Journal of Health Economics最新文献

英文中文

Has the shortened drug distribution chain cut drug prices? Evidence from the Two-Invoice System in China 药品分销链的缩短是否降低了药品价格？来自中国两票制的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2026-01-01 DOI: 10.1016/j.jhealeco.2025.103097

Xiaoxi Li , Fanyu Liu , Jianye Yan , Nina Yin

Global concerns over rising drug prices have led to regulatory efforts in the pharmaceutical industry targeting price transparency and distribution efficiency. This study examines the impact of China’s Two-Invoice System (TIS), a 2016 reform aimed at reducing drug costs by streamlining the pharmaceutical distribution chain and enhancing price transparency. With a theoretical model, we examine the decision-making for pharmaceutical manufacturers and distributors on pricing and promotion activities. We predict competing effects on drug prices: while intermediary markups inflated by double marginalization are reduced, the removal of efficient distributors may elevate supply chain expenses. Using a staggered difference-in-differences approach with procurement data from 2015 to 2019, we find that the implementation of TIS led to a 1.9% increase in average drug prices, contrary to policy expectations. Price increases were more pronounced for lower-priced drugs and in wealthier regions, for which the supply chain markups are limited and the effect of efficiency disruption might dominate. We also document a significant increase in sales and marketing expenses of the manufacturers, who are supposed to have absorbed a considerable amount of promotional costs previously borne by distributors. These findings underscore the unintended inefficiencies of regulatory reforms, highlighting the need for a balanced policy design that considers both cost control and market dynamics in healthcare.

全球对药品价格上涨的担忧导致制药行业的监管努力以价格透明度和分销效率为目标。本研究考察了中国两票制（TIS）的影响，这是2016年的一项改革，旨在通过简化药品分销链和提高价格透明度来降低药品成本。本文运用理论模型，考察了药品生产企业和经销商在定价和促销活动方面的决策。我们预测了对药品价格的竞争效应：虽然由于双重边缘化而膨胀的中间加价减少了，但高效分销商的消失可能会提高供应链费用。通过对2015年至2019年采购数据的交错差分方法，我们发现，TIS的实施导致平均药品价格上涨1.9%，与政策预期相反。价格较低的药品和较富裕地区的价格上涨更为明显，因为这些地区的供应链加价有限，效率中断的影响可能占主导地位。我们还记录了制造商的销售和营销费用的显著增加，他们应该已经吸收了之前由分销商承担的相当数量的促销成本。这些发现强调了监管改革的非预期的低效率，强调了兼顾医疗保健成本控制和市场动态的平衡政策设计的必要性。

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引用次数: 0

Workforce impacts of subsidised mental healthcare: Evidence on supply, geographic distribution, and earnings 补贴精神卫生保健对劳动力的影响：供应、地理分布和收入的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-26 DOI: 10.1016/j.jhealeco.2025.103102

Nicole Black, Anthony Harris, David W. Johnston, Trong-Anh Trinh

To improve access to affordable mental healthcare, Australia introduced a national, publicly-funded program in 2006 to subsidise psychological services, which were previously privately funded. Theory suggests that by increasing demand, subsidies should incentivise providers to expand supply, either by entering the workforce or by increasing hours. However, expansion depends on supply constraints, particularly in non-metropolitan areas with pronounced workforce shortages. This study examines the program’s effects on the size, work hours, demographic composition, location, and earnings of psychologists. Using an event-study design with administrative tax records and census data, we find that the program: (1) increased the supply of psychologists, with minimal effect on average hours worked per psychologist; (2) increased the likelihood of psychologists working in non-metropolitan areas, supporting broader access to mental healthcare; and (3) raised psychologists’ annual personal incomes.

为了改善获得负担得起的精神保健服务的机会，澳大利亚于2006年推出了一项由公共资助的国家方案，以补贴以前由私人资助的心理服务。理论表明，通过增加需求，补贴应该激励提供者通过进入劳动力市场或增加工作时间来扩大供应。然而，扩张取决于供应限制，特别是在劳动力明显短缺的非大都市地区。这项研究考察了该计划对心理学家的规模、工作时间、人口构成、地点和收入的影响。采用行政税收记录和人口普查数据的事件研究设计，我们发现该计划：(1)增加了心理学家的供应，对每位心理学家的平均工作时间影响最小；(2)增加了心理医生在非大都市地区工作的可能性，支持更广泛的心理保健服务；(3)提高了心理学家的个人年收入。

