Journal of Health Economics最新文献

英文中文

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 : 2025-09-01 Epub 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

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 : 2025-09-01 Epub 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

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 : 2025-09-01 Epub 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 earned income tax credits on intergenerational health mobility in the United States. 劳动所得税抵免对美国代际健康流动性的影响。

IF 3.6 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-09-01 Epub Date: 2025-08-07 DOI: 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.

代际卫生流动是卫生机会和平等的重要标志，但这一领域的实证研究仍然很少，特别是关于公共政策影响的实证研究。作为美国规模最大、最有效的反贫困项目之一，我们首次提出了劳动所得税抵免（EITC）对代际健康流动性影响的实证证据。我们使用收入动态小组研究中自我报告的健康状况，并探索儿童暴露于最大EITC收益的时间、地理和家庭结构差异。我们发现EITC总体上改善了代际健康流动性，尤其是向上的健康流动性。

引用次数: 0

Does knowing the costs of other physicians affect doctors’ referrals? 了解其他医生的费用会影响医生的转诊吗？

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-05-14 DOI: 10.1016/j.jhealeco.2025.103002

Scott Barkowski

Patient referrals from primary care physicians (PCPs) to specialists are common in the American health care industry, but are typically made without any knowledge of relative specialist costs. In this study, I estimate the effect of providing such information to PCPs on referral patterns. Implementing a field experiment with an Independent Practice Association (IPA), I sent a list of average costs for new ophthalmology referrals to randomly chosen primary care medical practices. Using administrative referral data, I find that PCPs increased referral share to less costly ophthalmology practices during the first two months after treatment by 4.6 percentage points for each reduction in costliness rank (e.g., each rank closer to the least expensive). Effects were only found for patients for whom the PCPs had cost reduction incentives, and dissipated over the following four months. For the patients whose referrals were affected, I estimate that the expected cost to the IPA of a referral to ophthalmology fell during the first two months by about $80 (45% of pre-intervention referral cost).

在美国的医疗保健行业中，病人从初级保健医生（pcp）转介到专科医生是很常见的，但通常是在不了解相关专科费用的情况下进行的。在本研究中，我估计了向pcp提供这些信息对转诊模式的影响。我与独立执业协会（IPA）一起实施了一项实地实验，随机选择初级保健医疗机构，向他们发送了一份新眼科转诊的平均费用清单。利用行政转诊数据，我发现在治疗后的头两个月，每降低一个费用等级（例如，每降低一个等级接近最便宜的等级），pcp将转诊份额增加到费用较低的眼科实践4.6个百分点。效果只在pcp有降低成本激励的患者中发现，并且在接下来的四个月内消失。对于那些转诊受到影响的患者，我估计在前两个月转诊到眼科的IPA预期成本下降了约80美元（干预前转诊成本的45%）。

引用次数: 0

The Effect of E-Cigarette Taxes on Substance Use 电子烟税对物质使用的影响

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-06-09 DOI: 10.1016/j.jhealeco.2025.103022

Dhaval Dave , Yang Liang , Johanna Catherine Maclean , Caterina Muratori , Joseph J. Sabia

Public health advocates warn that the rapid growth of legal markets for electronic nicotine delivery systems (ENDS) may generate a “gateway” to marijuana and harder drug consumption, particularly among teenagers. This study explores the effects of ENDS taxes on substance use. Analyses are based on difference-in-differences and event-study methods applied to both survey (Youth Risk Behavior Surveillance System and Behavioral Risk Factor Surveillance System) and administrative (Treatment Episode Data Set) data. Our results imply that a one-dollar increase in ENDS taxes (2023$) is associated with a 1.0 to 1.5 percentage point decline in teen marijuana use and in co-use of ENDS and marijuana. This result is consistent with e-cigarettes and marijuana being economic complements. We also find that youth responses to ENDS taxes, in terms of their ENDS use and spillovers into marijuana use, appear to moderate over the longer term. We find no evidence that ENDS taxes affect drug treatment admissions or consumption of illicit drugs other than marijuana such as cocaine, methamphetamine, or opioids.

