Journal of Health Economics最新文献

英文中文

Abortion restrictions and intimate partner violence in the Dobbs Era 多布斯时代的堕胎限制和亲密伴侣暴力。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-10-13 DOI: 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.

最高法院里程碑式的2022年多布斯判决推翻了罗伊诉韦德案，并在许多州引发了禁止或严格限制堕胎的法律，极大地改变了美国生殖健康的现状。此前的研究强调了堕胎限制对妇女和家庭的深远影响，其影响超出了对堕胎、生育和生育的直接影响。我们提供了一些关于后多布斯时代堕胎限制如何影响妇女暴露于亲密伴侣暴力（IPV）风险的第一批因果证据。IPV是妇女遭受的最常见的暴力形式，堕胎机会的变化可能对各种投入（经济资源、压力、家庭内部讨价还价）产生意想不到的影响，从而影响关系动态并增加IPV的风险。利用2017-2023年向执法部门报告的IPV事件信息，结合多布斯事件后到堕胎设施的县级旅行距离的变化，分析基于广义的差异中差异方法。我们发现，堕胎限制——通过旅行距离的增加和几乎完全禁止的存在来衡量——显著提高了受治疗县育龄妇女的IPV率，大约提高了7%到10%。这些估计意味着，在受到“触发禁令”处理的州，妇女中至少有9000例IPV额外事件，预计将增加超过12.4亿美元的社会成本。

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引用次数: 0

Prioritisation, risk selection, and illness severity in a mixed healthcare system 混合医疗保健系统中的优先级、风险选择和疾病严重程度。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-29 DOI: 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.

我们研究了疾病严重程度与混合医疗体系下私人参保者使用公共医疗服务之间的联系。我们的理论模型表明，这种关系取决于(1)公共医疗保健提供者实施的优先级，(2)把关系统的严格程度，(3)患者严重程度分布的偏度，以及(4)私营部门的风险选择行为。我们的实证分析表明，疾病严重程度与公共医疗保健使用之间的关系是u型的。正如我们的理论模型所指出的那样，u型曲线的上升部分不一定是私人医疗保健提供者风险选择的结果，而是反映了公共部门的优先级。根据我们的分析，处于疾病严重程度分布两端的个人将受益于用于缩短公共部门等待时间的额外资源。

引用次数: 0

Supply-side opioid restrictions and the retail pharmacy market 供应侧阿片类药物限制和零售药房市场。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-19 DOI: 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.

虽然政策制定者通常会限制被认为对公众健康有风险的商品的销售，但人们对这些政策是否以及如何影响公司业绩的了解相对较少。使用2000-2018年国家建立时间序列数据和差异中的差异策略，我们表明旨在减少阿片类药物过度处方的州“药丸厂”法律减少了零售药房的销售和就业。这些减少在竞争激烈的地区和独立药房最为明显，这是与药房药物转移有关的两个特征。与此同时，在没有药厂法的州，位于边境另一边的药店销售和就业都有所增加。接下来，我们表明，国家药丸厂法律与独立药店关闭的增加有关，尽管药店总数不变。我们的研究结果与这些法律是一致的，这些法律会对药店提供不适当的阿片类药物处方产生不利影响，而不会有意义地改变患者进入零售药店的途径。

引用次数: 0

Financial incentives and COVID-19 vaccinations: Evidence from a conditional cash transfer program 财政激励与COVID-19疫苗接种：来自有条件现金转移支付计划的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-19 DOI: 10.1016/j.jhealeco.2025.103063

Jakub Červený , Tomáš Hellebrandt , Peter Kravec

This paper investigates the effects of a nationwide conditional cash transfer program aimed at increasing COVID-19 vaccine uptake in Slovakia. Due to relatively low vaccination rates and the overcrowding of hospitals during the COVID-19 pandemic, the Slovak government decided to offer €200 or €300 cash transfers to individuals aged 60 or older, conditional on taking any of the available vaccines at the time. The eligibility requirements resulted in a discontinuity in treatment assignment at the age threshold. Our results suggest that the program significantly increased vaccination rates in the population. However, overall costs related to the intervention do not appear to outweigh the benefits.

