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Scaled-up nutrition services for child development: evidence from the Chilean School Meals Program 扩大儿童发展营养服务:来自智利学校供餐计划的证据
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-12-14 DOI: 10.1086/723824
J. C. Caro
{"title":"Scaled-up nutrition services for child development: evidence from the Chilean School Meals Program","authors":"J. C. Caro","doi":"10.1086/723824","DOIUrl":"https://doi.org/10.1086/723824","url":null,"abstract":"Childhood obesity is one of the major public health challenges of the 21st century. Randomized interventions have shown promising evidence of long-term effects from nutrition services on children’s health. However, it is yet unclear whether scaled-up programs, such as school meals, prevent children’s obesity risk. I implement a fuzzy regression discontinuity approach on national administrative data to estimate the short- and medium-run effects of the Chilean school meal program (SMP) on children’s body mass index (BMI) z-scores. Girls’ eligibility in first grade reduces local average obesity prevalence by 4 percentage points. Continued eligibility reduces boys’ local average obesity prevalence in fifth grade by .10 percentage points. Effects concentrate among children with high BMI z-scores and are partly driven by improvements in the nutritional quality of meals. Children attending schools providing psychosocial support exhibit larger benefits from SMP eligibility, consistent with spillover effects from the integration of stimulation and nutrition interventions.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"1 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42022947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Who Pays in Pay-for-Performance? 谁来支付绩效工资?
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-11-03 DOI: 10.1086/723280
Michael E Darden, Ian Paul McCarthy, E. Barrette
{"title":"Who Pays in Pay-for-Performance?","authors":"Michael E Darden, Ian Paul McCarthy, E. Barrette","doi":"10.1086/723280","DOIUrl":"https://doi.org/10.1086/723280","url":null,"abstract":"Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"435 - 460"},"PeriodicalIF":3.7,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Do “Must-Access” Prescription Drug Monitoring Programs Address Opioid Misuse? “必须访问”处方药监测计划如何解决阿片类药物滥用问题？
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-10-13 DOI: 10.1086/722979
Benjamin Ukert, D. Polsky
{"title":"How Do “Must-Access” Prescription Drug Monitoring Programs Address Opioid Misuse?","authors":"Benjamin Ukert, D. Polsky","doi":"10.1086/722979","DOIUrl":"https://doi.org/10.1086/722979","url":null,"abstract":"The opioid epidemic led to the creation of state Prescription Drug Monitoring Programs (PDMPs) that eventually mandated access. We examine how these “must-access” PDMPs influenced prescribing after an emergency department (ED) visit and in the long term for the working-age population. By using data from a large multistate commercial insurance database from 2010 to 2014 and estimating difference-in-differences models, we show that only the broadest must-access PDMPs reduced opioid prescribing after an ED visit and in the long term. We then compared changes in prescribing rates for opioid naïve relative to non–opioid naïve individuals to disentangle the influence of information from administration costs on prescriber behavior. Findings suggest that hassle cost explains the majority of the decline in initial prescribing, and that the information value drives most of the reduction in long-term outcomes.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"374 - 404"},"PeriodicalIF":3.7,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47721732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Regression Discontinuity Evidence on the Effectiveness of the Minimum Legal E-cigarette Purchasing Age 电子烟最低合法购买年龄有效性的回归不连续性证据
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-10-01 DOI: 10.1086/723401
Jeffrey S. DeSimone, D. Grossman, Nicolas R. Ziebarth
{"title":"Regression Discontinuity Evidence on the Effectiveness of the Minimum Legal E-cigarette Purchasing Age","authors":"Jeffrey S. DeSimone, D. Grossman, Nicolas R. Ziebarth","doi":"10.1086/723401","DOIUrl":"https://doi.org/10.1086/723401","url":null,"abstract":"Increases in youth vaping rates and concerns of a new generation of nicotine addicts recently prompted an increase in the federal minimum legal purchase age (MLPA) for tobacco products, including e-cigarettes, to 21 years. This study presents the first regression discontinuity evidence on the effectiveness of e-cigarette MLPA laws. Using data on 12th graders from Monitoring the Future, we obtain robust evidence that federal and state age 18 MLPAs decreased underage e-cigarette use by 15–20 percent and frequent use by 20–40 percent. These findings suggest that the age 21 federal MLPA could meaningfully reduce e-cigarette use among 18- to 20-year-olds.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"461 - 485"},"PeriodicalIF":3.7,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48940109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Learning to Work Together 学会一起工作
