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The Impact of Social Health Insurance on Student Performance: Evidence From an RDD in Peru.
IF 2 3区 医学
Health economics Pub Date : 2025-03-27 DOI: 10.1002/hec.4961
Miguel Angel Carpio, Lucero Gomez, Pablo Lavado
{"title":"The Impact of Social Health Insurance on Student Performance: Evidence From an RDD in Peru.","authors":"Miguel Angel Carpio, Lucero Gomez, Pablo Lavado","doi":"10.1002/hec.4961","DOIUrl":"https://doi.org/10.1002/hec.4961","url":null,"abstract":"<p><p>The literature on the effects of social health insurance focuses on its stated goals, which are health status and financial protection. In contrast, we examine the effect of the Peruvian program on student performance using a sharp RDD. We use a unique individual-level database built from the merger of household survey data and standardized test scores from a national census. We find that social health insurance has large effects on mathematics and reading comprehension scores. The clearest mechanism is a lower incidence of anemia among children and family members.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opioid Control Policies Can Also Reduce Domestic Violence.
IF 2 3区 医学
Health economics Pub Date : 2025-03-22 DOI: 10.1002/hec.4960
Andrei Barbos, Minglu Sun
{"title":"Opioid Control Policies Can Also Reduce Domestic Violence.","authors":"Andrei Barbos, Minglu Sun","doi":"10.1002/hec.4960","DOIUrl":"https://doi.org/10.1002/hec.4960","url":null,"abstract":"<p><p>Opioid abuse is an issue of serious concern in the United States, and it has been the focus of a multitude of state and federal level policies. Such policies can raise cost versus benefit considerations, which besides direct effects, must also account for potential second-order unintended consequences. We investigate the possibility of an important spillover of effective opioid control policies on reducing domestic violence. To this aim, we exploit the staggered implementation of the Mandatory Access Prescription Drug Monitoring Programs, which required health care providers to consult an electronic database before prescribing and/or dispersing controlled substances. These programs have been shown to be effective at reducing the utilization of prescription opioids. Our analysis suggests that they may have also decreased the instances of intimate partner assaults, driven primarily by a decrease in simple assaults.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Investigating the Spillover Mechanisms of Payment Incentives on the Outcomes for Non-Targeted Patients.
IF 2 3区 医学
Health economics Pub Date : 2025-03-21 DOI: 10.1002/hec.4956
Philip Britteon, Søren Rud Kristensen, Yiu-Shing Lau, Ruth McDonald, Matt Sutton
{"title":"Investigating the Spillover Mechanisms of Payment Incentives on the Outcomes for Non-Targeted Patients.","authors":"Philip Britteon, Søren Rud Kristensen, Yiu-Shing Lau, Ruth McDonald, Matt Sutton","doi":"10.1002/hec.4956","DOIUrl":"https://doi.org/10.1002/hec.4956","url":null,"abstract":"<p><p>Payment reforms in healthcare can have spillover effects on the care experienced by non-targeted patients treated by the same provider. Few empirical studies have quantitatively investigated the mechanisms behind these effects. We formulate theory-driven hypotheses to investigate the spillover mechanisms of a regional payment reform in the English National Health Service, using linked patient-physician data and difference-in-differences methods. We show that regional payment changes were associated with an increase in mortality of 0.321 percentage points (S.E. 0.114) for non-targeted emergency patients who were treated by physicians with no exposure to the incentives, compared to control regions. In contrast, the mortality rate for non-targeted patients reduced by 0.008 percentage points (S.E. 0.002) for every additional targeted patient treated per quarter by their physician. These findings were consistent across a range of sensitivity analyses. The findings suggest that providers diverted resources away from non-targeted patients but that patients benefitted from physicians learning from the incentives. We demonstrate how the formulation of theory-driven hypotheses about spillover mechanisms can improve the understanding of how and where spillover effects may occur, contributing to research design and policymaking.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wholesome Lunch to the Whole Classroom: Short- and Longer-Term Effects on Early Teenagers' Weight.
