{"title":"Social Comparisons and Adolescent Body Misperception: Evidence From School Entry Cutoffs.","authors":"Christopher S Carpenter, Brandyn F Churchill","doi":"10.1002/hec.4980","DOIUrl":"https://doi.org/10.1002/hec.4980","url":null,"abstract":"<p><p>We provide novel evidence on the role of social comparisons in shaping adolescent body misperception. Using an instrumental variables approach leveraging variation in relative age generated by school entry cutoff months and data from the Health Behaviour in School-Aged Children study, we show that relatively younger students are more likely to describe their bodies as lighter than the clinically relevant BMI category implied by their reported heights and weights compared to their same-age counterparts who are relatively older within their respective classrooms. This result is driven by relatively younger students who are classified as normal weight for their age describing themselves as \"too thin.\" We then show that relatively younger students are more likely to desire to gain weight, consume more calorie-dense foods, and report lower levels of physical activity. Overall, our results suggest that relatively younger students base their weight-related expectations and behaviors on their older peers.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527634","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}
{"title":"Deploying Differential Distance as an Instrumental Variable: Alternative Forms, Estimators, and Specifications.","authors":"Donghoon Lee, Anirban Basu","doi":"10.1002/hec.70003","DOIUrl":"https://doi.org/10.1002/hec.70003","url":null,"abstract":"<p><p>Despite well-established econometric theory, less attention is paid to the type of treatment effects being estimated using alternate instrumental variable (IV) approaches and the support for IV in the health literature. We illustrate this case using a commonly used IV-differential distance (DD). We summarize the literature and find that DD was used as an IV in various forms and approaches in the literature, leading to the estimation of different identified parameters, which were not always explained. We illustrate the sources of these differences using theoretical reasoning and a case study to evaluate the causal effects of going to a for-profit (FP) hospital versus a not-for-profit (NFP) hospital on the total cost of psychiatric inpatient stay. We find that estimates of treatment effects differ considerably when using two-stage least squares with binary versus continuous DD. In contrast, two-stage residual inclusion (2SRI) approaches using binary or continuous DD yield similar estimates of the treatment effects when we adequately model the control function. Both the 2SRI estimates are close to the average treatment effect estimate generated by local IV approaches, which can illustrate the extent of selection into FP versus NFP hospitals through marginal treatment effect heterogeneity.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527633","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}
{"title":"A Simple Measure of Catastrophic Health Expenditures.","authors":"Tomson Ogwang, Germano Mwabu","doi":"10.1002/hec.70007","DOIUrl":"https://doi.org/10.1002/hec.70007","url":null,"abstract":"<p><p>In this paper, we propose a simple Watts-type measure of catastrophic health expenditure (CHE) which is an adaptation of the classic Watts poverty measure. The appeal of the proposed measure stems from the fact that it is both additively decomposable (i.e., it provides information on the contributions of the various population subgroups of interest, e.g., as categorized by gender, race, region, etc., to the overall level of CHE), and multiplicatively decomposable (i.e., it enables identification of three key drivers of CHE, namely, CHE incidence, CHE intensity and CHE inequality). We also describe how the Watts-type CHE measure can be estimated and additively decomposed using the widely available ordinary least squares regression packages. The empirical example provided shows the policy value of the Watts-type CHE measure, which makes it a useful supplement to the Foster-Greer-Thorbecke type measures of CHE recently proposed by Ogwang and Mwabu. Temporal dynamics in the Watts-type CHE measures are also introduced.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495945","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}
Eduardo Ramirez Lizardi, Elisabeth Fevang, Knut Røed, Henning Øien
{"title":"Effects of Health Shocks on Adult Children's Labor Market Outcomes and Well-Being.","authors":"Eduardo Ramirez Lizardi, Elisabeth Fevang, Knut Røed, Henning Øien","doi":"10.1002/hec.70005","DOIUrl":"https://doi.org/10.1002/hec.70005","url":null,"abstract":"<p><p>Using Norwegian administrative register data, we assess the impact of unexpected health shocks hitting lone parents on offspring's labor market outcomes and well-being. We use first-time hip fractures or strokes as indicators of parental health shocks and estimate both the overall effects and the heterogeneous impacts by the survival time of the affected parent. We identify small, but significant, immediate responses in terms of an increase in physician-certified sickness absences and a higher risk of diagnosed mental disorders. The short-term effects are larger for offspring whose parents die shortly after the shock. Most of the effects fade out quickly, and the negative impacts on subsequent employment and earnings are small and only borderline statistically significant. In general, our results suggest that the responses to the deteriorating health of a parent tend to be short-lived and mostly manifest as temporary absences from work rather than complete detachment from the labor market.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495882","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}
