Italy, Germany, France, The Netherlands, Poland, and Portugal. We test to what extent propensities to contribute to public goods differ across countries. Using two efficiency treatments, we also test whether each country group adjusts its contribution when the relative efficiency of the public goods changes. We find no differences across countries in the propensity to contribute to either public budget. Moreover, all country groups level up their contribution to the European public good following an increase in its relative efficiency. We also devise a questionnaire to assess the impact of a sense of identity on contribution decisions and to control for the impact of COVID-19 and the current war in Ukraine on country and EU perceptions.
{"title":"Measuring the attitude towards a European public budget: A cross-country experiment","authors":"Marco Catola , Pietro Guarnieri , Veronica Pizziol , Chiara Rapallini","doi":"10.1016/j.jce.2024.08.003","DOIUrl":"10.1016/j.jce.2024.08.003","url":null,"abstract":"<div><div>We use a multilevel public goods game to investigate attitudes towards national public budgets and a European public budget in six Member States of the European Union: Italy, Germany, France, The Netherlands, Poland, and Portugal. We test to what extent propensities to contribute to public goods differ across countries. Using two efficiency treatments, we also test whether each country group adjusts its contribution when the relative efficiency of the public goods changes. We find no differences across countries in the propensity to contribute to either public budget. Moreover, all country groups level up their contribution to the European public good following an increase in its relative efficiency. We also devise a questionnaire to assess the impact of a sense of identity on contribution decisions and to control for the impact of COVID-19 and the current war in Ukraine on country and EU perceptions.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 963-979"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136127","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.07.003
Jiawei Fu , Congyi Zhou
Mental health directly influences individuals’ behaviors and decision-making processes, particularly for government officials grappling with mental health issues. This paper utilizes field data from China’s anti-corruption campaign to evaluate the campaign’s impact on mental health. Our findings indicate that depressive symptoms, as measured by CES-D8 scores, have risen significantly among government employees by 0.4 units per 100 increase in corruption investigation cases. This result suggests that the anti-corruption campaign within a year could potentially result in an average increase of 29% in depressive symptoms among government employees. Interestingly, no comparable effect was found among the general Chinese population. This discrepancy could be attributed to the transformative impact of the anti-corruption campaign on the internal governmental work environment, engendering stress among its employees.
{"title":"The impact of anti-corruption on mental health: Evidence from China","authors":"Jiawei Fu , Congyi Zhou","doi":"10.1016/j.jce.2024.07.003","DOIUrl":"10.1016/j.jce.2024.07.003","url":null,"abstract":"<div><div>Mental health directly influences individuals’ behaviors and decision-making processes, particularly for government officials grappling with mental health issues. This paper utilizes field data from China’s anti-corruption campaign to evaluate the campaign’s impact on mental health. Our findings indicate that depressive symptoms, as measured by CES-D8 scores, have risen significantly among government employees by 0.4 units per 100 increase in corruption investigation cases. This result suggests that the anti-corruption campaign within a year could potentially result in an average increase of 29% in depressive symptoms among government employees. Interestingly, no comparable effect was found among the general Chinese population. This discrepancy could be attributed to the transformative impact of the anti-corruption campaign on the internal governmental work environment, engendering stress among its employees.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 925-950"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136129","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.006
Shuo Chen , Jianan Li , Qin Yao
This paper explores the role of transportation infrastructure in pre-modern economic development by investigating the historical canal's closure. We quantify the effects of closing China's Grand Canal in 1826 by disastrous flooding, the world's largest and oldest manmade waterway, on market integration. We use archived grain prices from 1780 to 1911 and find that the canal's closure led to a 30% decline in market integration; this impact lasted for more than 70 years. Our results are robust while addressing the alternative measures of market integration, potential spillovers from treated groups to control groups, influences of forced openness, and potential measurement errors and standard error adjustments. We find evidence consistent with increasing transportation costs and information friction as the main potential mechanisms. Our findings highlight the importance of transportation infrastructure in reducing arbitrage costs and provide new evidence which is important to explain the process of the Great Divergence between China and Europe.
{"title":"Canal and trade: Transportation infrastructure and market integration in China, 1780–1911","authors":"Shuo Chen , Jianan Li , Qin Yao","doi":"10.1016/j.jce.2024.08.006","DOIUrl":"10.1016/j.jce.2024.08.006","url":null,"abstract":"<div><div>This paper explores the role of transportation infrastructure in pre-modern economic development by investigating the historical canal's closure. We quantify the effects of closing China's Grand Canal in 1826 by disastrous flooding, the world's largest and oldest manmade waterway, on market integration. We use archived grain prices from 1780 to 1911 and find that the canal's closure led to a 30% decline in market integration; this impact lasted for more than 70 years. Our results are robust while addressing the alternative measures of market integration, potential spillovers from treated groups to control groups, influences of forced openness, and potential measurement errors and standard error adjustments. We find evidence consistent with increasing transportation costs and information friction as the main potential mechanisms. Our findings highlight the importance of transportation infrastructure in reducing arbitrage costs and provide new evidence which is important to explain the process of the Great Divergence between China and Europe.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 793-812"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136044","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.007
Jeff Chan
This paper investigates the effects of restrictive immigration policies enacted in the US in 1921 and 1924 to explore the effects of immigration restrictions on recent immigrants using full-count US Census data and variation across national origins in the exclusionary policies. Immigrants more affected by the quotas were more likely to become naturalized citizens. Immigrants from countries that subsequently had migration reduced by the Acts were also more likely to marry someone born in the United States. The evidence in this paper, taken together, shows that the Immigrant Exclusion Act hastened the assimilation of already-landed immigrant men and impacted their short and long-run family outcomes.
