Pub Date : 2025-07-04DOI: 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.
{"title":"Lost in the net? Broadband internet and youth mental health","authors":"Dante Donati , Ruben Durante , Francesco Sobbrio , Dijana Zejcirovic","doi":"10.1016/j.jhealeco.2025.103017","DOIUrl":"10.1016/j.jhealeco.2025.103017","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103017"},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611715","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 : 2025-06-25DOI: 10.1016/j.jhealeco.2025.103029
Karinna Saxby , Thomas Buchmueller , Sonja C. de New , Dennis Petrie
Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72 % and 19 % of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related Emergency Department presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions.
{"title":"Regional variation in mental healthcare utilization and suicide: Evidence from movers in Australia","authors":"Karinna Saxby , Thomas Buchmueller , Sonja C. de New , Dennis Petrie","doi":"10.1016/j.jhealeco.2025.103029","DOIUrl":"10.1016/j.jhealeco.2025.103029","url":null,"abstract":"<div><div>Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72 % and 19 % of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related Emergency Department presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103029"},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569056","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 : 2025-06-24DOI: 10.1016/j.jhealeco.2025.103021
Eran Politzer
The provision of public health insurance through regulated markets requires a dynamic procurement of insurers over time. Using data from Medicaid managed care bids, I study the impacts of regulators’ decision to drop an insurer from the market on health care use among affected enrollees, who must switch to another health plan. Using a difference-in-differences framework, I find that after a plan is replaced, enrollees from the exiting plan have fewer visits to primary care physicians, lower utilization of prescription drugs, including those for chronic conditions, and more hospital admissions. These disruptions disproportionately affect sicker enrollees, particularly children and non-white beneficiaries. In the year following the exit, insurers’ spending on enrollees from exiting plans is 7% lower than the pre-exit baseline. Changes in provider networks and drug formularies may serve as mechanisms.
{"title":"A change of plans: Switching costs in the procurement of health insurance","authors":"Eran Politzer","doi":"10.1016/j.jhealeco.2025.103021","DOIUrl":"10.1016/j.jhealeco.2025.103021","url":null,"abstract":"<div><div>The provision of public health insurance through regulated markets requires a dynamic procurement of insurers over time. Using data from Medicaid managed care bids, I study the impacts of regulators’ decision to drop an insurer from the market on health care use among affected enrollees, who must switch to another health plan. Using a difference-in-differences framework, I find that after a plan is replaced, enrollees from the exiting plan have fewer visits to primary care physicians, lower utilization of prescription drugs, including those for chronic conditions, and more hospital admissions. These disruptions disproportionately affect sicker enrollees, particularly children and non-white beneficiaries. In the year following the exit, insurers’ spending on enrollees from exiting plans is 7% lower than the pre-exit baseline. Changes in provider networks and drug formularies may serve as mechanisms.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103021"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523487","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 : 2025-06-23DOI: 10.1016/j.jhealeco.2025.103023
Margherita Comola , Rokhaya Dieye , Bernard Fortin
This paper explores the role of gender heterogeneity in the social diffusion of obesity among adolescents and its policy implications. We propose a social interaction model which allows for gender-dependent heterogeneity in peer effects. Our empirical approach is consistent with the best response functions of a non-cooperative model where social interactions stem from the channel of pure spillover or pure conformity. We estimate the model using data on adolescent Body Mass Index and network-based interactions. Our approach allows us to account for network endogeneity. Our results show that peer effects are gender-dependent, and male students are particularly responsive to the weight of their female friends. According to simulations, reaching out to women results in an 8% increase in effectiveness in reducing overall BMI, based on the most conservative scenario. Thus, female-tailored interventions are likely to be more effective than a gender-neutral approach to fighting obesity in schools.