公共健康倡导者警告说，电子尼古丁输送系统（ENDS）合法市场的快速增长可能会为大麻和更严重的毒品消费提供“通道”，尤其是在青少年中。本研究探讨了ENDS税对物质使用的影响。分析基于差异中的差异和事件研究方法，应用于调查（青少年风险行为监测系统和行为风险因素监测系统）和行政（治疗事件数据集）数据。我们的研究结果表明，ENDS税每增加1美元（2023美元），青少年大麻使用以及ENDS和大麻的共同使用就会下降1.0到1.5个百分点。这一结果与电子烟和大麻是经济互补的观点是一致的。我们还发现，就终端使用和对大麻使用的溢出效应而言，青年对终端税的反应在长期内似乎是温和的。我们没有发现证据表明ENDS税会影响药物治疗的入院率或大麻以外的非法药物的消费，如可卡因、甲基苯丙胺或阿片类药物。

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引用次数: 0

High speed internet and the widening gender gap in adolescent mental health: Evidence from Spanish hospital records 高速互联网和青少年心理健康方面不断扩大的性别差距：来自西班牙医院记录的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-05-24 DOI: 10.1016/j.jhealeco.2025.103014

Esther Arenas-Arroyo , Daniel Fernandez-Kranz , Natalia Nollenberger

We exploit variations in fiber optic (FTTH) deployment to assess the impact of high-speed internet access on adolescent mental health. Our findings reveal that FTTH access increases addictive Internet usage and reduces time allocated to sleep, homework, as well as social interactions with family and friends. Access to FTTH increases mental health diagnoses in hospitals and contributes to a notable rise in adolescent suicide rates, particularly among girls. As new platforms and apps gain traction among adolescents, understanding the impact of connectivity improvement becomes important. This is especially relevant given the current FTTH growth replacing older broadband technologies.

我们利用光纤（FTTH）部署的变化来评估高速互联网接入对青少年心理健康的影响。我们的研究结果表明，FTTH接入增加了上瘾的互联网使用，减少了分配给睡眠、家庭作业以及与家人和朋友社交的时间。获得光纤到户服务增加了医院的精神健康诊断，并导致青少年自杀率显著上升，特别是在女孩中。随着新的平台和应用程序在青少年中越来越受欢迎，了解连接性改善的影响变得非常重要。鉴于目前FTTH的增长正在取代旧的宽带技术，这一点尤其重要。

引用次数: 0

When women take over: Physician gender and health care provision 当妇女接管：医生、性别和保健服务

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-05-10 DOI: 10.1016/j.jhealeco.2025.103000

Gerald J. Pruckner, Flora Stiftinger, Katrin Zocher

The share of female physicians has risen in OECD countries in recent decades, but we know little about the effects of physician gender on patient health care use. We exploit quasi-random assignment of primary care providers (PCPs) to existing PCP practices and patients and estimate the causal effect of female PCPs on health care provision. Using Austrian register data and a difference-in-differences strategy, we find that female PCPs generate 15% less revenue and see 7% fewer patients than male PCPs. Shifting the focus to patient-level outcomes, we observe that health care utilization remains largely unchanged following assignment to a female physician. However, results show that patients are more likely to leave PCP practices with female successors. Our results do not support the idea that the decision to change PCP is driven by preferences against being treated by female physicians. Instead, our analysis suggests that the observed differences are partly explained by female PCPs working fewer hours, especially those facing working time restrictions. As the share of female physicians continues to rise, measures to increase work flexibility may be necessary to maintain broad access to outpatient health care.

近几十年来，女医生在经合组织国家的比例有所上升，但我们对医生性别对患者医疗保健使用的影响知之甚少。我们利用准随机分配初级保健提供者（PCP）到现有的PCP实践和患者，并估计女性PCP对卫生保健提供的因果效应。使用奥地利注册数据和差异中的差异策略，我们发现女性pcp产生的收入比男性pcp少15%，看到的病人比男性pcp少7%。将重点转移到患者水平的结果，我们观察到，卫生保健的利用率在分配给女医生后基本保持不变。然而，结果显示，患者更有可能离开PCP实践与女性接班人。我们的研究结果不支持改变PCP的决定是由对女医生治疗的偏好所驱动的观点。相反，我们的分析表明，观察到的差异部分可以解释为女性pcp工作时间更短，尤其是那些面临工作时间限制的人。随着女医生的比例继续上升，可能有必要采取措施增加工作灵活性，以保持广泛获得门诊保健。

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引用次数: 0

The impact of neonatal care on moderate-risk infants: Evidence from healthcare use in the first two years of life 新生儿护理对中等风险婴儿的影响：来自生命头两年医疗保健使用的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-04-11 DOI: 10.1016/j.jhealeco.2025.102995

Serena Yu , Kei Lui , Denzil G Fiebig , Javeed Travadi , Caroline SE Homer , Lynn Sinclair , Vanessa Scarf , Rosalie Viney