本文调查了旨在提高斯洛伐克COVID-19疫苗接种率的全国性有条件现金转移计划的效果。由于2019冠状病毒病大流行期间疫苗接种率相对较低，医院人满为患，斯洛伐克政府决定向60岁及以上的个人提供200欧元或300欧元的现金转移支付，条件是接种当时可用的任何疫苗。资格要求导致年龄阈值的治疗分配不连续性。我们的结果表明，该计划显著提高了人口的疫苗接种率。然而，与干预相关的总体成本似乎并未超过收益。

引用次数: 0

The impact of PhD studies on mental health—a longitudinal population study 博士研究对心理健康的影响——一项纵向人口研究。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-19 DOI: 10.1016/j.jhealeco.2025.103070

Sanna Bergvall , Clara Fernström , Eva Ranehill , Anna Sandberg

Recent self-reported and cross-sectional survey evidence documents high levels of mental health problems among PhD students. We study the relationship between PhD studies and mental health care utilization using Swedish administrative records of prescriptions for psychiatric medication for the full population of PhD students. We find that prior to starting their PhD studies, prospective students use psychiatric medication at a rate similar to a matched sample of individuals with a master’s degree. However, following the start of their PhD studies, psychiatric medication use among PhD students increases substantially. This upward trend continues throughout the course of PhD studies, and by the fifth year medication use has increased by 40 percent compared to pre-PhD levels. After the fifth year, when most students in our sample graduate, the psychiatric medication use declines notably. Heterogeneity analyses indicate that the increase in medication use occurs broadly across different student subgroups and academic disciplines, with the exception of students in the medical and health sciences.

最近的自我报告和横断面调查证据表明，博士生的心理健康问题水平很高。我们利用瑞典所有博士生的精神科药物处方管理记录，研究博士研究与心理保健利用之间的关系。我们发现，在开始攻读博士学位之前，未来的学生使用精神科药物的比例与拥有硕士学位的匹配样本相似。然而，在博士生开始攻读博士学位之后，精神科药物的使用在博士生中大幅增加。这种上升趋势在整个博士学习过程中持续下去，到第五年，药物使用比博士前水平增加了40%。第五年后，当我们样本中的大多数学生毕业时，精神科药物的使用显著下降。异质性分析表明，除了医学和健康科学专业的学生外，药物使用的增加广泛发生在不同的学生亚组和学科中。

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引用次数: 0

Seasonal allergies and mental health: Do small health shocks affect suicidality? 季节性过敏和心理健康：小的健康冲击会影响自杀吗？

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-16 DOI: 10.1016/j.jhealeco.2025.103069

Joelle Abramowitz , Shooshan Danagoulian , Owen Fleming

Suicide rates increased 37% in the US from 2000 to 2018; while structural factors are extensively studied, short-term triggers remain less understood. We examine the impact of small exogenous shocks – allergies triggered by seasonal pollen – on suicides. Pollen allergies diminish cognitive function and disrupt sleep—predictors of suicidality. Combining disparate datasets across 34 localities in the United States from 2006 to 2018, we use a specification with granular fixed effects to identify the effect of pollen on suicides from daily variation in each. We find that as pollen levels rise, the count of suicides in a county increases – up to 7.4% more suicides when pollen levels at their highest levels. We find that individuals with a known mental health condition or treatment have 8.6% higher incidence of suicides on days with highest pollen. We also show that this effect is not spurious – Google searches for allergy and depression symptoms increase substantively as pollen levels rise. These estimates are robust to multiple specifications. As climate change extends and intensifies the pollen season, we expect its impact to more than double the number of suicides by the end of the century. These results point toward the importance of relatively small exogenous shocks on suicidality and the potential for relatively inexpensive and routine health care measures such as allergy testing and treatment to improve mental health.