{"title":"Heterogeneous peer effects and gender-based interventions for teenage obesity","authors":"Margherita Comola , Rokhaya Dieye , Bernard Fortin","doi":"10.1016/j.jhealeco.2025.103023","DOIUrl":"10.1016/j.jhealeco.2025.103023","url":null,"abstract":"<div><div>This paper explores the role of gender heterogeneity in the social diffusion of obesity among adolescents and its policy implications. We propose a social interaction model which allows for gender-dependent heterogeneity in peer effects. Our empirical approach is consistent with the best response functions of a non-cooperative model where social interactions stem from the channel of pure spillover or pure conformity. We estimate the model using data on adolescent Body Mass Index and network-based interactions. Our approach allows us to account for network endogeneity. Our results show that peer effects are gender-dependent, and male students are particularly responsive to the weight of their female friends. According to simulations, reaching out to women results in an 8% increase in effectiveness in reducing overall BMI, based on the most conservative scenario. Thus, female-tailored interventions are likely to be more effective than a gender-neutral approach to fighting obesity in schools.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103023"},"PeriodicalIF":3.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518966","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 : 2025-06-22DOI: 10.1016/j.jhealeco.2025.103018
Matthew Robson , Owen O’Donnell , Tom Van Ourti
We estimate welfare weights for health to facilitate program evaluation allowing for aversion to health inequality and to health inequity by three non-health characteristics. In a UK general population sample, 569 online experiment participants distribute constrained resources to determine the health of hypothetical individuals distinguished by randomly generated resource productivity as well as sex, income and smoking (41,460 observations). We elicit beliefs about responsibility for income and smoking, and use their associations with the allocations to estimate responsibility-sensitive weights for health by those two characteristics. We find weak prioritisation of females’ health, moderate prioritisation of the health of poorer individuals and strong prioritisation of the health of non-smokers over that of smokers. Substantial aversion to health inequality lowers weights on females and non-smokers, who are health-advantaged, and raises the weight on the poor, who are health-disadvantaged. As beliefs about responsibility for income and smoking strengthen, weights on the poor decrease and weights on non-smokers significantly increase.
{"title":"Responsibility-sensitive welfare weights for health","authors":"Matthew Robson , Owen O’Donnell , Tom Van Ourti","doi":"10.1016/j.jhealeco.2025.103018","DOIUrl":"10.1016/j.jhealeco.2025.103018","url":null,"abstract":"<div><div>We estimate welfare weights for health to facilitate program evaluation allowing for aversion to health inequality and to health inequity by three non-health characteristics. In a UK general population sample, 569 online experiment participants distribute constrained resources to determine the health of hypothetical individuals distinguished by randomly generated resource productivity as well as sex, income and smoking (41,460 observations). We elicit beliefs about responsibility for income and smoking, and use their associations with the allocations to estimate responsibility-sensitive weights for health by those two characteristics. We find weak prioritisation of females’ health, moderate prioritisation of the health of poorer individuals and strong prioritisation of the health of non-smokers over that of smokers. Substantial aversion to health inequality lowers weights on females and non-smokers, who are health-advantaged, and raises the weight on the poor, who are health-disadvantaged. As beliefs about responsibility for income and smoking strengthen, weights on the poor decrease and weights on non-smokers significantly increase.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103018"},"PeriodicalIF":3.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335818","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 : 2025-06-21DOI: 10.1016/j.jhealeco.2025.103027
Donghoon Lee , Anirban Basu , Jerome A. Dugan , Pinar Karaca-Mandic
The paper examines whether, among inpatient psychiatric admissions in California, for-profit (FP) hospitals engage in cream skimming, i.e., selecting patients for some characteristic(s) other than their need for care, which enhances the profitability of the provider. We propose a novel approach to identifying cream skimming using cost outcomes. Naïve treatment effect estimates of hospital ownership type consist of the combined effects of differential patient case mix (selection) and hospital cost containment strategies (execution). In contrast, an instrumental variable (IV) approach can control for case mix and establish the causal effects of ownership type due to its execution. We interpret the difference between the naïve and IV treatment effects to be driven by FP hospitals’ selection based on unobserved patient case mix. Our findings on patient selection show that FP hospitals are more likely than their not-for-profit (NFP) counterparts to admit higher-cost patients (who tend to be less profitable under the existing inpatient psychiatric care payment systems), providing no evidence of cream skimming by FP hospitals. Furthermore, our estimates of hospital execution indicate that FP hospitals are more likely than NFP hospitals to deliver inpatient services at lower costs. These results may alleviate concerns about the recent proliferation of FP psychiatric hospitals, particularly regarding cream skimming in this market.
