Journal of Health Economics最新文献

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Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees 养老院的工资补贴以及医疗补助计划参保者在人员配备和获得护理之间的权衡

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-07 DOI: 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.

工资补贴是提高养老院人员配备水平的一个很有前途的工具。然而，如果养老院能够吸引更多利润丰厚的非医疗补助居民，那么增加人员可能会以医疗补助计划参保者获得护理的机会为代价。在这项研究中，我考察了1998年至2010年期间国家医疗补助计划提供的一组工资补贴，使用养老院在补贴慷慨程度上的变化来确定补贴效果。我发现每个额外提供的补贴(2010)美元每resident-day每resident-day人员增加了超过10分钟,但降低了医疗补助的新养老院招生大约1.8百分点。这些数字转化为总体平均治疗效果，相当于在补贴前的平均人员配置上增加了约7.4%的人员配置，并且相对于补贴前的基线，医疗补助的入院份额减少了11.5%。补贴还增加了养老院居民的周转，降低了新入院居民的平均护理需求。总体而言，这些结果强调，虽然养老院工资补贴是鼓励增加人员水平的有效工具，但补贴也会导致养老院入院人数和入院居民特征的变化。

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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 : 2025-08-02 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

Intergenerational effects of sick leave on child human capital 病假对儿童人力资本的代际影响

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-31 DOI: 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.

本文利用世界上最大的社会保险计划之一：病假，研究了父母参与政府社会保险计划的代际后果。我们利用准随机分配的病人到全科医生（全科医生）在挪威，谁在他们的倾向证明不同长度的病假，以估计获得较长的病假对边缘个人的影响。将患者及其子女的管理数据联系起来，我们表明，分配给更宽松的全科医生会降低儿童在青春期的GPA，降低完成高中教育的可能性，并减少接受高等教育的入学率。这些影响似乎是通过父母轨迹的变化来发挥作用的：更多的病假导致更低的长期收入，更依赖福利，以及心理健康状况的恶化。

引用次数: 0

Overcoming medical overuse with AI assistance: An experimental investigation 用人工智能帮助克服医疗过度使用：一项实验调查

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-29 DOI: 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.

本研究探讨了人工智能（AI）在减少医疗过度治疗方面的作用，医疗过度治疗是一项增加成本和患者风险的关键医疗挑战。在武汉一家医院的196名医生和一所医学院的120名学生的两项实验中，我们在三种激励方案下使用了一种新的医疗处方任务：持平（固定工资）、累进（随着治疗量的增加而增加工资）和递减（对过度治疗的惩罚），以估计对人工智能援助的接受程度及其对过度治疗和治疗准确性的影响，并测试效果是否随激励而变化。据估计，人工智能推荐的一种治疗方法会使医生开出处方的概率增加25.7-28.4个百分点，在扁平化方案下效果最大。在他们不太熟悉的医疗领域，医生更容易接受人工智能的建议。我们估计，人工智能辅助将医生过度治疗的概率降低了10.9-25.7 pp(15.2-80.3%)，与渐进式和递减式方案相比，在扁平方案下具有更大的绝对和相对效果。AI辅助提高医生治疗准确性9.8-13.3 pp(14.6-19.9%)，其中回归方案下的绝对效果最大。这些发现得到了医学院实验的证实，该实验表明，在过度治疗的解释差异中，能力不足的因素占34%，金钱激励占22%，患者福利考虑占20%，与防御性医疗相关的因素占10%。这些结果为考虑将人工智能集成到医疗保健系统中的医疗保健管理员提供了有价值的见解。

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引用次数: 0

Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth 解释长期护理保险难题：相关性偏好和生活质量偏好在财富中的作用

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-17 DOI: 10.1016/j.jhealeco.2025.103030

David Crainich , Léontine Goldzahl , Florence Jusot , Doriane Mignon

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.

