Health economics最新文献

{"title":"Willingness to Care—Financial Incentives and Caregiving Decisions","authors":"Mara Rebaudo,&nbsp;Lena Calahorrano,&nbsp;Kathrin Hausmann","doi":"10.1002/hec.4918","DOIUrl":"10.1002/hec.4918","url":null,"abstract":"<p>As population aging will likely lead to an increasing number of people in need of care, the demand for informal care is expected to rise. In this context, it is often discussed whether financial incentives can motivate more individuals to assume caregiving responsibilities. We analyze the potential effect of financial incentives on the provision of informal care by estimating a structural model with endogenous labor supply and caregiving decisions. This allows us to investigate how both individual wages and financial compensations for caregiving affect the caregiving decision, while accounting for heterogeneous preferences. We find that wage increases are associated with a decreased willingness to care. Financially compensating potential carers for the opportunity costs from caregiving significantly increases the probability of providing care. However, across different subgroups, a large share of about 50% of potential carers remains unwilling to provide care despite the financial incentive. For these individuals, factors such as preferences and social norms outweigh financial considerations in their caregiving decision.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 3","pages":"442-455"},"PeriodicalIF":2.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709779","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":"Cesarean Section, Childhood Health, and Schooling: Quasi-Experimental Evidence From Denmark, Norway and Sweden","authors":"Jessica á Rogvi,&nbsp;Aline Bütikofer,&nbsp;Lone Krebs,&nbsp;Hanna Mühlrad,&nbsp;Miriam Wüst","doi":"10.1002/hec.4914","DOIUrl":"10.1002/hec.4914","url":null,"abstract":"<p>Despite being one of the most common surgical procedures in industrialized countries, there is limited causal evidence on the long-term consequences of Cesarean section (CS). We study the impacts of CS on health during ages 1–12 years and human capital outcomes at age 16 years, using exogenous variation in the probability of receiving a CS for breech births at term—a group with high CS risk. We use administrative data from Denmark, Norway, and Sweden to show that preventing complicated vaginal births benefits health at birth and reduces the number of all-cause hospital nights during childhood. Our findings for childhood diagnoses for asthma, allergies, diabetes mellitus type 1, and school outcomes are imprecise and do thus not lend strong support for prominent hypotheses on CS causing long-term immune dysfunction disorders and, thereby, worse human capital outcomes.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 3","pages":"431-441"},"PeriodicalIF":2.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692899","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":"Health Insurance Coverage Changes Under the Affordable Care Act Among High Housing Cost Households, 2010–18","authors":"Yu Cao,&nbsp;Yuxin Su,&nbsp;Guan Wang,&nbsp;Chengcheng Zhang","doi":"10.1002/hec.4912","DOIUrl":"10.1002/hec.4912","url":null,"abstract":"<p>This study examines the impact of the Affordable Care Act (ACA) on health insurance coverage among rent-burdened households—those spending more than 30% of their income on rent—and non-rent-burdened households. Using data from American Community Survey, we find that Medicaid take-up rate increased 8.88 percentage points (pp) among rent-burdened households and 7.54 pp among non-rent-burdened households in expansion states. Conditional on household income and demographic characteristics, rent-burdened households exhibit a 1.5 pp higher likelihood of Medicaid enrollment, with an additional decline of 0.7 pp in employer-sponsored insurance and 1.0 pp in directly purchased insurance enrollment. These effects were more pronounced among individuals aged over 26 and those in states without state-run exchanges. The findings show the importance of tailored Medicaid policies to assist households facing housing burdens, especially for those ineligible for housing vouchers.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 3","pages":"415-430"},"PeriodicalIF":2.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618747","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":"Impact of hospital-physician vertical integration on physician-administered drug spending and utilization","authors":"Jonathan S. Levin,&nbsp;Xiaoxi Zhao,&nbsp;Christopher Whaley","doi":"10.1002/hec.4909","DOIUrl":"10.1002/hec.4909","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>We estimate the effects of hospital-physician vertical integration on spending and utilization of physician-administered drugs for hematology-oncology, ophthalmology, and rheumatology. Using a 100% sample of Medicare fee-for-service medical claims from 2013 to 2017, we find that vertical integration shifts treatments away from physician offices and toward hospital outpatient departments. These shifts are accompanied by increases in physician-administered drug administration spending per procedure for all three specialties. Spending on Part B drugs also increases for hematologist-oncologists. At the same time, physician treatment intensity, as measured by the number of beneficiaries who receive drug infusions/injections and the number of drug infusions, decreases across all three specialties. These results suggest that the incentives of the Medicare reimbursement system, particularly site-of-care payment differentials and outpatient drug reimbursement rates, interact with vertical integration to lead to higher overall spending. Policies and merger guidelines should attempt to restrain spending increases attributed to vertical integration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 2","pages":"345-367"},"PeriodicalIF":2.