Journal of Health Economics最新文献

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Procurement institutions and essential drug supply in low and middle-income countries 低收入和中等收入国家的采购机构和基本药物供应

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-04-10 DOI: 10.1016/j.jhealeco.2025.102996

Lucy Xiaolu Wang , Nahim Bin Zahur

International procurement institutions play an important role in drug supply. We study price, delivery, and procurement lead time of drug products for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007–2017 across procurement institution types. We find that pooled procurement lowers prices: pooling internationally is most effective for small buyers and concentrated markets, while pooling within-country is most effective for large buyers and unconcentrated markets. Pooling can reduce delays, but at the cost of longer anticipated procurement lead times. Finally, pooled procurement is more effective for older drugs, compared to patent pooling institutions that target newer drugs. Our findings are robust to alternative fixed effects specifications, instrumental variable estimation, selection-on-unobservables tests, and additional analyses accounting for heterogeneity in demand elasticities across buyers and interactions with major global health initiatives.

国际采购机构在药品供应方面发挥着重要作用。我们研究了2007-2017年106个发展中国家主要传染病药品（抗逆转录病毒药物、抗疟疾药物、抗结核病药物和抗生素）的价格、交付和采购提前期，涵盖了采购机构类型。我们发现集中采购降低了价格：国际集中采购对小买家和集中市场最有效，而国内集中采购对大买家和非集中市场最有效。集中采购可以减少延误，但代价是延长预期的采购交货时间。最后，与针对新药的专利汇集机构相比，集中采购对老药更有效。我们的研究结果对于替代固定效应规范、工具变量估计、不可观察性选择测试以及考虑购买者需求弹性异质性和与主要全球卫生倡议相互作用的额外分析都是稳健的。

引用次数: 0

Does physician-hospital vertical integration signal care-coordination? Evidence from mover-stayer analysis of commercially insured enrollees 医院垂直整合是否预示着护理协调？来自商业参保人的动态分析的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-31 DOI: 10.1016/j.jhealeco.2025.102997

William Encinosa , Avi Dor

The sharp growth in physician groups being purchased by hospitals has sparked extensive policy debate, with little evidence on the merits of such integration. We fill the gap by examining care-coordination under integration. We exploit the fact that integration varies across MSAs and focus on PPO patients with employment-based moves between MSAs. We develop a mover-stayer model with heterogenous effects to examine whether vertically integrated practices treat patients differently, or whether they just treat different patients. Moving to a more integrated market causes an increase in care coordination indices. Specifically, moving to an area with more specialty care integration causes an increase in team referrals between primary and specialty care, less lab and imaging use, less out-of-network care, and reductions in spending. That is, systems are able to narrow the scope of specialty services overall, hence creating greater social efficiencies. Moving to a market with more integrated primary care causes an increase in preventive care, decreased inpatient use by women, but an increase in spending. JEL I11, L14, C22.

医院购买医生团体的急剧增长引发了广泛的政策辩论，几乎没有证据表明这种整合的优点。我们通过检查整合下的护理协调来填补这一空白。我们利用这一事实，整合不同的msa和专注于PPO患者之间的就业为基础的msa之间的移动。我们开发了一个具有异质性效应的推动者-停留者模型，以检验垂直整合实践是否对患者有不同的治疗，或者是否只是治疗不同的患者。向更加一体化的市场转移导致护理协调指数增加。具体来说，搬到一个专业护理整合程度更高的地区会增加初级和专业护理之间的团队转诊，减少实验室和成像的使用，减少网络外护理，并减少支出。也就是说，系统能够缩小专业服务的范围，从而创造更高的社会效率。向初级保健更加一体化的市场转移，导致预防性保健增加，妇女住院使用减少，但支出增加。耶11:11,14,22。

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引用次数: 0

COVID-19 and mortality among infants: Evidence from India COVID-19与婴儿死亡率：来自印度的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-28 DOI: 10.1016/j.jhealeco.2025.102991

Erdal Asker , Shatakshee Dhongde , Abu S. Shonchoy

We present the first survey-based evidence on infant mortality in a developing country during the COVID-19 pandemic. Employing high-quality, nationally representative data from India, our analyses document a significant rise in mortality rates among infants during a six month period in 2020 covering the pandemic and the ensuing lockdown. The difference-in-differences estimates show that mortality among infants at ages 1, 3, and 6 months increased by about 9, 13, and 16 deaths per 1000 births, corresponding to an increase of 30, 42, and 44 percent, respectively. Since COVID-19 had minimal direct impact on infant mortality, our estimates likely capture some of the indirect effects on infant mortality through income shocks, reduced healthcare access, and behavioral changes such as avoidance of hospitals for maternal care during this period.

