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}
Pub Date : 2025-10-13DOI: 10.1016/j.jhealeco.2025.103074
Dhaval Dave , Christine Piette Durrance , Bilge Erten , Yang Wang , Barbara Wolfe
In overturning Roe v. Wade and triggering laws in many states that ban or severely restrict abortion, the Supreme Court’s landmark 2022 Dobbs decision dramatically altered the landscape of reproductive health in the U.S. Prior research has highlighted the far-reaching impact of abortion restrictions for women and families, which extend beyond their proximate effects on abortions, births, and fertility. We provide some of the first causal evidence on how abortion restrictions in the post-Dobbs era have impacted women’s risk of exposure to intimate partner violence (IPV). IPV is the most common form of violence experienced by women, and changes in access to abortion may generate unintended effects on various inputs (economic resources, stress, intra-household bargaining) that could affect relationship dynamics and raise the risk of IPV. Leveraging information on IPV incidents reported to law enforcement from 2017–2023 combined with post-Dobbs changes in county-level travel distance to abortion facilities, analyses are based on a generalized difference-in-differences approach. We find that abortion restrictions – alternately measured by the increase in travel distance and by the pres- ence of a near-total ban – significantly increased the rate of IPV for reproductive-age women in treated counties by about seven to 10 percent. These estimates imply at least 9000 additional incidents of IPV among women in the treated “trigger ban” states, which is predicted to add over $1.24 billion in social costs.
{"title":"Abortion restrictions and intimate partner violence in the Dobbs Era","authors":"Dhaval Dave , Christine Piette Durrance , Bilge Erten , Yang Wang , Barbara Wolfe","doi":"10.1016/j.jhealeco.2025.103074","DOIUrl":"10.1016/j.jhealeco.2025.103074","url":null,"abstract":"<div><div>In overturning <em>Roe v. Wade</em> and triggering laws in many states that ban or severely restrict abortion, the Supreme Court’s landmark 2022 <em>Dobbs</em> decision dramatically altered the landscape of reproductive health in the U.S. Prior research has highlighted the far-reaching impact of abortion restrictions for women and families, which extend beyond their proximate effects on abortions, births, and fertility. We provide some of the first causal evidence on how abortion restrictions in the post-<em>Dobbs</em> era have impacted women’s risk of exposure to intimate partner violence (IPV). IPV is the most common form of violence experienced by women, and changes in access to abortion may generate unintended effects on various inputs (economic resources, stress, intra-household bargaining) that could affect relationship dynamics and raise the risk of IPV. Leveraging information on IPV incidents reported to law enforcement from 2017–2023 combined with post-<em>Dobbs</em> changes in county-level travel distance to abortion facilities, analyses are based on a generalized difference-in-differences approach. We find that abortion restrictions – alternately measured by the increase in travel distance and by the pres- ence of a near-total ban – significantly increased the rate of IPV for reproductive-age women in treated counties by about seven to 10 percent. These estimates imply at least 9000 additional incidents of IPV among women in the treated “trigger ban” states, which is predicted to add over $1.24 billion in social costs.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103074"},"PeriodicalIF":3.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460465","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 : 2025-09-29DOI: 10.1016/j.jhealeco.2025.103072
Pau Olivella , Marcos Vera-Hernández
We study the link between illness severity and the use of public health care services by the privately insured under a mixed healthcare system. Our theoretical model shows that this relationship depends on (1) the prioritisation implemented by public healthcare providers, (2) the stringency of the gatekeeping system, (3) the skewness of the patients’ severity distribution, and (4) the private sector’s risk selection behaviour. Our empirical analysis reveals that the relationship between illness severity and public healthcare use is U-shaped. As our theoretical model points out, the increasing part of the U-shape is not necessarily a consequence of risk selection by private healthcare providers, but could instead reflect prioritisation within the public sector. According to our analysis, individuals in both extremes of the illness severity distribution will benefit from additional resources to shorten public sector waiting times.
{"title":"Prioritisation, risk selection, and illness severity in a mixed healthcare system","authors":"Pau Olivella , Marcos Vera-Hernández","doi":"10.1016/j.jhealeco.2025.103072","DOIUrl":"10.1016/j.jhealeco.2025.103072","url":null,"abstract":"<div><div>We study the link between illness severity and the use of public health care services by the privately insured under a mixed healthcare system. Our theoretical model shows that this relationship depends on (1) the prioritisation implemented by public healthcare providers, (2) the stringency of the gatekeeping system, (3) the skewness of the patients’ severity distribution, and (4) the private sector’s risk selection behaviour. Our empirical analysis reveals that the relationship between illness severity and public healthcare use is U-shaped. As our theoretical model points out, the increasing part of the U-shape is not necessarily a consequence of risk selection by private healthcare providers, but could instead reflect prioritisation within the public sector. According to our analysis, individuals in both extremes of the illness severity distribution will benefit from additional resources to shorten public sector waiting times.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103072"},"PeriodicalIF":3.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304186","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 : 2025-09-19DOI: 10.1016/j.jhealeco.2025.103071
Anne M. Burton , Brandyn F. Churchill
While policymakers routinely limit the sale of goods thought to be of risk to public health, relatively less is known about whether and how these policies affect firm performance. Using 2000–2018 National Establishment Time-Series data and a difference-in-differences strategy, we show that state “pill mill” laws intended to reduce the overprescribing of opioids reduced retail pharmacy sales and employment. These reductions were most pronounced in highly competitive areas and for standalone pharmacies – two characteristics associated with pharmacy drug diversion. Meanwhile, pharmacies located across the border in states without a pill mill law experienced increases in sales and employment. Next, we show that state pill mill laws were associated with an increase in standalone pharmacy closures, though the total number of pharmacies was unchanged. Our results are consistent with these laws adversely affecting pharmacies filling inappropriate opioid prescriptions without meaningfully altering patient access to retail pharmacies.
{"title":"Supply-side opioid restrictions and the retail pharmacy market","authors":"Anne M. Burton , Brandyn F. Churchill","doi":"10.1016/j.jhealeco.2025.103071","DOIUrl":"10.1016/j.jhealeco.2025.103071","url":null,"abstract":"<div><div>While policymakers routinely limit the sale of goods thought to be of risk to public health, relatively less is known about whether and how these policies affect firm performance. Using 2000–2018 National Establishment Time-Series data and a difference-in-differences strategy, we show that state “pill mill” laws intended to reduce the overprescribing of opioids reduced retail pharmacy sales and employment. These reductions were most pronounced in highly competitive areas and for standalone pharmacies – two characteristics associated with pharmacy drug diversion. Meanwhile, pharmacies located across the border in states without a pill mill law experienced increases in sales and employment. Next, we show that state pill mill laws were associated with an increase in standalone pharmacy closures, though the total number of pharmacies was unchanged. Our results are consistent with these laws adversely affecting pharmacies filling inappropriate opioid prescriptions without meaningfully altering patient access to retail pharmacies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103071"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304201","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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