Pub Date : 2025-08-09DOI: 10.1016/j.jhealeco.2025.103051
Alex Hoagland, Guan Wang
Allowing pharmacists to directly treat patients may increase equitable access to healthcare and improve patient outcomes, but raises concerns about supply-side moral hazard or patient substitution away from regular physician-based care. We study the effects of a 2023 policy allowing pharmacists to prescribe for minor ailments in Ontario, Canada. We use Advan foot traffic data to measure how this policy affected visits to pharmacies and generated spillover effects on visits to non-pharmacy medical facilities (Research, 2022). Allowing pharmacists to prescribe led to a 16% increase in total visits to pharmacies and a 3% increase in visits to other providers. These increases were concentrated in materially deprived neighborhoods and benefited non-minority, non-immigrant populations the most. We use the policy as exogenous variation to identify substitution elasticities between pharmacy visits and traffic to other medical facilities. Overall, 20% of the increase in traffic to pharmacies spills over into increased use of outpatient-based care. Pharmacy traffic is a substitute for visits to hospitals and emergency departments, potentially as patients rely on pharmacists for triaging rather than emergency care.
{"title":"Prescribing power and equitable access to care: Evidence from pharmacists in Ontario, Canada","authors":"Alex Hoagland, Guan Wang","doi":"10.1016/j.jhealeco.2025.103051","DOIUrl":"10.1016/j.jhealeco.2025.103051","url":null,"abstract":"<div><div>Allowing pharmacists to directly treat patients may increase equitable access to healthcare and improve patient outcomes, but raises concerns about supply-side moral hazard or patient substitution away from regular physician-based care. We study the effects of a 2023 policy allowing pharmacists to prescribe for minor ailments in Ontario, Canada. We use Advan foot traffic data to measure how this policy affected visits to pharmacies and generated spillover effects on visits to non-pharmacy medical facilities (<span><span>Research, 2022</span></span>). Allowing pharmacists to prescribe led to a 16% increase in total visits to pharmacies and a 3% increase in visits to other providers. These increases were concentrated in materially deprived neighborhoods and benefited non-minority, non-immigrant populations the most. We use the policy as exogenous variation to identify substitution elasticities between pharmacy visits and traffic to other medical facilities. Overall, 20% of the increase in traffic to pharmacies spills over into increased use of outpatient-based care. Pharmacy traffic is a substitute for visits to hospitals and emergency departments, potentially as patients rely on pharmacists for triaging rather than emergency care.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103051"},"PeriodicalIF":3.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831250","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}
This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the health outcomes and behaviors of self-employed and unemployed populations, which have been largely overlooked by previous research. To address this, we applied a dosing difference-in-differences (DID) estimation method, exploiting variation in treatment intensity across municipalities. The DID estimation reveals that the SHC-SHG introduction led to a reduction in the proportion of people diagnosed with lifestyle-related diseases in the municipalities that required significant increases in per-capita health checkup program expenses to comply with the new program, with a more pronounced impact on those with multiple diagnoses compared to those with a single diagnosis. A subgroup analysis indicates that health improvements following the SHC-SHG introduction were observed among self-employed workers and homeowners, whereas such improvements were not evident among the unemployed and renters. Moreover, we identify significant behavioral changes among the population in the high-expansion municipalities following the policy introduction. A back-of-the-envelope calculation demonstrates the municipal response to the SHC-SHG introduction is cost-effective.
{"title":"Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan’s local government response to national policy","authors":"Masato Oikawa , Takamasa Otake , Toshihide Awatani , Haruko Noguchi , Akira Kawamura","doi":"10.1016/j.jhealeco.2025.103046","DOIUrl":"10.1016/j.jhealeco.2025.103046","url":null,"abstract":"<div><div>This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the health outcomes and behaviors of self-employed and unemployed populations, which have been largely overlooked by previous research. To address this, we applied a dosing difference-in-differences (DID) estimation method, exploiting variation in treatment intensity across municipalities. The DID estimation reveals that the SHC-SHG introduction led to a reduction in the proportion of people diagnosed with lifestyle-related diseases in the municipalities that required significant increases in per-capita health checkup program expenses to comply with the new program, with a more pronounced impact on those with multiple diagnoses compared to those with a single diagnosis. A subgroup analysis indicates that health improvements following the SHC-SHG introduction were observed among self-employed workers and homeowners, whereas such improvements were not evident among the unemployed and renters. Moreover, we identify significant behavioral changes among the population in the high-expansion municipalities following the policy introduction. A back-of-the-envelope calculation demonstrates the municipal response to the SHC-SHG introduction is cost-effective.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103046"},"PeriodicalIF":3.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866197","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 : 2025-08-07DOI: 10.1016/j.jhealeco.2025.103042
Thomas A. Hegland
Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.
