首页 > 最新文献

Journal of Health Economics最新文献

英文 中文
Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes 重返校园:COVID-19期间学校访问对COVID-19结果的影响
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-06-15 DOI: 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.
即使在全国突发公共卫生事件结束后,学校关闭对COVID-19传播的影响仍不清楚。我们使用与智能手机移动数据相关的1.3亿个家庭每周观察数据的医疗保健索赔数据来衡量县级学校访问变化对COVID-19结果的影响。我们使用了三重差异方法,利用县内有学龄儿童和没有学龄儿童的家庭之间的暴露差异,发现影响不大。我们发现COVID-19感染率上升,在低收入和COVID-19高流行县差异更大。
{"title":"Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes","authors":"Dena Bravata ,&nbsp;Jonathan Cantor ,&nbsp;Neeraj Sood ,&nbsp;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":"2025-08-01","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}
引用次数: 0
Do for-profit hospitals cream-skim patients? Evidence from inpatient psychiatric care in California 营利性医院会对病人进行奶油脱脂吗?来自加州住院精神病治疗的证据
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-06-21 DOI: 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.
本文考察了在加州的精神病住院患者中,营利性(FP)医院是否从事奶油撇脂,即选择患者的某些特征(s)而不是他们的护理需求,这提高了提供者的盈利能力。我们提出了一种利用成本结果来识别奶油撇脂的新方法。Naïve医院所有权类型的治疗效果估计包括不同患者病例组合(选择)和医院成本控制策略(执行)的综合效果。相比之下,工具变量(IV)方法可以控制案例组合并确定所有权类型因其执行而产生的因果效应。我们解释naïve和IV治疗效果之间的差异是由计划生育医院基于未观察到的患者病例组合的选择驱动的。我们对患者选择的研究结果表明,计划生育医院比非营利性医院更有可能接纳成本较高的患者(在现有的住院精神病护理支付系统下,这些患者往往利润较低),没有证据表明计划生育医院存在奶油脱脂现象。此外,我们对医院执行情况的估计表明,计划生育医院比非计划生育医院更有可能以较低的成本提供住院服务。这些结果可能减轻了人们对最近FP精神病医院激增的担忧,特别是对该市场中奶油撇脂的担忧。
{"title":"Do for-profit hospitals cream-skim patients? Evidence from inpatient psychiatric care in California","authors":"Donghoon Lee ,&nbsp;Anirban Basu ,&nbsp;Jerome A. Dugan ,&nbsp;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":"2025-08-01","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}
引用次数: 0
The effect of e-cigarette flavor bans on tobacco use 电子烟口味禁令对烟草使用的影响
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-05-22 DOI: 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.
支持限制加味电子烟销售的人士认为,加味电子烟对年轻人很有吸引力,会导致他们对尼古丁上瘾。利用来自各种调查(青少年风险行为调查、行为风险因素监测调查和烟草与健康人口评估)的数据,本研究是第一个研究州和地方限制销售调味电子尼古丁输送系统(ENDS)产品对青少年和年轻人烟草使用的影响的研究之一。我们发现强有力的证据表明,采用ENDS口味限制可以减少青少年短期频繁和日常使用ENDS的大约2 - 3个百分点。一些证据表明,这种影响在两年后减弱。我们还记录了18-30岁年轻人使用ENDS的减少,两年后似乎会加强。最后,有证据表明,在某些年龄组中,有香味的电子烟会被无香味的电子烟和香烟取代。
{"title":"The effect of e-cigarette flavor bans on tobacco use","authors":"Chad Cotti ,&nbsp;Charles Courtemanche ,&nbsp;Yang Liang ,&nbsp;Johanna Catherine Maclean ,&nbsp;Erik Nesson ,&nbsp;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":"2025-08-01","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}
引用次数: 0
Mental health and mortality trends in the United States 美国的心理健康和死亡率趋势
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-06-03 DOI: 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.
