Health economics最新文献

{"title":"Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis","authors":"Nibene Habib Somé,&nbsp;Rose Anne Devlin,&nbsp;Nirav Mehta,&nbsp;Sisira Sarma","doi":"10.1002/hec.4872","DOIUrl":"10.1002/hec.4872","url":null,"abstract":"<p>Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 10","pages":"2288-2305"},"PeriodicalIF":2.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4872","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426707","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":"Assessing the quality of public services: For-profits, chains, and concentration in the hospital market","authors":"Johannes S. Kunz,&nbsp;Carol Propper,&nbsp;Kevin E. Staub,&nbsp;Rainer Winkelmann","doi":"10.1002/hec.4861","DOIUrl":"10.1002/hec.4861","url":null,"abstract":"<p>We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk-adjust for hospital characteristics and county demographics. While the overall association between for-profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for-profit relative to non-profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for-profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not-for-profit hospitals.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"2162-2181"},"PeriodicalIF":2.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418584","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":"The effects of an unconditional cash transfer on parents' mental health in the United States","authors":"Clemente Pignatti,&nbsp;Zachary Parolin","doi":"10.1002/hec.4867","DOIUrl":"10.1002/hec.4867","url":null,"abstract":"<p>The provision of unconditional cash transfers may be one effective policy strategy for improving mental health, but causal evidence on their efficacy is rare in high-income countries. This study investigates the mental health consequences of the 2021 child tax credit (CTC) expansion, which temporarily provided unconditional and monthly cash support to most families with children in the United States. Using data from the Behavioral Risk Factor Surveillance System, we exploit differences in CTC benefit levels for households with younger versus older children. More generous CTC transfers are associated with a decrease in the number of bad mental health days reported by the parents. The effect materializes after the third monthly payment and disappears when the benefits are withdrawn. The CTC's improvement of mental health is larger for more credit-constrained individuals, including low-income households, women, and younger respondents.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 10","pages":"2253-2287"},"PeriodicalIF":2.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327430","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":"The effect of social media use on mental health of college students during the pandemic","authors":"Jane Cooley Fruehwirth,&nbsp;Alex Xingbang Weng,&nbsp;Krista M. Perreira","doi":"10.1002/hec.4871","DOIUrl":"10.1002/hec.4871","url":null,"abstract":"<p>Social media is viewed to be a key contributor to worsening mental health in adolescents, as most recently reflected in a public health advisory by the US Surgeon General. We provide new evidence on the causal effects of social media on mental health of college students during the Covid-19 pandemic, exploiting unique, longitudinal data collected before the Covid-19 pandemic began and at two points during the pandemic. We find small insignificant effects of social media 4 months into the pandemic during a period of social distancing, but large statistically significant negative effects 18 months into the pandemic when colleges were mostly back to normal operations. Using rich data on substance use, exercise, sleep, stress, and social support, we find some evidence of substitution away from activities that better support mental health at later stages of the pandemic but not at early stages. We find that the negative effects of social media are mostly concentrated among socially-isolated students. Both social support and resilience protect students from the negative effects of social media use. Policy implications include regulating social media while also bolstering social support and resilience as important protective factors.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 10","pages":"2229-2252"},"PeriodicalIF":2.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317039","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":"Business cycles and healthcare employment","authors":"Erkmen G. Aslim,&nbsp;Shin-Yi Chou,&nbsp;Kuhelika De","doi":"10.1002/hec.4866","DOIUrl":"10.1002/hec.4866","url":null,"abstract":"<p>Is healthcare employment recession-proof? We examine the long-standing hypothesis that healthcare employment is stable across the business cycle. We explicitly distinguish between negative aggregate demand and supply shocks in studying how healthcare employment responds to recessions, and show that this response depends largely on the type of the exogenous shock triggering the recession. First, aggregate healthcare employment responds procyclically during demand-induced recessions but remains stable during supply-induced recessions. Second, healthcare utilization drops significantly during demand-induced recessions, explaining the decline in healthcare employment during these periods. Finally, there is significant heterogeneity in the employment responses of the healthcare sub-sectors. While healthcare employment in most sub-sectors responds procyclically during recessions caused by both negative demand and supply shocks, it responds countercyclically in nursing-dominant sectors. Importantly, by isolating the recessionary impact of negative aggregate demand shocks from supply shocks on healthcare employment, we provide new empirical evidence that healthcare employment, in general, is <i>not</i> recession-proof.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"2123-2161"},"PeriodicalIF":2.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305766","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":"Local restrictions, population movement, and spillovers during the pandemic: Evidence from Japan's restaurant restriction","authors":"Zihan Xu,&nbsp;Satoru Shimokawa","doi":"10.1002/hec.4864","DOIUrl":"10.1002/hec.4864","url":null,"abstract":"<p>We investigate how a local restaurant restriction aimed at containing the COVID-19 pandemic influenced population movement and COVID-19 prevalence within and outside the restricted districts. Using data on restaurant location and hourly population at the 500-m-mesh level and on COVID-19 prevalence at both prefecture and municipality level in Japan, we employ a triple-difference approach and a difference-in-differences approach with fixed effects. While the policy decreased population movement to restaurant areas in the restricted districts, it caused spillovers of increasing population movement to restaurant areas in the neighboring nonrestricted districts. Consequently, COVID-19 prevalence worsened in the neighboring nonrestricted districts but improved in the restricted districts. Our findings suggest that imposing such local restrictions in the context of the pandemic may contain the pandemic only in the restricted districts while sacrificing economic activities within these districts and public health in neighboring nonrestricted districts.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"2105-2122"},"PeriodicalIF":2.