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Moral hazard and risk adjustment. 道德风险和风险调整。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-12-11 DOI: 10.1016/j.jhealeco.2024.102955
Gijsbert Zwart
{"title":"Moral hazard and risk adjustment.","authors":"Gijsbert Zwart","doi":"10.1016/j.jhealeco.2024.102955","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102955","url":null,"abstract":"<p><p>We analyse a model of optimal risk adjustment in competitive health-insurance markets which suffer from both ex-ante adverse selection and ex-post moral hazard. We find, firstly, that, unlike in an adverse-selection-only market, in an environment where also moral hazard is important, removing insurers' selection incentives requires risk-adjustment payments that do not fully equalize costs among consumer types. Current practice of attempting to correct for all predictable cost differences among consumers is then misguided. Secondly, if the sponsor of the risk-adjustment system is not only concerned with eliminating selection distortions, but also wants to redistribute towards high-risk consumers, the required higher risk-adjustment payments will introduce selection distortions in high-risk consumers' contracts. This leads to excessive equilibrium provision of care for those suffering severe health shocks. Finally, insurer market power creates countervailing incentives, helping the risk adjuster to combat selection distortions but working against a risk-adjustment regulation that also cares about redistribution.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102955"},"PeriodicalIF":3.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824669","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
Biological age and predicting future health care utilisation.
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-12-06 DOI: 10.1016/j.jhealeco.2024.102956
Apostolos Davillas, Andrew M Jones
{"title":"Biological age and predicting future health care utilisation.","authors":"Apostolos Davillas, Andrew M Jones","doi":"10.1016/j.jhealeco.2024.102956","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102956","url":null,"abstract":"<p><p>We explore the role of epigenetic biological age in predicting subsequent health care utilisation. We use longitudinal data from the UK Understanding Society panel, capitalising on the availability of baseline epigenetic biological age measures along with data on general practitioner (GP) consultations, outpatient (OP) visits, and hospital inpatient (IP) care collected 5-12 years from baseline. Using least absolute shrinkage and selection operator (LASSO) regression analyses and accounting for participants' pre-existing health conditions, baseline biological underlying health, and socio-economic predictors we find that biological age is selected as a predictor of future GP consultations and IP care, while chronological rather than biological age is selected for future OP visits. Post-selection prediction analysis and Shapley-Shorrocks decompositions, comparing our preferred prediction models to models that replace biological age with chronological age, suggest that biological ageing has a stronger role in the models predicting future IP care as opposed to \"gatekeeping\" GP consultations.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102956"},"PeriodicalIF":3.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822825","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 light of life: The effects of sunlight on suicide.
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-12-03 DOI: 10.1016/j.jhealeco.2024.102947
Shinsuke Tanaka, Tetsuya Matsubayashi
{"title":"The light of life: The effects of sunlight on suicide.","authors":"Shinsuke Tanaka, Tetsuya Matsubayashi","doi":"10.1016/j.jhealeco.2024.102947","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102947","url":null,"abstract":"<p><p>This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102947"},"PeriodicalIF":3.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822794","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
Triage at shift changes and distortions in the perception and treatment of emergency patients.
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-12-02 DOI: 10.1016/j.jhealeco.2024.102944
Simone Ferro, Chiara Serra
{"title":"Triage at shift changes and distortions in the perception and treatment of emergency patients.","authors":"Simone Ferro, Chiara Serra","doi":"10.1016/j.jhealeco.2024.102944","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102944","url":null,"abstract":"<p><p>Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses' assessments of patients' conditions and investigate the short- and medium-term consequences for patients. We show that triage nurses progressively become more lenient during their shifts, and identical ED patients arriving just after a shift change are thus assigned a lower priority. We show that these patients receive lower levels of care and require additional emergency care afterward. We conclude that distortions in nurses' initial assessments of urgency bias' medical staff's perceptions.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102944"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808394","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 does undervaluation in medical savings accounts (MSAs) affect healthcare utilization? Evidence from administrative data in China
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-12-01 DOI: 10.1016/j.jhealeco.2024.102946
Wei Huang , Xiaoyan Lei , Yuqi Ta
{"title":"How does undervaluation in medical savings accounts (MSAs) affect healthcare utilization? Evidence from administrative data in China","authors":"Wei Huang ,&nbsp;Xiaoyan Lei ,&nbsp;Yuqi Ta","doi":"10.1016/j.jhealeco.2024.102946","DOIUrl":"10.1016/j.jhealeco.2024.102946","url":null,"abstract":"<div><div>This study examines how the undervaluation of funds in Medical Savings Accounts (MSAs) influences healthcare utilization in China. Given that MSA funds are restricted to healthcare expenses, individuals may undervalue these funds relative to cash, leading to potential overuse of health care. Through an event study approach using administrative data, we find significant reductions in healthcare utilization after MSA balances are depleted—outpatient care expenses drop by 49 percent, and drugstore purchases decrease by 41 percent. These effects persist across socioeconomic groups, indicating that liquidity constraints are not a major factor. Our back-of-the-envelope calculations suggest that insured individuals undervalue MSA funds by 40–70 %. This research sheds light on the behavioral impacts of MSAs and the broader implications of perceived price distortions in health insurance.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102946"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748179","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
Driving under the influence of allergies: the effect of seasonal pollen on traffic fatalities.
