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Parental health penalty on adult children’s employment: Gender differences and long-term consequences 父母健康状况对成年子女就业的影响:性别差异和长期后果
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.jhealeco.2024.102886
Jiayi Wen , Haili Huang

This study examines the gender-specific and enduring impacts of parental health shocks on adult children’s employment in China, where both formal care and health insurance are limited. Using an event-study approach, we establish a causal link between parental health shocks and a notable decline in female employment, which persists for at least six years following the shock. Male employment, however, exhibits minimal change on average, although this conceals an increase among poor families, indicating a channel beyond heightened informal care. Our findings underscore the consequences of “growing old before getting rich” for developing countries.

在正规医疗和医疗保险都很有限的中国,本研究探讨了父母健康冲击对成年子女就业的性别差异和持久影响。通过事件研究法,我们确定了父母健康冲击与女性就业率显著下降之间的因果关系,这种关系在冲击发生后至少持续六年。然而,男性就业率平均变化极小,尽管这掩盖了贫困家庭就业率的上升,表明除了非正规护理的增加外,还有其他渠道。我们的研究结果强调了发展中国家 "未富先老 "的后果。
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引用次数: 0
The hidden toll of the pandemic: Excess mortality in non-COVID-19 hospital patients 大流行带来的隐性损失:非COVID-19住院病人的超额死亡率
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.jhealeco.2024.102882
Thiemo Fetzer , Christopher Rauh , Clara Schreiner

Seasonal infectious diseases can cause demand and supply pressures that reduce the ability of healthcare systems to provide high-quality care. This may generate negative spillover effects on the health outcomes of patients seeking medical help for unrelated reasons. Separating these indirect burdens from the direct consequences for infected patients is usually impossible due to a lack of suitable data and an absence of population testing. However, this paper finds robust empirical evidence of excess mortality among non-COVID-19 patients in an integrated public healthcare system: the English National Health Service (NHS). Analysing the forecast error in the NHS’ model for predicted mortality, we find at least one additional excess death among patients who sought medical help for reasons unrelated to COVID-19 for every 42 COVID-19-related deaths in the population. We identify COVID-19 pressures as a key driver of non-COVID-19 excess mortality in NHS hospitals during the pandemic, and characterize the hospital populations and medical conditions that were disproportionately affected. Our findings have substantive relevance in shaping our understanding of the wider burden of COVID-19, and other seasonal diseases more generally, and can contribute to debates on optimal public health policy.

季节性传染病会造成供需压力,降低医疗系统提供高质量医疗服务的能力。这可能会对因无关原因寻求医疗帮助的病人的健康结果产生负面溢出效应。由于缺乏合适的数据和人口测试,通常无法将这些间接负担与受感染病人的直接后果区分开来。然而,本文发现了强有力的实证证据,证明在英国国家医疗服务系统(NHS)这一综合公共医疗系统中,非 COVID-19 患者的死亡率过高。通过分析 NHS 预测死亡率模型中的预测误差,我们发现在因与 COVID-19 无关的原因寻求医疗帮助的患者中,每 42 例与 COVID-19 相关的死亡中,就至少有一例额外的超额死亡。我们发现 COVID-19 压力是大流行期间英国国家医疗服务系统医院非 COVID-19 超常死亡率的主要驱动因素,并描述了受影响过大的医院人群和医疗条件。我们的研究结果对于加深我们对 COVID-19 以及其他季节性疾病的更广泛负担的理解具有实质性意义,并有助于就最佳公共卫生政策展开讨论。
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引用次数: 0
Free-for-all: Does crowding impact outcomes because hospital emergency departments do not prioritise effectively? 自由散漫:医院急诊科没有有效地确定优先次序,拥挤是否会影响治疗效果?
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-04-10 DOI: 10.1016/j.jhealeco.2024.102881
Igor Francetic, Rachel Meacock, Matt Sutton