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300556","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":"Drinking in despair: Unintended consequences of automation in China","authors":"Wenyi Lu,&nbsp;Siyuan Fan","doi":"10.1002/hec.4865","DOIUrl":"10.1002/hec.4865","url":null,"abstract":"<p>The side effects of technological progress on the economy have been discussed frequently, but little is known regarding its health consequences. By combining the national individual-level panel data of alcohol drinking with the prefecture-level robot exposure rate in China, we find that one more robot exposure rate could induce up to 2.2% points increase in the probability of problem drinking. Such a pattern of problem drinking is explained by negative emotions, which can be ascribed to job loss due to substitution, higher income vulnerability, and reduced organization participation. Further, we provide evidence that automation can incur health costs, particularly for easily substituted workers, which would exacerbate health inequality in China. This paper sheds light on the impact of automation and the social incentives of problem drinking, emphasizing the possibly heterogeneous health cost accompanied by the automation process.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"2088-2104"},"PeriodicalIF":2.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293338","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":"Public health economics: Should it be more offensive?","authors":"Richard Smith","doi":"10.1002/hec.4868","DOIUrl":"10.1002/hec.4868","url":null,"abstract":"&lt;p&gt;“&lt;i&gt;The soft drinks tax can be expected to result in more than 4000 job losses across the UK&lt;/i&gt;” [ (Oxford Economics, &lt;span&gt;2016&lt;/span&gt;, pg 3). As public health moves further away from government provided or regulated activities, such as clean water, traffic safety and vaccination, and into policies directly impacting goods and services provided by commercial actors, statements such as these are becoming increasingly commonplace for those seeking to develop, implement and evaluate public health interventions. As commercial actors have a history of marshalling economics to go on the “offensive” in opposing policies, the question arises of whether, and if so how and when, health economics should similarly be mobilised?&lt;/p&gt;&lt;p&gt;Public health is increasingly involved in policies and interventions that impact on commercial entities, generating a substantial literature and concern around the behavior of these actors (https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health). This literature relates to the products or services that these commercial actors provide and the marketing and sales practices they engage in, of course, but also their use of, and response to, research and evidence related to policies that may negatively impact their activities. The tactics used by the tobacco industry to influence and negate public health campaigns to reduce smoking has long been subject to research (Saloojee &amp; Dagli, &lt;span&gt;2000&lt;/span&gt;). These tactics have been similarly observed and examined with respect to alcohol (Hawkins et al., &lt;span&gt;2012&lt;/span&gt;). Most recently, with the emphasis for public health moving on to obesity and unhealthy diets, we have seen concern that the commercial food and beverage sector is operating in a similar manner (Brownell &amp; Warner, &lt;span&gt;2009&lt;/span&gt;). The commercial sector is clearly very willing, and very able, to mobilise economics for “offensive” means to try and sink public health policies that may impact commercial activities.&lt;/p&gt;&lt;p&gt;Health economics, as an academic research discipline, takes what may be seen as a more objective approach to its role. Put simply, health economics typically seeks to establish the costs and benefits of the policy or intervention that it is engaged to evaluate. The problem, generally, with this approach is that it does not explicitly consider the key elements that the commercial sector is concerned with, and which commercial actors then use in an “economic offensive”. Many public health interventions concerned with diet, for example, have very little direct impact on the health sector; impacts that do occur tend to be positive, as reductions in the consumption of alcohol, soft drinks or unhealthy foods will not place a financial demand on health systems, and any health benefits will reduce demand for services. Similarly, such interventions often have very little direct impact on government; tax receipts from VAT may fall due to reduced product purchasing (though typ","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 10","pages":"2203-2205"},"PeriodicalIF":2.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260328","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":"Is anchoring at ‘dead’ a theoretical requirement for health state valuation?","authors":"Chris Sampson,&nbsp;David Parkin,&nbsp;Nancy Devlin","doi":"10.1002/hec.4863","DOIUrl":"10.1002/hec.4863","url":null,"abstract":"<p>Values that accompany generic health measures are typically anchored at 1 = full health and 0 = dead. Some health states may then be considered ‘worse than dead’ (WTD) and assigned negative values, which causes fundamental measurement problems. In this paper, we challenge the assumption that anchoring values at ‘dead = 0’ is necessary for quality-adjusted life year (QALY) estimation. We summarise the role of ‘dead’ in health state valuation and consider three critical questions: (i) whether the measurement properties of health state values require ‘dead’; (ii) whether ‘dead’ needs to be valued relative to health states; and (iii) whether values for states WTD are meaningful or useful. We conclude that anchoring 0 at dead is not a requirement of health status measurement or cost-effectiveness analysis. This results from reframing QALYs as the relevant unit of measurement and reframing values as being derived from QALYs rather than the reverse.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"1929-1935"},"PeriodicalIF":2.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237399","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":"Training labor and treatment behavior: Evidence from physician residency programs","authors":"Brendan Rabideau,&nbsp;Michael R. Richards,&nbsp;Christopher M. Whaley","doi":"10.1002/hec.4841","DOIUrl":"10.1002/hec.4841","url":null,"abstract":"<p>Public and private investments in physician human capital support a healthcare workforce to provide future medical services nationwide. Yet, little is known about how introducing training labor influences hospitals' provision of care. We leverage all-payer data and emergency medicine (EM) and obstetrics (OBGYN) residency program debuts to estimate local access and treatment intensity effects. We find that the introduction of EM programs coincides with less treatment intensity and suggestive increases in throughput. OBGYN programs adopt the pre-existing surgical tendencies of the hospital but may also relax some capacity constraints—allowing the marginal mother to avoid a riskier nearby hospital.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"33 9","pages":"2059-2087"},"PeriodicalIF":2.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199741","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}