{"title":"Do for-profit hospitals cream-skim patients? Evidence from inpatient psychiatric care in California","authors":"Donghoon Lee , Anirban Basu , Jerome A. Dugan , Pinar Karaca-Mandic","doi":"10.1016/j.jhealeco.2025.103027","DOIUrl":"10.1016/j.jhealeco.2025.103027","url":null,"abstract":"<div><div>The paper examines whether, among inpatient psychiatric admissions in California, for-profit (FP) hospitals engage in cream skimming, i.e., selecting patients for some characteristic(s) other than their need for care, which enhances the profitability of the provider. We propose a novel approach to identifying cream skimming using cost outcomes. Naïve treatment effect estimates of hospital ownership type consist of the combined effects of differential patient case mix (selection) and hospital cost containment strategies (execution). In contrast, an instrumental variable (IV) approach can control for case mix and establish the causal effects of ownership type due to its execution. We interpret the difference between the naïve and IV treatment effects to be driven by FP hospitals’ selection based on unobserved patient case mix. Our findings on patient selection show that FP hospitals are more likely than their not-for-profit (NFP) counterparts to admit higher-cost patients (who tend to be less profitable under the existing inpatient psychiatric care payment systems), providing no evidence of cream skimming by FP hospitals. Furthermore, our estimates of hospital execution indicate that FP hospitals are more likely than NFP hospitals to deliver inpatient services at lower costs. These results may alleviate concerns about the recent proliferation of FP psychiatric hospitals, particularly regarding cream skimming in this market.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103027"},"PeriodicalIF":3.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523488","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}
We provide new evidence on how child-related career interruptions affect long-term health behaviors by examining the impact of maternal leave duration on smoking habits across 14 European countries. Linking data on maternity and parental leave policies from 1960 to 2010 with survey data on mothers’ health behaviors, birth, and employment histories, we identify the effects of absence from work due to child birth on lifetime smoking in an instrumental variable framework based on within- and between-country variations in policies. We find that a one-month increase in leave duration raises the probability of a mother smoking later in life by 1.2 percentage points. Additionally, a one-month increase in child-related absence from work extends the lifetime duration of smoking by 7 months, the number of cigarettes smoked per day by 0.2 cigarettes, and the number of pack years by 0.6. We document potential non-linearities in these effects, suggesting that shorter leave durations may have a protective effect, while very long absence from work could promote harmful health behaviors. Heterogeneity analyses reveal that the observed effects are mediated by the partners’ lack of financial support around childbirth, while employment status and other socio-demographic characteristics do not play a significant role.
{"title":"Absence from work and lifetime smoking behavior: Evidence from European maternal leave policies","authors":"Anna-Theresa Renner , Mujaheed Shaikh , Sonja Spitzer","doi":"10.1016/j.jhealeco.2025.103004","DOIUrl":"10.1016/j.jhealeco.2025.103004","url":null,"abstract":"<div><div>We provide new evidence on how child-related career interruptions affect long-term health behaviors by examining the impact of maternal leave duration on smoking habits across 14 European countries. Linking data on maternity and parental leave policies from 1960 to 2010 with survey data on mothers’ health behaviors, birth, and employment histories, we identify the effects of absence from work due to child birth on lifetime smoking in an instrumental variable framework based on within- and between-country variations in policies. We find that a one-month increase in leave duration raises the probability of a mother smoking later in life by 1.2 percentage points. Additionally, a one-month increase in child-related absence from work extends the lifetime duration of smoking by 7 months, the number of cigarettes smoked per day by 0.2 cigarettes, and the number of pack years by 0.6. We document potential non-linearities in these effects, suggesting that shorter leave durations may have a protective effect, while very long absence from work could promote harmful health behaviors. Heterogeneity analyses reveal that the observed effects are mediated by the partners’ lack of financial support around childbirth, while employment status and other socio-demographic characteristics do not play a significant role.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103004"},"PeriodicalIF":3.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470441","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 : 2025-06-15DOI: 10.1016/j.jhealeco.2025.103025
Dena Bravata , Jonathan Cantor , Neeraj Sood , Christopher Whaley
The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts. We find increases in COVID-19 infection rates, with larger differences in low-income and higher COVID-19 prevalence counties.
{"title":"Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes","authors":"Dena Bravata , Jonathan Cantor , Neeraj Sood , Christopher Whaley","doi":"10.1016/j.jhealeco.2025.103025","DOIUrl":"10.1016/j.jhealeco.2025.103025","url":null,"abstract":"<div><div>The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts. We find increases in COVID-19 infection rates, with larger differences in low-income and higher COVID-19 prevalence counties.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103025"},"PeriodicalIF":3.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365039","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 : 2025-06-11DOI: 10.1016/j.jhealeco.2025.103024
Md Shahjahan, Giulia La Mattina, Padmaja Ayyagari
In this study, we examine the inter-generational effects of the 1994 Female Secondary School Stipend Program (FSSSP) on child health inputs and child health outcomes in Bangladesh. Prior studies have shown that the FSSSP significantly increased secondary schooling among rural girls. Applying a difference-in-differences model based on differential exposure to FSSSP by birth cohort and rural residence, we find that full immunization rates increased by 4.2 percentage points among children of mothers eligible for a stipend for 5 years relative to children of mothers who were not eligible, but there were no significant effects for children of mothers eligible for a stipend for only 2 years. We also find improvements in other health inputs (e.g., antenatal care) and in child health outcomes (e.g., mortality). We also explore changes in marriage, fertility, autonomy, labor supply, and media exposure, which may contribute to the observed improvements in child health.