我们提出了关于COVID-19大流行期间发展中国家婴儿死亡率的首次基于调查的证据。我们的分析采用了来自印度的高质量、具有全国代表性的数据，记录了2020年6个月期间婴儿死亡率的显著上升，涵盖了大流行和随后的封锁。差异中的差异估计表明，1个月、3个月和6个月婴儿的死亡率分别增加了约9、13和16‰，相当于分别增加了30%、42%和44%。由于COVID-19对婴儿死亡率的直接影响很小，我们的估计可能会通过收入冲击、医疗保健可及性减少以及行为改变（如在此期间避免去医院接受孕产妇护理）来反映对婴儿死亡率的一些间接影响。

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

Journal of Health Economics

Pub 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。

引用次数: 0

The effects of Vietnam-era military service on the long-term health of veterans: A bounds analysis 越战时期服兵役对退伍军人长期健康的影响：一个界限分析

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-19 DOI: 10.1016/j.jhealeco.2025.102984

Xintong Wang , Carlos A. Flores , Alfonso Flores-Lagunes

We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans’ health outcomes using a restricted version of the National Health Interview Survey 1974–2013 and employing the draft lotteries as an instrumental variable. We conduct inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the “compliers”), as well as for those who volunteer for enlistment (the “always takers”). The causal analysis for volunteers, who represent over 70% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ sharp nonparametric bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 38 years after the end of the Vietnam War. We do not find consistent statistical evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear around 10 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service.

我们使用1974-2013年全国健康访谈调查的限制版本，并采用选秀彩票作为工具变量，分析了美国越战时期服兵役对退伍军人健康结果的短期和长期影响。我们对服兵役对健康的影响进行了推断，对象是服从抽签草案分配的个人（“填表者”），以及那些自愿入伍的人（“总是填表者”）。对志愿者（占退伍军人总数的70%以上）的因果分析，在这一通常关注编译者的文献中是新颖的。由于志愿者的效果不是点识别的，我们采用了依赖于温和的平均弱单调性假设的尖锐非参数边界。我们研究了越南战争结束后长达38年的一系列健康结果和行为，包括死亡率。与先前的文献一致，我们没有发现对编译者有害健康影响的一致统计证据。然而，对于志愿者，我们的文件表明，他们的估计界限显示，在冲突结束后10年左右出现统计上显著的有害健康影响。作为一个群体，退伍军人在服兵役期间经历了类似的统计上显著的有害健康影响。这些发现对退伍军人服务后的补偿和医疗保健政策具有启示意义。

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引用次数: 0

How do we age? A decomposition of Gompertz law 我们是如何变老的？Gompertz定律的分解

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-19 DOI: 10.1016/j.jhealeco.2025.102988

Casper Worm Hansen , Holger Strulik

A strong regularity of human life is Gompertz’s law, which predicts a near-perfect exponential increase in mortality with age. In this paper, we take into account that chronological age is not a cause of death and decompose Gompertz’s law into two equally strong laws: (i) an exponential increase in health deficits as measured by the frailty index, and (ii) a power law association between the frailty index and the mortality rate. We show how the increase in the frailty index can be derived from the feature of self-productivity of health deficits. We explore the robustness of the Gompertz decomposition across countries, sex, and over time and show how information about mortality rates can be used to infer the state of health of an age-structured population. Finally, we use this method to infer the biological ages of past populations, such as Australians in 1940 and Swedes in 1770.

