Journal of Health Economics最新文献

英文中文

Intensive care supply and admission decisions

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-10 DOI: 10.1016/j.jhealeco.2025.102967

Seth Freedman , Lauren Hoehn-Velasco , Diana R. Jolles

Over 2005–2019, the number of neonatal intensive care units (NICUs) grew by 10%, and the number of NICU beds increased by 30%. This expansion in intensive care has raised concerns over unwarranted intensive care admissions. In this study, we examine whether the greater supply of NICUs causally raises admission rates. Our event-study results show that an additional NICU opening in a county raises the share of newborns admitted to the NICU by 8%. The majority of new NICU admissions come from healthier newborns (2,500 grams and over) rather than very premature newborns (

<

1,500 grams). Admission for the smallest newborns (those under 1,500 grams) only increases in counties with limited NICU access. In these areas, greater NICU supply also reduces mortality, but only for very small newborns (

<

1,500 grams). Together, our findings suggest a tradeoff, where higher NICU supply reduces neonatal mortality for the most vulnerable infants while also raising admission for healthier newborns.

引用次数: 0

Driving under the influence of allergies: the effect of seasonal pollen on traffic fatalities 过敏影响下的驾驶：季节性花粉对交通事故死亡的影响。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102945

Shooshan Danagoulian , Monica Deza

Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the role of transitory health shocks or situational factors at explaining variations in fatal traffic accidents has been understudied. Exploring daily variation in city-specific pollen counts, this study finds novel evidence that traffic fatalities increase on days in which the local pollen count is particularly high. We find that the effects are present in accidents involving private vehicles and occur most frequently on the weekends, suggesting potentially the missed opportunity to avoid these fatalities. We do not find similar effects for fleet vehicles. These findings remain robust to alternative specifications and alternative definitions of high pollen count. Taken together, this study finds evidence that a prevalent and transitory exogenous health-shock, namely pollen allergies, increases traffic fatalities. Given our lack of evidence of avoidance, these effects are not mechanical and are likely driven by cognitive impairments that arise as a result of seasonal allergies.

尽管交通事故是可以预防的，但它仍然是美国人死亡的主要原因。虽然已经采取了若干政策来改善交通安全，其影响也有充分的记录，但暂时的健康冲击或情境因素在解释致命交通事故变化方面的作用尚未得到充分研究。在探索城市特定花粉数量的日常变化时，这项研究发现了新的证据，即在当地花粉数量特别高的日子里，交通死亡人数会增加。我们发现，这种影响在涉及私家车的事故中存在，而且最常发生在周末，这表明可能错过了避免这些死亡的机会。我们在车队中没有发现类似的效果。这些发现对于高花粉计数的其他规格和其他定义仍然是可靠的。综上所述，本研究发现了一种普遍而短暂的外源性健康冲击，即花粉过敏，会增加交通死亡人数的证据。鉴于我们缺乏回避的证据，这些影响不是机械的，很可能是由季节性过敏引起的认知障碍造成的。

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引用次数: 0

Moral hazard and risk adjustment 道德风险和风险调整。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102955

Gijsbert Zwart

We analyse a model of optimal risk adjustment in competitive health-insurance markets which suffer from both ex-ante adverse selection and ex-post moral hazard. We find, firstly, that, unlike in an adverse-selection-only market, in an environment where also moral hazard is important, removing insurers’ selection incentives requires risk-adjustment payments that do not fully equalize costs among consumer types. Current practice of attempting to correct for all predictable cost differences among consumers is then misguided. Secondly, if the sponsor of the risk-adjustment system is not only concerned with eliminating selection distortions, but also wants to redistribute towards high-risk consumers, the required higher risk-adjustment payments will introduce selection distortions in high-risk consumers’ contracts. This leads to excessive equilibrium provision of care for those suffering severe health shocks. Finally, insurer market power creates countervailing incentives, helping the risk adjuster to combat selection distortions but working against a risk-adjustment regulation that also cares about redistribution.

本文分析了竞争性医疗保险市场中存在事前逆向选择和事后道德风险的最优风险调整模型。首先，我们发现，与只有逆向选择的市场不同，在道德风险也很重要的环境中，取消保险公司的选择激励需要风险调整支付，这并不能完全平衡消费者类型之间的成本。目前试图纠正消费者之间所有可预测的成本差异的做法是错误的。其次，如果风险调整制度的发起者不仅关心消除选择扭曲，而且希望向高风险消费者进行再分配，那么所需的较高风险调整支付将在高风险消费者的合同中引入选择扭曲。这导致向遭受严重健康冲击的人提供过度均衡的护理。最后，保险公司的市场力量创造了抵消性激励，帮助风险调整者对抗选择扭曲，但与同样关心再分配的风险调整监管背道而驰。

引用次数: 0

Triage at shift changes and distortions in the perception and treatment of emergency patients 分诊在轮班变化和扭曲的感知和治疗的紧急病人。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102944

Simone Ferro , Chiara Serra

Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses’ assessments of patients’ conditions and investigate the short- and medium-term consequences for patients. We show that triage nurses progressively become more lenient during their shifts, and identical ED patients arriving just after a shift change are thus assigned a lower priority. We show that these patients receive lower levels of care and require additional emergency care afterward. We conclude that distortions in nurses’ initial assessments of urgency bias’ medical staff’s perceptions.