{"title":"Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees","authors":"Thomas A. Hegland","doi":"10.1016/j.jhealeco.2025.103042","DOIUrl":"10.1016/j.jhealeco.2025.103042","url":null,"abstract":"<div><div>Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103042"},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831251","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 : 2025-08-02DOI: 10.1016/j.jhealeco.2025.103044
Benjamin J. McMichael
The increased use of nurse practitioners (NPs) to provide healthcare represents an important policy option to expand access to care. However, restrictive scope-of-practice laws limit NPs’ ability to deliver care in about half of all states. I examine the effect of relaxing these laws (by granting NPs full practice authority) on hospital discharges for conditions classified as prevention quality indicators (PQIs) across 22 states between 2010 and 2019. PQIs measure hospital admissions that may be avoidable with timely outpatient care. I find that full practice authority reduces avoidable hospitalizations for diabetes and other chronic conditions, with particularly consistent effects among privately insured patients. Hospital stays for PQI conditions become longer on average, suggesting that relatively healthier patients are more likely to avoid hospitalization. These results indicate that full practice authority improves access to outpatient care and allows for more efficient use of inpatient resources.
{"title":"The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations","authors":"Benjamin J. McMichael","doi":"10.1016/j.jhealeco.2025.103044","DOIUrl":"10.1016/j.jhealeco.2025.103044","url":null,"abstract":"<div><div>The increased use of nurse practitioners (NPs) to provide healthcare represents an important policy option to expand access to care. However, restrictive scope-of-practice laws limit NPs’ ability to deliver care in about half of all states. I examine the effect of relaxing these laws (by granting NPs full practice authority) on hospital discharges for conditions classified as prevention quality indicators (PQIs) across 22 states between 2010 and 2019. PQIs measure hospital admissions that may be avoidable with timely outpatient care. I find that full practice authority reduces avoidable hospitalizations for diabetes and other chronic conditions, with particularly consistent effects among privately insured patients. Hospital stays for PQI conditions become longer on average, suggesting that relatively healthier patients are more likely to avoid hospitalization. These results indicate that full practice authority improves access to outpatient care and allows for more efficient use of inpatient resources.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103044"},"PeriodicalIF":3.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757935","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 : 2025-07-31DOI: 10.1016/j.jhealeco.2025.103047
Julie Riise , Barton Willage , Alexander Willén
This paper examines the intergenerational consequences of parental participation in government social insurance programs, using one of the largest social insurance programs in the world: sick leave. We exploit quasi-random assignment of patients to general practitioners (GPs) in Norway, who vary in their propensity to certify sick leave of different lengths, to estimate the effects of access to longer sick leave for the marginal individual. Linking administrative data on patients and their children, we show that assignment to a more lenient GP lowers children’s GPA in adolescence, reduces the likelihood of completing upper secondary education, and decreases enrollment in higher education. These effects appear to operate through changes in parental trajectories: more sick leave leads to lower long-term earnings, greater reliance on welfare, and deterioration in mental health.
{"title":"Intergenerational effects of sick leave on child human capital","authors":"Julie Riise , Barton Willage , Alexander Willén","doi":"10.1016/j.jhealeco.2025.103047","DOIUrl":"10.1016/j.jhealeco.2025.103047","url":null,"abstract":"<div><div>This paper examines the intergenerational consequences of parental participation in government social insurance programs, using one of the largest social insurance programs in the world: sick leave. We exploit quasi-random assignment of patients to general practitioners (GPs) in Norway, who vary in their propensity to certify sick leave of different lengths, to estimate the effects of access to longer sick leave for the marginal individual. Linking administrative data on patients and their children, we show that assignment to a more lenient GP lowers children’s GPA in adolescence, reduces the likelihood of completing upper secondary education, and decreases enrollment in higher education. These effects appear to operate through changes in parental trajectories: more sick leave leads to lower long-term earnings, greater reliance on welfare, and deterioration in mental health.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103047"},"PeriodicalIF":3.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772049","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 : 2025-07-29DOI: 10.1016/j.jhealeco.2025.103043
Ziyi Wang , Lijia Wei , Lian Xue
This study examines the role of Artificial Intelligence (AI) in reducing medical overtreatment, a critical healthcare challenge that increases costs and patient risks. In two experiments – with 196 physicians at a hospital and 120 students at a medical school in Wuhan – we use a novel medical prescription task under three incentive schemes: flat (constant pay), progressive (pay increases with treatment quantity), and regressive (penalties for overtreatment) to estimate receptivity to AI assistance and its effects on overtreatment and treatment accuracy, and test whether effects vary with incentives. AI recommendation of a treatment is estimated to increase the probability a physician prescribes it by 25.7–28.4 percentage points (pp), with the largest effect under the flat scheme. Physicians are more receptive to AI recommendations in medical domains with which they are less familiar. We estimate that AI assistance reduces the probability a physician overtreats by 10.9–25.7 pp (15.2–80.3%), with significantly larger absolute and relative effects under the flat scheme compared to progressive and regressive schemes. AI assistance improves physicians’ treatment accuracy by 9.8–13.3 pp (14.6–19.9%), with the largest absolute effect under the regressive scheme. These findings are corroborated by the medical school experiment, which reveals that factors indicative of insufficient ability account for 34% of the explained variation in overtreatment, monetary incentives account for 22%, patient welfare considerations account for 20%, and factors related to defensive medicine for 10%. These results provide valuable insights for healthcare administrators considering AI integration into healthcare systems.
