Pub Date : 2025-09-01DOI: 10.1016/j.jhealeco.2025.103031
Conor Lennon , Johanna Catherine Maclean , Keith Teltser
{"title":"Corrigendum to “Ridesharing and substance use disorder treatment” [Journal of Health Economics Volume 99, January 2025, 102941]","authors":"Conor Lennon , Johanna Catherine Maclean , Keith Teltser","doi":"10.1016/j.jhealeco.2025.103031","DOIUrl":"10.1016/j.jhealeco.2025.103031","url":null,"abstract":"","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103031"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709684","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 : 2025-09-01Epub Date: 2025-08-07DOI: 10.1016/j.jhealeco.2025.103048
Katie Jajtner, Yang Wang
Intergenerational health mobility is an important marker of health opportunity and equity, yet empirical research in this field remains sparse, particularly concerning the effects of public policies. We present the first empirical evidence of the effects of the Earned Income Tax Credits (EITC), one of the largest and most effective anti-poverty programs in the US, on intergenerational health mobility. We use self-reported health status from the Panel Study of Income Dynamics and explore temporal, geographic, and family structure variations in childhood exposure to maximum EITC benefits. We find that the EITC generally improved intergenerational health mobility, especially upward health mobility.
{"title":"The effects of earned income tax credits on intergenerational health mobility in the United States.","authors":"Katie Jajtner, Yang Wang","doi":"10.1016/j.jhealeco.2025.103048","DOIUrl":"10.1016/j.jhealeco.2025.103048","url":null,"abstract":"<p><p>Intergenerational health mobility is an important marker of health opportunity and equity, yet empirical research in this field remains sparse, particularly concerning the effects of public policies. We present the first empirical evidence of the effects of the Earned Income Tax Credits (EITC), one of the largest and most effective anti-poverty programs in the US, on intergenerational health mobility. We use self-reported health status from the Panel Study of Income Dynamics and explore temporal, geographic, and family structure variations in childhood exposure to maximum EITC benefits. We find that the EITC generally improved intergenerational health mobility, especially upward health mobility.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"103048"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812642","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 : 2025-08-27DOI: 10.1016/j.jhealeco.2025.103050
Yuan Lyu , Zhaocheng Zhang
The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing the first empirical evidence on the effects of provider mergers on quality, using evidence from the English primary care market. Examining all provider mergers from 2014 to 2018, we find that mergers improve certain aspects of clinical quality management, but they do not translate into broader population-level clinical quality gains, and patient satisfaction declines significantly. Importantly, the effects vary by merger motivation and the size of the merging parties, rather than their geographic proximity. Survival-driven mergers help sustain care quality and patient access, whereas efficiency-driven mergers lead to greater quality deterioration. Mergers between larger practices also lead to more negative outcomes than those involving smaller practices. In contrast, we find no significant difference between within-market and cross-market mergers. An exploration of the mechanism reveals that changes in market concentration do not explain the observed quality outcomes. Instead, shifts in workforce composition, driven by the underlying merger motivations, play a key role.
