Journal of Health Economics最新文献

英文中文

Fertility responses to tropical cyclones: Causal evidence and mechanisms 热带气旋对生育力的响应：因果证据和机制

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-01 Epub Date: 2025-11-20 DOI: 10.1016/j.jhealeco.2025.103083

Ha Trong Nguyen, Francis Mitrou

In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influence childbearing decisions among Australians of reproductive age. Using an individual fixed effects model and exogenous variation in cyclone exposure, we find a robust and substantial decline in fertility, occurring only after the most severe category 5 cyclones, with the effect weakening as distance from the cyclone’s eye increases. We find no evidence of delayed cyclone effects, indicating that the fertility loss attributable to these most severe cyclones is permanent. Our findings are robust to extensive validity checks, including a falsification test and various randomization tests. The fertility decline is most pronounced among younger adults, individuals with lower educational attainment, those childless at baseline, and those lacking prior private health or residential insurance. While physical health, financial constraints, and migration appear unlikely to drive the effect, the evidence points to reduced family formation, increased marital breakdown, child mortality, cyclone-induced home damage, elevated psychological stress, and heightened risk perceptions as plausible mechanisms.

鉴于人们日益关注不断升级的自然灾害风险和持续的低生育率，本文量化了热带气旋的因果影响，并确定了热带气旋影响育龄澳大利亚人生育决策的途径。利用个体固定效应模型和气旋暴露的外源性变化，我们发现生育率出现强劲而实质性的下降，这种下降只发生在最严重的5级气旋之后，随着与气旋眼距离的增加，这种影响减弱。我们没有发现延迟气旋影响的证据，这表明这些最严重的气旋造成的生育力损失是永久性的。我们的发现是稳健的广泛的有效性检查，包括证伪检验和各种随机化检验。生育率下降在年轻人、受教育程度较低的人、基线时无子女的人以及先前缺乏私人健康或住宅保险的人中最为明显。虽然身体健康、经济拮据和移民似乎不太可能造成这种影响，但有证据表明，家庭组建减少、婚姻破裂增加、儿童死亡率增加、飓风导致的家庭破坏、心理压力增加以及风险认知增强是可能的机制。

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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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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 : 2025-12-01 Epub 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

The impact of vertical integration on health care delivery and costs: Evidence from physician–pharmacy integration 垂直整合对医疗服务提供和成本的影响：来自医药学整合的证据。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-12-01 Epub Date: 2025-11-27 DOI: 10.1016/j.jhealeco.2025.103085

Pragya Kakani

Vertical integration among health care providers is an increasingly common feature of U.S. health care. This study investigates the impact of vertical integration in the context of oncology practices launching in-house pharmacies dispensing high-cost oral cancer treatments using a stacked event study design. I find physician–pharmacy integration lowers point-of-sale drug prices paid by plans due to 1.0% lower prices at in-house pharmacies. I also find physician–pharmacy integration increases the number of patients filling new prescriptions by 6.2% and reduces time-to-fill for new prescriptions requiring prior authorization. These effects may arise because in-house pharmacies individually have limited bargaining power and because vertical integration decreases coordination costs, reflected by faster prior authorization.

医疗保健提供者之间的垂直整合是美国医疗保健日益普遍的特征。本研究采用堆叠事件研究设计，调查垂直整合在肿瘤学实践背景下的影响，开展内部药房分配高成本口腔癌治疗。我发现，由于内部药房的价格降低了1.0%，医生与药房的整合降低了计划支付的销售点药品价格。我还发现，医药学整合使填写新处方的患者数量增加了6.2%，并减少了需要事先授权的新处方的填写时间。这些影响可能会出现，因为内部药房单独的议价能力有限，因为垂直整合降低了协调成本，这反映在更快的事先授权上。

引用次数: 0

Using stock price movements to estimate the harm from collusive drug patent litigation settlements 利用股价变动估算药品专利合谋诉讼和解的危害

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-08-22 DOI: 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.

在制药行业，投资研发的激励与有效定价之间的权衡有一种特殊的形式。在非专利药竞争开始之前，品牌药的价格很高，而非专利药竞争开始的时间通常取决于专利侵权诉讼的结果。一个潜在的结果是品牌和潜在的仿制药竞争对手之间的串通协议，延迟竞争，品牌通过支付仿制药挑战者来分享延迟带来的利润。合谋的专利和解一直困扰着全球制药市场的竞争，尤其是在全球最大的市场美国。本文估计了这些串通和解的成本，以美国药品购买者的股票价格变动。如果品牌公司通过串谋获得的利润增加被资本化到股票价格中，那么结算公告后的价值变化就可以用来估计从更高的价格流向购买者的新利润。我们收集了2014-2023年期间达成的64项和解协议的数据，并使用后来浮出水面的公告描述和信息来确定17项潜在的共谋和解。我们运用事件研究方法发现，与先前的研究一致，没有共谋迹象的结算公告对品牌公司的股价没有显著影响，这意味着它们倾向于满足交易者的预期。股票价格平均上涨约3.5%，在有共谋迹象的和解后，这意味着他们通过推迟通用上市来增加品牌利润。这些增长相当于2014-2023年期间美国采购商支出每年增加31 - 32亿美元。将我们的估计纳入整个行业，意味着支出的增长可能接近每年120亿美元。

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引用次数: 0

The effects of restricted abortion access on IUDs and vasectomies: Evidence from Texas 限制人工流产对宫内节育器和输精管切除术的影响：来自德克萨斯州的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-07-16 DOI: 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.