我们利用超过200万份急诊科（ED）记录，将机器学习和回归不连续相结合，记录了分诊护士对患者病情评估中的新扭曲，并调查了对患者的短期和中期后果。我们表明，分诊护士在轮班期间逐渐变得更加宽松，相同的急诊科患者在换班后到达，因此被分配较低的优先级。我们表明，这些患者接受较低水平的护理，并需要额外的紧急护理。我们得出的结论是，护士对紧急情况的初步评估扭曲了医务人员的看法。

引用次数: 0

Ridesharing and substance use disorder treatment 拼车和药物使用障碍治疗。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102941

Conor Lennon , Johanna Catherine Maclean , Keith Teltser

We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data Set to estimate the effect of ridesharing on admissions to substance use disorder treatment. People needing such treatment report transportation as a barrier to receiving care. We find that UberX entry into a Core Based Statistical Area has no effect on the overall number of treatment admissions. However, we find a decline in non-intensive outpatient treatment which is fully offset by an increase in intensive outpatient treatment. Given the required relative frequency of non-intensive and intensive outpatient treatment in terms of visits per week, our findings indicate that UberX helps to reduce transportation barriers to accessing healthcare. Event-studies show parallel trends in outcomes before UberX entry and results are robust to numerous sensitivity checks.

我们研究拼车是否为那些需要持续医疗保健的人提供了一种有意义的交通选择。具体来说，我们将全美UberX入境的变化与治疗事件数据集相结合，以估计拼车对药物使用障碍治疗入院的影响。需要这种治疗的人报告说，运输是接受治疗的障碍。我们发现UberX进入基于核心的统计区域对治疗入院的总人数没有影响。然而，我们发现非强化门诊治疗的下降完全抵消了强化门诊治疗的增加。考虑到每周非重症门诊和重症门诊所需的相对频率，我们的研究结果表明，UberX有助于减少就医的交通障碍。事件研究表明，在UberX进入之前，结果呈平行趋势，并且结果对许多敏感性检查都是稳健的。

引用次数: 0

Biological age and predicting future health care utilisation 生物年龄和预测未来的医疗保健利用。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102956

Apostolos Davillas , Andrew M. Jones

We explore the role of epigenetic biological age in predicting subsequent health care utilisation. We use longitudinal data from the UK Understanding Society panel, capitalising on the availability of baseline epigenetic biological age measures along with data on general practitioner (GP) consultations, outpatient (OP) visits, and hospital inpatient (IP) care collected 5–12 years from baseline. Using least absolute shrinkage and selection operator (LASSO) regression analyses and accounting for participants’ pre-existing health conditions, baseline biological underlying health, and socio-economic predictors we find that biological age is selected as a predictor of future GP consultations and IP care, while chronological rather than biological age is selected for future OP visits. Post-selection prediction analysis and Shapley-Shorrocks decompositions, comparing our preferred prediction models to models that replace biological age with chronological age, suggest that biological ageing has a stronger role in the models predicting future IP care as opposed to “gatekeeping” GP consultations.

我们探讨了表观遗传生物年龄在预测后续医疗保健使用方面的作用。我们使用了英国 "了解社会 "小组的纵向数据，利用从基线开始 5-12 年收集的基线表观遗传生物年龄测量数据以及全科医生（GP）咨询、门诊（OP）就诊和医院住院（IP）护理数据。通过使用最小绝对收缩和选择算子（LASSO）回归分析，并考虑到参与者之前的健康状况、基线生物学基础健康状况和社会经济预测因素，我们发现生物年龄被选为未来全科医生咨询和 IP 护理的预测因子，而未来门诊就诊的预测因子是年代年龄而非生物年龄。通过选择后预测分析和 Shapley-Shorrocks 分解，将我们首选的预测模型与用纪年年龄替代生物年龄的模型进行比较，结果表明，在预测未来 IP 护理的模型中，生物年龄的作用比全科医生会诊的 "把关 "作用更大。

引用次数: 0

The light of life: The effects of sunlight on suicide 生命之光：阳光对自杀的影响。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-01-01 DOI: 10.1016/j.jhealeco.2024.102947

Shinsuke Tanaka , Tetsuya Matsubayashi

This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.