引用次数: 0

Individualized disability support schemes and their impact on autism diagnoses 个性化残疾支持方案及其对自闭症诊断的影响。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-20 DOI: 10.1016/j.jhealeco.2025.103100

Maathumai Ranjan, Robert Breunig

This paper examines the impact of individualized funding for disability supports on autism diagnoses. We identify these effects using the staggered roll out of the National Disability Insurance Scheme (NDIS), which provides individualized funding for non-medical disability interventions. We find compelling evidence that the introduction of the NDIS has led to a 32 % increase in reported autism prevalence and accounts for 47 % of new diagnoses since the introduction of the scheme. We find a significant reduction in diagnoses from government subsided healthcare professionals, accompanied by an increase in diagnoses from disability service providers. A lower threshold for autism recognition appears more consistent with our results than catch-up in historically underdiagnosed groups.

本文探讨了残疾支持的个性化资助对自闭症诊断的影响。我们使用国家残疾保险计划（NDIS）的交错推出来确定这些影响，该计划为非医疗残疾干预提供个性化资金。我们发现令人信服的证据表明，自引入NDIS以来，报告的自闭症患病率增加了32%，占新诊断的47%。我们发现来自政府资助的医疗保健专业人员的诊断显著减少，同时来自残疾服务提供者的诊断增加。较低的自闭症识别门槛似乎与我们的结果更一致，而不是在历史上未被诊断的群体中追赶。

引用次数: 0

Does telemedicine technology affect prescribing quality in primary care? The case of antibiotics 远程医疗技术会影响初级保健的处方质量吗？抗生素的例子。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-12 DOI: 10.1016/j.jhealeco.2025.103096

Daniel Avdic , Johannes S. Kunz , Susan J. Méndez , Maria Wiśniewska

We study the impact of telemedicine technology on antibiotic prescription rates using linked administrative data from Australia on physicians and their patients. We classify physicians by their relative use of virtual consultations after the introduction of government-subsidised telemedicine services and compare their antibiotic prescribing rates before and after telemedicine services became available. We find that more intense telemedicine adopters prescribe less antibiotics while keeping prescribing quality unchanged. Our results are not explained by patient sorting, doctor shopping, or changes in the intensity of consultations.

我们研究了远程医疗技术对抗生素处方率的影响，使用了澳大利亚医生及其患者的相关行政数据。在引入政府补贴的远程医疗服务后，我们根据医生对虚拟咨询的相对使用情况对他们进行了分类，并比较了他们在远程医疗服务提供之前和之后的抗生素处方率。我们发现，更多的远程医疗采用者在保持处方质量不变的情况下，开的抗生素更少。我们的结果不能用病人分类、医生购物或会诊强度的变化来解释。

引用次数: 0

Optimal mental health belief formation with information avoidance: A decision-theoretic model 信息回避的最优心理健康信念形成：一个决策理论模型

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-01 DOI: 10.1016/j.jhealeco.2025.103084

Daehyun Kim

Mental health stigma hinders access to healthcare by distorting belief formation and decision-making. Stigmatized individuals often underestimate their risk of mental illness and avoid diagnostic information. This study develops a decision-theoretic model that formalizes how stigma reinforces identity-congruent actions, driving belief distortion and information avoidance. By integrating insights from information preference theory and identity utility, the model explains why individuals with strong stigma-driven identity concerns are prone to optimistic bias and resist diagnostic tests to protect their self-concept. The study contributes to the literature in three key ways. First, it conceptually extends economic theory by endogenizing belief distortion, identity-congruent action, and information avoidance within a unified decision-making structure. By introducing stigma as a formally modeled individual-specific parameter — previously underexplored in economics — the framework improves our ability to capture heterogeneity in health-related decision-making and strengthens the theoretical bridge between economic modeling and clinical mental health research. Second, it provides a theoretical framework linking clinical phenomena such as denial, delayed treatment-seeking, and treatment discontinuation within a formal decision-theoretic model. Third, it offers a structured foundation for experimental and empirical research by demonstrating how stigma, a quantifiable construct, systematically influences decision-making through identity-driven actions and belief distortion.

