Pub Date : 2025-06-07DOI: 10.1016/j.jhealeco.2025.103020
Jill R. Horwitz , Austin Nichols , Anthony Yu , Carrie H. Colla , David M. Cutler
Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.
{"title":"Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging","authors":"Jill R. Horwitz , Austin Nichols , Anthony Yu , Carrie H. Colla , David M. Cutler","doi":"10.1016/j.jhealeco.2025.103020","DOIUrl":"10.1016/j.jhealeco.2025.103020","url":null,"abstract":"<div><div>Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103020"},"PeriodicalIF":3.4,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330319","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 : 2025-06-05DOI: 10.1016/j.jhealeco.2025.103003
Adeline Delavande , Emilia Del Bono , Angus Holford
This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individuals’ minimum and maximum subjective probabilities of different health outcomes, and define belief imprecision as the range between these values. We document substantial heterogeneity in the degree of imprecision across respondents, which remains largely unexplained by standard demographic characteristics. To assess the behavioral impact of imprecise beliefs, we ask beliefs about future outcomes under hypothetical scenarios that feature different levels of protective behaviors. We find that individuals who expect protective behaviors to reduce not only the subjective probability of a negative health outcome, but also the degree of imprecision associated with it, behave more protectively.
{"title":"Imprecise health beliefs and health behavior","authors":"Adeline Delavande , Emilia Del Bono , Angus Holford","doi":"10.1016/j.jhealeco.2025.103003","DOIUrl":"10.1016/j.jhealeco.2025.103003","url":null,"abstract":"<div><div>This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individuals’ minimum and maximum subjective probabilities of different health outcomes, and define belief imprecision as the range between these values. We document substantial heterogeneity in the degree of imprecision across respondents, which remains largely unexplained by standard demographic characteristics. To assess the behavioral impact of imprecise beliefs, we ask beliefs about future outcomes under hypothetical scenarios that feature different levels of protective behaviors. We find that individuals who expect protective behaviors to reduce not only the subjective probability of a negative health outcome, but also the degree of imprecision associated with it, behave more protectively.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103003"},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330323","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 : 2025-06-04DOI: 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 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 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.
{"title":"Regression and decomposition with ordinal health outcomes","authors":"Qian Wu , David M. Kaplan","doi":"10.1016/j.jhealeco.2025.103012","DOIUrl":"10.1016/j.jhealeco.2025.103012","url":null,"abstract":"<div><div>Although ordinal health outcome values are categories like “poor” health or “moderate” depression, they are often assigned values <span><math><mrow><mn>1</mn><mo>,</mo><mn>2</mn><mo>,</mo><mn>3</mn><mo>,</mo><mo>…</mo></mrow></math></span> 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 <span><math><mrow><mn>1</mn><mo>,</mo><mn>2</mn><mo>,</mo><mn>3</mn><mo>,</mo><mo>…</mo></mrow></math></span> 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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103012"},"PeriodicalIF":3.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243515","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 : 2025-06-03DOI: 10.1016/j.jhealeco.2025.103015
Christopher J. Ruhm
This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence with increased attention to so-called “deaths of despair.” The main takeaway is that although declining psychological health has likely contributed to adverse mortality trends—especially among prime-age non-Hispanic Whites—its overall impact is limited and not well captured by standard definitions of “deaths of despair.” Five key findings support this conclusion. First, mental health deteriorated between 1993 and 2019 for all population groups examined. Second, these declines are associated with higher predicted death rates and help explain worsening mortality trends for prime-age non-Hispanic Whites and, to a lesser extent, non-Hispanic Blacks between 1999 and 2019. Third, while these correlations lend some support to the broader idea of “deaths of despair,” the specific causes comprising them appear to be both more expansive and different from those previously emphasized. Fourth, heterogeneity in how worsening mental distress affects mortality—rather than in mental health trends themselves—is more important in explaining Black-White disparities in its overall impact. Finally, in the primary specifications, deteriorating mental health accounts for an estimated 9 % to 29 % of the rise in mortality rates among prime-age Whites in recent years.
{"title":"Mental health and mortality trends in the United States","authors":"Christopher J. Ruhm","doi":"10.1016/j.jhealeco.2025.103015","DOIUrl":"10.1016/j.jhealeco.2025.103015","url":null,"abstract":"<div><div>This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence with increased attention to so-called “deaths of despair.” The main takeaway is that although declining psychological health has likely contributed to adverse mortality trends—especially among prime-age non-Hispanic Whites—its overall impact is limited and not well captured by standard definitions of “deaths of despair.” Five key findings support this conclusion. First, mental health deteriorated between 1993 and 2019 for all population groups examined. Second, these declines are associated with higher predicted death rates and help explain worsening mortality trends for prime-age non-Hispanic Whites and, to a lesser extent, non-Hispanic Blacks between 1999 and 2019. Third, while these correlations lend some support to the broader idea of “deaths of despair,” the specific causes comprising them appear to be both more expansive and different from those previously emphasized. Fourth, heterogeneity in how worsening mental distress affects mortality—rather than in mental health trends themselves—is more important in explaining Black-White disparities in its overall impact. Finally, in the primary specifications, deteriorating mental health accounts for an estimated 9 % to 29 % of the rise in mortality rates among prime-age Whites in recent years.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103015"},"PeriodicalIF":3.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196460","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 : 2025-05-31DOI: 10.1016/j.jhealeco.2025.103016
Luigi Siciliani , Jinglin Wen , James Gaughan
Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.
