Pub Date : 2025-03-14DOI: 10.1016/j.jhealeco.2025.102989
Wei Lyu , George L. Wehby , Robert Kaestner
During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.
{"title":"Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks","authors":"Wei Lyu , George L. Wehby , Robert Kaestner","doi":"10.1016/j.jhealeco.2025.102989","DOIUrl":"10.1016/j.jhealeco.2025.102989","url":null,"abstract":"<div><div>During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102989"},"PeriodicalIF":3.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143654666","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 : 2025-03-04DOI: 10.1016/j.jhealeco.2025.102987
Øyvind Snilsberg, Tor Iversen
This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.
{"title":"The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program","authors":"Øyvind Snilsberg, Tor Iversen","doi":"10.1016/j.jhealeco.2025.102987","DOIUrl":"10.1016/j.jhealeco.2025.102987","url":null,"abstract":"<div><div>This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102987"},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593144","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 : 2025-03-03DOI: 10.1016/j.jhealeco.2025.102976
Kurt R. Brekke , Dag Morten Dalen , Odd Rune Straume
We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan’s surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.
{"title":"Taking the competitor’s pill: When combination therapies enter pharmaceutical markets","authors":"Kurt R. Brekke , Dag Morten Dalen , Odd Rune Straume","doi":"10.1016/j.jhealeco.2025.102976","DOIUrl":"10.1016/j.jhealeco.2025.102976","url":null,"abstract":"<div><div>We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan’s surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102976"},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563364","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 : 2025-02-19DOI: 10.1016/j.jhealeco.2025.102974
Alicia Atwood, Sarah Pearlman
We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes “immune amnesia”, leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.
{"title":"The long term benefits of the measles vaccine in Mexico","authors":"Alicia Atwood, Sarah Pearlman","doi":"10.1016/j.jhealeco.2025.102974","DOIUrl":"10.1016/j.jhealeco.2025.102974","url":null,"abstract":"<div><div>We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes “immune amnesia”, leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102974"},"PeriodicalIF":3.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552136","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}
Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.
{"title":"The impact of budget cuts on individual patient health: Causal evidence from hospital closures","authors":"Simone Ghislandi , Anna-Theresa Renner , Nirosha Elsem Varghese","doi":"10.1016/j.jhealeco.2025.102975","DOIUrl":"10.1016/j.jhealeco.2025.102975","url":null,"abstract":"<div><div>Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102975"},"PeriodicalIF":3.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437340","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 : 2025-02-06DOI: 10.1016/j.jhealeco.2025.102970
Yoko Ibuka , Junya Hamaaki
Studies indicate that mortality increases after income receipt. To explore whether this is due to increased economic activity around the period of receiving income, we examine within-month patterns in ambulance transport incidents, focusing on location and timing. Using Japan’s National Pension payments made every two months, we compare the number of ambulance transport incidents on the day of pension payment and on surrounding days in payment months with those in non-payment months. The results show a 4.5% increase in ambulance transport incidents on the day of pension payment, linked to increased activities such as gambling, shopping, and dining out. We show suggestive evidence that income receipt boosts economic activities by the mechanism of easing liquidity constraints. These findings have implications for healthcare system preparedness and the optimal design of public benefit payment.
{"title":"Income receipt, economic activities, and health: Evidence from ambulance transport patterns","authors":"Yoko Ibuka , Junya Hamaaki","doi":"10.1016/j.jhealeco.2025.102970","DOIUrl":"10.1016/j.jhealeco.2025.102970","url":null,"abstract":"<div><div>Studies indicate that mortality increases after income receipt. To explore whether this is due to increased economic activity around the period of receiving income, we examine within-month patterns in ambulance transport incidents, focusing on location and timing. Using Japan’s National Pension payments made every two months, we compare the number of ambulance transport incidents on the day of pension payment and on surrounding days in payment months with those in non-payment months. The results show a 4.5% increase in ambulance transport incidents on the day of pension payment, linked to increased activities such as gambling, shopping, and dining out. We show suggestive evidence that income receipt boosts economic activities by the mechanism of easing liquidity constraints. These findings have implications for healthcare system preparedness and the optimal design of public benefit payment.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"100 ","pages":"Article 102970"},"PeriodicalIF":3.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379275","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 : 2025-02-06DOI: 10.1016/j.jhealeco.2025.102973
Chad D. Meyerhoefer , Bingjin Xue , Anna Poznańska
Theories of minority stress suggest recent legislation limiting LGBT rights can reduce the health of LGBT individuals and their families. We investigate how the creation of LGBT-free zones across Poland during 2019 and 2020 affected mental health and mortality. We find that annual suicide attempts increased by 16.5 %, or 5 attempts per 100k, deaths from external causes, including automobile accidents, suicides and other accidents and injuries increased 10.6 %, or 5.6 deaths per 100k, and suicide deaths increased 17.0 % (p = 0.108), or 1.9 deaths per 100k, in LGBT-free zones. The rise in suicide attempts was concentrated among individuals aged 13–18 and 45–49 and coincided with an 8.8 % increase in sales of prescription drugs for addictive disorders. However, there was no change in the use of psychotropic medications used to treat mental health conditions, indicative of limited access to mental health care.
