Journal of Health Economics最新文献

A large body of literature demonstrates that exposure to major adverse events such as natural disasters affects physical and mental health. Less is known about health consequences of long-term exposure to smaller, recurring shocks such as mining-induced earthquakes. Leveraging data from the Dutch Lifelines Cohort Study and Biobank and the Royal Netherlands Meteorological Institute, we examine mental health effects of frequent earthquakes generated by the extraction of natural gas, which was a major source of economic revenue for the Netherlands. Long-term exposure is captured by the accumulated peak ground acceleration. We employ individual-level fixed effects models to deal with selective exposure. We find that exposure increases depression and anxiety symptoms. Our results are robust to selective migration and to varying the exposure indicator. The results support a reassessment of the societal costs of the mining of natural gas.

Minimum supervised driving hours (MSDH) are a key component of Graduated Driver Licensing (GDL) policy. GDL has been shown to reduce motor vehicle accidents, but its optimal design is far from clear. Exploiting two discrete MSDH changes in New South Wales (the largest state in Australia), we estimate causal effects of various MSDH options, providing evidence on driver safety under different regimes. Increasing MSDH from zero to 50 h lowered the risk of a motor vehicle accident in the first year of unsupervised driving by around 23%. Further increasing the mandate to 120 h had no additional benefit.

We propose a theoretical model to study individual lifestyle choices related to calorie intake and physical activity, depending on personal fitness and body weight. The model builds on the rational eating literature and can generate a variety of behaviors that are consistent with the empirical evidence. In particular, we show that engaging in periods of a sedentary lifestyle can be a rational, utility-maximizing decision-a finding that is not present in the existing literature but is empirically widespread. Additionally, we show the possible existence of multiple equilibria and multiple indifferent lifestyles. The former justifies policy interventions to help individuals exit a self-reinforcing, but unhealthy equilibrium; the latter provides a theoretical basis for remediation plans that compensate for earlier unhealthy behaviors.

Immunotherapy is a breakthrough innovation in cancer care, but it is also among the most expensive treatments, with costs exceeding $150,000 per patient. We study the introduction of immune checkpoint inhibitors (ICIs), the most widely used class of immunotherapy drugs. In 2022, ICIs accounted for 44% of the $17.5 billion Medicare Part B cancer drug spending. We focus on metastatic melanoma, the first approved indication for ICIs. While overall cancer mortality rates declined since the 1990s, melanoma mortality rates increased through the early 2010s. Following the first ICI approvals in 2011 and 2014, melanoma mortality declined sharply. Using traditional Medicare claims, we estimate the impact of the introduction of ICIs on healthcare utilization, costs, and 1-year survival for patients with metastatic melanoma, relative to metastatic colorectal cancer (CRC), where ICIs were not approved until 2017. Variation in approval timing allows us to isolate the effect of ICIs from broader cancer care trends. We find that ICIs reduced 1-year mortality by 6.2%. Since about 1 in 5 metastatic melanoma patients received ICIs, this implies a 28.0% reduction among treated patients. The introduction of ICIs also reduced chemotherapy and radiation use, but increased Medicare spending by 59.3% or about 260% among ICI-treated patients. Accounting for life expectancy gains beyond one year, the benefits of ICIs for melanoma patients appear comparable, or potentially even greater, than the substantial added Medicare costs. Nonetheless, ICI use remains relatively low given large survival benefits and few alternative treatments, suggesting that costs and other barriers limit patient access.