这项研究调查了21世纪初,心理健康状况的恶化是否在某些人群的死亡率上升中发挥了重要作用。随着人们对所谓的“绝望死亡”的关注越来越多,这个问题变得越来越突出。主要的结论是,尽管心理健康状况的下降可能导致了不良的死亡率趋势——尤其是在非西班牙裔白人的黄金年龄——但其总体影响是有限的,而且没有被“绝望死亡”的标准定义很好地捕捉到。五个关键发现支持了这一结论。首先,在1993年至2019年期间,所有受调查人群的心理健康状况都有所恶化。其次,这些下降与较高的预测死亡率有关,并有助于解释1999年至2019年期间黄金年龄非西班牙裔白人和非西班牙裔黑人(在较小程度上)死亡率趋势的恶化。第三,虽然这些相关性为“绝望死亡”这一更广泛的观点提供了一些支持,但构成它们的具体原因似乎更广泛,也与之前强调的不同。第四,精神压力恶化如何影响死亡率的异质性——而不是精神健康趋势本身——在解释其总体影响的黑人-白人差异方面更为重要。最后,在主要指标中,近年来壮年白人死亡率上升的原因中,估计有9%至29%是心理健康恶化造成的。
{"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":"2025-08-01","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}
引用次数: 0
Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging 重新考虑技术管制:需求证明政策对诊断影像数量和质量的影响
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-06-07 DOI: 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.
关于《需要证明法》对医疗保健影响的估计并不一致,可能是因为并非所有《需要证明法》都适用于所有服务。使用识别成像相关CON定律的原始数据集和州边界的回归不连续设计,我们估计CON对诊断成像的使用和质量的影响。与不受监管的州相比,受监管州的医疗保险受益人接受任何图像的可能性更小,甚至更不可能接受低价值的图像。高价值成像不受影响。总的来说,用于成像的CON减少了低价值的护理,同时保持了高价值的护理不变。
{"title":"Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging","authors":"Jill R. Horwitz ,&nbsp;Austin Nichols ,&nbsp;Anthony Yu ,&nbsp;Carrie H. Colla ,&nbsp;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":"2025-08-01","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}
引用次数: 0
Imprecise health beliefs and health behavior 不精确的健康信念和健康行为
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-08-01 Epub Date: 2025-06-05 DOI: 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.
本文研究了COVID-19背景下的信念不准确性,当时对健康结果的不确定性普遍存在。我们在大流行开始几个月后对年轻人样本进行了调查。我们推导出个体对不同健康结果的最小和最大主观概率,并将信念不精确定义为这些值之间的范围。我们记录了受访者不精确程度的实质性异质性,这在很大程度上仍无法解释标准人口统计学特征。为了评估不精确信念对行为的影响,我们询问了在具有不同保护行为水平的假设情景下对未来结果的信念。我们发现,那些期望保护行为不仅能减少负面健康结果的主观概率,还能减少与之相关的不精确程度的人,会表现得更有保护意识。
{"title":"Imprecise health beliefs and health behavior","authors":"Adeline Delavande ,&nbsp;Emilia Del Bono ,&nbsp;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":"2025-08-01","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}
引用次数: 0
Corrigendum to “Nudging the Nudger: A Field Experiment on the Effect of Performance Feedback to Increase Organ Donor Registrations” [Journal of Health Economics, 97, 102914, 2024] “轻推轻推:绩效反馈对增加器官捐献者登记效果的现场实验”[卫生经济杂志,97,102914,2024]。
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-05-01 Epub Date: 2025-03-24 DOI: 10.1016/j.jhealeco.2025.102990
Julian House , Nicola Lacetera , Mario Macis , Nina Mazar
{"title":"Corrigendum to “Nudging the Nudger: A Field Experiment on the Effect of Performance Feedback to Increase Organ Donor Registrations” [Journal of Health Economics, 97, 102914, 2024]","authors":"Julian House ,&nbsp;Nicola Lacetera ,&nbsp;Mario Macis ,&nbsp;Nina Mazar","doi":"10.1016/j.jhealeco.2025.102990","DOIUrl":"10.1016/j.jhealeco.2025.102990","url":null,"abstract":"","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102990"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711927","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}
引用次数: 0
Social genetic insurance: A life-cycle perspective 社会遗传保险:生命周期视角
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-05-01 Epub Date: 2025-04-18 DOI: 10.1016/j.jhealeco.2025.102994
Hélène Schernberg
Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redistributing from low-risk to high-risk individuals in period 1 can increase social welfare, even when the high-risk are not financially penalized. Temporally risk-averse individuals value reductions in the risk to their lifetime utility brought by illness, such as increased morbidity and mortality. A social insurance can achieve this by taxing the low-risk and subsidizing the high-risk. I calibrate a multi-period life-cycle model for breast cancer and Huntington’s disease and quantify the optimal redistribution. For these two conditions, which are rare, substantial transfers to the high-risk can be achieved with minimal taxation on the low-risk. Thus, the welfare of the high-risk is substantially improved with little impact on the low-risk.
