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Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees 养老院的工资补贴以及医疗补助计划参保者在人员配备和获得护理之间的权衡
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-08-07 DOI: 10.1016/j.jhealeco.2025.103042
Thomas A. Hegland
{"title":"Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees","authors":"Thomas A. Hegland","doi":"10.1016/j.jhealeco.2025.103042","DOIUrl":"10.1016/j.jhealeco.2025.103042","url":null,"abstract":"<div><div>Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103042"},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831251","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 impact of nurse practitioner scope-of-practice laws on preventable hospitalizations 护士执业范围法对可预防住院治疗的影响
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-08-02 DOI: 10.1016/j.jhealeco.2025.103044
Benjamin J. McMichael
{"title":"The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations","authors":"Benjamin J. McMichael","doi":"10.1016/j.jhealeco.2025.103044","DOIUrl":"10.1016/j.jhealeco.2025.103044","url":null,"abstract":"<div><div>The increased use of nurse practitioners (NPs) to provide healthcare represents an important policy option to expand access to care. However, restrictive scope-of-practice laws limit NPs’ ability to deliver care in about half of all states. I examine the effect of relaxing these laws (by granting NPs full practice authority) on hospital discharges for conditions classified as prevention quality indicators (PQIs) across 22 states between 2010 and 2019. PQIs measure hospital admissions that may be avoidable with timely outpatient care. I find that full practice authority reduces avoidable hospitalizations for diabetes and other chronic conditions, with particularly consistent effects among privately insured patients. Hospital stays for PQI conditions become longer on average, suggesting that relatively healthier patients are more likely to avoid hospitalization. These results indicate that full practice authority improves access to outpatient care and allows for more efficient use of inpatient resources.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103044"},"PeriodicalIF":3.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757935","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
Intergenerational effects of sick leave on child human capital 病假对儿童人力资本的代际影响
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-07-31 DOI: 10.1016/j.jhealeco.2025.103047
Julie Riise , Barton Willage , Alexander Willén
{"title":"Intergenerational effects of sick leave on child human capital","authors":"Julie Riise ,&nbsp;Barton Willage ,&nbsp;Alexander Willén","doi":"10.1016/j.jhealeco.2025.103047","DOIUrl":"10.1016/j.jhealeco.2025.103047","url":null,"abstract":"<div><div>This paper examines the intergenerational consequences of parental participation in government social insurance programs, using one of the largest social insurance programs in the world: sick leave. We exploit quasi-random assignment of patients to general practitioners (GPs) in Norway, who vary in their propensity to certify sick leave of different lengths, to estimate the effects of access to longer sick leave for the marginal individual. Linking administrative data on patients and their children, we show that assignment to a more lenient GP lowers children’s GPA in adolescence, reduces the likelihood of completing upper secondary education, and decreases enrollment in higher education. These effects appear to operate through changes in parental trajectories: more sick leave leads to lower long-term earnings, greater reliance on welfare, and deterioration in mental health.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103047"},"PeriodicalIF":3.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772049","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
Overcoming medical overuse with AI assistance: An experimental investigation 用人工智能帮助克服医疗过度使用：一项实验调查
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-07-29 DOI: 10.1016/j.jhealeco.2025.103043
Ziyi Wang , Lijia Wei , Lian Xue
{"title":"Overcoming medical overuse with AI assistance: An experimental investigation","authors":"Ziyi Wang ,&nbsp;Lijia Wei ,&nbsp;Lian Xue","doi":"10.1016/j.jhealeco.2025.103043","DOIUrl":"10.1016/j.jhealeco.2025.103043","url":null,"abstract":"<div><div>This study examines the role of Artificial Intelligence (AI) in reducing medical overtreatment, a critical healthcare challenge that increases costs and patient risks. In two experiments – with 196 physicians at a hospital and 120 students at a medical school in Wuhan – we use a novel medical prescription task under three incentive schemes: <em>flat</em> (constant pay), <em>progressive</em> (pay increases with treatment quantity), and <em>regressive</em> (penalties for overtreatment) to estimate receptivity to AI assistance and its effects on overtreatment and treatment accuracy, and test whether effects vary with incentives. AI recommendation of a treatment is estimated to increase the probability a physician prescribes it by 25.7–28.4 percentage points (pp), with the largest effect under the flat