IF 2 3区 医学
Health economics Pub Date : 2025-03-18 DOI: 10.1002/hec.4959
Shiko Maruyama, Sayaka Nakamura
{"title":"Wholesome Lunch to the Whole Classroom: Short- and Longer-Term Effects on Early Teenagers' Weight.","authors":"Shiko Maruyama, Sayaka Nakamura","doi":"10.1002/hec.4959","DOIUrl":"https://doi.org/10.1002/hec.4959","url":null,"abstract":"<p><p>Previous studies on the effect of school lunch programs on child obesity have been hampered by effect heterogeneity, self-selection, and stigma-induced under-reporting, having produced mixed findings. Its potential long-lasting effect has also been debated. We study the body-weight effect of a Japanese school lunch program, which provides nutritional lunch to all students at participating municipal junior highs. The lack of means testing and individual participation choice offers causal estimates of actual participation for a diverse and representative group of children. By exploiting almost universal school lunch coverage for elementary school children nationwide, we construct a difference-in-differences (DID) framework. Using the 1975-1994 National Nutrition Survey, a nationally representative household survey with measured height and weight, we find a regressive benefit of school lunch: while no statistically significant effect is found for the full sample, we find significant obesity-reducing effects for the subsamples of children with low socioeconomic backgrounds. This obesity-reducing effect remains at least a few years after graduation, implying effect through not only nutritional contents but also guiding healthy eating behavior. We find little evidence that school lunch reduces underweight. Propensity score weighting, the DID analysis for percentiles, and various falsification tests confirm the robustness of our estimates.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does Publicly-Funded Adult Social Care Impact Informal and Unpaid Carers' Quality of Life in England?
IF 2 3区 医学
Health economics Pub Date : 2025-03-18 DOI: 10.1002/hec.4957
Francesco Longo, Karl Claxton, Andrea Salas-Ortiz, James Lomas, Stephen Martin
{"title":"Does Publicly-Funded Adult Social Care Impact Informal and Unpaid Carers' Quality of Life in England?","authors":"Francesco Longo, Karl Claxton, Andrea Salas-Ortiz, James Lomas, Stephen Martin","doi":"10.1002/hec.4957","DOIUrl":"https://doi.org/10.1002/hec.4957","url":null,"abstract":"<p><p>Informal carers are important for their care recipients, but the burden of care may have a detrimental effect on the carer's well-being. Publicly-funded Adult Social Care (simply, ASC) in England may alleviate this burden. We therefore investigate whether ASC expenditure improves carers' quality of life and the channels through which this effect may exist. We analyze data on informal carers from the biennial Survey of Adult Carers in England in 2014/15, 2016/17, 2018/19 and 2021/22. We implement panel data instrumental variables methods that use conditionally exogenous variability in the local taxation to identify the causal effect of ASC expenditure. Our main finding suggests that a £1000-increase in ASC expenditure per client increases, on average, the carer-reported quality of life score by 0.3, which amounts to 4.2% of its average in 2021/22. Moreover, ASC expenditure has a beneficial impact on informal carers' care tasks, health, range of employment choices, and finances.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Behavioral Responses to Healthcare Funding Decisions and Their Impact on Value for Money: Evidence From Australia.
IF 2 3区 医学
Health economics Pub Date : 2025-03-18 DOI: 10.1002/hec.4958
Peter Ghijben, Dennis Petrie, Silva Zavarsek, Gang Chen, Emily Lancsar
{"title":"Behavioral Responses to Healthcare Funding Decisions and Their Impact on Value for Money: Evidence From Australia.","authors":"Peter Ghijben, Dennis Petrie, Silva Zavarsek, Gang Chen, Emily Lancsar","doi":"10.1002/hec.4958","DOIUrl":"https://doi.org/10.1002/hec.4958","url":null,"abstract":"<p><p>Value for money is fundamental to health insurance schemes given insurers must choose which treatments to fund. Assessing value for money ex ante is challenging, however, because costs and outcomes depend on how treatments are used. Estimates often rely on evidence from early randomized controlled trials conducted prior to regulatory approval, where provider and patient behaviors are tightly controlled. This approach ignores how different supply conditions and incentives in practice influence behaviors. This paper considers how provider and patient incentives can differ between trial and practice settings and analyses how healthcare use changed when new prostate cancer treatments were funded on the public health insurance scheme in Australia. We find evidence that doctors treated patients with worse prognosis compared to the trials, patients ceased prior treatment and switched to the new treatments earlier than expected, and treatment duration was longer than expected. These and other behavioral responses reduced value for money ex post. Our findings suggest that health insurers should carefully consider the supply conditions and incentives in practice when funding new treatments.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Care Partnership Effects on Medicaid and Private Insurance.
