Health economics最新文献

{"title":"Healthcare Costs Following Medical Gender-Affirmation: Evidence From Whole-of-Population Australian Administrative Data","authors":"Karinna Saxby,&nbsp;Dennis Petrie,&nbsp;Brendan J. Nolan","doi":"10.1002/hec.70127","DOIUrl":"10.1002/hec.70127","url":null,"abstract":"<p>Gender incongruence in trans and nonbinary (“trans”) populations is often associated with psychological distress and increased demand for mental healthcare. Gender-affirming hormone therapy (GAHT) is a key component of care for many trans people, yet long-term evidence around its cost implications remains limited despite increasing uptake and policy attention worldwide. We provide the first population-based evidence on the healthcare costs of GAHT initiation using longitudinal administrative data from 32,313 trans Australians who initiated testosterone-based GAHT (tGAHT) or estradiol-based GAHT (eGAHT) between 2013 and 2024. Employing a dynamic difference-in-differences design, we estimate the impacts on government expenditure and patient out-of-pocket costs in the 6 years after initiation, using future initiators as controls. We find that initiating tGAHT leads to an additional AUD$3119 (USD$2246) in government expenditure and AUD$143 (USD$103) in out-of-pocket costs over 6 years; corresponding estimates were AUD$8348 (USD$6011) and AUD$1269 (USD$914) for eGAHT recipients. For tGAHT recipients, both government and out-of-pocket costs declined after initiation, with mental healthcare reductions exceeding ongoing hormone therapy expenditure after 6 years. For eGAHT recipients, costs also fell but remained above baseline, driven by sustained prescription spending. Taken together with quality-of-life benefits, our results suggest GAHT is likely to be cost-effective.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1468-1481"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390767","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":"Lead in Drinking Water and Child Health: Evidence From Jackson, Mississippi","authors":"Eunsik Chang,&nbsp;Kendall Kennedy,&nbsp;Justine Mallatt","doi":"10.1002/hec.70121","DOIUrl":"10.1002/hec.70121","url":null,"abstract":"<div>\u0000 \u0000 <p>This paper quantifies the impact of prenatal exposure to lead in drinking water on infant health at birth by exploiting a quasi-experiment in Jackson, Mississippi. This setting provides a unique context where behavioral changes to avoid lead-contaminated water are limited due to delayed water testing and dissemination of information about lead contamination. We apply synthetic control using other US cities and Mississippi counties as donors to identify the effect of lead exposure on birth outcomes. We find that prenatal lead exposure in Jackson increased the incidence of low birth weight by approximately 1.5 percentage points, relative to a synthetic Jackson.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1450-1467"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368050","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":"Air Pollution Control and Residents' Weight: Empirical Evidence From China's Action Plan","authors":"Nianyu Du,&nbsp;Lele Liu,&nbsp;Liangqiang Jiang,&nbsp;Shijiu Yin","doi":"10.1002/hec.70130","DOIUrl":"10.1002/hec.70130","url":null,"abstract":"<div>\u0000 \u0000 <p>Air pollution is a significant environmental issue with widespread impacts on public health. Evidence on the causal effect of air pollution control policies on weight-related outcomes remains limited. This study fills this gap by leveraging the Air Pollution Prevention and Control Action Plan as a quasi-natural experiment, combining four waves (2010, 2012, 2014, 2016) of panel data from the China Family Panel Studies (CFPS). Employing a difference-in-differences framework, we find that implementing this policy significantly reduces overweight risk among residents. Mechanism analyses indicate that the policy primarily lowers overweight risk by increasing physical exercise frequency and alleviating depressive symptoms. Further heterogeneity analyses show this impact is particularly pronounced among urban residents, young adults, females, and individuals with lower educational attainment. Our findings clarify the causal link between environmental regulation and population health, and provide actionable insights for policymakers to design coordinated interventions that leverage air quality improvements to advance public health goals.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1482-1495"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404670","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 Impact of Various Tax Bases and Rates on Cannabis Consumption Among US Adults Who use Recreational Cannabis","authors":"Yanyun He,&nbsp;Lei Xu,&nbsp;Hojin Park,&nbsp;Shaoying Ma,&nbsp;Ce Shang","doi":"10.1002/hec.70129","DOIUrl":"10.1002/hec.70129","url":null,"abstract":"&lt;p&gt;As an increasing number of states legalize recreational cannabis, it is increasingly important to understand the optimal tax design for recreational cannabis. Currently, various tax bases (weight, potency, price) and rates are used. However, the empirical evidence on the impact of tax-related attributes (pre-tax prices, tetrahydrocannabinol [THC] levels, tax bases, and tax rates) and their interactions on consumption is limited. To address this evidence gap, this study utilizes a split-sample volumetric choice experiment to understand the impact of pre-tax prices, tax bases, tax rates, and THC levels on cannabis consumption and THC intake by US adult users. We further estimated the own- and cross-price elasticities for four cannabis forms (legal flower, illegal flower, edibles, and