{"title":"Changing the pace of the melting pot: The effects of immigration restrictions on immigrant assimilation","authors":"Jeff Chan","doi":"10.1016/j.jce.2024.08.007","DOIUrl":"10.1016/j.jce.2024.08.007","url":null,"abstract":"<div><div>This paper investigates the effects of restrictive immigration policies enacted in the US in 1921 and 1924 to explore the effects of immigration restrictions on recent immigrants using full-count US Census data and variation across national origins in the exclusionary policies. Immigrants more affected by the quotas were more likely to become naturalized citizens. Immigrants from countries that subsequently had migration reduced by the Acts were also more likely to marry someone born in the United States. The evidence in this paper, taken together, shows that the Immigrant Exclusion Act hastened the assimilation of already-landed immigrant men and impacted their short and long-run family outcomes.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 733-754"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.09.002
Mhamed Ben Salah , Cédric Chambru , Maleke Fourati
This paper uses spatial variations in the enrolment rate of Tunisian pupils in 1931 to estimate the weight of colonial history on medium- and long-run educational attainment. We assemble a new dataset on the location of public primary schools and the number of pupils and teachers, together with population data for 1931. We match these data with information on education at the district level, derived from two population censuses conducted in 1984 and 2014. We find that a one per cent increase in the enrolment rate in 1931 is associated with a 2.37 percentage points increase in the literacy rate in 1984, and a 1.89 percentage points increase in 2014. We further investigate the exposure to colonial public primary education across different age cohorts. We find that our results are mainly driven by older generations, and tend to fade for younger cohorts. While we provide qualitative evidence that a cultural transmission of education may have contributed to this persistence, we also argue that the continuous effort and investment made by Tunisian governments to achieve universal primary enrolment best explain the decline in spatial disparities in educational attainment.
{"title":"The colonial legacy of education: Evidence from Tunisia","authors":"Mhamed Ben Salah , Cédric Chambru , Maleke Fourati","doi":"10.1016/j.jce.2024.09.002","DOIUrl":"10.1016/j.jce.2024.09.002","url":null,"abstract":"<div><div>This paper uses spatial variations in the enrolment rate of Tunisian pupils in 1931 to estimate the weight of colonial history on medium- and long-run educational attainment. We assemble a new dataset on the location of public primary schools and the number of pupils and teachers, together with population data for 1931. We match these data with information on education at the district level, derived from two population censuses conducted in 1984 and 2014. We find that a one per cent increase in the enrolment rate in 1931 is associated with a 2.37 percentage points increase in the literacy rate in 1984, and a 1.89 percentage points increase in 2014. We further investigate the exposure to colonial public primary education across different age cohorts. We find that our results are mainly driven by older generations, and tend to fade for younger cohorts. While we provide qualitative evidence that a cultural transmission of education may have contributed to this persistence, we also argue that the continuous effort and investment made by Tunisian governments to achieve universal primary enrolment best explain the decline in spatial disparities in educational attainment.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 773-792"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.002
Heyu Xiong
How important is the age and experience of political leaders for the quality of governance? I explore this question in the context of imperial China, where autocratic rule centered on the institution of the emperor persisted for nearly 2,000 years. While the issue of child emperors is frequently discussed in the historiography of China, the impact of minor rulers has not been explored empirically. Using rich biographical information on the lives of rulers, I show evidence consistent with the notion that the age of emperors mattered for the effective administration of the Chinese state. In particular, the incidences of minor monarchs appear to accelerate the decline of a dynasty and occur more frequently toward the end of an imperial dynasty. The rule of minor monarchs coincides with the timing of dynastic crises, nomadic attacks, peasant revolts, and declines in fiscal capacity. To assess causality, I conduct two tests. First, I validate my baseline findings using an instrumental variable strategy that exploits the early but natural deaths of preceding emperors. Second, I show that estimated relationships become stronger after the Tang-Song transition, during which the administrative power of the emperor increased dramatically relative to that of the civilian bureaucracy. Overall, the results in this paper suggest that in the absence of institutional constraints, weak executive leadership can lead to poor national outcomes even in a highly bureaucratized state.