即使在没有重新分类风险的情况下,时间风险厌恶也可以证明社会遗传保险计划是合理的。我为那些在第0阶段进行基因测试,可能在第2阶段生病的个体建模。我表明,在第一阶段,从低风险人群到高风险人群的再分配可以增加社会福利,即使高风险人群没有受到经济惩罚。短期风险厌恶者重视疾病对其终生效用带来的风险减少,例如发病率和死亡率的增加。社会保险可以通过向低风险人群征税和补贴高风险人群来实现这一目标。我为乳腺癌和亨廷顿氏病校准了一个多周期生命周期模型,并量化了最佳再分配。对于这两种罕见的情况,可以在对低风险国家征税最少的情况下实现向高风险国家的大量转移。因此,高风险人群的福利得到了实质性的改善,而对低风险人群的影响很小。
{"title":"Social genetic insurance: A life-cycle perspective","authors":"Hélène Schernberg","doi":"10.1016/j.jhealeco.2025.102994","DOIUrl":"10.1016/j.jhealeco.2025.102994","url":null,"abstract":"<div><div>Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redistributing from low-risk to high-risk individuals in period 1 can increase social welfare, even when the high-risk are not financially penalized. Temporally risk-averse individuals value reductions in the risk to their lifetime utility brought by illness, such as increased morbidity and mortality. A social insurance can achieve this by taxing the low-risk and subsidizing the high-risk. I calibrate a multi-period life-cycle model for breast cancer and Huntington’s disease and quantify the optimal redistribution. For these two conditions, which are rare, substantial transfers to the high-risk can be achieved with minimal taxation on the low-risk. Thus, the welfare of the high-risk is substantially improved with little impact on the low-risk.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102994"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865032","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}
引用次数: 0
Disability insurance screening and worker health 残疾保险筛选和工人健康
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-05-01 Epub Date: 2025-03-26 DOI: 10.1016/j.jhealeco.2025.102986
Alexander Ahammer , Analisa Packham
We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening, they are more likely to remain in the labor force. However, we estimate no statistical differences in any physical or mental health outcomes, and can rule out large effects on overall healthcare utilization. Our findings imply that imposing stricter DI screening can yield large fiscal benefits, on the margin.
我们从劳动力参与、项目溢出效应和工人健康等方面提供了新的证据,证明了更具针对性的残疾保险(DI)项目的回报。为此,我们分析了奥地利工人在工作场所受伤后经历不同程度的申请筛选。我们发现,当工人面临更严格的筛选时,他们更有可能留在劳动力市场。然而,我们估计在任何身体或心理健康结果上没有统计学差异,并且可以排除对整体医疗保健利用的大影响。我们的研究结果表明,实施更严格的残障筛查可以在边际上产生巨大的财政效益。
{"title":"Disability insurance screening and worker health","authors":"Alexander Ahammer ,&nbsp;Analisa Packham","doi":"10.1016/j.jhealeco.2025.102986","DOIUrl":"10.1016/j.jhealeco.2025.102986","url":null,"abstract":"<div><div>We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening, they are more likely to remain in the labor force. However, we estimate no statistical differences in any physical or mental health outcomes, and can rule out large effects on overall healthcare utilization. Our findings imply that imposing stricter DI screening can yield large fiscal benefits, on the margin.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102986"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The incentive to treat: Physician agency and the expansion of the 340B drug pricing program 治疗的激励:医生代理和340B药品定价计划的扩大
IF 3.4 2区 经济学 Q1 ECONOMICS Pub Date : 2025-05-01 Epub Date: 2025-02-03 DOI: 10.1016/j.jhealeco.2025.102971
Danea Horn
The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.
340B药物定价计划激励医疗保健提供者增加药物使用。它允许某些安全网医院和诊所以相当大的折扣从制造商那里购买门诊药物,但由付款人以全价偿还。然而,之前的文献在很大程度上没有研究340B计划如何影响医生的处方行为。在本文中,我提供了340B供应商在乳腺癌治疗中的医生代理的证据。我利用该计划的交错扩散来确定340B参与对处方行为和患者结果的影响。加入340B计划的医生增加了接受药物治疗的患者比例,并增加了每位患者的处方强度。我还发现,不包括在临床治疗建议和治疗副作用的药物的处方显著增加。尽管使用了更多的强化治疗,我发现生存率没有统计学上的显著变化。
{"title":"The incentive to treat: Physician agency and the expansion of the 340B drug pricing program","authors":"Danea Horn","doi":"10.1016/j.jhealeco.2025.102971","DOIUrl":"10.1016/j.jhealeco.2025.102971","url":null,"abstract":"<div><div>The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102971"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510889","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}
引用次数: 0
期刊
Journal of Health Economics
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1