scheme. Physicians are more receptive to AI recommendations in medical domains with which they are less familiar. We estimate that AI assistance reduces the probability a physician overtreats by 10.9–25.7 pp (15.2–80.3%), with significantly larger absolute and relative effects under the flat scheme compared to progressive and regressive schemes. AI assistance improves physicians’ treatment accuracy by 9.8–13.3 pp (14.6–19.9%), with the largest absolute effect under the regressive scheme. These findings are corroborated by the medical school experiment, which reveals that factors indicative of <em>insufficient ability</em> account for 34% of the explained variation in overtreatment, <em>monetary incentives</em> account for 22%, <em>patient welfare considerations</em> account for 20%, and factors related to <em>defensive medicine</em> for 10%. These results provide valuable insights for healthcare administrators considering AI integration into healthcare systems.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103043"},"PeriodicalIF":3.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779673","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
Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth 解释长期护理保险难题：相关性偏好和生活质量偏好在财富中的作用
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-07-17 DOI: 10.1016/j.jhealeco.2025.103030
David Crainich , Léontine Goldzahl , Florence Jusot , Doriane Mignon
{"title":"Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth","authors":"David Crainich ,&nbsp;Léontine Goldzahl ,&nbsp;Florence Jusot ,&nbsp;Doriane Mignon","doi":"10.1016/j.jhealeco.2025.103030","DOIUrl":"10.1016/j.jhealeco.2025.103030","url":null,"abstract":"<div><div>The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions—specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103030"},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687590","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 effects of restricted abortion access on IUDs and vasectomies: Evidence from Texas 限制人工流产对宫内节育器和输精管切除术的影响：来自德克萨斯州的证据
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-07-16 DOI: 10.1016/j.jhealeco.2025.103041
Bradley Crowe , Graham Gardner , Cara Haughey
{"title":"The effects of restricted abortion access on IUDs and vasectomies: Evidence from Texas","authors":"Bradley Crowe ,&nbsp;Graham Gardner ,&nbsp;Cara Haughey","doi":"10.1016/j.jhealeco.2025.103041","DOIUrl":"10.1016/j.jhealeco.2025.103041","url":null,"abstract":"<div><div>Both contraception and abortion result in fertility reductions, but whether they are substitutes remains an open question. In 2013, Texas passed House Bill 2 (HB2), a policy that imposed strict regulations on abortion providers. Using administrative outpatient records from Texas, we exploit the passage of HB2 to identify the effects of restricted abortion access on the timing and demand for intrauterine devices (IUDs) and vasectomies using an event study design. We find evidence that expectations of limited abortion access significantly increase the demand for IUDs, with no effect on the incidence of vasectomies. These findings support the hypothesis that abortion and contraception are substitutes, particularly for individuals with the capacity to become pregnant.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103041"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779736","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
Effects of informal caring on labour market outcomes of carers: Evidence from HILDA 非正式照顾对照顾者劳动力市场结果的影响：来自HILDA的证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-07-12 DOI: 10.1016/j.jhealeco.2025.103028
Pelin Akyol , Matt Nolan
{"title":"Effects of informal caring on labour market outcomes of carers: Evidence from HILDA","authors":"Pelin Akyol ,&nbsp;Matt Nolan","doi":"10.1016/j.jhealeco.2025.103028","DOIUrl":"10.1016/j.jhealeco.2025.103028","url":null,"abstract":"<div><div>This study examines the causal impact of informal caregiving on labour market outcomes and well-being using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We combine an event study design with an instrumental variable (IV) strategy, leveraging exogenous variation from serious illness or injury to a family member. Event study results show that health shocks significantly increase informal caregiving, with particularly large effects for women and older individuals. These shocks also lead to reductions in employment among these groups, as well as declines in hours worked, worsening mental health, and increased reliance on government support and early retirement. To isolate the causal effect of caregiving, we instrument caregiving with the timing of the health shock. IV estimates indicate that assuming caregiving responsibilities leads to large reductions in labour supply—weekly work hours fall by 9.7 h for main carers and up to 22.5 h for carers of partners. Our findings highlight the substantial economic costs of informal caregiving, with important implications for labour force participation in an ageing society.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103028"},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604817","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 effects of state paid sick leave mandates on parental childcare time 国家带薪病假规定对父母育儿时间的影响
