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Medical ethics and physician motivations 医德与医生的动机。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-09-30 DOI: 10.1016/j.jhealeco.2024.102933
Brendon P. Andrews
{"title":"Medical ethics and physician motivations","authors":"Brendon P. Andrews","doi":"10.1016/j.jhealeco.2024.102933","DOIUrl":"10.1016/j.jhealeco.2024.102933","url":null,"abstract":"<div><div>This paper provides an institutional economics framework for analyzing medical ethics. An ethical policy partitions the set of physician actions into (un)ethical subsets, with unethical actions then unavailable. Individual physicians’ preferences over policies combined with a political process determine equilibrium constraints. I show that physicians’ concern for colleagues’ patients uniquely motivates their support for ethics which restrict behavior under strong assumptions. Without these assumptions, even identical physicians might ban actions they would otherwise select for reasons varying from protecting patients to differences in the costs of maintaining ethical policies. Interestingly, heightened altruism for colleagues’ patients makes the former reasoning less credible. Novel applications for ‘Provide Free Care to Physicians’ and ‘Duty to Treat in a Pandemic’ demonstrate: (i) rising physician income can explain long-run weakening of both formal ethics in the United States; and (ii) the duty to treat can deteriorate as fewer physicians are required to improve pandemic outcomes.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102933"},"PeriodicalIF":3.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376263","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
The devastating dance between opioid and housing crises: Evidence from OxyContin reformulation 阿片类药物与住房危机之间毁灭性的共舞：奥施康定重新配方的证据。
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-09-15 DOI: 10.1016/j.jhealeco.2024.102930
Ashley C. Bradford , Wei Fu , Shijun You
{"title":"The devastating dance between opioid and housing crises: Evidence from OxyContin reformulation","authors":"Ashley C. Bradford ,&nbsp;Wei Fu ,&nbsp;Shijun You","doi":"10.1016/j.jhealeco.2024.102930","DOIUrl":"10.1016/j.jhealeco.2024.102930","url":null,"abstract":"<div><div>Housing instability and drug misuse are two of the United States' most pressing challenges, each bearing profound health and societal consequences. A crucial yet largely underexplored question is the extent to which the opioid crisis has intensified housing instability. Our study ventures into this relatively uncharted nexus, investigating how the OxyContin reformulation, a pivotal moment in the U.S. opioid epidemic, impacted eviction rates. Employing a dose-response Difference-in-Differences model and analyzing eviction data from 2004 to 2016, we demonstrate that the OxyContin reformulation precipitated a significant increase in evictions, especially in areas with weak eviction protections or limited access to psychiatric treatment resources. Channel analyses reveal increased marijuana initiation and heightened mental and physical health issues following the reformulation. Moreover, the OxyContin reformulation leads to greater reliance on the Supplemental Nutrition Assistance Program, signaling an escalated financial strain on governmental resources. Finally, we find evidence of increased marital disruption post-reformulation. Our findings underscore the urgent need for collaborative efforts between public health and housing authorities to address both the opioid and housing crises.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102930"},"PeriodicalIF":3.4,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378488","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
Pharmaceutical innovation collaboration, evaluation, and matching 医药创新合作、评估和匹配
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-09-11 DOI: 10.1016/j.jhealeco.2024.102922
Qianshuo Liu
{"title":"Pharmaceutical innovation collaboration, evaluation, and matching","authors":"Qianshuo Liu","doi":"10.1016/j.jhealeco.2024.102922","DOIUrl":"10.1016/j.jhealeco.2024.102922","url":null,"abstract":"<div><p>This paper theoretically studies pharmaceutical innovation collaborations, where heterogeneous firms compete for heterogeneous academics. At an interim stage, the firm evaluates the project, which allows it to monitor academics and decide whether to terminate the project to avoid the loss from a future failure. This paper explores the contract, project termination strategy, and collaboration matching. The firm’s innovation strategy (exploitations or explorations) determines the evaluation structure, which may affect the market equilibrium. By considering different innovation strategies, this paper shows that in each case, the equilibrium matching is unique (either positive or negative assortative). Consequently, the chosen innovation strategy plays a pivotal role in shaping equilibrium matching outcomes. These findings provide theoretical insights into pharma-academic alliances, shed light on the observed positive or negative assortative properties in the market, and advocate for the consideration of innovation strategies and evaluation structures in future research endeavors. Moreover, this paper also provides several empirical and policy implications.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102922"},"PeriodicalIF":3.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629624000675/pdfft?md5=c1899ebfe1f66563988a7911ed4c8c8f&pid=1-s2.0-S0167629624000675-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167837","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
Paying for advance care planning in medicare: Impacts on care and spending near end of life 在医疗保险中支付预先护理计划的费用：对临终护理和支出的影响
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-09-06 DOI: 10.1016/j.jhealeco.2024.102921