避孕和堕胎都会导致生育率下降，但它们是否是替代品仍然是一个悬而未决的问题。2013年，德克萨斯州通过了众议院法案2 (HB2)，该政策对堕胎提供者施加了严格的监管。使用来自德克萨斯州的行政门诊记录，我们利用HB2的传递来确定限制流产对宫内节育器（iud）和输精管切除术的时间和需求的影响。我们发现有证据表明，对有限堕胎途径的期望显著增加了对宫内节育器的需求，而对输精管结扎的发生率没有影响。这些发现支持了堕胎和避孕是替代品的假设，特别是对有能力怀孕的人来说。

引用次数: 0

Prescribing power and equitable access to care: Evidence from pharmacists in Ontario, Canada 处方权力和公平获得护理：来自加拿大安大略省药剂师的证据

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-08-09 DOI: 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.

允许药剂师直接治疗患者可能会增加获得医疗保健的公平机会并改善患者的治疗效果，但会引起对供应方道德风险或患者替代常规医生护理的担忧。我们研究了2023年加拿大安大略省允许药剂师为小病开处方的政策的影响。我们使用Advan人流量数据来衡量这一政策如何影响药房的访问量，并对非药房医疗设施的访问量产生溢出效应（Research, 2022）。允许药剂师开处方导致到药店的总访问量增加了16%，到其他提供者的访问量增加了3%。这些增长集中在物质匮乏的社区，非少数民族和非移民人口受益最多。我们使用政策作为外生变量来识别药房访问和交通到其他医疗设施之间的替代弹性。总体而言，药店客流量增加的20%会导致门诊护理的使用增加。药房流量是去医院和急诊科的替代品，因为病人可能依赖药剂师进行分诊，而不是紧急护理。

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引用次数: 0

Lost in the net? Broadband internet and youth mental health 在网里迷路了？宽带互联网与青少年心理健康

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-07-04 DOI: 10.1016/j.jhealeco.2025.103017

Dante Donati , Ruben Durante , Francesco Sobbrio , Dijana Zejcirovic

How does the internet affect young people’s mental health? We study this question using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we combine with broadband internet availability at the municipal level. Broadband internet access raises the prevalence of mental disorders among younger cohorts (born between 1985 and 1995) by 0.08 standard deviation units, but it does not impact older individuals (1974 and 1984). The adverse effects are driven by individuals who were exposed early in their lives (before the age of 20). These effects persist when examining instances of self-harm and urgent or compulsory hospitalizations, indicating that the negative outcomes are not merely a result of increased awareness and detection of these conditions. The detrimental impacts span across different pathologies, including depression, anxiety, drug abuse, and personality disorders for both genders, in addition to eating disorders for females.

互联网是如何影响年轻人的心理健康的？我们使用2001年至2013年间意大利医院诊断的精神障碍病例的行政数据来研究这个问题，我们将这些数据与市级的宽带互联网可用性相结合。宽带互联网接入使年轻人群（1985年至1995年之间出生）的精神障碍患病率提高了0.08个标准差单位，但对老年人（1974年和1984年）没有影响。这些不良影响是由那些在生命早期（20岁之前）接触过的人造成的。在审查自残和紧急或强制住院的情况时，这些影响仍然存在，表明负面结果不仅仅是提高对这些情况的认识和发现的结果。这种有害影响跨越了不同的病理，包括抑郁、焦虑、药物滥用和男女的人格障碍，以及女性的饮食失调。

引用次数: 0

The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations 护士执业范围法对可预防住院治疗的影响

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-08-02 DOI: 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.

越来越多地使用执业护士（NPs）来提供医疗保健，这是扩大获得医疗保健的一个重要政策选择。然而，在大约一半的州，限制执业范围的法律限制了护士提供护理的能力。我研究了放宽这些法律（通过授予NPs充分的执业权）对2010年至2019年期间22个州分类为预防质量指标（PQIs）的医院出院情况的影响。PQIs衡量的是可以通过及时的门诊治疗避免的住院情况。我发现，充分的实践权力减少了糖尿病和其他慢性疾病的可避免的住院治疗，对私人保险患者的影响尤其一致。PQI患者的平均住院时间更长，这表明相对健康的患者更有可能避免住院。这些结果表明，充分的实践权力提高了获得门诊护理，并允许更有效地利用住院资源。

引用次数: 0

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