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Using Policy Learning to Inform Health Insurance Targeting: A Case Study of Indonesia. 利用政策学习为健康保险目标提供信息：以印度尼西亚为例。
IF 2.4 3区 医学
Health economics Pub Date : 2025-09-08 DOI: 10.1002/hec.70031
Vishalie Shah, Andrew M Jones, Ivana Malenica, Taufik Hidayat, Noemi Kreif
{"title":"Using Policy Learning to Inform Health Insurance Targeting: A Case Study of Indonesia.","authors":"Vishalie Shah, Andrew M Jones, Ivana Malenica, Taufik Hidayat, Noemi Kreif","doi":"10.1002/hec.70031","DOIUrl":"10.1002/hec.70031","url":null,"abstract":"<p><p>This paper demonstrates how optimal policy learning can inform the targeted allocation of Indonesia's two subsidized health insurance programmes. Using national survey data, we develop policy rules aimed at minimizing \"catastrophic health expenditure\" among enrollees of APBD or APBN, the two government-funded schemes. Employing a super learner ensemble approach, we use regression and machine learning methods of varying complexity to estimate conditional average treatment effects and construct policy rules to optimize program benefits, both with and without budget constraints. We find that the financial impact of APBD enrollment over APBN differs with household characteristics, particularly demographic composition, socioeconomic status, and geography. Households assigned to APBD under the policy rule are typically urban-based with better facilities, whereas rural households with less accessible healthcare are assigned to APBN-a pattern intensified under budget constraints. Both constrained and unconstrained optimal policy assignments show lower expected catastrophic expenditure risk than the current assignment strategy. This study contributes to the literature on heterogeneous treatment effects, optimal policy leaning, and health financing in developing countries, showcasing data-driven solutions for more equitable resource allocation in public health insurance contexts.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023143","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
Chinese Aid for Transportation Infrastructure and Child Health in Africa. 中国援助非洲交通基础设施和儿童健康。
IF 2.4 3区 医学
Health economics Pub Date : 2025-09-07 DOI: 10.1002/hec.70035
Jia Li
{"title":"Chinese Aid for Transportation Infrastructure and Child Health in Africa.","authors":"Jia Li","doi":"10.1002/hec.70035","DOIUrl":"https://doi.org/10.1002/hec.70035","url":null,"abstract":"<p><p>This study investigates the impact of transportation infrastructure financed by Chinese aid on child health in 11 sub-Saharan African countries using Demographic and Health Survey data matched with the precise geospatial features of transportation infrastructure. We find that an additional year of exposure to transportation infrastructure significantly increases children's height-for-age z-scores by 0.041 standard deviations and reduces the likelihood of stunting by 1.6 percentage points among urban households without migration experience, relative to children in the control group. Our analysis, which employs mother fixed-effects specifications, yields consistent results. Notably, we find that the positive effects of transportation infrastructure are primarily attributable to exposure during the construction phase of aid projects. The increased likelihood of mothers securing paid employment during this period may serve as a critical mechanism driving the observed effects of exposure to transportation infrastructure.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008304","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
Comprehensive E-Cigarette Flavor Bans and Tobacco Use Among Youth and Adults. 全面禁止电子烟口味和青少年和成年人的烟草使用。
IF 2.4 3区 医学
Health economics Pub Date : 2025-09-03 DOI: 10.1002/hec.70030
Henry Saffer, Selen Ozdogan, Michael Grossman, Daniel Dench, Dhaval Dave
{"title":"Comprehensive E-Cigarette Flavor Bans and Tobacco Use Among Youth and Adults.","authors":"Henry Saffer, Selen Ozdogan, Michael Grossman, Daniel Dench, Dhaval Dave","doi":"10.1002/hec.70030","DOIUrl":"10.1002/hec.70030","url":null,"abstract":"<p><p>The vast majority of youth e-cigarette users consume flavored e-cigarettes, raising concerns from public health advocates that flavors may drive youth initiation and continued use of e-cigarettes. Flavors drew further notice from the public health community following the sudden outbreak of lung injury among vapers in 2019, prompting several states to enact sweeping bans on flavored e-cigarettes. In this study, we examine the effects of these comprehensive bans on e-cigarette use and potential spillovers into other tobacco use by youth, young adults, and adults. We utilize both standard difference-in-differences (DID) and synthetic DID methods, in conjunction with four national data sets. We find evidence that young adults decrease their use of e-cigarettes by about two to three percentage points, while increasing cigarette use. For youth, there is some suggestive evidence of increasing cigarette use, though these results are undermined by pre-trend differences between treatment and control units. The bans have no effect on e-cigarette and smoking participation among adults 25 and over. Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution toward traditional smoking in some populations.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951618","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
The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums. 废除非经济损害上限和医疗事故保险费。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-31 DOI: 10.1002/hec.70032
Yuji Mizushima, Christopher Whaley, Hao Yu