vaping concentrates). We collected a nationally representative sample of &lt;i&gt;N&lt;/i&gt; = 1525 US adults aged 21+ who reported the past 30-day use of recreational cannabis in June and July 2024. Participants were randomized into seeing one of the three different tax bases, and each person answered 9 choice questions where they were given varying combinations of pre-tax prices, tax rates, and THC levels of the four cannabis products. Zero-inflated negative binomial regressions were used to estimate the impacts of varying factors on the cannabis consumption (units and THC) and own- and cross-price elasticities. The interactions between tax bases and their targeted attributes were explored using a linear model accounting for individual fixed effects. Higher pre-tax prices and tax rates significantly reduce consumption, whereas higher THC levels increase consumption. Compared to a tax rate of 60% of pretax prices or equivalent, an 80% rate does not induce further consumption reduction. The overall price elasticities of cannabis demand range from −0.4 to −0.5, with form- or product-specific price elasticities ranging between −0.2 and −0.4. Illegal and legal flowers are substitutes for each other. Edibles and cartridges are complements for each other. In addition, illegal flowers are substitutes for legal cartridges, and edibles are complements to flowers. While increases in the prices of legal products significantly reduce their consumption, 89% of this reduction may be offset by switching to illegal products. While tax bases do not significantly impact consumption, a potency tax base reduces the consumption of higher potency products, and a price tax base reduces the consumption of higher-priced products. If the illegal market is restricted, policymakers can expect increasing cannabis prices using excise taxes to reduce both unit and THC consumption, while generating tax revenues. However, given the sizable illegal market, a large portion of the consumption reduction due to taxes may be offset by switching to illegal products. Tax rates reduce consumption in addition to base prices. There is room to increase cannabis tax rates to 60% of pretax prices or equivalent to counter ","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1519-1531"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411465","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":"Threat Effects and Work Incentives: Evidence From a Danish Sick Leave Reform","authors":"Jeppe Elholm Madsen","doi":"10.1002/hec.70126","DOIUrl":"10.1002/hec.70126","url":null,"abstract":"<p>This paper investigates the effects of a 2014 policy reform on paid sick leave in Denmark. The reform shortened the eligibility period from 56 to 26 weeks for paid sick leave and introduced a mandatory return-to-work activation program for individuals whose benefits were not extended. The reform initially led to a temporary increase in returns to employment, as individuals on sick leave resumed work to avoid entering the mandatory activation program. However, this effect fades in the long run, and no sustained employment improvements were observed.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1496-1518"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411475","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":"Rural-Urban Migration and the Health of Left-Behind Older Adults","authors":"Tess Stafford,&nbsp;Xiaoyun Zhang,&nbsp;Katja Hanewald","doi":"10.1002/hec.70128","DOIUrl":"10.1002/hec.70128","url":null,"abstract":"<div>\u0000 \u0000 <p>We study the effect of rural-urban migration on the well-being of older adults who remain in rural communities in China, a country that is experiencing extensive rural-urban migration and rapid population aging. We exploit China's historic “sent-down youth” program which temporarily relocated millions of urban youth to rural villages and created lasting social ties between sending cities and receiving villages. These ties coupled with present-day variation in urban growth create exogenous variation in present-day rural-urban migration rates, which we use in an instrumental variables framework to identify the causal effects of migration on health. Results suggest that migration negatively affects the physical, cognitive, and emotional health of older adults that remain behind.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1613-1629"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591228","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 Effects of Compulsory Licensing: A Case Study of HIV Drugs","authors":"Nicolau Martin-Bassols,&nbsp;Miquel Serra-Burriel,&nbsp;Kerstin Noelle Vokinger","doi":"10.1002/hec.70123","DOIUrl":"10.1002/hec.70123","url":null,"abstract":"<p>Compulsory licensing is a legal mechanism that allows governments the use of patented medicines without the owner's consent, subject to conditions and compensation, to meet public-health needs. Despite its policy relevance and increasing use, empirical evidence on its market effects remains limited. This study examines the association between compulsory licensing and the commercial accessibility and affordability of HIV medications across 11 countries from 2002 to 2022. We combine quarterly data on drug sales and prices from IQVIA with implementation dates from the TRIPS Flexibilities Database, focusing on 21 HIV drugs subject to at least one compulsory license. Using a staggered difference-in-differences design, we estimate the average treatment effect on the treated (ATT) of compulsory licensing on drug consumption and prices, under a parallel trends assumption. We find an economically meaningful increase in retail and hospital sales following the implementation of compulsory licenses, amounting to approximately 21% of a standard deviation in the countries that implemented them. In addition, we estimate a reduction in prices of approximately 19% of a standard deviation. These associations are consistent with compulsory licenses having contributed to improved availability of HIV drugs through commercial channels, with meaningful effects on prices. Our estimates do not capture—and therefore cannot rule out—potential additional effects on access via public importation or production, donations, or NGO-led supply chains.