{"title":"Impact of primary care market mergers on quality: Evidence from the English NHS","authors":"Yuan Lyu , Zhaocheng Zhang","doi":"10.1016/j.jhealeco.2025.103050","DOIUrl":"10.1016/j.jhealeco.2025.103050","url":null,"abstract":"<div><div>The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing the first empirical evidence on the effects of provider mergers on quality, using evidence from the English primary care market. Examining all provider mergers from 2014 to 2018, we find that mergers improve certain aspects of clinical quality management, but they do not translate into broader population-level clinical quality gains, and patient satisfaction declines significantly. Importantly, the effects vary by merger motivation and the size of the merging parties, rather than their geographic proximity. Survival-driven mergers help sustain care quality and patient access, whereas efficiency-driven mergers lead to greater quality deterioration. Mergers between larger practices also lead to more negative outcomes than those involving smaller practices. In contrast, we find no significant difference between within-market and cross-market mergers. An exploration of the mechanism reveals that changes in market concentration do not explain the observed quality outcomes. Instead, shifts in workforce composition, driven by the underlying merger motivations, play a key role.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103050"},"PeriodicalIF":3.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092768","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 : 2025-08-27DOI: 10.1016/j.jhealeco.2025.103052
Hoyt Bleakley
While health affects economic development and wellbeing through a variety of pathways, one commonly suggested channel is a “horizon” mechanism in which increased longevity induces additional education. A recent literature devotes much attention to how much education responds to increasing longevity, while this study asks instead what impact this specific channel has on wellbeing (welfare). I note that death is like a tax on human-capital investments, which suggests using a standard tool of introductory economics: triangles. I estimate the (triangular) gain from reoptimization when education adjusts to lower adult mortality. Even for implausibly large responses of education to survival differences, almost all of today’s low-human-development countries, if switched instantaneously to Japan’s survival curve, would place a value on this channel of less than 3% of income. (This contrasts with a 40% ‘rectangle’ that they would gain even if education were held fixed.) Calibrating the model instead with well identified studies, I find that the horizon triangle for the typical low-income country is less than a percent of lifetime income.
{"title":"Longevity, Education, and Income: How large is the triangle?","authors":"Hoyt Bleakley","doi":"10.1016/j.jhealeco.2025.103052","DOIUrl":"10.1016/j.jhealeco.2025.103052","url":null,"abstract":"<div><div>While health affects economic development and wellbeing through a variety of pathways, one commonly suggested channel is a “horizon” mechanism in which increased longevity induces additional education. A recent literature devotes much attention to how much education responds to increasing longevity, while this study asks instead what impact this specific channel has on wellbeing (welfare). I note that death is like a tax on human-capital investments, which suggests using a standard tool of introductory economics: triangles. I estimate the (triangular) gain from reoptimization when education adjusts to lower adult mortality. Even for implausibly large responses of education to survival differences, almost all of today’s low-human-development countries, if switched instantaneously to Japan’s survival curve, would place a value on this channel of less than 3% of income. (This contrasts with a 40% ‘rectangle’ that they would gain even if education were held fixed.) Calibrating the model instead with well identified studies, I find that the horizon triangle for the typical low-income country is less than a percent of lifetime income.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103052"},"PeriodicalIF":3.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911839","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 : 2025-08-22DOI: 10.1016/j.jhealeco.2025.103054
Keith M. Drake , Thomas G. McGuire
The tradeoff between incentives to invest in R&D and efficient pricing takes a special form in the pharmaceutical sector. Brand drugs command high prices until generic competition begins, the timing of which usually depends on the outcome of patent infringement litigation. One potential outcome is a collusive agreement between the brand and a potential generic competitor that delays competition, with the brand sharing the profits from the delay by paying the generic challenger. Collusive patent settlements have plagued competition in pharmaceutical markets globally and especially in the U.S., the world’s largest market. This paper estimates the cost of these collusive settlements to U.S. drug purchasers using stock price movements. If the brand firm’s increase in profits from collusion is capitalized into stock prices, the change in value upon a settlement announcement can be used to estimate the new profit flows from higher prices to purchasers. We assembled data on 64 settlements reached during 2014–2023 and used the announcement descriptions and information that surfaced later to identify 17 potentially collusive settlements. We applied event study methods and found, consistent with prior research, that settlement announcements with no indication of collusion had no significant effect on the stock prices of brand firms implying that they tended to meet traders’ expectations. Stock prices increased by approximately 3.5 %, on average, after settlements with an indication of collusion, implying they increased brand profits by delaying generic entry. These increases correspond to a total increase in U.S. purchaser spending of $3.1-$3.2 billion per year during 2014–2023. Factoring up our estimate to the entire industry implies the increase in spending may be closer to $12 billion per year.
