Pub Date : 2025-11-26DOI: 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.
{"title":"The effects of wealth shocks on public and private long-term care insurance","authors":"Joan Costa-Font , Richard G Frank , Nilesh Raut","doi":"10.1016/j.jhealeco.2025.103086","DOIUrl":"10.1016/j.jhealeco.2025.103086","url":null,"abstract":"<div><div>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 <em>local market variation</em> 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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"106 ","pages":"Article 103086"},"PeriodicalIF":3.6,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980791","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 : 2025-11-21DOI: 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.
{"title":"Nursing shortages and patient outcomes","authors":"Elaine Kelly , Carol Propper , Ben Zaranko","doi":"10.1016/j.jhealeco.2025.103082","DOIUrl":"10.1016/j.jhealeco.2025.103082","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"105 ","pages":"Article 103082"},"PeriodicalIF":3.6,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665689","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 : 2025-11-08DOI: 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.
{"title":"Contraceptive access and infant health outcomes","authors":"James Flynn","doi":"10.1016/j.jhealeco.2025.103081","DOIUrl":"10.1016/j.jhealeco.2025.103081","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103081"},"PeriodicalIF":3.6,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519701","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 : 2025-11-06DOI: 10.1016/j.jhealeco.2025.103080
Hanming Fang , Ami Ko
To limit price variation across consumers in the Health Insurance Marketplaces, the Patient Protection and Affordable Care Act (ACA) mandates that insurance plans be uniformly priced across multiple counties within the same geographic rating area. However, the ACA does not require insurers to offer plans in every county, creating the potential for partial rating area offering. Using data from the federally-facilitated Marketplaces, we find that selective participation is both prevalent and persistent throughout the 2016–2022 period. We investigate whether this selective offering reflects anticompetitive market segmentation. In six of the seven years, the evidence is inconsistent with collusive motives. Only in 2018, a year characterized by a particularly low number of insurers with extensive multimarket contact, do we find evidence suggesting anticompetitive motives were among the drivers of selective participation within rating areas.
为了限制健康保险市场中消费者之间的价格差异，《患者保护和平价医疗法案》（Patient Protection and Affordable Care Act， ACA）要求保险计划在同一地理评级区域内的多个县统一定价。然而，ACA并没有要求保险公司在每个县都提供保险计划，这就创造了部分评级地区提供保险的可能性。使用来自联邦政府推动的市场的数据，我们发现选择性参与在2016-2022年期间既普遍又持续。我们调查这种选择性提供是否反映了反竞争的市场细分。在这七年中，有六年的证据与共谋动机不一致。只有在2018年，即拥有广泛多市场联系的保险公司数量特别少的一年，我们才发现有证据表明，反竞争动机是评级领域选择性参与的驱动因素之一。
{"title":"Partial rating area offering and tests for anticompetitive market segmentation in the ACA Marketplaces","authors":"Hanming Fang , Ami Ko","doi":"10.1016/j.jhealeco.2025.103080","DOIUrl":"10.1016/j.jhealeco.2025.103080","url":null,"abstract":"<div><div>To limit price variation across consumers in the Health Insurance Marketplaces, the Patient Protection and Affordable Care Act (ACA) mandates that insurance plans be uniformly priced across multiple counties within the same geographic rating area. However, the ACA does not require insurers to offer plans in every county, creating the potential for <em>partial rating area offering</em>. Using data from the federally-facilitated Marketplaces, we find that selective participation is both prevalent and persistent throughout the 2016–2022 period. We investigate whether this selective offering reflects anticompetitive market segmentation. In six of the seven years, the evidence is inconsistent with collusive motives. Only in 2018, a year characterized by a particularly low number of insurers with extensive multimarket contact, do we find evidence suggesting anticompetitive motives were among the drivers of selective participation within rating areas.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103080"},"PeriodicalIF":3.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497382","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 : 2025-10-30DOI: 10.1016/j.jhealeco.2025.103075
Dung D. Le , Teresa Molina , Yoko Ibuka , Rei Goto
Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers’ exposure to the ban across cohorts and in “treatment intensity,” calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.