IF 2 3区 医学
Health economics Pub Date : 2025-03-15 DOI: 10.1002/hec.4949
Joan Costa-Font, Nilesh Raut
{"title":"Long-Term Care Partnership Effects on Medicaid and Private Insurance.","authors":"Joan Costa-Font, Nilesh Raut","doi":"10.1002/hec.4949","DOIUrl":"https://doi.org/10.1002/hec.4949","url":null,"abstract":"<p><p>We examine the impact of the Long-Term Care Insurance Partnership (LTCIP) program-a collaborative initiative between the state-level Medicaid programs and private health insurance companies designed to promote private long-term care insurance (LTCI)-on insurance ownership and Medicaid utilization. We draw on individual-level longitudinal data and employ a difference-in-differences (DD) design adjusted for the staggered implementation of the program between 2005 and 2018. Our results suggest that the rollout of the LTCIP program led to a 1.54 percentage point (pp) (14.7%) increase in LTCI ownership and a 0.82 pp (13.3%) reduction in Medicaid uptake. Our estimates suggest that these combined effects led to an approximate average cost saving of $74 per 65-year-old participant. These findings are explained by a certain degree of substitution between LTCIP and traditional LTCI contracts, ultimately postponing the use of Medicaid benefits.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Connections and COVID19 Vaccination.
IF 2 3区 医学
Health economics Pub Date : 2025-03-15 DOI: 10.1002/hec.4953
Arnab K Basu, Nancy H Chau, Oleg Firsin
{"title":"Social Connections and COVID19 Vaccination.","authors":"Arnab K Basu, Nancy H Chau, Oleg Firsin","doi":"10.1002/hec.4953","DOIUrl":"https://doi.org/10.1002/hec.4953","url":null,"abstract":"<p><p>This paper unpacks the effects of social networks on county-level COVID19 vaccinations in the US. We jointly assess the contemporaneous and dynamic network ef-fects of vaccination exposure, to distinguish between network-mediated contemporane-ous effects (e.g., \"vaccine-hunter\" Facebook groups crowd-source information about ac-cess and efficacy) and longer-term effects (e.g., vaccine exposure chips away vaccine hesi-tancy). Accounting for possible correlated shocks, socio-economic/spatial confounders, and pandemic-related shifters, we find positive stage-of-pandemic dependent contempo-raneous friendship network effects, and null dynamic network effect, thus sharply dis-tinguishing COVID19 vaccination from other infection-mitigating practices in terms of openness to social-learning over time.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Copayments for Prescription Drugs: The Drivers of Demand Responses.
IF 2 3区 医学
Health economics Pub Date : 2025-03-09 DOI: 10.1002/hec.4955
Jouko Verho, Jarkko Harju
{"title":"Copayments for Prescription Drugs: The Drivers of Demand Responses.","authors":"Jouko Verho, Jarkko Harju","doi":"10.1002/hec.4955","DOIUrl":"https://doi.org/10.1002/hec.4955","url":null,"abstract":"<p><p>We study the demand responses of the drug copayment threshold in Finland using detailed prescription drug purchase data. The analysis reveals that the average drug costs increase discontinuously by 17% at the threshold above which out-of-pocket drug costs decrease substantially. Our results suggest an average price elasticity of -0.17, which indicates evident moral hazard costs. Approximately 80% of the overall effect is due to individuals buying drugs in larger quantities rather than purchasing higher-priced drugs. The heterogeneity analysis suggests that the responses are largest for drug categories taken on an as-needed rather than a regular basis.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
For Better or Worse? Subjective Expectations and Cost-Benefit Trade-Offs in Health Behavior: An Application to Lockdown Compliance in the United Kingdom
IF 2 3区 医学
Health economics Pub Date : 2025-03-07 DOI: 10.1002/hec.4942
Gabriella Conti, Pamela Giustinelli
{"title":"For Better or Worse? Subjective Expectations and Cost-Benefit Trade-Offs in Health Behavior: An Application to Lockdown Compliance in the United Kingdom","authors":"Gabriella Conti,&nbsp;Pamela Giustinelli","doi":"10.1002/hec.4942","DOIUrl":"10.1002/hec.4942","url":null,"abstract":"<p>We study the determinants of voluntary compliance in the early phase of the COVID-19 pandemic. Using rich data on subjective expectations we collected during the spring 2020 lockdown in the UK, we estimate a simple model of compliance choice with uncertain costs and benefits whose estimates quantify the utility trade-offs underlying compliance. Using these estimates, we decompose group differences in compliance into components due to preferences vis-à-vis expectations and compute the monetary compensation required for different groups to comply. We find citizens face intuitive trade-offs between costs and benefits of noncompliance, with the largest costs being the disutility of passing away from COVID-19 and the psychological cost of being caught transgressing, and the largest benefit being preserving own mental health. Significant heterogeneity exists across groups, with women's higher compliance being explained by gender differences in both preferences and expectations, while vulnerables' higher compliance being mainly driven by differences in preferences. The response of individual behavior to others' behavior, too, varies across personal characteristics and circumstances. Our findings underscore the importance for public health policies to take into account behavior-relevant heterogeneity in citizens' preferences, expectations, and responses to others.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 5","pages":"992-1012"},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4942","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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