{"title":"The Repeal of Noneconomic Damage Caps and Medical Malpractice Insurance Premiums.","authors":"Yuji Mizushima, Christopher Whaley, Hao Yu","doi":"10.1002/hec.70032","DOIUrl":"10.1002/hec.70032","url":null,"abstract":"<p><p>Noneconomic damage caps are controversial because they seek to balance uncertain benefits through reductions in physician precautionary costs, against uncertain harms to patient welfare. Opposing policy actions at the state-level reflect this controversy as some states have enacted noneconomic damage caps over the past few decades while others repealed their caps. Our difference-in-differences analyses suggest that repeals increase premiums. These increases are larger after State Supreme Court decisions, affecting all cases in a state, compared with State Circuit Court decisions affecting only specific cases. Magnitudes differ by physician specialty, with larger effects observed in obstetrics/gynecology and general surgery, compared with internal medicine. Our estimates of these repeals are larger than estimates on enactments reported in the literature, suggesting a potential asymmetry between enacting and repealing damage caps.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951624","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
Robot Effects on Worker's Compensation Benefits. 机器人对工人补偿福利的影响。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-27 DOI: 10.1002/hec.70033
Hyejin Kim
{"title":"Robot Effects on Worker's Compensation Benefits.","authors":"Hyejin Kim","doi":"10.1002/hec.70033","DOIUrl":"https://doi.org/10.1002/hec.70033","url":null,"abstract":"<p><p>This paper examines the effect of robots on workplace injury benefits paid in South Korea. Using the administrative data on worker's compensation, I found that the increase in robot exposure contributes to the significant decline in the average benefit amount per covered worker, mainly driven by the reduction in the number of claims, rather than the size of claims. The effects are stronger, especially for serious cases such as permanent disability.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951681","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
Incentivizing Hospital Quality Through Care Bundling 通过护理捆绑激励医院质量。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-17 DOI: 10.1002/hec.70024
Katja Grašič, Adrián Villaseñor, James Gaughan, Nils Gutacker, Luigi Siciliani
{"title":"Incentivizing Hospital Quality Through Care Bundling","authors":"Katja Grašič,&nbsp;Adrián Villaseñor,&nbsp;James Gaughan,&nbsp;Nils Gutacker,&nbsp;Luigi Siciliani","doi":"10.1002/hec.70024","DOIUrl":"10.1002/hec.70024","url":null,"abstract":"<p>Policymakers increasingly implement pay-for-performance schemes to incentivize quality of care. A key design issue when incentivizing several process measures of quality relates to whether the payment should be linked to the performance on each measure or whether the payment should be conditional on all of the process measures of quality being provided, which we refer to as “care bundling”. After developing a theoretical framework of provider incentives under care bundling, we employ a difference-in-difference analysis to evaluate the Best Practice Tariff for fragility hip fracture, introduced in England in 2010, which rewards providers based on a care bundle of nine process measures that need to be jointly achieved. The design of the processes was evidence-based and the size of the bonus was significant, up to 20% of the baseline tariff. The results suggest that the policy was successful in increasing the proportion of patients for whom all of the criteria are met by 52.5 percentage points in the first 5 years after its introduction. Temporal ordering of processes might matter under care bundling, but we do not find evidence that English providers exerted less effort to meet process measures if they already failed to meet an earlier one. Overall, we find that a scheme based on care bundle, which is evidence based and uses a sizable bonus, can be effective in improving hospital performance.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 11","pages":"2140-2160"},"PeriodicalIF":2.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872825","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
Evaluating OPUF's Role in Health State Valuations: Strengths, Limitations, and Comparative Analysis. 评估OPUF在健康状态评估中的作用：优势、局限性和比较分析。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-17 DOI: 10.1002/hec.70027
Afschin Gandjour
{"title":"Evaluating OPUF's Role in Health State Valuations: Strengths, Limitations, and Comparative Analysis.","authors":"Afschin Gandjour","doi":"10.1002/hec.70027","DOIUrl":"https://doi.org/10.1002/hec.70027","url":null,"abstract":"<p><p>This article examines the Online Elicitation of Personal Utility Functions (OPUF) method as a novel approach for health state valuation. While OPUF offers a structured, modular alternative to traditional methods, it also presents notable challenges. Chief among these is its reliance on compositional trade-offs between health dimensions (e.g., pain, mobility, anxiety), which may inadequately reflect how individuals experience health holistically. Additionally, OPUF's use of numerical rating scales does not guarantee that resulting utility values exhibit interval properties-a requirement for robust interpretation in economic evaluations. To contextualize OPUF within the broader landscape of valuation methods, this article introduces a classification scheme outlining alternative approaches and their respective trade-offs in terms of precision, cognitive burden, and feasibility.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872824","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
The Impact of Multimarket Competition on Generic Drugs' Regulated Prices. 多市场竞争对仿制药管制价格的影响。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-16 DOI: 10.1002/hec.70029