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-11-24 DOI: 10.1016/j.jhealeco.2024.102945
Shooshan Danagoulian, Monica Deza
{"title":"Driving under the influence of allergies: the effect of seasonal pollen on traffic fatalities.","authors":"Shooshan Danagoulian, Monica Deza","doi":"10.1016/j.jhealeco.2024.102945","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102945","url":null,"abstract":"<p><p>Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the role of transitory health shocks or situational factors at explaining variations in fatal traffic accidents has been understudied. Exploring daily variation in city-specific pollen counts, this study finds novel evidence that traffic fatalities increase on days in which the local pollen count is particularly high. We find that the effects are present in accidents involving private vehicles and occur most frequently on the weekends, suggesting potentially the missed opportunity to avoid these fatalities. We do not find similar effects for fleet vehicles. These findings remain robust to alternative specifications and alternative definitions of high pollen count. Taken together, this study finds evidence that a prevalent and transitory exogenous health-shock, namely pollen allergies, increases traffic fatalities. Given our lack of evidence of avoidance, these effects are not mechanical and are likely driven by cognitive impairments that arise as a result of seasonal allergies.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102945"},"PeriodicalIF":3.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808393","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
Ridesharing and substance use disorder treatment.
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-11-23 DOI: 10.1016/j.jhealeco.2024.102941
Conor Lennon, Johanna Catherine Maclean, Keith Teltser
{"title":"Ridesharing and substance use disorder treatment.","authors":"Conor Lennon, Johanna Catherine Maclean, Keith Teltser","doi":"10.1016/j.jhealeco.2024.102941","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102941","url":null,"abstract":"<p><p>We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data Set to estimate the effect of ridesharing on admissions to substance use disorder treatment. People needing such treatment report transportation as a barrier to receiving care. We find that UberX entry into a Core Based Statistical Area has no effect on the overall number of treatment admissions. However, we find a decline in non-intensive outpatient treatment which is fully offset by an increase in intensive outpatient treatment. Given the required relative frequency of non-intensive and intensive outpatient treatment in terms of visits per week, our findings indicate that UberX helps to reduce transportation barriers to accessing healthcare. Event-studies show parallel trends in outcomes before UberX entry and results are robust to numerous sensitivity checks.</p>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"99 ","pages":"102941"},"PeriodicalIF":3.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787547","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
Put a bet on it: Can self-funded commitment contracts curb fitness procrastination? 赌一把自费承诺合同能否遏制健身拖延症？
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-11-12 DOI: 10.1016/j.jhealeco.2024.102943
Devon Spika , Linnea Wickström Östervall , Ulf Gerdtham , Erik Wengström
{"title":"Put a bet on it: Can self-funded commitment contracts curb fitness procrastination?","authors":"Devon Spika ,&nbsp;Linnea Wickström Östervall ,&nbsp;Ulf Gerdtham ,&nbsp;Erik Wengström","doi":"10.1016/j.jhealeco.2024.102943","DOIUrl":"10.1016/j.jhealeco.2024.102943","url":null,"abstract":"<div><div>We investigate the use of a highly scalable intervention to help individuals achieve their physical activity goals: self-funded commitment contracts. Using a randomised experiment, we compare the effect of soft (non-incentivised) and hard (incentivised) contracts among 1629 members of a gym in Stockholm, Sweden. We find a significant positive impact of being offered a hard contract on monthly visits to the gym and the probability of meeting one’s contract goal. Relative to the control group, being offered a hard contract significantly increases gym visits by 21%, while being offered a soft contract leads to an 8% increase.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102943"},"PeriodicalIF":3.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Universal free school meals and children’s bodyweight. Impacts by age and duration of exposure 普及免费校餐与儿童体重。按年龄和接触时间划分的影响。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-11-12 DOI: 10.1016/j.jhealeco.2024.102937
Angus Holford , Birgitta Rabe
{"title":"Universal free school meals and children’s bodyweight. Impacts by age and duration of exposure","authors":"Angus Holford ,&nbsp;Birgitta Rabe","doi":"10.1016/j.jhealeco.2024.102937","DOIUrl":"10.1016/j.jhealeco.2024.102937","url":null,"abstract":"<div><div>We study the impact on children’s bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to estimate effects at different ages and durations of exposure, based on nurse-collected, population-wide health data for state school children. Exposure to universal free lunches reduces obesity prevalence and BMI among children aged 4–5 and 10–11, but older children’s bodyweights are less responsive than younger children’s. We find tentative evidence that effects may be cumulative, as impacts are largest for those exposed to universal free school meals throughout primary school.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102937"},"PeriodicalIF":3.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Universal Credit: Welfare reform and mental health 通用信贷：福利改革与心理健康。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-11-10 DOI: 10.1016/j.jhealeco.2024.102940
Mike Brewer , Thang Dang , Emma Tominey
{"title":"Universal Credit: Welfare reform and mental health","authors":"Mike Brewer ,&nbsp;Thang Dang ,&nbsp;Emma Tominey","doi":"10.1016/j.jhealeco.2024.102940","DOIUrl":"10.1016/j.jhealeco.2024.102940","url":null,"abstract":"<div><div>The UK Universal Credit (UC) welfare reform simplified the benefits system whilst strongly incentivising a return to sustainable employment. Exploiting a staggered roll-out, we estimate the differential effect of unemployment under UC versus the former system on mental health. Groups with fewer insurance possibilities – single adults and lone parents – experience a mental health deterioration of 8.4-13.9% standard deviations which persists into the subsequent year. For couples, UC partially or fully mitigates mental health consequences of unemployment. Exploring mechanisms, for single adults and lone parents, reduced benefit income and strict job search requirements dominate any positive welfare effects of the reduced administrative burden of claiming benefits.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102940"},"PeriodicalIF":3.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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