人类生活的一个重要规律是冈珀茨定律，该定律预测死亡率随着年龄的增长呈近乎完美的指数增长。在本文中，我们考虑到计时年龄并不是死亡的原因，并将 Gompertz 定律分解为两个同样强大的定律：(i) 以虚弱指数衡量的健康缺陷的指数增长，以及 (ii) 虚弱指数与死亡率之间的幂律关联。我们展示了虚弱指数的增加如何从健康缺陷的自生产性特征中推导出来。我们探讨了 Gompertz 分解法在不同国家、不同性别和不同时期的稳健性，并展示了如何利用死亡率信息来推断年龄结构人口的健康状况。最后，我们用这种方法来推断过去人口的生理年龄，如 1940 年的澳大利亚人和 1770 年的瑞典人。

引用次数: 0

Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks 收入对婴儿健康的影响：来自扩大的儿童税收抵免和流行病刺激检查的证据

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-14 DOI: 10.1016/j.jhealeco.2025.102989

Wei Lyu , George L. Wehby , Robert Kaestner

During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.

在2019冠状病毒病大流行期间，联邦政府发放了刺激支票，并扩大了儿童税收抵免。这些补贴因婚姻状况和家庭子女数量而异。我们利用怀孕期间收入的这种似是而非的外生变化来估计收入对婴儿健康的影响。数据来自出生证明，样本集中在受过高中或更低教育的母亲身上。主要估计表明，大流行现金支付对婴儿健康（出生体重、胎龄和胎儿生长结局）几乎没有统计学上的显著影响，也没有临床或经济上有意义的影响，至少对大多数母亲收到的支付范围而言是如此。

引用次数: 0

The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program 基于团队的初级保健对与质量相关的保健服务和获得初级保健的影响：挪威初级保健团队试点方案

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-04 DOI: 10.1016/j.jhealeco.2025.102987

Øyvind Snilsberg, Tor Iversen

This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.

本研究评估了挪威的初级保健团队（PHT）试点方案，该方案在全科诊所引入了团队护理，以改善对复杂病情患者的护理。诊所雇用护士，并在以活动为基础的模式和集体资助模式之间做出选择。本分析考察了基于活动的筹资模式，其中纳入了护士按服务收费（FFS）。采用差异中的差异（DID）方法，该研究评估了该计划对与质量相关的初级保健服务、非工作时间护理、住院、全科医生（gp）工作时间和患者名单长度的影响。研究结果表明，初级保健服务增加了目标群体（主要由护士提供）的质量相关服务，而不影响全科医生的工作时间或名单长度，这表明增加的护士能力是用来加强对目标患者的护理，而不是扩大初级保健的可及性。除了对门诊护理敏感的2型糖尿病患者的住院率可能减少外，几乎没有证据表明初级保健以外的医疗保健利用发生了变化。

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引用次数: 0

Taking the competitor’s pill: When combination therapies enter pharmaceutical markets 服用竞争对手的药片：当联合疗法进入制药市场

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-03-03 DOI: 10.1016/j.jhealeco.2025.102976

Kurt R. Brekke , Dag Morten Dalen , Odd Rune Straume

We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan’s surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.

我们研究了联合疗法在制药市场上的竞争效应，这关键取决于联合使用药物的额外治疗价值和最相关的单一疗法的治疗可替代性。如果治疗价值足够大，采用联合疗法会导致价格上涨，而且可能会减少健康计划的盈余（定义为扣除药物支出的总健康福利净额），这有点矛盾。如果允许企业协调其价格设定，这将导致统一定价下的价格上涨，而指示定价下的价格下跌。允许后一种定价方案可能会提高分配效率，但只会以更高的药品支出为代价。

引用次数: 0

The long term benefits of the measles vaccine in Mexico 麻疹疫苗在墨西哥的长期效益

IF 3.4 2区经济学 Q1 ECONOMICS

Journal of Health Economics

Pub Date : 2025-02-19 DOI: 10.1016/j.jhealeco.2025.102974

Alicia Atwood, Sarah Pearlman

We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes “immune amnesia”, leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.

我们调查的影响，在教育和就业减少麻疹源于一个全国性的免疫计划在墨西哥。该方案显著改善了儿童健康状况，因为麻疹会导致“免疫健忘症”，使个人容易感染其他疾病。我们发现，麻疹疫苗大大提高了男女的受教育程度，对妇女的影响主要集中在初中，而对男子的影响则分散在初中和高中。劳动力市场的结果也有所改善，女性就业大幅增加，男性收入显著增加。

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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