Carolina Santos, Eduardo Costa, Sara Machado
{"title":"The Impact of Multimarket Competition on Generic Drugs' Regulated Prices.","authors":"Carolina Santos, Eduardo Costa, Sara Machado","doi":"10.1002/hec.70029","DOIUrl":"https://doi.org/10.1002/hec.70029","url":null,"abstract":"<p><p>Competition between firms selling similar drugs is often fostered by policymakers as a means to curb pharmaceutical spending. While firms may compete within these specific drug markets, they also repeatedly encounter rival firms in different markets. This may shape competitive dynamics within and between markets. Yet, multimarket contacts, particularly relevant for multiproduct firms such as pharmaceutical companies, are often overlooked by pricing regulations. This paper investigates how multimarket contacts influence competition between pharmaceutical firms in off-patent markets. Using detailed product-level information on all retail pharmacy sales of generic statin drugs, we quantify the universe of multimarket contacts between firms in these off-patent markets, in Portugal, between 2015 and 2017. We then assess how multimarket contacts affect price competition. To do so, we explore the strict price regulation in Portuguese generic drug markets. Specifically, the Portuguese Internal Reference Pricing System (RPS) defines a price cap for each generic drug. Rather than examining absolute drug prices, we quantify the degree of price competition as the ratio between a firm's drug price and its regulatory price cap (price-to-cap ratio). We find that firms with more multimarket interactions set prices closer to price caps, consistent with the mutual forbearance hypothesis. This effect persists after controlling for brand status, lagged market share, and is not explained by common ownership. Our main results are consistent across alternative model specifications. However, due to limited within-firm variation over time, the effect is not significant in system generalized method of moment instrumental variable estimates. These results suggest that price caps may act as coordination anchors, thus lowering price competition between firms. Policymakers should consider targeted price cap adjustments as safeguards to preserve competition in off-patent drug markets.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862239","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
Is Caring Productive? The Effect of Adult Social Care on Paid Production in England. 关心有成效吗？英国成人社会关怀对有偿生产的影响。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-14 DOI: 10.1002/hec.70026
Francesco Longo, Karl Claxton, Anne Mason, Andrea Salas-Ortiz, Adrian Villasenor-Lopez
{"title":"Is Caring Productive? The Effect of Adult Social Care on Paid Production in England.","authors":"Francesco Longo, Karl Claxton, Anne Mason, Andrea Salas-Ortiz, Adrian Villasenor-Lopez","doi":"10.1002/hec.70026","DOIUrl":"https://doi.org/10.1002/hec.70026","url":null,"abstract":"<p><p>Long-term care (LTC) provides essential support to service users and informal carers to improve their quality of life. By improving quality of life, LTC can potentially impact economic growth, for example, it may enable service users of working age and their carers to spend more time in paid employment. This study investigates the effect of publicly-funded LTC expenditure on a measure of paid production across local authorities in England. We analyze yearly data from 2014/15 to 2019/20 using a dynamic panel model estimated by the Arellano-Bond estimator. We find that a £1000 increase in LTC expenditure per client increases paid production per capita by £216 in the short run and by £670 in the long run. These findings may inform policy makers interested in assessing the financial sustainability of LTC policies.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855020","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
Health and Unemployment During a Negative Labor Demand Shock 负劳动力需求冲击期间的健康和失业。
IF 2.4 3区 医学
Health economics Pub Date : 2025-08-13 DOI: 10.1002/hec.70025
Espen Bratberg, Tor Helge Holmås, Egil Kjerstad, Kjell Vaage
{"title":"Health and Unemployment During a Negative Labor Demand Shock","authors":"Espen Bratberg,&nbsp;Tor Helge Holmås,&nbsp;Egil Kjerstad,&nbsp;Kjell Vaage","doi":"10.1002/hec.70025","DOIUrl":"10.1002/hec.70025","url":null,"abstract":"<div>\u0000 \u0000 <p>The association between unemployment and health is well documented, but causality remains unclear. This paper investigates how pre-existing health conditions amplify the effects of adverse labor market shocks. Using variation in local unemployment generated by a shock in the petroleum prices that hit the geographic center of the petroleum industry in Norway, but left other regions more or less unaffected, our study reveals that workers with compromised health face a higher likelihood of unemployment during downturns. Heterogeneity analysis reveals differences in susceptibility based on gender, age, education, and job type. Females exhibit greater sensitivity to health, and the youngest age group is most affected. Furthermore, higher education and white-collar jobs correlate with amplified health-related unemployment effects. Conversely, poor health in combination with high age, low education, and blue-collar jobs increases the uptake of social insurance during the economic downturn, pointing toward the substitutability between unemployment benefits and health-related benefits.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 11","pages":"2114-2139"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845591","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
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