Unexpected peaks in volumes of attendances at hospital emergency departments (EDs) have been found to affect waiting times, intensity of care and outcomes. We ask whether these effects of ED crowding on patients are caused by poor clinical prioritisation or a quality-quantity trade-off generated by a binding capacity constraint. We study the effects of crowding created by lower-severity patients on the outcomes of approximately 13 million higher-severity patients attending the 140 public EDs in England between April 2016 and March 2017. Our identification approach relies on high-dimensional fixed effects to account for planned capacity. Unexpected demand from low-severity patients has very limited effects on the care provided to higher-severity patients throughout their entire pathway in ED. Detrimental effects of crowding caused by low-severity patients materialise only at very high levels of unexpected demand, suggesting that binding resource constraints impact patient care only when demand greatly exceeds the ED's expectations. These effects are smaller than those caused by crowding induced by higher-severity patients, suggesting an efficient prioritisation of incoming patients in EDs.

研究发现,医院急诊科(ED)就诊量的意外高峰会影响候诊时间、护理强度和治疗效果。我们的问题是,急诊室拥挤对患者造成的这些影响是由于临床优先排序不当造成的,还是由于有约束力的容量限制所产生的质量-数量权衡造成的。我们研究了 2016 年 4 月至 2017 年 3 月期间,英格兰 140 家公立急诊室中约 1300 万名严重程度较高的患者就诊时,低严重程度患者造成的拥挤对其治疗效果的影响。我们的识别方法依赖于高维固定效应来考虑计划容量。低严重程度患者的意外需求对严重程度较高的患者在急诊室就诊的整个过程中的护理影响非常有限。只有在意外需求量非常大的情况下,低危重病人造成的拥挤才会产生不利影响,这表明只有当需求量大大超出急诊室的预期时,约束性资源限制才会对病人护理产生影响。这些影响比严重程度较高的病人造成的拥挤影响要小,这表明急诊室对入院病人进行了有效的优先排序。
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引用次数: 0
Politics and health care spending in the United States: A case study from the passage of the 2003 Medicare Modernization Act 美国的政治与医疗支出:2003 年《医疗保险现代化法案》通过后的案例研究
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-04-04 DOI: 10.1016/j.jhealeco.2024.102878
Zack Cooper , Amanda Kowalski , Eleanor Neff Powell , Jennifer D. Wu

This paper analyzes the interplay between congressional politics, the actions of the executive branch, and hospitals’ regulated Medicare payments. We focus on the 2003 Medicare Modernization Act (MMA) and analyze a provision in the law – Section 508 – that raised certain hospitals’ regulated payments. We show, via our analysis of the Section 508 program, that Medicare payments are malleable and can be influenced by political dynamics. In the cross-section, hospitals represented by members of Congress who voted “yea” on the MMA were more likely to receive Section 508 payment increases. We interviewed the Secretary of Health and Human Services who oversaw the MMA, and he described how these payment increases were designed to win support for the law. The Section 508 payment increases raised hospitals’ activity and spending. Members of Congress representing recipient hospitals received increased campaign contributions after the Section 508 payment increases were extended. Ultimately, our analysis highlights how Medicare payment increases can serve as an appealing tool for legislative leaders working to win votes for wider pieces of legislation.

本文分析了国会政治、行政部门行动和医院受监管的医疗保险支付之间的相互作用。我们将重点放在 2003 年的《医疗保险现代化法案》(Medicare Modernization Act,MMA)上,并分析了该法案中的一项条款--第 508 条--该条款提高了某些医院的规定支付额度。我们通过对 508 条款的分析表明,医疗保险支付具有可塑性,会受到政治动态的影响。在横截面上,对《医疗保险法》投赞成票的国会议员所代表的医院更有可能获得第 508 款的支付增长。我们采访了负责监督 MMA 的卫生与公众服务部部长,他介绍了增加支付的目的是为了赢得对法律的支持。第 508 条支付的增加提高了医院的活动和支出。在第 508 款增加支付后,代表受援医院的国会议员收到了更多的竞选捐款。最终,我们的分析强调了医疗保险支付的增加如何成为立法领导人为更广泛的立法赢得选票的一个吸引人的工具。
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引用次数: 0
Competition, quality and integrated health care 竞争、质量和综合医疗保健
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-28 DOI: 10.1016/j.jhealeco.2024.102880
Kurt R. Brekke , Luigi Siciliani , Odd Rune Straume