2000年至2018年，美国的自杀率上升了37%；虽然结构性因素得到了广泛的研究，但短期触发因素仍鲜为人知。我们研究了由季节性花粉引发的小外源冲击对自杀的影响。花粉过敏会降低认知功能，破坏睡眠预测自杀。结合2006年至2018年美国34个地区的不同数据集，我们使用具有颗粒固定效应的规范，从每个地区的日常变化中确定花粉对自杀的影响。我们发现，随着花粉水平的上升，一个县的自杀人数也会增加——当花粉水平达到最高水平时，自杀人数会增加7.4%。我们发现，在花粉最高的日子里，有已知精神健康状况或治疗的个体的自杀率高出8.6%。我们还表明，这种影响不是虚假的——谷歌对过敏和抑郁症状的搜索随着花粉水平的上升而大幅增加。这些估计对于多个规范是可靠的。随着气候变化延长和加剧花粉季节，我们预计到本世纪末，其影响将使自杀人数增加一倍以上。这些结果指出了相对较小的外源性冲击对自杀的重要性，以及相对便宜和常规的医疗保健措施的潜力，如过敏测试和治疗，以改善心理健康。

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引用次数: 0

When do supply-side drug control policies save lives? Evidence from pharmacy methadone restrictions 供给侧药物管制政策何时能拯救生命？来自药房美沙酮限制的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-16 DOI: 10.1016/j.jhealeco.2025.103067

J. Travis Donahoe , Coleman Drake

The literature commonly finds that supply-side drug control policies are an ineffective response to drug epidemics because they cause substitution to more dangerous illicit drugs. We document a policy that was implemented in response to the intertwined methadone and prescription opioid epidemics in the U.S. in the early 2000s and that sharply contradicts this. In 2008, the U.S. Drug Enforcement Administration and drug manufacturers halted shipments of highly potent methadone formulations to all pharmacies nationwide due to concerns over their involvement in rising overdose death rates. However, rather than causing substitution to illicit drugs, we show this response caused substitution to safer methadone products and prevented roughly 1,600 overdose deaths over a two-year period. Findings underscore that supply-side drug control policies can be effective responses to drug epidemics in contexts where they are appropriately targeted to push consumers towards safer rather than more harmful substances.

文献通常发现，供应方面的药物管制政策是对毒品流行的无效反应，因为它们导致对更危险的非法药物的替代。我们记录了一项政策，该政策是为了应对21世纪初美国美沙酮和处方阿片类药物相互交织的流行病而实施的，与此截然相反。2008年，美国缉毒局和药品制造商停止向全国所有药店运送强效美沙酮制剂，原因是担心它们与不断上升的过量死亡率有关。然而，我们表明，这种反应并没有导致对非法药物的替代，而是导致了对更安全的美沙酮产品的替代，并在两年内防止了大约1600例过量死亡。调查结果强调指出，如果供应方药物管制政策的目标适当，能够促使消费者使用更安全而不是更有害的物质，那么这些政策可以有效地应对毒品流行。

引用次数: 0

Polluted air, healthier diets: Household food consumption patterns in response to air quality in China 空气污染，饮食健康：中国家庭食物消费模式对空气质量的响应

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-16 DOI: 10.1016/j.jhealeco.2025.103068

Wei Huang , Keyan Xiang , Xi Yu , Hong Zou

This study examines how air pollution affects household food consumption using high-frequency data from over 30,000 households in 25 Chinese cities (2014–2019). Employing an instrumental variable approach based on wind direction, we find that a one-standard-deviation increase in PM2.5 raises weekly expenditure on healthy foods, such as fruits, vegetables, and dairy, by 9.3 yuan, or 11 % of the within-household standard deviation. Spending on less healthy foods remains unaffected, suggesting targeted adjustments toward nutrient-dense foods. These changes improve nutrient intake but are immediate and transitory, with no evidence of lasting dietary shifts. The effects are stronger for higher-income households and those with elderly members, reflecting health concerns and financial flexibility, while lower-income households show constrained responses. Air pollution also reduces dining out expenditures, indicating a substitution toward home-prepared meals. These findings highlight air pollution’s welfare costs, socioeconomic disparities, and the need for equitable public health policies.

