{"title":"The effects of tobacco 21 laws on smoking and vaping: Evidence from panel data and biomarkers","authors":"Chad Cotti , Philip DeCicca , Erik Nesson","doi":"10.1016/j.jhealeco.2024.102932","DOIUrl":"10.1016/j.jhealeco.2024.102932","url":null,"abstract":"<div><div>We use data from the Population Assessment of Tobacco Use and Health (PATH), a longitudinal data set including self-reported and biomarker measures of tobacco use, to examine the effects of state-level tobacco 21 (T21) laws on smoking and vaping. T21 laws reduce self-reported cigarette smoking among 18-to-20 year olds, concentrated in males. Initial non-users who “age-out” of treatment are less likely to subsequently initiate self-reported smoking or vaping. Treated smokers are less likely to buy their own cigarettes and more likely to buy cigarettes in a different state. Biomarker results are mixed, and we find some evidence of a reduction in nicotine exposure but less evidence for a reduction in exposure to tobacco. Finally, we test for non-classical measurement error. T21 laws reduce the probability that clinically identified likely cigarette smokers self-report as smokers, which may increase the apparent effect of T21 laws on cigarette smoking as measured by self-reports.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102932"},"PeriodicalIF":3.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432277","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}
{"title":"The impact of children's access to public health insurance on their cognitive development and behavior","authors":"Marie Hull , Ji Yan","doi":"10.1016/j.jhealeco.2024.102935","DOIUrl":"10.1016/j.jhealeco.2024.102935","url":null,"abstract":"<div><div>While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrumental variable strategy to estimate the effect of cumulative eligibility gain on cognitive and behavioral outcomes measured at three points during childhood. Our analysis leverages substantial variation in cumulative eligibility due to the dramatic public insurance expansions between the 1980s and 2000s. We find that increased eligibility improves child cognitive skills and present suggestive evidence on better behavioral outcomes. There are notable heterogeneous effects across the subgroups of interest. Both prenatal eligibility and childhood eligibility are important for driving gains in the test scores at older ages. Improved child health is found to be a mediator of the impact of increased eligibility.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"98 ","pages":"Article 102935"},"PeriodicalIF":3.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479501","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}
{"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}
{"title":"The devastating dance between opioid and housing crises: Evidence from OxyContin reformulation","authors":"Ashley C. Bradford , Wei Fu , 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}
{"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}
{"title":"Paying for advance care planning in medicare: Impacts on care and spending near end of life","authors":"Alice J. Chen , 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}
{"title":"Hospital competition when patients learn through experience","authors":"Luís Sá , 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}
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 , Yang Liang , Johanna Catherine Maclean , Caterina Muratori , 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}
{"title":"Health insurance, agricultural production and investments","authors":"Kai Liu , Benjapon Prommawin , 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}
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 , David Powell , Rosalie Liccardo Pacula , Evan Peet , Rahi Abouk , 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}