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618749","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":"Trade Liberalization and Mortality Rates: Evidence of Pro-Cyclical Mortality From Brazil","authors":"Vinicius Curti Cícero,&nbsp;Lucas Cardoso Corrêa Dias,&nbsp;Sammy Zahran","doi":"10.1002/hec.4915","DOIUrl":"10.1002/hec.4915","url":null,"abstract":"<p>We trace the evolution of all-cause mortality rates in Brazilian regions with varying exposure to trade-induced economic shocks before, during, and after liberalization reforms in the 1990s. We find consistent evidence of pro-cyclical mortality, with areas more exposed to tariff reductions experiencing larger declines in mortality across varying time horizons. The observed decline in mortality rates is evident across sex, age groups, and for both internal and external causes of mortality. We falsify the observed relationship between mortality and tariff reductions with analyses of causes of death that are plausibly unrelated to economic activity. Concerning proximate mechanisms involved in our finding of pro-cyclical mortality, we show that healthcare infrastructure expanded in local economies more affected by the trade-induced economic shock. This expansion was characterized by the increased capital-intensity of care, facilitated by the import of diagnostic technologies that reduce mortality from internal causes. We also find supporting evidence for the idea that pro-cyclical mortality is partially caused by a decrease in transport and non-transport-related accidents. Overall, our findings highlight an underappreciated dimension of trade policy effects, namely public health.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 3","pages":"392-414"},"PeriodicalIF":2.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618753","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":"Medical Resource Scarcity and Inequality in COVID-19 Fatality Rates: Evidence From Hospitalized Patients in Wuhan, China","authors":"Dandan Zhang,&nbsp;Xiang-Ming Zhang,&nbsp;Xiao Liu","doi":"10.1002/hec.4916","DOIUrl":"10.1002/hec.4916","url":null,"abstract":"<div>\u0000 \u0000 <p>Wuhan, China, where SARS-CoV-2 was detected first, has been recorded as one of the epicenters with the highest COVID-19 fatality rates worldwide. High COVID-19 fatality rates may stem from severe medical resource scarcity, especially in the early stage of the pandemic outbreak. In the first few weeks of the COVID-19 outbreak, <i>Wuhan</i> experienced the hardship of a severe “hospital run” period, when hospitals operated far beyond their maximum capacity and then soon transformed into “inclusive healthcare,” that is, every infectious person can access free medical treatment. Based on detailed administrative data of hospital admission and medical treatment for 1537 COVID-19 patients, we investigate how the COVID-19 fatality rates can be affected by the patient's socioeconomic status (SES) and differences in the effect between the two periods. Our estimation results show that low-SES patients had higher fatality rates during the “hospital run” period. Differential opportunities for hospitalization do not drive this inequality in fatality rates; rather, they are driven by the medical treatment after hospital admission, namely reduced treatment intensity and limited access to specific medical treatment and medications for COVID-19. When the government implemented the “inclusive healthcare” policy, severe medical resource scarcity was alleviated, and the inequality in fatality rates ceased to exist. These findings verify the existence of medical inequality among low-SES people amid severe medical resource shortages and also highlight the importance of rapidly increasing hospital capacity and medical supply in reducing possible unequal treatment and tackling inequalities in medical outcomes, especially during a public health crisis.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 3","pages":"376-391"},"PeriodicalIF":2.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618751","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":"Employment shocks and demand for pain medication: Understanding the channels that drive opioid use","authors":"Isabel Musse","doi":"10.1002/hec.4901","DOIUrl":"10.1002/hec.4901","url":null,"abstract":"<p>Higher employment ratios can affect opioid use through two main channels: by increasing physical pain from working or by reducing mental distress that may contribute to substance misuse. To separate these channels, I contrast the effect of labor demand shocks on the use of opioids with the effect on the use of over-the-counter painkillers—commonly used to treat pain but not mental distress. I find that during local economic expansions, opioid use declines while the demand for over-the-counter pain relief medication increases. Employment changes in high injury industries accentuate this pattern. One possible explanation is that, during local economic expansions, the use of pain medications to manage work injuries increases while the misuse of opioids decreases.