心理健康耻辱通过扭曲信念形成和决策阻碍获得医疗保健。被污名化的个体往往低估了他们患精神疾病的风险，并回避诊断信息。本研究发展了一个决策理论模型，该模型形式化了耻辱如何强化身份一致行为，驱动信念扭曲和信息回避。通过整合信息偏好理论和身份效用的见解，该模型解释了为什么具有强烈耻辱驱动的身份关注的个体倾向于乐观偏见并抵制诊断测试以保护他们的自我概念。这项研究在三个关键方面为文献做出了贡献。首先，它在概念上扩展了经济理论，将信念扭曲、身份一致行为和信息回避内因化为统一的决策结构。通过将病耻感作为一个正式建模的个人特定参数（此前在经济学中未得到充分探索），该框架提高了我们捕捉与健康相关决策异质性的能力，并加强了经济建模与临床心理健康研究之间的理论桥梁。其次，它提供了一个理论框架，将临床现象，如拒绝，延迟寻求治疗和治疗终止在正式的决策理论模型中联系起来。第三，它为实验和实证研究提供了一个结构化的基础，展示了耻辱，一个可量化的结构，如何通过身份驱动的行为和信念扭曲系统地影响决策。

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引用次数: 0

Fertility responses to tropical cyclones: Causal evidence and mechanisms 热带气旋对生育力的响应：因果证据和机制

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-01 DOI: 10.1016/j.jhealeco.2025.103083

Ha Trong Nguyen, Francis Mitrou

In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influence childbearing decisions among Australians of reproductive age. Using an individual fixed effects model and exogenous variation in cyclone exposure, we find a robust and substantial decline in fertility, occurring only after the most severe category 5 cyclones, with the effect weakening as distance from the cyclone’s eye increases. We find no evidence of delayed cyclone effects, indicating that the fertility loss attributable to these most severe cyclones is permanent. Our findings are robust to extensive validity checks, including a falsification test and various randomization tests. The fertility decline is most pronounced among younger adults, individuals with lower educational attainment, those childless at baseline, and those lacking prior private health or residential insurance. While physical health, financial constraints, and migration appear unlikely to drive the effect, the evidence points to reduced family formation, increased marital breakdown, child mortality, cyclone-induced home damage, elevated psychological stress, and heightened risk perceptions as plausible mechanisms.

鉴于人们日益关注不断升级的自然灾害风险和持续的低生育率，本文量化了热带气旋的因果影响，并确定了热带气旋影响育龄澳大利亚人生育决策的途径。利用个体固定效应模型和气旋暴露的外源性变化，我们发现生育率出现强劲而实质性的下降，这种下降只发生在最严重的5级气旋之后，随着与气旋眼距离的增加，这种影响减弱。我们没有发现延迟气旋影响的证据，这表明这些最严重的气旋造成的生育力损失是永久性的。我们的发现是稳健的广泛的有效性检查，包括证伪检验和各种随机化检验。生育率下降在年轻人、受教育程度较低的人、基线时无子女的人以及先前缺乏私人健康或住宅保险的人中最为明显。虽然身体健康、经济拮据和移民似乎不太可能造成这种影响，但有证据表明，家庭组建减少、婚姻破裂增加、儿童死亡率增加、飓风导致的家庭破坏、心理压力增加以及风险认知增强是可能的机制。

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引用次数: 0

The impact of vertical integration on health care delivery and costs: Evidence from physician–pharmacy integration 垂直整合对医疗服务提供和成本的影响：来自医药学整合的证据。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-01 DOI: 10.1016/j.jhealeco.2025.103085

Pragya Kakani

Vertical integration among health care providers is an increasingly common feature of U.S. health care. This study investigates the impact of vertical integration in the context of oncology practices launching in-house pharmacies dispensing high-cost oral cancer treatments using a stacked event study design. I find physician–pharmacy integration lowers point-of-sale drug prices paid by plans due to 1.0% lower prices at in-house pharmacies. I also find physician–pharmacy integration increases the number of patients filling new prescriptions by 6.2% and reduces time-to-fill for new prescriptions requiring prior authorization. These effects may arise because in-house pharmacies individually have limited bargaining power and because vertical integration decreases coordination costs, reflected by faster prior authorization.

医疗保健提供者之间的垂直整合是美国医疗保健日益普遍的特征。本研究采用堆叠事件研究设计，调查垂直整合在肿瘤学实践背景下的影响，开展内部药房分配高成本口腔癌治疗。我发现，由于内部药房的价格降低了1.0%，医生与药房的整合降低了计划支付的销售点药品价格。我还发现，医药学整合使填写新处方的患者数量增加了6.2%，并减少了需要事先授权的新处方的填写时间。这些影响可能会出现，因为内部药房单独的议价能力有限，因为垂直整合降低了协调成本，这反映在更快的事先授权上。

引用次数: 0

The effects of wealth shocks on public and private long-term care insurance 财富冲击对公共和私人长期护理保险的影响

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-11-26 DOI: 10.1016/j.jhealeco.2025.103086

Joan Costa-Font , Richard G Frank , Nilesh Raut

The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level variation in stock market wealth from 1996 to 2016, we show that exogenous wealth shocks significantly reduce the probability of LTCI coverage, without altering Medicaid eligibility among people with housing and financial assets. The effect of shocks to liquid wealth strongly dominates the effect of housing wealth changes. A $100 K increase in housing (financial) wealth reduces the likelihood of LTCI coverage by 1.24 (3.22) percentage points.