{"title":"The impact of the Female Secondary School Stipend Program on child health","authors":"Md Shahjahan, Giulia La Mattina, Padmaja Ayyagari","doi":"10.1016/j.jhealeco.2025.103024","DOIUrl":"10.1016/j.jhealeco.2025.103024","url":null,"abstract":"<div><div>In this study, we examine the inter-generational effects of the 1994 Female Secondary School Stipend Program (FSSSP) on child health inputs and child health outcomes in Bangladesh. Prior studies have shown that the FSSSP significantly increased secondary schooling among rural girls. Applying a difference-in-differences model based on differential exposure to FSSSP by birth cohort and rural residence, we find that full immunization rates increased by 4.2 percentage points among children of mothers eligible for a stipend for 5 years relative to children of mothers who were not eligible, but there were no significant effects for children of mothers eligible for a stipend for only 2 years. We also find improvements in other health inputs (e.g., antenatal care) and in child health outcomes (e.g., mortality). We also explore changes in marriage, fertility, autonomy, labor supply, and media exposure, which may contribute to the observed improvements in child health.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103024"},"PeriodicalIF":3.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321994","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 : 2025-06-11DOI: 10.1016/j.jhealeco.2025.103026
Stefan A. Lipman , Thorsten Pachur
Time Trade-Off (TTO) and Standard Gamble (SG) tasks are commonly used methods to measure utilities for health states (e.g., diabetes, being in a wheelchair). Importantly, however, the two methods have been shown to typically yield discrepant utilities for a given health state. Here we examine the cognitive processes underlying this utility gap by analyzing individuals’ attentional patterns when evaluating health states in the TTO and SG tasks. In an online experiment, each respondent completed both a TTO and an SG task and we used the process-tracing methodology Mouselab to record respondents’ attention allocation to the tasks’ attributes: health states and their durations (in both TTO and SG), and probabilities (in SG only). In the TTO task, attention was approximately balanced between the health state and duration attributes, whereas in the SG task, attention was focussed on the probability and the health state attributes. Individuals who paid more attention to the task-specific trade-off attribute (i.e., duration and probability in TTO and SG, respectively) seemed to be less willing to make those trade-offs, leading to higher utilities for the health states. Notably, the utility gap was associated with individual differences in attention allocation: respondents who adjusted their attention allocation less to the task-specific trade-offs produced more discrepant utilities between the TTO and SG tasks. Our findings underscore the key role of attentional processes in preference construction, highlighting that differences in the utilities people assign to health states could potentially be influenced by altering attention allocation.
{"title":"Attentional processes underlying health state valuation with time trade-off and standard gamble tasks","authors":"Stefan A. Lipman , Thorsten Pachur","doi":"10.1016/j.jhealeco.2025.103026","DOIUrl":"10.1016/j.jhealeco.2025.103026","url":null,"abstract":"<div><div>Time Trade-Off (TTO) and Standard Gamble (SG) tasks are commonly used methods to measure utilities for health states (e.g., diabetes, being in a wheelchair). Importantly, however, the two methods have been shown to typically yield discrepant utilities for a given health state. Here we examine the cognitive processes underlying this <em>utility gap</em> by analyzing individuals’ attentional patterns when evaluating health states in the TTO and SG tasks. In an online experiment, each respondent completed both a TTO and an SG task and we used the process-tracing methodology Mouselab to record respondents’ attention allocation to the tasks’ attributes: health states and their durations (in both TTO and SG), and probabilities (in SG only). In the TTO task, attention was approximately balanced between the health state and duration attributes, whereas in the SG task, attention was focussed on the probability and the health state attributes. Individuals who paid more attention to the task-specific trade-off attribute (i.e., duration and probability in TTO and SG, respectively) seemed to be less willing to make those trade-offs, leading to higher utilities for the health states. Notably, the utility gap was associated with individual differences in attention allocation: respondents who adjusted their attention allocation less to the task-specific trade-offs produced more discrepant utilities between the TTO and SG tasks. Our findings underscore the key role of attentional processes in preference construction, highlighting that differences in the utilities people assign to health states could potentially be influenced by altering attention allocation.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103026"},"PeriodicalIF":3.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365488","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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