E Kathleen Adams, Sara Markowitz, Michael R Kramer, Peter J Joski, Anne L Dunlop
{"title":"Decomposing Racial Disparities in Severe Maternal Morbidity Within Insurance Groups.","authors":"E Kathleen Adams, Sara Markowitz, Michael R Kramer, Peter J Joski, Anne L Dunlop","doi":"10.1002/hec.70002","DOIUrl":"10.1002/hec.70002","url":null,"abstract":"<p><p>Rates of severe maternal morbidity (SMM) are related to maternal, hospital, and residential factors, but the contribution of these factors to racial disparities in SMM within Medicaid and private insured groups is largely unknown. Linked Georgia vital records/hospital discharge data for 2016-2020 are used to identify SMM during delivery or within 42 days postpartum for Medicaid and private insured. The Oaxaca-Blinder decomposition is used to describe the percentage of the Black-White SMM gap explained, based on linear probability models without and with hospital fixed-effects. While the rate of SMM is higher for Medicaid than private insured, the Black-White SMM gap is lower within Medicaid than private insured (1.15 vs. 1.40 per 100 deliveries). Including hospital fixed-effects increased the explained gap by 29.1 percentage points (from 13.8% to 42.9%) within Medicaid and by 9.4 percentage points (from 20.0% to 29.4%) within private insured. Residential factors significantly reduced the Black-White gap explained for Medicaid (-19.6%) but were insignificant (∼0%) for privately insured. According to the Oaxaca-Blinder algebraic calculation, differences in within-hospital processes by race contribute a large portion of the discriminatory Black-White SMM gap among Georgia deliveries while residential areas with greater provider access tends to reduce the gap among Medicaid insured.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340043","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}
{"title":"Heterogenous Mental Health Impacts of a Forced Relocation: The Red Zone in Christchurch (New Zealand).","authors":"Thoa Hoang, Ilan Noy, Thinh Le Van","doi":"10.1002/hec.70004","DOIUrl":"10.1002/hec.70004","url":null,"abstract":"<p><p>People are sometimes forced to move, and it is plausible that such relocation involves significant psychological costs. The challenge in identifying the mental health consequences of moving is that most moves are (at least partly) voluntary so that the sample of movers is self-selected. We focus on a natural experiment, the government-mandated relocation of some households after all households experienced an exogenous shock. We use this experiment to identify the causal impact of moving on people's mental health, distinguishing between less severe and more severe health conditions, and between individuals with pre-existing mental health conditions and those without. The event we focus on is the 2011 Christchurch (New Zealand) earthquake, and the consequent decision of the government to relocate about 8000 households from some of the earthquake-affected areas. We use a comprehensive administrative dataset that includes health records with information on hospital attendance, specialist services, and prescribed medications for (almost) every resident in the city and compare the relocated individuals to those who lived elsewhere in the earthquake-damaged city. We examine both the likelihood of receiving mental health treatment (the extensive margin), and the intensity of treatment, measured by the number of visits to a clinic or hospital (the intensive margin). We find a statistically significant increase in the likelihood and frequency of receiving treatment for moderate mental health problems among individuals compelled to relocate, when compared to other residents of the earthquake-affected city who were allowed to remain in situ. This increase persisted to December 2013 for everyone, and remained significant for the elderly to the end of 2018. We found no such increase in health care utilisation for more severe mental health symptoms that required more acute interventions (in clinics or hospitals).</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340044","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}
{"title":"Do Rurality-Based Financial Incentives Improve Equity of Primary Healthcare Access? Evidence From Australia.","authors":"Karinna Saxby, Yuting Zhang","doi":"10.1002/hec.70000","DOIUrl":"https://doi.org/10.1002/hec.70000","url":null,"abstract":"<p><p>In Australia, as in many other countries, people living in rural and remote areas experience poorer health outcomes and use less primary healthcare compared to urban populations. Aiming to reduce these inequities, in 2022 the Australian government increased rural-based financial incentives for General Practitioners (GPs) to \"bulk bill\" (i.e., provide care with zero patient out-of-pocket costs) children and concession card holders (low-income patients and older adults) living in rural and remote, but not urban areas. Using whole-of-population administrative data and exploiting variation in the eligibility of geographic areas to receive these incentives, we find that, compared to people living in urban areas, the reform led to a 2.7% (95% CI 2.2; 3.2) increase in the number of GP visits, a 9.0% (95% CI 8.4; 9.5) increase in the number of bulk billed GP visits, and a 13.0% (95% CI 12.4; 13.7) reduction in the out-of-pocket cost per GP visit among people living in rural areas. Effects were more pronounced for people with higher initial out-of-pocket costs-adults rather than children, people without concession cards, and people living in areas with less socioeconomic disadvantage. Altogether, while the reform has gone some way to reduce out-of-pocket costs for rural patients, benefits are unequal and inequities in access remain.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325313","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}