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-09-22 DOI: 10.1086/722605
Chad Stecher, Jonathan D. Ketcham
{"title":"Learning to Work Together","authors":"Chad Stecher, Jonathan D. Ketcham","doi":"10.1086/722605","DOIUrl":"https://doi.org/10.1086/722605","url":null,"abstract":"We study whether teams’ productivity improves as they gain experience working together. We leverage unique clinical data to observe team experience and individual physician and staff experience in coronary catheterization laboratories. Teams are composed of cardiologists, nurses, and technicians who work together synchronistically. We observe teams and individuals at hospitals across the United States from 2001 to 2009, including the rate at which they gain experience using drug-eluting stents (DES) from their introduction in the US in 2003 onward. We estimate models of productivity and clinical outcomes that account for team experience, physician experience, and staff experience conditional on each other and on time-invariant physician and staff characteristics, hospital-specific monthly effects, and an extensive set of patient-level clinical factors. Greater experience performing DES cases together improves teams’ productivity, lowering total case time, procedure time, and non-physician labor costs while leaving clinical outcomes unchanged. In contrast, physicians’ and staffs’ individual experience with DES does not improve productivity conditional on other factors. The effects of team experience with DES appears generalized, with gains from experience with competitor brands of DES about as large as those from the specific brand of DES being used for a given case.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"231 - 261"},"PeriodicalIF":3.7,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41862209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Caring to Work or Working to Care 关心工作还是关心工作
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-09-20 DOI: 10.1086/722588
Gonzalo Arrieta, Jun Yu Li
{"title":"Caring to Work or Working to Care","authors":"Gonzalo Arrieta, Jun Yu Li","doi":"10.1086/722588","DOIUrl":"https://doi.org/10.1086/722588","url":null,"abstract":"We seek to understand how the labor market decisions of the family adjust in response to plausibly exogenous health shocks. Family members might work less to provide caregiving, or work more in response to medical expenditures and loss of income by the ill individual. We use records of emergency department (ED) visits and hospitalizations to empirically determine the size of these effects. Using ED events, we find evidence of intra-family insurance. By exploring how insurance varies by the severity of the health shock, we find that family labor supply responses decrease as the caregiving need increases.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"175 - 204"},"PeriodicalIF":3.7,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46809967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The Effect of Extended Unemployment Insurance Generosity on Population Mental Health 延长失业保险宽裕度对人口心理健康的影响
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-09-19 DOI: 10.1086/722556
Jie Chen, Xiaohui Guo, Lizhong Peng, M. Qian
{"title":"The Effect of Extended Unemployment Insurance Generosity on Population Mental Health","authors":"Jie Chen, Xiaohui Guo, Lizhong Peng, M. Qian","doi":"10.1086/722556","DOIUrl":"https://doi.org/10.1086/722556","url":null,"abstract":"This study contributes to a small but growing literature on the health effects of unemployment insurance (UI) by examining the impact of extended benefit generosity during the Great Recession on population mental health. Using data from the 2003–13 Behavioral Risk Factor Surveillance System as well as cross-state and time series variation in UI policies, we estimate that a one standard deviation (or $1,000) increase in UI generosity is associated with a 5.1 (0.5) percent improvement in self-reported mental health among the unemployed. We also provide evidence for the validity of our research design through an event study model and supplementary regressions that incorporate county or county-by-time fixed effects. However, we find no definitive evidence that UI affects general/physical health, health insurance, access to care, or health behaviors.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"148 - 174"},"PeriodicalIF":3.7,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42192664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of a Free Family Planning Program on Fertility 免费计划生育计划对生育率的影响
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-09-19 DOI: 10.1086/722557
Aaron M. Gamino