长期护理服务和支持（LTSS）的融资在很大程度上依赖于住房或金融财富形式的自我保险。从1996年到2016年，我们利用地方市场房价的变化和股票市场财富的个人水平变化，发现外源性财富冲击显著降低了LTCI覆盖的概率，而没有改变住房和金融资产人群的医疗补助资格。对流动财富的冲击的影响强烈地支配着住房财富变化的影响。住房（金融）财富每增加10万美元，LTCI覆盖的可能性就会降低1.24（3.22）个百分点。

引用次数: 0

Nursing shortages and patient outcomes 护理短缺和患者预后

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-11-21 DOI: 10.1016/j.jhealeco.2025.103082

Elaine Kelly , Carol Propper , Ben Zaranko

This paper examines the effect of nurse shortages on healthcare production. Employing novel high-frequency data, we examine what effect the absence of nursing staff has on inpatient mortality and other outcomes associated with nursing care. We find significant adverse mortality impacts of shortages of nurses with degree-level qualifications: for the average ward, the absence of a nurse with university degree-equivalent level training increases the odds of a patient death by approximately 10%, while there is no effect of shortages of less qualified nursing assistants. For qualified nurses, there are returns to firm (hospital) specific human capital: increasing the average firm-specific experience among degree qualified nurses by one year is associated with an 8% reduction in the odds of a patient death, the equivalent to adding three-quarters of an extra qualified nurse to the ward. Adverse mortality impacts of shortages are particularly concentrated among patients of relatively low, rather than high, clinical severity. The largest impacts are for those diagnosed with sepsis, a condition where early detection is important for survival and where nurses have a central role in detection and subsequent control.

本文考察了护士短缺对医疗保健生产的影响。采用新颖的高频数据，我们研究了护理人员的缺席对住院病人死亡率和其他与护理相关的结果的影响。我们发现具有学位水平资格的护士短缺对死亡率有显著的不利影响：对于普通病房来说，缺乏具有大学学位同等水平培训的护士会使患者死亡的几率增加约10%，而资历较低的护理助理的短缺则没有影响。对于合格的护士来说，公司（医院）特定人力资本有回报：获得学位的护士在公司的平均工作经验每增加一年，病人死亡的几率就会降低8%，相当于为病房增加了四分之三的合格护士。短缺对死亡率的不良影响尤其集中在临床严重程度相对较低而不是较高的患者中。影响最大的是那些被诊断为败血症的人，在这种情况下，早期发现对生存很重要，护士在发现和随后的控制方面发挥着核心作用。

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Contraceptive access and infant health outcomes 获得避孕药具和婴儿健康结果

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-11-08 DOI: 10.1016/j.jhealeco.2025.103081

James Flynn

This paper documents an important unintended consequence of expanding contraceptive access; it reduces the rates of adverse infant health outcomes. I study a large family planning initiative in the St. Louis metropolitan area that provided thousands of long-acting reversible contraceptives (LARCs) to reproductive-age women at no cost. Using a synthetic difference-in-differences design, I find that the program led to substantial improvements in infant health, reducing extremely preterm births by 2.18 and infant deaths by 1.74 per 1,000 live births, reductions of approximately 20% for each outcome. I find meaningful reductions for both Black and White mothers, though the effects on Black mothers are less precisely estimated and are smaller as a percentage of the baseline rates, particularly for extremely preterm births.

本文记录了扩大避孕药具获取的一个重要的意外后果；它降低了不良婴儿健康结果的发生率。我研究了圣路易斯市区的一个大型计划生育项目，该项目为育龄妇女免费提供了数千种长效可逆避孕药具（LARCs）。通过综合差异中差异设计，我发现该项目显著改善了婴儿健康状况，每1,000名活产婴儿中极早产率降低了2.18例，婴儿死亡率降低了1.74例，每项结果都降低了约20%。我发现黑人和白人母亲都有明显的减少，尽管对黑人母亲的影响没有得到精确的估计，而且在基线率中所占的百分比也较小，尤其是在极度早产的情况下。

引用次数: 0

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