{"title":"Living alone and provider behaviour in public and private hospitals","authors":"Luigi Siciliani , Jinglin Wen , James Gaughan","doi":"10.1016/j.jhealeco.2025.103016","DOIUrl":"10.1016/j.jhealeco.2025.103016","url":null,"abstract":"<div><div>Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103016"},"PeriodicalIF":3.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297401","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 : 2025-05-24DOI: 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.
{"title":"High speed internet and the widening gender gap in adolescent mental health: Evidence from Spanish hospital records","authors":"Esther Arenas-Arroyo , Daniel Fernandez-Kranz , Natalia Nollenberger","doi":"10.1016/j.jhealeco.2025.103014","DOIUrl":"10.1016/j.jhealeco.2025.103014","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103014"},"PeriodicalIF":3.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220819","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 estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a destination country. Using a standard Difference-in-Differences model, we estimate a decline between 60% and 70% in voluntary pregnancy termination (VPT) rates for the new EU citizens from the two Eastern countries. We also introduce a novel framework to separate the total effect of the enlargement into a “citizenship” effect due to (legal or illegal) migrants already present in Italy and a “selection” effect due to new flows of immigrants. We show that the findings are robust to several alternative explanations. The drop in abortions points to legal status as a way to empower immigrant women.
{"title":"Legal status and voluntary abortions by immigrants","authors":"Luca Pieroni , Melcior Rosselló Roig , Luca Salmasi , Gilberto Turati","doi":"10.1016/j.jhealeco.2025.103001","DOIUrl":"10.1016/j.jhealeco.2025.103001","url":null,"abstract":"<div><div>We estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a destination country. Using a standard Difference-in-Differences model, we estimate a decline between 60% and 70% in voluntary pregnancy termination (VPT) rates for the new EU citizens from the two Eastern countries. We also introduce a novel framework to separate the total effect of the enlargement into a “citizenship” effect due to (legal or illegal) migrants already present in Italy and a “selection” effect due to new flows of immigrants. We show that the findings are robust to several alternative explanations. The drop in abortions points to legal status as a way to empower immigrant women.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103001"},"PeriodicalIF":3.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196459","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 : 2025-05-22DOI: 10.1016/j.jhealeco.2025.103013
Chad Cotti , Charles Courtemanche , Yang Liang , Johanna Catherine Maclean , Erik Nesson , Joseph J. Sabia
Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Behavioral Risk Factor Surveillance Survey, and Population Assessment of Tobacco and Health), this study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. We find robust evidence that the adoption of an ENDS flavor restriction reduces short-run frequent and everyday ENDS use among youths by approximately two-to-three percentage-points. Some evidence suggests that this effect weakens after two years. We also document reductions in ENDS use among young adults aged 18-30 that appear to strengthen after two years. Finally, evidence suggests substitution from flavored ENDS to unflavored ENDS and cigarettes among certain age groups.
{"title":"The effect of e-cigarette flavor bans on tobacco use","authors":"Chad Cotti , Charles Courtemanche , Yang Liang , Johanna Catherine Maclean , Erik Nesson , Joseph J. Sabia","doi":"10.1016/j.jhealeco.2025.103013","DOIUrl":"10.1016/j.jhealeco.2025.103013","url":null,"abstract":"<div><div>Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Behavioral Risk Factor Surveillance Survey, and Population Assessment of Tobacco and Health), this study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. We find robust evidence that the adoption of an ENDS flavor restriction reduces short-run frequent and everyday ENDS use among youths by approximately two-to-three percentage-points. Some evidence suggests that this effect weakens after two years. We also document reductions in ENDS use among young adults aged 18-30 that appear to strengthen after two years. Finally, evidence suggests substitution from flavored ENDS to unflavored ENDS and cigarettes among certain age groups.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103013"},"PeriodicalIF":3.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518963","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 : 2025-05-14DOI: 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).
{"title":"Does knowing the costs of other physicians affect doctors’ referrals?","authors":"Scott Barkowski","doi":"10.1016/j.jhealeco.2025.103002","DOIUrl":"10.1016/j.jhealeco.2025.103002","url":null,"abstract":"<div><div>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).</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103002"},"PeriodicalIF":3.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167263","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 : 2025-05-10DOI: 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.
{"title":"When women take over: Physician gender and health care provision","authors":"Gerald J. Pruckner, Flora Stiftinger, Katrin Zocher","doi":"10.1016/j.jhealeco.2025.103000","DOIUrl":"10.1016/j.jhealeco.2025.103000","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103000"},"PeriodicalIF":3.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946779","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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