Advances in evidence-based neonatal care have led to large improvements in the survival rates of high-risk newborns. Yet studies have documented wide variation in the care of more prevalent moderate-risk infants, who comprise a much larger proportion of admissions to neonatal care. In this study, we build on a small literature which uses quasi-experimental design to understand the impact of neonatal care, and for the first time, examine this moderate-risk cohort of infants. We use individual-level data on the full population of births in the state of New South Wales, Australia to examine the impact of neonatal care on the healthcare use of moderate-risk infants in the first two years of life. We implement a regression discontinuity design exploiting admission protocols based on birthweight among neonatal units of three different and explicit levels of capability. Unlike previous studies, which examine differences in outcomes across the high-risk cut-off at 1500 g, our study examines differences for moderate-risk infants born near birthweight cut-offs closer to normal birth weight (2500 g). While admission to the neonatal unit jumps across the cut-off, we find modest impacts on downstream healthcare use, including both in-hospital and out-of-hospital care. However, we identify heterogeneous effects across varying capability levels. Moderate risk infants admitted to lower capability neonatal units received more cost-intensive care, resulting in reduced healthcare use following discharge from hospital, while the same was not observed for those admitted to the highest capability units. We suggest that this is due to more aggressive clinical management at lower capability units, and leave this as a priority for future research.

循证新生儿护理的进步导致高危新生儿存活率的大幅提高。然而，研究表明，对更普遍的中等风险婴儿的护理存在很大差异，这些婴儿在新生儿护理中所占的比例要大得多。在这项研究中，我们建立在一个小文献，使用准实验设计来了解新生儿护理的影响，并首次检查这个中等风险的婴儿队列。我们使用澳大利亚新南威尔士州全部出生人口的个人数据来检查新生儿护理对生命头两年中度风险婴儿医疗保健使用的影响。我们实施了一个回归不连续设计，利用基于出生体重的入院协议，在三个不同的和明确的能力水平的新生儿单位。与以往的研究不同的是，我们的研究考察了在1500克的高危分界点附近出生的中等风险婴儿的差异，这些婴儿的出生体重分界点更接近正常出生体重（2500克）。虽然新生儿病房的入院率跨越了临界值，但我们发现对下游医疗保健使用的影响不大，包括院内和院外护理。然而，我们在不同的能力水平上识别异质效应。在能力较低的新生儿病房住院的中度风险婴儿接受了更多的成本密集型护理，导致出院后医疗保健使用减少，而在能力最高的病房住院的婴儿则没有观察到这种情况。我们认为这是由于较低能力单位的更积极的临床管理，并将其作为未来研究的优先事项。

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引用次数: 0

Regression and decomposition with ordinal health outcomes 有序健康结果的回归和分解

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-08-01 Epub Date: 2025-06-04 DOI: 10.1016/j.jhealeco.2025.103012

Qian Wu , David M. Kaplan

Although ordinal health outcome values are categories like “poor” health or “moderate” depression, they are often assigned values

1, 2, 3, \dots

for convenience. We provide results on interpretation of subsequent analysis based on ordinary least squares (OLS) regression. For description, unlike for prediction, the OLS estimand’s interpretation does not require that the

1, 2, 3, \dots

are cardinal values: it is always the “best linear approximation” of a summary of the conditional survival functions. Further, for Blinder–Oaxaca-type decomposition, the OLS-based estimator is numerically equivalent to a certain counterfactual-based decomposition of the survival function, again regardless of any cardinal values. Empirically, with 2022 U.S. data for working-age adults, we estimate a higher incidence of depression in the rural population, and we decompose the rural–urban difference. Including a nonparametric estimator that we describe, estimators agree that 33%–39% of the rural–urban difference is statistically explained by income, education, age, sex, and geographic region. The OLS-based detailed decomposition shows this is mostly from income.

虽然有序健康结果值属于“健康欠佳”或“中度”抑郁等类别，但为了方便起见，它们通常被赋值为1、2、3、…。我们提供了基于普通最小二乘（OLS）回归的后续分析的解释结果。对于描述，与预测不同，OLS估计的解释不要求1,2,3，…是基数值：它总是条件生存函数总结的“最佳线性近似值”。此外，对于blinder - oaxaca型分解，基于ols的估计量在数值上等同于生存函数的某个基于反事实的分解，同样与任何基数值无关。从经验上看，根据2022年美国工作年龄成年人的数据，我们估计农村人口中抑郁症的发病率较高，并对城乡差异进行了分解。包括我们描述的非参数估计量，估计者一致认为城乡差异的33%-39%在统计上可以用收入、教育、年龄、性别和地理区域来解释。基于ols的详细分解显示，这主要来自收入。

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