{"title":"Overcoming medical overuse with AI assistance: An experimental investigation","authors":"Ziyi Wang , Lijia Wei , Lian Xue","doi":"10.1016/j.jhealeco.2025.103043","DOIUrl":"10.1016/j.jhealeco.2025.103043","url":null,"abstract":"<div><div>This study examines the role of Artificial Intelligence (AI) in reducing medical overtreatment, a critical healthcare challenge that increases costs and patient risks. In two experiments – with 196 physicians at a hospital and 120 students at a medical school in Wuhan – we use a novel medical prescription task under three incentive schemes: <em>flat</em> (constant pay), <em>progressive</em> (pay increases with treatment quantity), and <em>regressive</em> (penalties for overtreatment) to estimate receptivity to AI assistance and its effects on overtreatment and treatment accuracy, and test whether effects vary with incentives. AI recommendation of a treatment is estimated to increase the probability a physician prescribes it by 25.7–28.4 percentage points (pp), with the largest effect under the flat scheme. Physicians are more receptive to AI recommendations in medical domains with which they are less familiar. We estimate that AI assistance reduces the probability a physician overtreats by 10.9–25.7 pp (15.2–80.3%), with significantly larger absolute and relative effects under the flat scheme compared to progressive and regressive schemes. AI assistance improves physicians’ treatment accuracy by 9.8–13.3 pp (14.6–19.9%), with the largest absolute effect under the regressive scheme. These findings are corroborated by the medical school experiment, which reveals that factors indicative of <em>insufficient ability</em> account for 34% of the explained variation in overtreatment, <em>monetary incentives</em> account for 22%, <em>patient welfare considerations</em> account for 20%, and factors related to <em>defensive medicine</em> for 10%. These results provide valuable insights for healthcare administrators considering AI integration into healthcare systems.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103043"},"PeriodicalIF":3.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779673","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}
The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions—specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.
{"title":"Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth","authors":"David Crainich , Léontine Goldzahl , Florence Jusot , Doriane Mignon","doi":"10.1016/j.jhealeco.2025.103030","DOIUrl":"10.1016/j.jhealeco.2025.103030","url":null,"abstract":"<div><div>The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions—specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103030"},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687590","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 : 2025-07-16DOI: 10.1016/j.jhealeco.2025.103041
Bradley Crowe , Graham Gardner , Cara Haughey
Both contraception and abortion result in fertility reductions, but whether they are substitutes remains an open question. In 2013, Texas passed House Bill 2 (HB2), a policy that imposed strict regulations on abortion providers. Using administrative outpatient records from Texas, we exploit the passage of HB2 to identify the effects of restricted abortion access on the timing and demand for intrauterine devices (IUDs) and vasectomies using an event study design. We find evidence that expectations of limited abortion access significantly increase the demand for IUDs, with no effect on the incidence of vasectomies. These findings support the hypothesis that abortion and contraception are substitutes, particularly for individuals with the capacity to become pregnant.