Alice J. Chen , Jing Li
{"title":"Paying for advance care planning in medicare: Impacts on care and spending near end of life","authors":"Alice J. Chen ,&nbsp;Jing Li","doi":"10.1016/j.jhealeco.2024.102921","DOIUrl":"10.1016/j.jhealeco.2024.102921","url":null,"abstract":"<div><p>Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variables approach, we conduct the first study on the causal effect of Medicare reimbursement for advance care planning (ACP)—the process of discussing and recording patient preferences for goals of care—on care utilization, spending, and mortality outcomes for critically ill Medicare patients. We find that billed ACP services substantially increase hospice use and hospice spending within a year, accompanied by corresponding increase in one-year mortality. The impacts of ACP services on hospice use and spending are especially prominent among patients with dementia and those of lower socioeconomic status. Among decedents, death is significantly less likely to occur in the hospital, and total and inpatient spending within the last 30 days of life fall significantly. Our findings suggest that paying for ACP services can be effective in improving hospice use for critically ill Medicare patients, with the (possibly intended) consequence of increased one-year mortality.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102921"},"PeriodicalIF":3.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230092","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
Hospital competition when patients learn through experience 患者从经验中学习时的医院竞争
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-09-01 DOI: 10.1016/j.jhealeco.2024.102920
Luís Sá , Odd Rune Straume
{"title":"Hospital competition when patients learn through experience","authors":"Luís Sá ,&nbsp;Odd Rune Straume","doi":"10.1016/j.jhealeco.2024.102920","DOIUrl":"10.1016/j.jhealeco.2024.102920","url":null,"abstract":"<div><p>We study competing hospitals’ incentives for quality provision in a dynamic setting where healthcare is an <em>experience good</em>. In our model, the utility a patient derives from choosing a particular provider depends on a subjective component specific to the match between the patient and the provider, which can only be learned through experience. We find that the experience-good nature of healthcare can either reinforce or dampen the demand responsiveness to quality and the hospitals’ incentives for quality provision, depending on two key factors: the shape of the distribution of match-specific utilities and the cost relationship between quality provision and treatment volume. We establish conditions under which ignoring the experience dimension of healthcare leads to inaccurate assessments of the competitiveness of hospital markets.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"97 ","pages":"Article 102920"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629624000651/pdfft?md5=a97672c723f81dbaa82eaa61356b188b&pid=1-s2.0-S0167629624000651-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122457","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
Do e-cigarette retail licensure laws reduce youth tobacco use? 电子烟零售许可法能减少青少年烟草使用吗？
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-08-22 DOI: 10.1016/j.jhealeco.2024.102919
Charles Courtemanche , Yang Liang , Johanna Catherine Maclean , Caterina Muratori , Joseph J. Sabia
{"title":"Do e-cigarette retail licensure laws reduce youth tobacco use?","authors":"Charles Courtemanche ,&nbsp;Yang Liang ,&nbsp;Johanna Catherine Maclean ,&nbsp;Caterina Muratori ,&nbsp;Joseph J. Sabia","doi":"10.1016/j.jhealeco.2024.102919","DOIUrl":"10.1016/j.jhealeco.2024.102919","url":null,"abstract":"<div><p>E-cigarette licensure laws (ELLs) require retailers to obtain a state license to sell e-cigarettes over the counter. This study is the first to comprehensively explore the effect of ELL adoption on youth tobacco product use. Using data from the State Youth Risk Behavior Survey (YRBS) and a difference-in-differences approach, we find no evidence that ELL adoption reduces youth ENDS use. The precision of our estimates allows us to rule out, with 95 % confidence, ELL-induced declines in prior-month, frequent, and everyday youth ENDS use of more than 0.7, 0.3, and 0.4 percentage points, respectively. The pattern of null findings persists when we examine ELLs that impose higher penalties for retailer non-compliance, higher renewable licensure fees, and criminal in addition to civil penalties. We conclude that ELLs have only limited success in curbing access to ENDS among youths.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102919"},"PeriodicalIF":3.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162728","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
Health insurance, agricultural production and investments 医疗保险、农业生产和投资
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-08-08 DOI: 10.1016/j.jhealeco.2024.102918
Kai Liu , Benjapon Prommawin , Fred Schroyen
{"title":"Health insurance, agricultural production and investments","authors":"Kai Liu ,&nbsp;Benjapon Prommawin ,&nbsp;Fred Schroyen","doi":"10.1016/j.jhealeco.2024.102918","DOIUrl":"10.1016/j.jhealeco.2024.102918","url":null,"abstract":"<div><p>We study the effects of health insurance coverage on agricultural production decisions, examining the causal relationships by exploiting a health care reform and providing a theoretical framework to elucidate underlying mechanisms. We find that the reform led to long-run increases in total cultivation investments and output, accompanied by a shift in households’ cultivation portfolio towards riskier crops. We explain these findings using a model of agricultural investment, highlighting the important roles of health insurance in mitigating background medical expenditure risks and enhancing health. We also find that the reform improved households’ financial well-being through reduced debts and defaults on loans.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"97 ","pages":"Article 102918"},"PeriodicalIF":3.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048048","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
Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients 调查纳洛酮分发的复杂性：哪些政策对药店和潜在接受者至关重要
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-07-17 DOI: 10.1016/j.jhealeco.2024.102917
Rosanna Smart , David Powell , Rosalie Liccardo Pacula , Evan Peet , Rahi Abouk , Corey S. Davis
{"title":"Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients","authors":"Rosanna Smart ,&nbsp;David Powell ,&nbsp;Rosalie Liccardo Pacula ,&nbsp;Evan Peet ,&nbsp;Rahi Abouk ,&nbsp;Corey S. Davis","doi":"10.1016/j.jhealeco.2024.102917","DOIUrl":"10.1016/j.jhealeco.2024.102917","url":null,"abstract":"<div><p>Despite efforts to expand naloxone access, opioid-related overdoses remain a significant contributor to mortality. We study state efforts to expand naloxone distribution through pharmacies by reducing the non-monetary costs to prescribers, dispensers, and/or potential recipients of naloxone. We find that laws that only address liability costs have small and insignificant effects on the volume of naloxone dispensed through pharmacies. In contrast, we estimate large effects of laws removing the need for patients to obtain prescriptions from traditional prescribers (e.g., primary care physicians): laws authorizing non-patient-specific prescription distribution and laws granting pharmacists prescriptive authority. We test whether areas designated as primary care shortage areas—where it would be costlier to obtain a prescription—were disproportionately impacted. Shortage areas experienced sharper growth in pharmacy naloxone dispensing in states adopting prescriptive authority policies. These gains were primarily due to those facing low out-of-pocket costs, suggesting that price barriers also must be addressed to increase naloxone purchases.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"97 ","pages":"Article 102917"},"PeriodicalIF":3.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629624000626/pdfft?md5=96cfa0f5c572e743211cbb53409d0e74&pid=1-s2.0-S0167629624000626-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736478","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
Financial incentives for sanitation take-up: A randomized control trial in rural Vietnam 促进卫生设施使用的财政激励措施：越南农村随机对照试验
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-07-07 DOI: 10.1016/j.jhealeco.2024.102916
Cuong Viet Nguyen , Tung Duc Phung
{"title":"Financial incentives for sanitation take-up: A randomized control trial in rural Vietnam","authors":"Cuong Viet Nguyen ,&nbsp;Tung Duc Phung","doi":"10.1016/j.jhealeco.2024.102916","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2024.102916","url":null,"abstract":"<div><p>This study assesses the impact of financial incentives on hygienic latrine ownership by poor/near-poor households in Vietnam. Rural communes were randomly assigned to a control group and three treatment arm groups: (T1) a rebate for households that installed a hygienic latrine; (T2) a financial reward for commune governments if the proportion of hygienic latrines in their commune increased by 30 percentage points; (T3) both a household rebate and a commune reward. We find a strong and positive effect from the household rebate (treatment arms 1 and 3) but an insignificant effect from the commune reward (treatment arm 2) on household ownership of a septic tank latrine. Our analysis provides suggestive evidence that microcredit is a channel through which a rebate encourages the installation of septic tank latrines. We also find that treatment arm 3 increases people's knowledge regarding sanitation and the availability of water and soap for handwashing within households.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"97 ","pages":"Article 102916"},"PeriodicalIF":3.4,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141593757","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
Housing wealth, fertility and children's health in China: A regression discontinuity design 中国的住房财富、生育率和儿童健康：回归不连续设计
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2024-07-06 DOI: 10.1016/j.jhealeco.2024.102915
Geer Ang , Ya Tan , Yingjia Zhai , Fan Zhang , Qinghua Zhang
{"title":"Housing wealth, fertility and children's health in China: A regression discontinuity design","authors":"Geer Ang ,&nbsp;Ya Tan ,&nbsp;Yingjia Zhai ,&nbsp;Fan Zhang ,&nbsp;Qinghua Zhang","doi":"10.1016/j.jhealeco.2024.102915","DOIUrl":"10.1016/j.jhealeco.2024.102915","url":null,"abstract":"<div><p>This paper examines the influence of housing wealth on fertility outcomes through a regression discontinuity design based on a 2006 Chinese housing-market policy. Our analysis reveals that the positive impact of this policy on housing wealth significantly enhances the likelihood of fertility by 7.3 %. Our result implies that a 1 % increase in housing wealth can raise the fertility rate by 0.18 %. Furthermore, we observe that children born subsequent to the positive housing wealth shock exhibit improved health, not only at birth but also over the long term. Lastly, we present suggestive evidence suggesting that both parental pre-birth time allocation and parental health may help explain the documented positive effects of housing wealth on fertility rates.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"97 ","pages":"Article 102915"},"PeriodicalIF":3.4,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604445","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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