{"title":"Implications of the decline in LGBT rights for population mental health: Evidence from Polish “LGBT-free zones”","authors":"Chad D. Meyerhoefer , Bingjin Xue , Anna Poznańska","doi":"10.1016/j.jhealeco.2025.102973","DOIUrl":"10.1016/j.jhealeco.2025.102973","url":null,"abstract":"<div><div>Theories of minority stress suggest recent legislation limiting LGBT rights can reduce the health of LGBT individuals and their families. We investigate how the creation of LGBT-free zones across Poland during 2019 and 2020 affected mental health and mortality. We find that annual suicide attempts increased by 16.5 %, or 5 attempts per 100k, deaths from external causes, including automobile accidents, suicides and other accidents and injuries increased 10.6 %, or 5.6 deaths per 100k, and suicide deaths increased 17.0 % (<em>p</em> = 0.108), or 1.9 deaths per 100k, in LGBT-free zones. The rise in suicide attempts was concentrated among individuals aged 13–18 and 45–49 and coincided with an 8.8 % increase in sales of prescription drugs for addictive disorders. However, there was no change in the use of psychotropic medications used to treat mental health conditions, indicative of limited access to mental health care.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"100 ","pages":"Article 102973"},"PeriodicalIF":3.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420210","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 : 2025-02-03DOI: 10.1016/j.jhealeco.2025.102971
Danea Horn
The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.
{"title":"The incentive to treat: Physician agency and the expansion of the 340B drug pricing program","authors":"Danea Horn","doi":"10.1016/j.jhealeco.2025.102971","DOIUrl":"10.1016/j.jhealeco.2025.102971","url":null,"abstract":"<div><div>The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102971"},"PeriodicalIF":3.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510889","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 : 2025-01-31DOI: 10.1016/j.jhealeco.2025.102968
Marcella Alsan , Romaine A. Campbell , Lukas Leister , Ayotomiwa Ojo
We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden. We conducted a survey experiment in which respondents were shown a photo of a current NIH investigator in which race (Black/White) was randomized. Sex was also randomized as a relevant benchmark. Black respondents reported 0.35 standard deviation units higher interest in participating in a clinical study led by a race concordant investigator (a 12.6% increase). Sex concordance had no effect. Further analyses indicate that perceived trustworthiness and attractiveness are the most important factors explaining these results.
{"title":"Investigator racial diversity and clinical trial participation","authors":"Marcella Alsan , Romaine A. Campbell , Lukas Leister , Ayotomiwa Ojo","doi":"10.1016/j.jhealeco.2025.102968","DOIUrl":"10.1016/j.jhealeco.2025.102968","url":null,"abstract":"<div><div>We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden. We conducted a survey experiment in which respondents were shown a photo of a current NIH investigator in which race (Black/White) was randomized. Sex was also randomized as a relevant benchmark. Black respondents reported 0.35 standard deviation units higher interest in participating in a clinical study led by a race concordant investigator (a 12.6% increase). Sex concordance had no effect. Further analyses indicate that perceived trustworthiness and attractiveness are the most important factors explaining these results.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"100 ","pages":"Article 102968"},"PeriodicalIF":3.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143336543","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 : 2025-01-25DOI: 10.1016/j.jhealeco.2025.102969
Katherine Meckel , Katherine Rittenhouse
One in nine Americans smokes cigarettes, and a disproportionate share of smokers suffer from mental illness. Despite this correlation, there exists little rigorous evidence on the effects of smoking cessation on mental health. We re-use data from a randomized trial of a smoking cessation treatment to estimate short and long-term impacts on previously un-analyzed measures of mental distress. We find that smoking cessation increases short-run mental distress, while reducing milder forms of long-run distress. We provide suggestive evidence on mechanisms including physical health, marriage, employment and substance use. Our results suggest that cessation efforts and mental health supports are complementary interventions in the short run and provide new evidence of welfare gains from cessation in the long run.
{"title":"The effect of smoking cessation on mental health: Evidence from a randomized trial","authors":"Katherine Meckel , Katherine Rittenhouse","doi":"10.1016/j.jhealeco.2025.102969","DOIUrl":"10.1016/j.jhealeco.2025.102969","url":null,"abstract":"<div><div>One in nine Americans smokes cigarettes, and a disproportionate share of smokers suffer from mental illness. Despite this correlation, there exists little rigorous evidence on the effects of smoking cessation on mental health. We re-use data from a randomized trial of a smoking cessation treatment to estimate short and long-term impacts on previously un-analyzed measures of mental distress. We find that smoking cessation increases short-run mental distress, while reducing milder forms of long-run distress. We provide suggestive evidence on mechanisms including physical health, marriage, employment and substance use. Our results suggest that cessation efforts and mental health supports are complementary interventions in the short run and provide new evidence of welfare gains from cessation in the long run.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"100 ","pages":"Article 102969"},"PeriodicalIF":3.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143103840","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号