{"title":"Using stock price movements to estimate the harm from collusive drug patent litigation settlements","authors":"Keith M. Drake , Thomas G. McGuire","doi":"10.1016/j.jhealeco.2025.103054","DOIUrl":"10.1016/j.jhealeco.2025.103054","url":null,"abstract":"<div><div>The tradeoff between incentives to invest in R&D and efficient pricing takes a special form in the pharmaceutical sector. Brand drugs command high prices until generic competition begins, the timing of which usually depends on the outcome of patent infringement litigation. One potential outcome is a collusive agreement between the brand and a potential generic competitor that delays competition, with the brand sharing the profits from the delay by paying the generic challenger. Collusive patent settlements have plagued competition in pharmaceutical markets globally and especially in the U.S., the world’s largest market. This paper estimates the cost of these collusive settlements to U.S. drug purchasers using stock price movements. If the brand firm’s increase in profits from collusion is capitalized into stock prices, the change in value upon a settlement announcement can be used to estimate the new profit flows from higher prices to purchasers. We assembled data on 64 settlements reached during 2014–2023 and used the announcement descriptions and information that surfaced later to identify 17 potentially collusive settlements. We applied event study methods and found, consistent with prior research, that settlement announcements with no indication of collusion had no significant effect on the stock prices of brand firms implying that they tended to meet traders’ expectations. Stock prices increased by approximately 3.5 %, on average, after settlements with an indication of collusion, implying they increased brand profits by delaying generic entry. These increases correspond to a total increase in U.S. purchaser spending of $3.1-$3.2 billion per year during 2014–2023. Factoring up our estimate to the entire industry implies the increase in spending may be closer to $12 billion per year.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103054"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906951","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 : 2025-08-21DOI: 10.1016/j.jhealeco.2025.103019
Michael F. Lovenheim , Jun Hyun Yun
The U.S. healthcare system requires substantial out-of-pocket payments by most consumers, which can prevent some from receiving needed medical services. At the same time, housing wealth comprises a significant proportion of household wealth that could be used to pay for medical care. We analyze the effects of housing wealth on out-of-pocket medical expenditures among older homeowners. Using data from the Health and Retirement Study and various measures of home price changes, we find no evidence that housing wealth impacts out-of-pocket medical spending. The estimates are universally small and precise, allowing us to rule out even modest-sized effects. Effects are zero across the expenditure distribution, for specific categories of expenditure, and for different types of homeowners split by health insurance status and SES. We present suggestive evidence that our results represent a mix of homeowners not needing to access their housing wealth for additional medical care and being unwilling or unable to access their home equity.
{"title":"The effect of housing wealth on health care spending","authors":"Michael F. Lovenheim , Jun Hyun Yun","doi":"10.1016/j.jhealeco.2025.103019","DOIUrl":"10.1016/j.jhealeco.2025.103019","url":null,"abstract":"<div><div>The U.S. healthcare system requires substantial out-of-pocket payments by most consumers, which can prevent some from receiving needed medical services. At the same time, housing wealth comprises a significant proportion of household wealth that could be used to pay for medical care. We analyze the effects of housing wealth on out-of-pocket medical expenditures among older homeowners. Using data from the Health and Retirement Study and various measures of home price changes, we find no evidence that housing wealth impacts out-of-pocket medical spending. The estimates are universally small and precise, allowing us to rule out even modest-sized effects. Effects are zero across the expenditure distribution, for specific categories of expenditure, and for different types of homeowners split by health insurance status and SES. We present suggestive evidence that our results represent a mix of homeowners not needing to access their housing wealth for additional medical care and being unwilling or unable to access their home equity.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103019"},"PeriodicalIF":3.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879150","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 : 2025-08-20DOI: 10.1016/j.jhealeco.2025.103049
Helmuth Cremer , Jean-Marie Lozachmeur
This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforehand, while curative care is decided after health status is known.