本研究利用2014-2019年中国25个城市3万多户家庭的高频数据，研究了空气污染如何影响家庭食品消费。采用基于风向的工具变量方法，我们发现PM2.5每增加一个标准差，每周在健康食品（如水果、蔬菜和乳制品）上的支出就会增加9.3元，占家庭内标准差的11%。在不太健康的食品上的支出不受影响，这表明有针对性地调整营养密集的食品。这些变化改善了营养摄入，但都是直接和短暂的，没有证据表明饮食会发生持久的变化。对高收入家庭和有老年人的家庭的影响更大，反映出健康问题和财务灵活性，而低收入家庭的反应则受到限制。空气污染也减少了外出就餐的支出，表明人们开始转向在家做饭。这些发现强调了空气污染的福利成本、社会经济差异以及制定公平的公共卫生政策的必要性。

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引用次数: 0

Do doctors contribute to socioeconomic inequalities in health care provision? An audit experiment in Tunisia 医生是否助长了医疗服务中的社会经济不平等？突尼斯的审计实验。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-16 DOI: 10.1016/j.jhealeco.2025.103066

Rym Ghouma , Mylène Lagarde , Timothy Powell-Jackson

In this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit experiment in Tunisia, sending standardised patients with the same symptoms to 130 public and private primary care doctors for consultation. Informed by in-depth qualitative work, we vary the attitude and appearance of the patients so that they appear to be “poor” or “middle-class”. We find no evidence that doctors manage patients differently, but they respond to the socioeconomic profile of patients by prescribing fewer expensive drugs and giving out more free drugs to poorer patients. We also show significant differences in communication between patients: doctors are more likely to provide more explanation to richer patients about the diagnosis, the drugs prescribed and the treatment plan. These differences are not explained by time constraints as doctors spent comparable time with both types of patients. To the extent that differences in communication with patients can lead to differences in patients’ health decisions, our results suggest that doctors could contribute indirectly to health inequalities.

在本文中，我们探讨了健康不平等的一个重要但未被充分研究的驱动因素：医生是否在临床遇到不同社会经济背景的患者时采取不同的治疗方法。我们在突尼斯设计了一项审计实验，将具有相同症状的标准化患者送到130名公立和私立初级保健医生那里进行咨询。通过深入的定性工作，我们改变了病人的态度和外表，使他们看起来像是“穷人”或“中产阶级”。我们没有发现任何证据表明医生对病人的管理方式有所不同，但他们对病人的社会经济状况做出了回应，开出了更少的昂贵药物，并向较贫穷的病人提供了更多的免费药物。我们还发现，患者之间的沟通也存在显著差异：医生更有可能对病情丰富的患者提供更多的解释，包括诊断、处方药物和治疗方案。这些差异不能用时间限制来解释，因为医生在这两种类型的患者身上花费的时间相当。在某种程度上，与患者沟通的差异会导致患者健康决策的差异，我们的研究结果表明，医生可能间接导致健康不平等。

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引用次数: 0

Algorithmic decision-making in health care: Evidence from post-acute care in Medicare Advantage 医疗保健中的算法决策：来自医疗保险优势急症后护理的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-08 DOI: 10.1016/j.jhealeco.2025.103055

Jeffrey Marr

Health insurers use predictive algorithms to determine the necessary level of care and deny services they deem unnecessary. Using a difference-in-differences design, I study the partnership of a large Medicare Advantage insurer with a firm that uses a predictive algorithm to aid post-acute care coverage decisions. This partnership led to an immediate and sustained 13 percent decline in the length of skilled nursing facility stays. This effect was partially driven by large declines in longer skilled nursing facility stays (over 30 days). Despite reductions in health care use, I do not observe changes in health outcomes following the adoption of the predictive algorithm.

医疗保险公司使用预测算法来确定必要的护理水平，并拒绝他们认为不必要的服务。我使用差异中的差异设计，研究了一家大型医疗保险优势保险公司与一家公司的合作关系，该公司使用预测算法来帮助急性后护理保险决策。这种合作关系使熟练护理机构的住院时间立即持续减少了13%。造成这种影响的部分原因是在熟练护理机构停留较长时间（超过30天）的人数大幅下降。尽管医疗保健的使用减少了，但我没有观察到采用预测算法后健康结果的变化。

引用次数: 0

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