{"title":"Minor monarchs: The ‘Bad-Emperor’ problem in Chinese history","authors":"Heyu Xiong","doi":"10.1016/j.jce.2024.08.002","DOIUrl":"10.1016/j.jce.2024.08.002","url":null,"abstract":"<div><div>How important is the age and experience of political leaders for the quality of governance? I explore this question in the context of imperial China, where autocratic rule centered on the institution of the emperor persisted for nearly 2,000 years. While the issue of child emperors is frequently discussed in the historiography of China, the impact of minor rulers has not been explored empirically. Using rich biographical information on the lives of rulers, I show evidence consistent with the notion that the age of emperors mattered for the effective administration of the Chinese state. In particular, the incidences of minor monarchs appear to accelerate the decline of a dynasty and occur more frequently toward the end of an imperial dynasty. The rule of minor monarchs coincides with the timing of dynastic crises, nomadic attacks, peasant revolts, and declines in fiscal capacity. To assess causality, I conduct two tests. First, I validate my baseline findings using an instrumental variable strategy that exploits the early but natural deaths of preceding emperors. Second, I show that estimated relationships become stronger after the Tang-Song transition, during which the administrative power of the emperor increased dramatically relative to that of the civilian bureaucracy. Overall, the results in this paper suggest that in the absence of institutional constraints, weak executive leadership can lead to poor national outcomes even in a highly bureaucratized state.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 813-824"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136122","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jce.2024.08.005
Hongqiao Fu , Jialin Huang , Ling Li , Winnie Yip
This study examined how hospitals responded to increases in the prices of previously underpriced pediatric services. In May 2018, the city of Guangzhou in southern China mandated price increases of 30 % for 408 pediatric service items when children patients aged under 6. Prices for patients aged 6 and over, however, remained unchanged. Using case-level discharge data from public hospitals in Guangzhou, we employed a regression discontinuity design to estimate the differences in health expenditures, treatment intensity, and readmission rate between patients hospitalized just before and after the age of 6. Since we observed no behavioral changes for children aged above 6, and an absence of demand-side response among children aged under 6, the estimated effects can be interpreted as providers' response to increases in pediatric service prices for children aged under 6. We found that the higher service prices significantly increased expenditures on medical services per admission for children aged under 6 by 15.8 %. The magnitude of this estimate provided suggestive evidence that increased expenditures on medical service were mainly driven by the mechanical price effect and the provision of medical services remained largely unchanged, because 408 pediatric services with price increase of 30 % accounted for almost half of the total service expenditures. Moreover, this pricing reform reduced drug expenditures and antibiotics expenditures per admission for children aged under 6 by 21.2 % and 31.8 %, respectively. Given that there was no price change in prescription drugs, the fall in drug and antibiotics expenditures was primarily due to behavioral effects on the supply side. The reduction in drug expenditures nearly offset the increase in expenditures on medical services, resulting in statistically insignificant changes in total expenditures per admission. Furthermore, we observed no measurable changes in treatment intensity or readmission rates around the age of 6. These findings suggested that increased prices for previously underpriced services may reduce the over-prescription of drugs without increasing total health expenditures and sacrificing healthcare quality, highlighting the potential of mitigating distortions in medical prices in improving health system performance.
{"title":"Hospital response to increases in prices of pediatric services: Evidence from China","authors":"Hongqiao Fu , Jialin Huang , Ling Li , Winnie Yip","doi":"10.1016/j.jce.2024.08.005","DOIUrl":"10.1016/j.jce.2024.08.005","url":null,"abstract":"<div><div>This study examined how hospitals responded to increases in the prices of previously underpriced pediatric services. In May 2018, the city of Guangzhou in southern China mandated price increases of 30 % for 408 pediatric service items when children patients aged under 6. Prices for patients aged 6 and over, however, remained unchanged. Using case-level discharge data from public hospitals in Guangzhou, we employed a regression discontinuity design to estimate the differences in health expenditures, treatment intensity, and readmission rate between patients hospitalized just before and after the age of 6. Since we observed no behavioral changes for children aged above 6, and an absence of demand-side response among children aged under 6, the estimated effects can be interpreted as providers' response to increases in pediatric service prices for children aged under 6. We found that the higher service prices significantly increased expenditures on medical services per admission for children aged under 6 by 15.8 %. The magnitude of this estimate provided suggestive evidence that increased expenditures on medical service were mainly driven by the mechanical price effect and the provision of medical services remained largely unchanged, because 408 pediatric services with price increase of 30 % accounted for almost half of the total service expenditures. Moreover, this pricing reform reduced drug expenditures and antibiotics expenditures per admission for children aged under 6 by 21.2 % and 31.8 %, respectively. Given that there was no price change in prescription drugs, the fall in drug and antibiotics expenditures was primarily due to behavioral effects on the supply side. The reduction in drug expenditures nearly offset the increase in expenditures on medical services, resulting in statistically insignificant changes in total expenditures per admission. Furthermore, we observed no measurable changes in treatment intensity or readmission rates around the age of 6. These findings suggested that increased prices for previously underpriced services may reduce the over-prescription of drugs without increasing total health expenditures and sacrificing healthcare quality, highlighting the potential of mitigating distortions in medical prices in improving health system performance.</div></div>","PeriodicalId":48183,"journal":{"name":"Journal of Comparative Economics","volume":"52 4","pages":"Pages 897-924"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136123","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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