{"title":"The effects of restricted abortion access on IUDs and vasectomies: Evidence from Texas","authors":"Bradley Crowe , Graham Gardner , Cara Haughey","doi":"10.1016/j.jhealeco.2025.103041","DOIUrl":"10.1016/j.jhealeco.2025.103041","url":null,"abstract":"<div><div>Both contraception and abortion result in fertility reductions, but whether they are substitutes remains an open question. In 2013, Texas passed House Bill 2 (HB2), a policy that imposed strict regulations on abortion providers. Using administrative outpatient records from Texas, we exploit the passage of HB2 to identify the effects of restricted abortion access on the timing and demand for intrauterine devices (IUDs) and vasectomies using an event study design. We find evidence that expectations of limited abortion access significantly increase the demand for IUDs, with no effect on the incidence of vasectomies. These findings support the hypothesis that abortion and contraception are substitutes, particularly for individuals with the capacity to become pregnant.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103041"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779736","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 : 2025-07-12DOI: 10.1016/j.jhealeco.2025.103028
Pelin Akyol , Matt Nolan
This study examines the causal impact of informal caregiving on labour market outcomes and well-being using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We combine an event study design with an instrumental variable (IV) strategy, leveraging exogenous variation from serious illness or injury to a family member. Event study results show that health shocks significantly increase informal caregiving, with particularly large effects for women and older individuals. These shocks also lead to reductions in employment among these groups, as well as declines in hours worked, worsening mental health, and increased reliance on government support and early retirement. To isolate the causal effect of caregiving, we instrument caregiving with the timing of the health shock. IV estimates indicate that assuming caregiving responsibilities leads to large reductions in labour supply—weekly work hours fall by 9.7 h for main carers and up to 22.5 h for carers of partners. Our findings highlight the substantial economic costs of informal caregiving, with important implications for labour force participation in an ageing society.
{"title":"Effects of informal caring on labour market outcomes of carers: Evidence from HILDA","authors":"Pelin Akyol , Matt Nolan","doi":"10.1016/j.jhealeco.2025.103028","DOIUrl":"10.1016/j.jhealeco.2025.103028","url":null,"abstract":"<div><div>This study examines the causal impact of informal caregiving on labour market outcomes and well-being using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We combine an event study design with an instrumental variable (IV) strategy, leveraging exogenous variation from serious illness or injury to a family member. Event study results show that health shocks significantly increase informal caregiving, with particularly large effects for women and older individuals. These shocks also lead to reductions in employment among these groups, as well as declines in hours worked, worsening mental health, and increased reliance on government support and early retirement. To isolate the causal effect of caregiving, we instrument caregiving with the timing of the health shock. IV estimates indicate that assuming caregiving responsibilities leads to large reductions in labour supply—weekly work hours fall by 9.7 h for main carers and up to 22.5 h for carers of partners. Our findings highlight the substantial economic costs of informal caregiving, with important implications for labour force participation in an ageing society.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103028"},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604817","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 : 2025-07-11DOI: 10.1016/j.jhealeco.2025.103033
Johanna Catherine Maclean , Sabrina Wulff Pabilonia
The U.S. lacks a federal paid sick leave policy. To date, 18 states and the District of Columbia have adopted or announced paid sick leave mandates that require employers to provide up to seven days of paid leave per year that can be used for family responsibilities and healthcare. Using time diaries from the 2004–2023 American Time Use Survey and difference-in-differences methods, we estimate the effects of these state paid sick leave mandates on parents’ time spent providing childcare. We find that post-mandate, parental time spent providing primary childcare time increases by 5.8%, with effects being driven by women with younger children. Parents also increase their total time with children by 3.4%, and fathers living with school-aged children only increase their time supervising children while participating in leisure activities by 11.9%. Overall, our findings suggest that paid sick leave mandates allow working parents to better balance work and childcare responsibilities.
{"title":"The effects of state paid sick leave mandates on parental childcare time","authors":"Johanna Catherine Maclean , Sabrina Wulff Pabilonia","doi":"10.1016/j.jhealeco.2025.103033","DOIUrl":"10.1016/j.jhealeco.2025.103033","url":null,"abstract":"<div><div>The U.S. lacks a federal paid sick leave policy. To date, 18 states and the District of Columbia have adopted or announced paid sick leave mandates that require employers to provide up to seven days of paid leave per year that can be used for family responsibilities and healthcare. Using time diaries from the 2004–2023 American Time Use Survey and difference-in-differences methods, we estimate the effects of these state paid sick leave mandates on parents’ time spent providing childcare. We find that post-mandate, parental time spent providing primary childcare time increases by 5.8%, with effects being driven by women with younger children. Parents also increase their total time with children by 3.4%, and fathers living with school-aged children only increase their time supervising children while participating in leisure activities by 11.9%. Overall, our findings suggest that paid sick leave mandates allow working parents to better balance work and childcare responsibilities.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103033"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852749","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号