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Living alone and provider behaviour in public and private hospitals 公立和私立医院的独居和提供者行为
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-05-31 DOI: 10.1016/j.jhealeco.2025.103016
Luigi Siciliani , Jinglin Wen , James Gaughan
{"title":"Living alone and provider behaviour in public and private hospitals","authors":"Luigi Siciliani ,&nbsp;Jinglin Wen ,&nbsp;James Gaughan","doi":"10.1016/j.jhealeco.2025.103016","DOIUrl":"10.1016/j.jhealeco.2025.103016","url":null,"abstract":"<div><div>Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103016"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297401","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
Legal status and voluntary abortions by immigrants 移民的法律地位和自愿堕胎
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-05-22 DOI: 10.1016/j.jhealeco.2025.103001
Luca Pieroni , Melcior Rosselló Roig , Luca Salmasi , Gilberto Turati
{"title":"Legal status and voluntary abortions by immigrants","authors":"Luca Pieroni ,&nbsp;Melcior Rosselló Roig ,&nbsp;Luca Salmasi ,&nbsp;Gilberto Turati","doi":"10.1016/j.jhealeco.2025.103001","DOIUrl":"10.1016/j.jhealeco.2025.103001","url":null,"abstract":"<div><div>We estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a destination country. Using a standard Difference-in-Differences model, we estimate a decline between 60% and 70% in voluntary pregnancy termination (VPT) rates for the new EU citizens from the two Eastern countries. We also introduce a novel framework to separate the total effect of the enlargement into a “citizenship” effect due to (legal or illegal) migrants already present in Italy and a “selection” effect due to new flows of immigrants. We show that the findings are robust to several alternative explanations. The drop in abortions points to legal status as a way to empower immigrant women.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103001"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196459","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 for-profit hospitals cream-skim patients? Evidence from inpatient psychiatric care in California 营利性医院会对病人进行奶油脱脂吗？来自加州住院精神病治疗的证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-06-21 DOI: 10.1016/j.jhealeco.2025.103027
Donghoon Lee , Anirban Basu , Jerome A. Dugan , Pinar Karaca-Mandic
{"title":"Do for-profit hospitals cream-skim patients? Evidence from inpatient psychiatric care in California","authors":"Donghoon Lee ,&nbsp;Anirban Basu ,&nbsp;Jerome A. Dugan ,&nbsp;Pinar Karaca-Mandic","doi":"10.1016/j.jhealeco.2025.103027","DOIUrl":"10.1016/j.jhealeco.2025.103027","url":null,"abstract":"<div><div>The paper examines whether, among inpatient psychiatric admissions in California, for-profit (FP) hospitals engage in cream skimming, i.e., selecting patients for some characteristic(s) other than their need for care, which enhances the profitability of the provider. We propose a novel approach to identifying cream skimming using cost outcomes. Naïve treatment effect estimates of hospital ownership type consist of the combined effects of differential patient case mix (selection) and hospital cost containment strategies (execution). In contrast, an instrumental variable (IV) approach can control for case mix and establish the causal effects of ownership type due to its execution. We interpret the difference between the naïve and IV treatment effects to be driven by FP hospitals’ selection based on unobserved patient case mix. Our findings on patient selection show that FP hospitals are more likely than their not-for-profit (NFP) counterparts to admit higher-cost patients (who tend to be less profitable under the existing inpatient psychiatric care payment systems), providing no evidence of cream skimming by FP hospitals. Furthermore, our estimates of hospital execution indicate that FP hospitals are more likely than NFP hospitals to deliver inpatient services at lower costs. These results may alleviate concerns about the recent proliferation of FP psychiatric hospitals, particularly regarding cream skimming in this market.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103027"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523488","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
Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes 重返校园：COVID-19期间学校访问对COVID-19结果的影响
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-06-15 DOI: 10.1016/j.jhealeco.2025.103025
Dena Bravata , Jonathan Cantor , Neeraj Sood , Christopher Whaley
{"title":"Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes","authors":"Dena Bravata ,&nbsp;Jonathan Cantor ,&nbsp;Neeraj Sood ,&nbsp;Christopher Whaley","doi":"10.1016/j.jhealeco.2025.103025","DOIUrl":"10.1016/j.jhealeco.2025.103025","url":null,"abstract":"<div><div>The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts. We find increases in COVID-19 infection rates, with larger differences in low-income and higher COVID-19 prevalence counties.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103025"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365039","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 e-cigarette flavor bans on tobacco use 电子烟口味禁令对烟草使用的影响
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-05-22 DOI: 10.1016/j.jhealeco.2025.103013
Chad Cotti , Charles Courtemanche , Yang Liang , Johanna Catherine Maclean , Erik Nesson , Joseph J. Sabia
{"title":"The effect of e-cigarette flavor bans on tobacco use","authors":"Chad Cotti ,&nbsp;Charles Courtemanche ,&nbsp;Yang Liang ,&nbsp;Johanna Catherine Maclean ,&nbsp;Erik Nesson ,&nbsp;Joseph J. Sabia","doi":"10.1016/j.jhealeco.2025.103013","DOIUrl":"10.1016/j.jhealeco.2025.103013","url":null,"abstract":"<div><div>Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Behavioral Risk Factor Surveillance Survey, and Population Assessment of Tobacco and Health), this study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. We find robust evidence that the adoption of an ENDS flavor restriction reduces short-run frequent and everyday ENDS use among youths by approximately two-to-three percentage-points. Some evidence suggests that this effect weakens after two years. We also document reductions in ENDS use among young adults aged 18-30 that appear to strengthen after two years. Finally, evidence suggests substitution from flavored ENDS to unflavored ENDS and cigarettes among certain age groups.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103013"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518963","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