{"title":"The Spillover Effects of a City-Wide Global Budget and Case-Based Payment Reform on Inbound Non-Resident Patients.","authors":"Yawen Jiang","doi":"10.1002/hec.4979","DOIUrl":"https://doi.org/10.1002/hec.4979","url":null,"abstract":"<p><p>This study investigates the spillover effects of a city-wide global budget and case-based payment reform (known as the DIP reform) on non-resident patients from another city in the same province. By developing a theoretical model, I hypothesize that nontrivial deviation costs from reform-driven standard patient journeys could lead to reduced charges for patients who seek care in the reform city but are not subject to its payment reform policies. To test this hypothesis, I employ a difference-in-differences approach using discharge records to compare outcomes between patients from a non-reform outbound city hospitalized in the reform city, where DIP was implemented, and those hospitalized in other non-reform cities within the same province. The results indicate that the DIP reform significantly reduced total hospital charges for non-resident patients, without compromising care quality as measured by readmission rates. Notably, high-cost hospitals experienced more pronounced charge reductions compared to low-cost hospitals, highlighting the need to manage heterogeneous impacts on different healthcare providers to ensure equitable healthcare delivery.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293637","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}
Rebecca G. Njuguna, Henry Cust, The POWER Team, Aurélia Lépine
{"title":"Does the Risk Premium Differ Between Women Engaging in Commercial and Transactional Sex? Evidence From Urban Cameroon","authors":"Rebecca G. Njuguna, Henry Cust, The POWER Team, Aurélia Lépine","doi":"10.1002/hec.4964","DOIUrl":"10.1002/hec.4964","url":null,"abstract":"<p>Female sex workers (FSWs) can receive a premium for engaging in unprotected and other risky sexual behaviours. Women engaging in transactional sex, defined as ‘non-commercial sexual relationships motivated by the implicit assumption that sex is exchanged for material support’, are thought to share similar economic incentives as women engaging in commercial sex. Using a panel of up to six sex acts from longitudinal datasets stratified by FSWs and women engaging in transactional sex in Cameroon, we provide evidence consistent with literature of a 30% condomless risk premium for FSWs. We then provide the first empirical evidence of a discount for condomless sex of 14% for women engaging in transactional sex. Qualitative analysis offers two explanations for this surprising finding, first a lack of HIV awareness among women engaging in transactional sex, and second, that risky sex acts are a demonstration of investment of trust in relationships and represent unobservable exchange of value. Given the larger number of women engaging in transactional relationships compared to FSWs in sub-Saharan Africa, and their lower awareness of HIV risks, this finding offers a significant explanation for the disproportionate burden of HIV incidence among adolescents and young women in sub-Saharan Africa.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 8","pages":"1474-1486"},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283615","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}
{"title":"Hungry no More? The Joint Impact of Minimum Wages and the Earned Income Tax Credit on Food Insecurity.","authors":"Otto Lenhart, Kalyan Chakraborty","doi":"10.1002/hec.70001","DOIUrl":"https://doi.org/10.1002/hec.70001","url":null,"abstract":"<p><p>In this study, we provide evidence on the combined effect of state minimum wages and state Earned Income Tax Credit (EITC) benefits on food insecurity. Using data from the Current Population Survey Food Security Supplement (CPS-FSS) between 2001 and 2019 and a sample of individuals with at most a High School degree, we estimate difference-in-differences models to examine whether the policies have a joint impact on food insecurity. Our study adds to a small number of papers evaluating potential interactions between state minimum wages and EITC laws. Our analysis reveals the presence of joint effects of the two programs in terms of reducing food insecurity. We find that a $1 increase in minimum wages reducing the likelihood of households experiencing very low food security by 6.0 percent in states with state EITC laws, with the effect being even larger (9.8 percent) in states with high EITC benefits. When examining a potential mechanism through which the two policies improve food security, we provide evidence for a joint impact on reducing poverty rates. In contrast, we find no evidence that minimum wages alone impact food insecurity or poverty rates in states without state EITC laws.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257964","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}