Integration of health care services has been promoted in several countries to improve the quality and coordination of care. We investigate the effects of such integration in a model where providers compete on quality to attract patients under regulated prices. We identify countervailing effects of integration on quality of care. While integration makes coordination of care more profitable for providers due to bundled payments, it also softens competition as patient choice is restricted. We also identify circumstances due to asymmetries across providers and/or services under which integration either increases or reduces the quality of services provided. In the absence of synergies, integration generally leads to increases in quality for some services and reductions for others. The corresponding effect on health benefits depends largely on whether integration leads to quality dispersion or convergence across services. If the softening of competition effect is weak, integration is likely to improve quality and patient outcomes.

为提高医疗服务的质量和协调性,一些国家提倡整合医疗服务。我们在一个模型中研究了这种整合的影响,在该模型中,医疗服务提供者在受管制的价格下,通过质量竞争来吸引患者。我们发现了整合对医疗质量的反作用。虽然由于捆绑支付,整合使医疗服务提供者在协调医疗服务时更有利可图,但由于患者的选择受到限制,整合也削弱了竞争。我们还发现,由于医疗服务提供者和/或服务之间的不对称,整合要么会提高服务质量,要么会降低服务质量。在没有协同效应的情况下,整合一般会导致某些服务质量的提高,而另一些服务质量的降低。对健康效益的相应影响在很大程度上取决于一体化是导致服务质量分散还是趋同。如果竞争软化效应较弱,整合就有可能提高质量,改善病人的治疗效果。
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引用次数: 0
The demand for skills training among Medicaid home-based caregivers 医疗补助家庭护理人员对技能培训的需求
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-26 DOI: 10.1016/j.jhealeco.2024.102877
Christopher J. Cronin , Ethan M.J. Lieber

Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.

医疗补助计划每年花费近 1000 亿美元用于残疾人的家庭和社区护理。其中大部分护理服务由个人护理助理提供,但他们中很少有人接受过与所提供服务相关的培训。我们进行了一项随机对照试验,以估算他们对培训的需求。我们发现,这些护理人员中有 13% 在没有激励措施的情况下完成了培训。如果向这些护理人员支付四倍于其小时工资的报酬,则培训完成率会提高约 9 个百分点。另外的实验结果表明,在确认知道培训的人中,经济激励措施使培训完成率从 35% 提高到 58%。基于这些结果的需求曲线表明,虽然许多护理人员都很重视培训机会,但旨在普及培训的政策需要大量的经济激励措施。
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引用次数: 0
Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health 生不逢时:探索种族隔离对婴儿健康的因果影响
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-20 DOI: 10.1016/j.jhealeco.2024.102876
Hoa Vu , Tiffany L. Green , Laura E.T. Swan

Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults’ health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black–White inequality over the life course.

先前的研究发现,高度的居住种族隔离或种族/民族群体相互隔离的程度与婴儿健康状况恶化有关,尤其是在非西班牙裔(NH)黑人婴儿群体中。然而,由于受到隔离是非随机的,目前还不清楚隔离是否以及在多大程度上与婴儿健康有因果关系。为了克服这一经验上的局限性,我们利用 19 世纪铁轨位置的外生变化来预测当代的种族隔离,这种方法由 Ananat(2011 年)首次提出。与之前的文献一致,我们发现住宅隔离与该地区黑人婴儿的负面出生结果有显著的统计学关联。使用 OLS 方法低估了隔离对婴儿健康的负面影响。我们未能检测到对新罕布什尔州白人婴儿健康结果的类似影响。此外,我们还发现了住宅隔离可能影响黑人婴儿健康结果的几种关键机制,包括前三个月获得产前护理的机会较少、反黑人偏见程度较高、交通障碍较多以及粮食不安全程度增加。鉴于不良的出生结果会对成年人的健康和福祉产生不利影响,研究结果表明,胎儿时期受到的住宅隔离可能会对黑人-白人一生中的不平等产生重要影响。
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引用次数: 0
Analyzing health outcomes measured as bounded counts 分析以有界计数衡量的健康结果
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-17 DOI: 10.1016/j.jhealeco.2024.102875
John Mullahy