Mental health and mortality trends in the United States 美国的心理健康和死亡率趋势
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-06-03 DOI: 10.1016/j.jhealeco.2025.103015
Christopher J. Ruhm
{"title":"Mental health and mortality trends in the United States","authors":"Christopher J. Ruhm","doi":"10.1016/j.jhealeco.2025.103015","DOIUrl":"10.1016/j.jhealeco.2025.103015","url":null,"abstract":"<div><div>This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence with increased attention to so-called “deaths of despair.” The main takeaway is that although declining psychological health has likely contributed to adverse mortality trends—especially among prime-age non-Hispanic Whites—its overall impact is limited and not well captured by standard definitions of “deaths of despair.” Five key findings support this conclusion. First, mental health deteriorated between 1993 and 2019 for all population groups examined. Second, these declines are associated with higher predicted death rates and help explain worsening mortality trends for prime-age non-Hispanic Whites and, to a lesser extent, non-Hispanic Blacks between 1999 and 2019. Third, while these correlations lend some support to the broader idea of “deaths of despair,” the specific causes comprising them appear to be both more expansive and different from those previously emphasized. Fourth, heterogeneity in how worsening mental distress affects mortality—rather than in mental health trends themselves—is more important in explaining Black-White disparities in its overall impact. Finally, in the primary specifications, deteriorating mental health accounts for an estimated 9 % to 29 % of the rise in mortality rates among prime-age Whites in recent years.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103015"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196460","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
Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging 重新考虑技术管制：需求证明政策对诊断影像数量和质量的影响
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-06-07 DOI: 10.1016/j.jhealeco.2025.103020
Jill R. Horwitz , Austin Nichols , Anthony Yu , Carrie H. Colla , David M. Cutler
{"title":"Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging","authors":"Jill R. Horwitz ,&nbsp;Austin Nichols ,&nbsp;Anthony Yu ,&nbsp;Carrie H. Colla ,&nbsp;David M. Cutler","doi":"10.1016/j.jhealeco.2025.103020","DOIUrl":"10.1016/j.jhealeco.2025.103020","url":null,"abstract":"<div><div>Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103020"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330319","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
Imprecise health beliefs and health behavior 不精确的健康信念和健康行为
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-08-01 Epub Date: 2025-06-05 DOI: 10.1016/j.jhealeco.2025.103003
Adeline Delavande , Emilia Del Bono , Angus Holford
{"title":"Imprecise health beliefs and health behavior","authors":"Adeline Delavande ,&nbsp;Emilia Del Bono ,&nbsp;Angus Holford","doi":"10.1016/j.jhealeco.2025.103003","DOIUrl":"10.1016/j.jhealeco.2025.103003","url":null,"abstract":"<div><div>This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individuals’ minimum and maximum subjective probabilities of different health outcomes, and define belief imprecision as the range between these values. We document substantial heterogeneity in the degree of imprecision across respondents, which remains largely unexplained by standard demographic characteristics. To assess the behavioral impact of imprecise beliefs, we ask beliefs about future outcomes under hypothetical scenarios that feature different levels of protective behaviors. We find that individuals who expect protective behaviors to reduce not only the subjective probability of a negative health outcome, but also the degree of imprecision associated with it, behave more protectively.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"102 ","pages":"Article 103003"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330323","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
Corrigendum to “Nudging the Nudger: A Field Experiment on the Effect of Performance Feedback to Increase Organ Donor Registrations” [Journal of Health Economics, 97, 102914, 2024] “轻推轻推：绩效反馈对增加器官捐献者登记效果的现场实验”[卫生经济杂志，97,102914,2024]。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-05-01 Epub Date: 2025-03-24 DOI: 10.1016/j.jhealeco.2025.102990
Julian House , Nicola Lacetera , Mario Macis , Nina Mazar
{"title":"Corrigendum to “Nudging the Nudger: A Field Experiment on the Effect of Performance Feedback to Increase Organ Donor Registrations” [Journal of Health Economics, 97, 102914, 2024]","authors":"Julian House ,&nbsp;Nicola Lacetera ,&nbsp;Mario Macis ,&nbsp;Nina Mazar","doi":"10.1016/j.jhealeco.2025.102990","DOIUrl":"10.1016/j.jhealeco.2025.102990","url":null,"abstract":"","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102990"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711927","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
Social genetic insurance: A life-cycle perspective 社会遗传保险：生命周期视角
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-05-01 Epub Date: 2025-04-18 DOI: 10.1016/j.jhealeco.2025.102994
Hélène Schernberg
{"title":"Social genetic insurance: A life-cycle perspective","authors":"Hélène Schernberg","doi":"10.1016/j.jhealeco.2025.102994","DOIUrl":"10.1016/j.jhealeco.2025.102994","url":null,"abstract":"<div><div>Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redistributing from low-risk to high-risk individuals in period 1 can increase social welfare, even when the high-risk are not financially penalized. Temporally risk-averse individuals value reductions in the risk to their lifetime utility brought by illness, such as increased morbidity and mortality. A social insurance can achieve this by taxing the low-risk and subsidizing the high-risk. I calibrate a multi-period life-cycle model for breast cancer and Huntington’s disease and quantify the optimal redistribution. For these two conditions, which are rare, substantial transfers to the high-risk can be achieved with minimal taxation on the low-risk. Thus, the welfare of the high-risk is substantially improved with little impact on the low-risk.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102994"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865032","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
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