{"title":"The Effect of a Free Family Planning Program on Fertility","authors":"Aaron M. Gamino","doi":"10.1086/722557","DOIUrl":"https://doi.org/10.1086/722557","url":null,"abstract":"In this paper, I estimate the effect of access to family planning clinics on birth rates. The Louisiana Family Planning Program opened more than 140 clinics between 1965 and 1970. By 1971, a family planning clinic was operating in each Louisiana county. Exploiting the variation in dates when clinics began operating in each county, I employ two-way fixed effects and staggered difference-in-differences designs to assess the impact of family planning access on birth rates. I find that clinic openings led to a 5 to 7 percent decrease in birth rates.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"127 - 147"},"PeriodicalIF":3.7,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46089218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do Class Size Reductions Protect Students from Infectious Diseases? 缩减班级规模能保护学生免受传染病的侵害吗？
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-09-01 DOI: 10.1086/719354
M. Oikawa, Ryuichi Tanaka, S. Bessho, H. Noguchi
{"title":"Do Class Size Reductions Protect Students from Infectious Diseases?","authors":"M. Oikawa, Ryuichi Tanaka, S. Bessho, H. Noguchi","doi":"10.1086/719354","DOIUrl":"https://doi.org/10.1086/719354","url":null,"abstract":"We evaluate the causal effect of class size (number of students in a classroom) on incidence of class closure due to the flu, as an outcome of an infectious disease epidemic. For identification of causal effects, we apply a regression discontinuity design using discontinuous variation of class sizes, around the class size cap set by regulation, to administrative data of public primary and middle school students in one of the largest municipalities within the Tokyo metropolitan area from 2015 to 2017. Most classrooms in Japan are constructed in accordance with a standard of classroom area, 63 square meters; class size reduction improves social distancing among students in a classroom. We find that class size reduction is effective in reducing class closures due to the flu: a one-unit reduction of class size decreases class closure by about 5 percent. Additionally, forming small classes with 27 students at most, satisfying the social distancing of 1.5 meters recommended to prevent droplet infection including influenza and COVID-19, reduces class closure by about 90 percent. Moreover, we find that the older the students, the larger the effects of class size reduction. Our findings provide evidence for the effectiveness of social distancing policy in primary and middle schools to protect students from droplet infectious disease spread, including COVID-19.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"449 - 476"},"PeriodicalIF":3.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44034411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Value of an Additional Day of Post-acute Care in a Skilled Nursing Facility 在专业护理机构额外进行一天急性期后护理的价值
IF 3.7 2区 经济学
American Journal of Health Economics Pub Date : 2022-07-22 DOI: 10.1086/721706
R. Werner, Norma B. Coe, Mingyu Qi, R. Konetzka
{"title":"The Value of an Additional Day of Post-acute Care in a Skilled Nursing Facility","authors":"R. Werner, Norma B. Coe, Mingyu Qi, R. Konetzka","doi":"10.1086/721706","DOIUrl":"https://doi.org/10.1086/721706","url":null,"abstract":"With ongoing efforts to improve the value of health care in the United States and reduce wasteful spending, we examine empirically the value trade-offs involved in an additional day in a skilled nursing facility (SNF) after hospital discharge. To control for potential endogeneity, we use the percentage of Medicare beneficiaries enrolled in Medicare Advantage in each county-year as an instrument for individuals’ SNF length of stay among Traditional Medicare beneficiaries, as local Medicare Advantage penetration puts downward pressure on SNF length of stay for all SNF patients but does not directly affect utilization management of those enrolled in Traditional Medicare. We also test for heterogeneity in treatment effect across patients by clinical complexity and two non-health-related factors, marital status and nursing home profit status. We find that one additional day in a SNF lowers short-term readmission rates, but this effect is small and heterogeneous across patient types. The most clinically complex patients (those with the longest predicted SNF stays) benefit the most from an additional SNF day, as do patients whose stays are shorter because of non-health-related factors. The cost savings from reduced readmission rates are small and do not offset the additional SNF costs.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"1 - 21"},"PeriodicalIF":3.7,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46147551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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