这项研究调查了阳光照射对自杀率的因果影响。利用1979年至2004年美国各县日照和自杀率的月-年数据，我们首次提供了强有力的证据，证明日照不足会增加自杀率。我们还发现，日照不足会增加含有抑郁语言的谷歌搜索量，这表明对心理健康有潜在的不利影响。重要的是，我们的研究结果支持生物途径而不是其他机制。据估计，阳光对自杀的影响在程度上往往超过其他干预措施，这为阳光作为自杀发生率的重要风险因素提供了新的视角。

引用次数: 0

Is supported employment effective for Disability Insurance recipients with mental health conditions? Evidence from a randomized experiment in Belgium 支持就业对有精神健康问题的残疾保险受助人有效吗？来自比利时随机实验的证据。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2024-12-26 DOI: 10.1016/j.jhealeco.2024.102958

Sébastien Fontenay , Ilan Tojerow

We conduct a randomized experiment (n = 600) to evaluate a Supported Employment (SE) program that, through intensive job coaching and follow-along support, aims to increase work activity of Belgian Disability Insurance (DI) recipients with mental health conditions. The control group gets regular vocational rehabilitation. After a 30-month follow-up period, we find that SE increases the probability of working while claiming DI by 7.5 percentage points and reduces the amount of DI benefit received by 110 euros per month (−9.5 percent).

我们开展了一项随机试验（n = 600），对一项辅助就业（SE）计划进行评估。该计划通过强化就业指导和后续支持，旨在提高比利时精神疾病残疾保险（DI）领取者的工作积极性。对照组则接受常规的职业康复治疗。经过 30 个月的跟踪调查，我们发现，SE 计划将申请 DI 的工作概率提高了 7.5 个百分点，并将每月领取的 DI 福利金额减少了 110 欧元（-9.5%）。

引用次数: 0

The pharmacist will see you now: Pharmacist prescribed contraceptives and fertility rates 药剂师现在要见你了：药剂师开了避孕药具和生育率。

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2024-12-18 DOI: 10.1016/j.jhealeco.2024.102942

Daniel Grossman , Arijit Ray , Allyssa Wadsworth

Policies that increase contraceptive access for young women and their partners are a potentially low-cost way of reducing unintended pregnancies and improving later life outcomes. Several states have recently implemented laws that allow pharmacists to prescribe contraceptives to women without the need to see a physician. We study the effect of these state laws on fertility rates. Using US Natality files for 2014–2020, we employ a difference-in-differences strategy using the 13 states that had enacted a law until the first quarter of 2020 as the treated group, and the 15 policy-implementing states post-2020 quarter 1 as the control group. We find approximately 0.5 fewer births per 1000 women aged 15–49 per quarter occur post law implementation, compared to control states. The effect of the policy appears to be focused among women aged 25–34 and 40–44 and women with a high school education or less.

增加年轻妇女及其伴侣获得避孕药具的政策可能是减少意外怀孕和改善晚年生活结果的低成本方式。几个州最近实施了法律，允许药剂师在不需要看医生的情况下给妇女开避孕药。我们研究了这些州法律对生育率的影响。使用2014-2020年的US Natality文件，我们采用差异中的差异策略，将在2020年第一季度之前颁布法律的13个州作为实验组，将2020年第一季度之后实施政策的15个州作为对照组。我们发现，与控制州相比，法律实施后每季度每1000名15-49岁妇女的生育率减少了约0.5。该政策的效果似乎主要集中在25-34岁和40-44岁的女性以及高中以下教育程度的女性。

引用次数: 0

How does undervaluation in medical savings accounts (MSAs) affect healthcare utilization? Evidence from administrative data in China 医疗储蓄账户（msa）的低估如何影响医疗保健利用？来自中国行政数据的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2024-12-01 DOI: 10.1016/j.jhealeco.2024.102946

Wei Huang , Xiaoyan Lei , Yuqi Ta

This study examines how the undervaluation of funds in Medical Savings Accounts (MSAs) influences healthcare utilization in China. Given that MSA funds are restricted to healthcare expenses, individuals may undervalue these funds relative to cash, leading to potential overuse of health care. Through an event study approach using administrative data, we find significant reductions in healthcare utilization after MSA balances are depleted—outpatient care expenses drop by 49 percent, and drugstore purchases decrease by 41 percent. These effects persist across socioeconomic groups, indicating that liquidity constraints are not a major factor. Our back-of-the-envelope calculations suggest that insured individuals undervalue MSA funds by 40–70 %. This research sheds light on the behavioral impacts of MSAs and the broader implications of perceived price distortions in health insurance.

本研究探讨了医疗储蓄账户（msa）资金低估对中国医疗保健利用的影响。鉴于MSA资金仅限于医疗保健费用，相对于现金，个人可能低估这些资金的价值，从而导致潜在的过度使用医疗保健。通过使用管理数据的事件研究方法，我们发现MSA余额耗尽后医疗保健利用率显著降低-门诊护理费用下降49%，药店采购减少41%。这些影响在社会经济群体中持续存在，表明流动性约束不是主要因素。我们的粗略计算表明，投保个人低估了MSA资金的40 - 70%。这项研究揭示了msa对行为的影响，以及健康保险中感知价格扭曲的更广泛含义。

引用次数: 0

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