{"title":"The intergenerational health effects of child marriage bans","authors":"Dung D. Le , Teresa Molina , Yoko Ibuka , Rei Goto","doi":"10.1016/j.jhealeco.2025.103075","DOIUrl":"10.1016/j.jhealeco.2025.103075","url":null,"abstract":"<div><div>Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers’ exposure to the ban across cohorts and in “treatment intensity,” calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103075"},"PeriodicalIF":3.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416386","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 : 2025-10-30DOI: 10.1016/j.jhealeco.2025.103078
Manuel Bagues , Carmen Villa
Many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 over the past decades. These policies often comprise a bundle of reforms including restrictions on alcohol sales to minors, venue access limitations, and advertising controls. We provide novel evidence of the impact of MLDA changes on educational outcomes by exploiting their staggered timing across Spanish regions. Alcohol consumption among adolescents aged 14–17 decreased by 7 to 17% and exam performance improved by 4% of a standard deviation. We also observe a 10% decrease in the use of anxiolytics and hypnosedatives, suggesting improved mental health. There are no significant changes in the use of other substances, leisure habits or study effort. These findings are consistent with neurobiological evidence that alcohol directly impairs cognitive development and increases anxiety-related behaviours. Reducing teenage alcohol consumption represents a substantial opportunity to improve educational outcomes in Europe, where youth drinking rates remain notably high.
{"title":"Minimum legal drinking age and educational outcomes","authors":"Manuel Bagues , Carmen Villa","doi":"10.1016/j.jhealeco.2025.103078","DOIUrl":"10.1016/j.jhealeco.2025.103078","url":null,"abstract":"<div><div>Many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 over the past decades. These policies often comprise a bundle of reforms including restrictions on alcohol sales to minors, venue access limitations, and advertising controls. We provide novel evidence of the impact of MLDA changes on educational outcomes by exploiting their staggered timing across Spanish regions. Alcohol consumption among adolescents aged 14–17 decreased by 7 to 17% and exam performance improved by 4% of a standard deviation. We also observe a 10% decrease in the use of anxiolytics and hypnosedatives, suggesting improved mental health. There are no significant changes in the use of other substances, leisure habits or study effort. These findings are consistent with neurobiological evidence that alcohol directly impairs cognitive development and increases anxiety-related behaviours. Reducing teenage alcohol consumption represents a substantial opportunity to improve educational outcomes in Europe, where youth drinking rates remain notably high.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103078"},"PeriodicalIF":3.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466382","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 : 2025-10-27DOI: 10.1016/j.jhealeco.2025.103079
Daniel S. Hamermesh , Michał Myck
We consider how a physical disability alters patterns of time use. A disability may raise the time cost of some activities, making them differentially less worth doing; or it may make switching activities more costly. Both possibilities predict that fewer activities will be undertaken, with more time spent on each. These explanations describe our correlational findings based on non-working ATUS 2008–22 respondents ages 70+, 32 % of whom self-assess a disability. Data from the 2013 Polish Time Use Survey, where disability is medically certified, show similar results and demonstrate the same loss of variety over multiple days. Remarkably similar basic results are found using homogenized British, Canadian, French, Italian, and Spanish time diaries. Evidence from a “sesqui-difference” test on the ATUS data hints that the relationship is causal. Overall, a mobility/physical disability leads an otherwise identical person to engage in over 10 % fewer activities on a typical day. The lost variety represents extra costs equivalent in data from six countries to over twice the average annual income of older individuals.