This paper assesses analytical strategies that respect the bounded-count nature of health outcomes encountered often in empirical applications. Absent in the literature is a comprehensive discussion and critique of strategies for analyzing and understanding such data. The paper's goal is to provide an in-depth consideration of prominent issues arising in and strategies for undertaking such analyses, emphasizing the merits and limitations of various analytical tools empirical researchers may contemplate. Three main topics are covered. First, bounded-count health outcomes' measurement properties are reviewed and their implications assessed. Second, issues arising when bounded-count outcomes are the objects of concern in evaluations are described. Third, the (conditional) probability and moment structures of bounded-count outcomes are derived and corresponding specification and estimation strategies presented with particular attention to partial effects. Many questions may be asked of such data in health research and a researcher's choice of analytical method is often consequential.

本文评估了在实证应用中经常遇到的尊重健康结果有界计数性质的分析策略。文献中缺乏对分析和理解此类数据的策略的全面讨论和评论。本文的目标是深入探讨进行此类分析时出现的突出问题和策略,强调实证研究人员可能考虑的各种分析工具的优点和局限性。主要涉及三个主题。首先,回顾有界数健康结果的测量特性,并评估其影响。其次,介绍在评估中以有界数结果为关注对象时出现的问题。第三,推导出有界计数结果的(条件)概率和矩结构,并介绍相应的规范和估算策略,特别关注部分效应。在健康研究中,可能会对此类数据提出许多问题,研究人员对分析方法的选择往往会产生影响。
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引用次数: 0
Pricing above value: Selling to a market with selection problems 定价高于价值:向存在选择问题的市场销售
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.jhealeco.2024.102868
Jan Boone

This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine.

本文表明,下游市场的选择激励扭曲了上游价格。投入品的价格有可能高于商品对最终消费者的价值。我们将这一观点应用于向存在选择问题的医疗保险市场销售药品的制药公司。我们明确了药品以高于治疗价值的价格出售的条件。该模型的另一个特点是,存在过度的私人动机来缩小市场规模,例如以个性化医疗的形式。
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引用次数: 0
Effects of nurse visit copayment on primary care use: Do low-income households pay the price? 护士出诊共付额对初级保健使用的影响:低收入家庭是否付出了代价?
IF 3.5 2区 经济学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.jhealeco.2024.102866
Tapio Haaga , Petri Böckerman , Mika Kortelainen , Janne Tukiainen

Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%–10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.

提供初级医疗服务的护士越来越多,但有关费用分担的文献却很少关注护士上门服务。我们采用了一种交错差分设计,研究了对芬兰成年人使用公共初级医疗服务的情况采用 10 欧元的护士就诊共付额所产生的影响。我们发现,在为期一年的跟踪调查中,共付额使护士上门服务减少了 9%-10%。收入的绝对值存在异质性,但相对值不存在异质性。对全科医生(GP)使用的溢出效应是负面的,但规模较小,统计意义不一。我们还分析了随后在全国范围内取消共付额的情况。然而,由于平行趋势假设缺乏可信度,我们没有就此得出因果结论。总体而言,我们的分析表明,适度的共付额可能会对低收入人群造成更大的就医障碍。我们还提供了一个将分析前计划用于回顾性观察数据的例子。
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引用次数: 0
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Journal of Health Economics
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