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 2","pages":"316-344"},"PeriodicalIF":2.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602052","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":"Horizontal inequity in the use of mental healthcare in Australia","authors":"Nicole Black,&nbsp;David W. Johnston,&nbsp;Martin Knapp,&nbsp;Michael A. Shields,&nbsp;Gloria H. Y. Wong","doi":"10.1002/hec.4910","DOIUrl":"10.1002/hec.4910","url":null,"abstract":"<p>For people experiencing mental health problems, timely access to high-quality healthcare is imperative for improving outcomes. However, limited availability of services, high out-of-pocket costs, insufficient health literacy and stigmatizing attitudes may mean people do not receive the necessary treatment. We analyze Australian longitudinal data to document the extent and predictors of horizontal inequity in mental healthcare use among people with a newly developed mild or moderate mental disorder. Importantly, we compare people with similar health, residing in the same area, thus controlling for differences in healthcare needs and availability of services. Results suggest that mental healthcare use is not significantly associated with household income or financial hardship. In contrast, we find significant inequities by educational attainment, with university graduates around 50% more likely to receive mental healthcare than high-school dropouts. These findings are robust across subsamples and alternative modeling approaches, including panel data models with individual fixed-effects. Additional explorations of the education gradient suggest a potential pathway through mental health-specific knowledge and attitudes.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 2","pages":"297-315"},"PeriodicalIF":2.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582340","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 addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid","authors":"Shelby R. Steuart","doi":"10.1002/hec.4911","DOIUrl":"10.1002/hec.4911","url":null,"abstract":"<p>To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (<i>p</i> &lt; 0.01) and 7.74% (<i>p</i> &lt; 0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (<i>p</i> &lt; 0.01) in the prescribing rate and a 16.2% decrease (<i>p</i> &lt; 0.001) in the units per prescription. The main analysis was conducted using the Borusyak et al. (2023) Imputation Estimator with a robustness check using the Callaway and Sant’Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant’Anna's (2021) DD Estimator.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 2","pages":"283-296"},"PeriodicalIF":2.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575907","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":"Mental health impacts of spousal caregiving intensity in the US","authors":"Jennifer A. Ailshire,&nbsp;Maria Casanova","doi":"10.1002/hec.4908","DOIUrl":"10.1002/hec.4908","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>In the US, spouses are a major source of informal care for older adults and, therefore, key to the US national strategy to provide long-term care to the growing population of older adults. Understanding the mental health impacts of spousal caregiving is therefore critically important. Existing studies on the topic have often been limited by methodological limitations, and most overlook the role of caregiving intensity. In this study, we assess the impact of providing different intensities of caregiving to a spouse on mental health outcomes using data from the Health and Retirement Study. We address the endogeneity of the decision to provide different caregiving intensities using an augmented inverse probability weighted (AIPW) estimator adapted to handle multivalued treatments. We check the robustness of our estimates to the AIPW's identifying assumptions by re-estimating the model using a dynamic fixed effects estimator. We find strong evidence that becoming a caregiver is associated with worsened mental health outcomes for women, while the evidence for men is weaker. When disaggregating by caregiving intensity, we find that transitions into high-intensity caregiving lead to large increases in depression symptoms and the probability of exhibiting major depression for both men and women. The overall mental health impact of transiting into caregiving is driven almost exclusively by the negative impact of high-intensity caregiving, as transitions into low- and moderate-intensity caregiving are not associated with worsening mental health in most specifications. This study provides timely insights that can inform the targeting of long-term care policies and programs aimed at supporting family caregivers of older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 2","pages":"267-282"},"PeriodicalIF":2.0,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499075","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}