In an ideal scenario where health status is observable, optimal insurance provides lump-sum payments unrelated to expenditures. However, when severity is unobservable (causing ex post moral hazard), this approach is not incentive-compatible. Instead, optimal insurance designs benefits that increase with both preventive and curative care, as higher expenditures reduce informational rents and align incentives.
Preventive care, though chosen before illness occurs, affects incentive constraints due to two factors: (1) it is more effective for severely ill individuals, and (2) they have lower marginal utility of income, meaning preventive expenditures impact them less. These effects shape the optimal reimbursement structure.
Additionally, when individuals misperceive preventive care benefits, the main results hold, but an extra corrective (Pigouvian) term appears in the reimbursement formula to adjust for this misperception.
{"title":"Nonlinear reimbursement rules for preventive and curative medical care","authors":"Helmuth Cremer , Jean-Marie Lozachmeur","doi":"10.1016/j.jhealeco.2025.103049","DOIUrl":"10.1016/j.jhealeco.2025.103049","url":null,"abstract":"<div><div>This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforehand, while curative care is decided after health status is known.</div><div>In an ideal scenario where health status is observable, optimal insurance provides lump-sum payments unrelated to expenditures. However, when severity is unobservable (causing ex post moral hazard), this approach is not incentive-compatible. Instead, optimal insurance designs benefits that increase with both preventive and curative care, as higher expenditures reduce informational rents and align incentives.</div><div>Preventive care, though chosen before illness occurs, affects incentive constraints due to two factors: (1) it is more effective for severely ill individuals, and (2) they have lower marginal utility of income, meaning preventive expenditures impact them less. These effects shape the optimal reimbursement structure.</div><div>Additionally, when individuals misperceive preventive care benefits, the main results hold, but an extra corrective (Pigouvian) term appears in the reimbursement formula to adjust for this misperception.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103049"},"PeriodicalIF":3.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906952","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 : 2025-08-20DOI: 10.1016/j.jhealeco.2025.103045
Anikó Bíró , Péter Elek
We estimate the impact of firm quality – primarily measured by the firm-level wage premium – on the health maintenance of employees. Using linked employer–employee administrative panel data from Hungary, we analyze the dynamics of healthcare use before and after moving to a new firm. We show that moving to a higher-paying firm leads to higher consumption of drugs for cardiovascular conditions and more diagnostic and primary care visits, without evidence of deteriorating physical health, and, among men and older workers, to lower consumption of medications for mental health conditions. The results are robust to using alternative firm quality indicators based on productivity and worker flows, and to controlling for firm size, individual wage, and possible peer effects. The results suggest that higher-paying firms provide beneficial health-related amenities via the detection of previously undiagnosed chronic physical illnesses and improved mental health. Plausible mechanisms include higher-quality occupational health check-ups and less stressful working conditions.
{"title":"Firm quality and health maintenance","authors":"Anikó Bíró , Péter Elek","doi":"10.1016/j.jhealeco.2025.103045","DOIUrl":"10.1016/j.jhealeco.2025.103045","url":null,"abstract":"<div><div>We estimate the impact of firm quality – primarily measured by the firm-level wage premium – on the health maintenance of employees. Using linked employer–employee administrative panel data from Hungary, we analyze the dynamics of healthcare use before and after moving to a new firm. We show that moving to a higher-paying firm leads to higher consumption of drugs for cardiovascular conditions and more diagnostic and primary care visits, without evidence of deteriorating physical health, and, among men and older workers, to lower consumption of medications for mental health conditions. The results are robust to using alternative firm quality indicators based on productivity and worker flows, and to controlling for firm size, individual wage, and possible peer effects. The results suggest that higher-paying firms provide beneficial health-related amenities via the detection of previously undiagnosed chronic physical illnesses and improved mental health. Plausible mechanisms include higher-quality occupational health check-ups and less stressful working conditions.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103045"},"PeriodicalIF":3.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866198","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 : 2025-08-09DOI: 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}
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