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1427-1434"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307948","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":"Star Ratings and Willingness to Travel for Hospital Care","authors":"Kaylyn Sanbower,&nbsp;Ian McCarthy,&nbsp;Leonardo Sanchez-Aragon","doi":"10.1002/hec.70138","DOIUrl":"10.1002/hec.70138","url":null,"abstract":"<div>\u0000 \u0000 <p>Choosing a hospital for elective inpatient care is a complex decision due to pervasive information asymmetries and multidimensional quality attributes. Online reviews provide an accessible and salient source of hospital quality information that could influence patient choices. Using the universe of hospital Yelp reviews and inpatient claims data for elective procedures in Florida (2012–2017), we exploit exogenous variation in online ratings to estimate the causal effect of online reviews on hospital selection. Depending on the underlying condition, we find that patients are willing to travel 7.9% farther for labor and delivery and 33.5% farther for orthopedic surgery for a one-standard-deviation increase in a hospital's rating percentile rank within its market, which is roughly a half-star increase. The larger response for orthopedic procedures is consistent with greater reliance on online information when provider relationships are weaker. Falsification tests on emergency admissions yield null results, confirming that online reviews influence elective rather than urgent decision-making. Our findings highlight the role of consumer-generated information in healthcare markets and suggest that online platforms can meaningfully shape provider competition.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"35 10","pages":"1597-1612"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591264","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":"Null Effects of the State Pension Age on Mortality in the Netherlands.","authors":"Adriaan Kalwij, Arie Kapteyn","doi":"10.1002/hec.70149","DOIUrl":"https://doi.org/10.1002/hec.70149","url":null,"abstract":"<p><p>Increasing the state pension (SP) age in the Netherlands from 65 years in 2012 to 67 in 2024 has been shown to cause individuals to work longer. This study addresses a concern regarding possible adverse health effects of an increased SP-age, for example, because individuals trade health investments for working time. We empirically investigated the effects of individuals' SP-age on their annual probability of dying (mortality)-our health measure-by using data for the period 2012-2022 of 1.6 million individuals born in the years 1950-1957. For estimating causal effects we used a regression discontinuity framework which exploited that individuals' SP-age depends on their year and month of birth. Our empirical findings show negative associations of mortality with the SP-age and work, and do not support a causal effect of the SP-age on mortality, nor a causal effect of work on mortality. These findings hold for both genders, across socioeconomic groups, and for different causes of death. Hence, our findings suggest null effects of the SP-age on mortality.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827586","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":"Medical Brain Drain: The Role of Job Attributes and Individual Traits.","authors":"Marco Bertoni, Debdeep Chattopadhyay, Yuanyuan Gu","doi":"10.1002/hec.70148","DOIUrl":"https://doi.org/10.1002/hec.70148","url":null,"abstract":"<p><p>Medical brain drain poses a major challenge for health systems, reducing physician supply and undermining public investment in medical training. Prior work examined migration flows and their macroeconomic determinants. This study uses a discrete choice experiment to assess how individual background and personality traits shape medical student intentions to migrate and whether job attributes are valued differently at home and abroad. We surveyed 527 senior medical students from 12 Italian universities between November 2020 and July 2021, using Italy as a pertinent case given high physician emigration and limited inflow of foreign-trained doctors. We find that students require compensation of around 30% of physicians' average starting salary to accept a job abroad rather than at home. Those from higher-quality schools or medical families, and those who are more altruistic, competitive, and risk-tolerant, require less compensation to migrate. Valuations of several job attributes also differ by location: at home, students value permanent contracts and professional development; abroad, they are willing to accept temporary contracts but reject under-skilling. These findings suggest that emigration may disproportionately involve the best-trained students. Policy simulations show that improving working conditions, job security, or professional development opportunities each substantially increases the predicted probability of choosing a domestic job, with salary increases having the largest effects.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808418","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}