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-07-11 DOI: 10.1016/j.jhealeco.2025.103033
Johanna Catherine Maclean , Sabrina Wulff Pabilonia
{"title":"The effects of state paid sick leave mandates on parental childcare time","authors":"Johanna Catherine Maclean ,&nbsp;Sabrina Wulff Pabilonia","doi":"10.1016/j.jhealeco.2025.103033","DOIUrl":"10.1016/j.jhealeco.2025.103033","url":null,"abstract":"<div><div>The U.S. lacks a federal paid sick leave policy. To date, 18 states and the District of Columbia have adopted or announced paid sick leave mandates that require employers to provide up to seven days of paid leave per year that can be used for family responsibilities and healthcare. Using time diaries from the 2004–2023 American Time Use Survey and difference-in-differences methods, we estimate the effects of these state paid sick leave mandates on parents’ time spent providing childcare. We find that post-mandate, parental time spent providing primary childcare time increases by 5.8%, with effects being driven by women with younger children. Parents also increase their total time with children by 3.4%, and fathers living with school-aged children only increase their time supervising children while participating in leisure activities by 11.9%. Overall, our findings suggest that paid sick leave mandates allow working parents to better balance work and childcare responsibilities.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103033"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852749","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
Abortion access and child protective services involvement 堕胎和儿童保护服务的参与
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-07-11 DOI: 10.1016/j.jhealeco.2025.103032
Christine Piette Durrance , Yang Wang , Barbara Wolfe
{"title":"Abortion access and child protective services involvement","authors":"Christine Piette Durrance ,&nbsp;Yang Wang ,&nbsp;Barbara Wolfe","doi":"10.1016/j.jhealeco.2025.103032","DOIUrl":"10.1016/j.jhealeco.2025.103032","url":null,"abstract":"<div><div>Existing evidence has found that abortion restrictions result in fewer and delayed abortions. Such restrictions may indirectly affect child wellbeing both through changes in births and for existing children in the home through mechanisms including substantial financial strains, negative health consequences, and intra-household power dynamics. Following the <em>Dobbs</em> decision, state-level abortion decisions have led to significantly greater abortion restrictions. We investigate the effects of abortion access on child welfare involvement using data from the National Child Abuse &amp; Neglect Data System (NCANDS). We utilize pre- and post-<em>Dobbs</em> data from 2017-2023, and estimate both difference-in-differences and event study methods, using both distance changes and policy changes. We find that increased distance to nearest abortion care is associated with higher rates of CPS referrals. Our findings provide critical insights into the broader social and health implications of abortion restrictions in post-<em>Dobbs</em>.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103032"},"PeriodicalIF":3.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663442","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
Lost in the net? Broadband internet and youth mental health 在网里迷路了？宽带互联网与青少年心理健康
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-07-04 DOI: 10.1016/j.jhealeco.2025.103017
Dante Donati , Ruben Durante , Francesco Sobbrio , Dijana Zejcirovic
{"title":"Lost in the net? Broadband internet and youth mental health","authors":"Dante Donati ,&nbsp;Ruben Durante ,&nbsp;Francesco Sobbrio ,&nbsp;Dijana Zejcirovic","doi":"10.1016/j.jhealeco.2025.103017","DOIUrl":"10.1016/j.jhealeco.2025.103017","url":null,"abstract":"<div><div>How does the internet affect young people’s mental health? We study this question using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we combine with broadband internet availability at the municipal level. Broadband internet access raises the prevalence of mental disorders among younger cohorts (born between 1985 and 1995) by 0.08 standard deviation units, but it does not impact older individuals (1974 and 1984). The adverse effects are driven by individuals who were exposed early in their lives (before the age of 20). These effects persist when examining instances of self-harm and urgent or compulsory hospitalizations, indicating that the negative outcomes are not merely a result of increased awareness and detection of these conditions. The detrimental impacts span across different pathologies, including depression, anxiety, drug abuse, and personality disorders for both genders, in addition to eating disorders for females.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103017"},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611715","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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