{"title":"The time cost of a disability","authors":"Daniel S. Hamermesh , Michał Myck","doi":"10.1016/j.jhealeco.2025.103079","DOIUrl":"10.1016/j.jhealeco.2025.103079","url":null,"abstract":"<div><div>We consider how a physical disability alters patterns of time use. A disability may raise the time cost of some activities, making them differentially less worth doing; or it may make switching activities more costly. Both possibilities predict that fewer activities will be undertaken, with more time spent on each. These explanations describe our correlational findings based on non-working ATUS 2008–22 respondents ages 70+, 32 % of whom self-assess a disability. Data from the 2013 Polish Time Use Survey, where disability is medically certified, show similar results and demonstrate the same loss of variety over multiple days. Remarkably similar basic results are found using homogenized British, Canadian, French, Italian, and Spanish time diaries. Evidence from a “sesqui-difference” test on the ATUS data hints that the relationship is causal. Overall, a mobility/physical disability leads an otherwise identical person to engage in over 10 % fewer activities on a typical day. The lost variety represents extra costs equivalent in data from six countries to over twice the average annual income of older individuals.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103079"},"PeriodicalIF":3.6,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446419","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 : 2025-10-24DOI: 10.1016/j.jhealeco.2025.103073
Dhaval Dave , Bilge Erten , Pinar Keskin , Shuo Zhang
Substance abuse is a major risk factor for intimate partner violence (IPV). We investigate how a key supply-side intervention – the abuse-deterrent reformulation of a widely-diverted opioid, OxyContin – affected IPV. Our results indicate counties with greater baseline rates of prescription opioid usage experienced relatively larger declines in IPV after OxyContin’s reformulation. The reformulation reduced IPV only in states with smaller illicit drug markets, while states with larger illicit drug markets experienced increased heroin-involved IPV due to substitution towards illicit opioids. Our results underscore the importance of identifying populations at high risk of substitution to illicit opioids and moderating this risk with evidence-based policies.
{"title":"From addiction to aggression: The spillover effects of opioid policies on intimate partner violence","authors":"Dhaval Dave , Bilge Erten , Pinar Keskin , Shuo Zhang","doi":"10.1016/j.jhealeco.2025.103073","DOIUrl":"10.1016/j.jhealeco.2025.103073","url":null,"abstract":"<div><div>Substance abuse is a major risk factor for intimate partner violence (IPV). We investigate how a key supply-side intervention – the abuse-deterrent reformulation of a widely-diverted opioid, OxyContin – affected IPV. Our results indicate counties with greater baseline rates of prescription opioid usage experienced relatively larger declines in IPV after OxyContin’s reformulation. The reformulation reduced IPV only in states with smaller illicit drug markets, while states with larger illicit drug markets experienced increased heroin-involved IPV due to substitution towards illicit opioids. Our results underscore the importance of identifying populations at high risk of substitution to illicit opioids and moderating this risk with evidence-based policies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103073"},"PeriodicalIF":3.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410279","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 : 2025-10-20DOI: 10.1016/j.jhealeco.2025.103077
Andrea Bernini , Sven A. Hartmann
This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 9.5 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.
{"title":"The effect of West German television on smoking and health: A natural experiment from German reunification","authors":"Andrea Bernini , Sven A. Hartmann","doi":"10.1016/j.jhealeco.2025.103077","DOIUrl":"10.1016/j.jhealeco.2025.103077","url":null,"abstract":"<div><div>This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 9.5 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103077"},"PeriodicalIF":3.6,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460430","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 : 2025-10-17DOI: 10.1016/j.jhealeco.2025.103076
Thomas Thivillon
This paper uses original panel data from Senegal to evaluate the effect of elderly household members’ deaths on the educational attainment of female children. Using a triple-difference strategy with child fixed-effects, I show that the death of a co-resident aged 60 or older is associated with 20% additional education completed over a period of 4 years by affected girls. I present evidence that changes in demand for informal caregiving among adolescent girls within the household are one of the mechanisms at play. These results highlight the central role of female teenagers in caregiving activities and suggest that policies that increase the availability of formal care for the elderly could reduce gender inequalities in education in contexts similar to Senegal.
{"title":"Demand for informal caregiving and human capital accumulation: Evidence from elderly deaths in Senegal","authors":"Thomas Thivillon","doi":"10.1016/j.jhealeco.2025.103076","DOIUrl":"10.1016/j.jhealeco.2025.103076","url":null,"abstract":"<div><div>This paper uses original panel data from Senegal to evaluate the effect of elderly household members’ deaths on the educational attainment of female children. Using a triple-difference strategy with child fixed-effects, I show that the death of a co-resident aged 60 or older is associated with 20% additional education completed over a period of 4 years by affected girls. I present evidence that changes in demand for informal caregiving among adolescent girls within the household are one of the mechanisms at play. These results highlight the central role of female teenagers in caregiving activities and suggest that policies that increase the availability of formal care for the elderly could reduce gender inequalities in education in contexts similar to Senegal.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103076"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394760","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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