本文调查了长期护理保险的两个需求侧决定因素的作用：相关性偏好和相对偏好的生活质量比财富。我们建立了这些偏好对购买长期护理和长期护理保险合同的共同决策的影响模型。我们使用法国实验室实验的数据来测试该模型。虽然实验结果仅为理论预测提供部分支持，特别是，相关性厌恶不能解释过度保险，但我们的分析提供了证据，证明相关性寻求和相对于财富的生活质量的相对偏好解释了长期护理保险的有限吸收。

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 : 2025-07-16 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

Effects of informal caring on labour market outcomes of carers: Evidence from HILDA 非正式照顾对照顾者劳动力市场结果的影响：来自HILDA的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-12 DOI: 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.

本研究利用澳大利亚家庭、收入和劳动力动态（HILDA）调查的数据，考察了非正式护理对劳动力市场结果和福祉的因果影响。我们将事件研究设计与工具变量（IV）策略结合起来，利用从严重疾病或伤害到家庭成员的外源性变异。事件研究结果表明，健康冲击大大增加了非正式护理，对妇女和老年人的影响尤其大。这些冲击还导致这些群体的就业减少，工作时间缩短，心理健康状况恶化，越来越依赖政府支持和提前退休。为了分离护理的因果效应，我们将护理与健康冲击的时间联系起来。IV估计表明，承担照顾责任导致劳动力供应大幅减少，主要照顾者每周工作时间减少9.7小时，伴侣照顾者每周工作时间最多减少22.5小时。我们的研究结果强调了非正式护理的巨大经济成本，这对老龄化社会的劳动力参与具有重要意义。

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引用次数: 0

The effects of state paid sick leave mandates on parental childcare time 国家带薪病假规定对父母育儿时间的影响

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-11 DOI: 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.

美国没有联邦带薪病假政策。迄今为止，18个州和哥伦比亚特区已经通过或宣布了带薪病假规定，要求雇主每年提供最多7天的带薪病假，用于家庭责任和医疗保健。利用2004-2023年美国时间使用调查的时间日记和差异中的差异方法，我们估计了这些州带薪病假规定对父母提供儿童保育时间的影响。我们发现，在强制执行后，父母提供初级儿童保育的时间增加了5.8%，其影响是由孩子更小的妇女推动的。父母与孩子在一起的总时间也增加了3.4%，而与学龄儿童一起生活的父亲在参加休闲活动的同时监督孩子的时间只增加了11.9%。总的来说，我们的研究结果表明，带薪病假的规定可以让在职父母更好地平衡工作和照顾孩子的责任。

引用次数: 0

Abortion access and child protective services involvement 堕胎和儿童保护服务的参与

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-07-11 DOI: 10.1016/j.jhealeco.2025.103032

Christine Piette Durrance , Yang Wang , Barbara Wolfe

Existing evidence has found that abortion restrictions result in fewer and delayed abortions. Such restrictions may indirectly affect child wellbeing both through changes in births and for existing children in the home through mechanisms including substantial financial strains, negative health consequences, and intra-household power dynamics. Following the Dobbs decision, state-level abortion decisions have led to significantly greater abortion restrictions. We investigate the effects of abortion access on child welfare involvement using data from the National Child Abuse & Neglect Data System (NCANDS). We utilize pre- and post-Dobbs data from 2017-2023, and estimate both difference-in-differences and event study methods, using both distance changes and policy changes. We find that increased distance to nearest abortion care is associated with higher rates of CPS referrals. Our findings provide critical insights into the broader social and health implications of abortion restrictions in post-Dobbs.

现有证据表明，堕胎限制导致堕胎减少和延迟。这种限制可能通过出生变化间接影响儿童福祉，也可能通过大量财政压力、负面健康后果和家庭内部权力动态等机制间接影响家中现有儿童。在多布斯案判决之后，州一级的堕胎决定导致了更大的堕胎限制。我们调查了堕胎对儿童福利参与的影响，使用的数据来自国家儿童虐待；疏忽数据系统（NCANDS）。我们利用2017-2023年的dobbs前后数据，并使用距离变化和政策变化来估计差异中的差异和事件研究方法。我们发现，距离最近的堕胎护理增加与CPS转诊率较高有关。我们的研究结果为多布斯后堕胎限制的更广泛的社会和健康影响提供了重要的见解。

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 : 2025-07-04 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

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