{"title":"Nursing shortages and patient outcomes","authors":"Elaine Kelly , Carol Propper , Ben Zaranko","doi":"10.1016/j.jhealeco.2025.103082","DOIUrl":"10.1016/j.jhealeco.2025.103082","url":null,"abstract":"<div><div>This paper examines the effect of nurse shortages on healthcare production. Employing novel high-frequency data, we examine what effect the absence of nursing staff has on inpatient mortality and other outcomes associated with nursing care. We find significant adverse mortality impacts of shortages of nurses with degree-level qualifications: for the average ward, the absence of a nurse with university degree-equivalent level training increases the odds of a patient death by approximately 10%, while there is no effect of shortages of less qualified nursing assistants. For qualified nurses, there are returns to firm (hospital) specific human capital: increasing the average firm-specific experience among degree qualified nurses by one year is associated with an 8% reduction in the odds of a patient death, the equivalent to adding three-quarters of an extra qualified nurse to the ward. Adverse mortality impacts of shortages are particularly concentrated among patients of relatively low, rather than high, clinical severity. The largest impacts are for those diagnosed with sepsis, a condition where early detection is important for survival and where nurses have a central role in detection and subsequent control.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"105 ","pages":"Article 103082"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665689","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}
Daniel Avdic , Johannes S. Kunz , Susan J. Méndez , Maria Wiśniewska
{"title":"Does telemedicine technology affect prescribing quality in primary care? The case of antibiotics","authors":"Daniel Avdic , Johannes S. Kunz , Susan J. Méndez , Maria Wiśniewska","doi":"10.1016/j.jhealeco.2025.103096","DOIUrl":"10.1016/j.jhealeco.2025.103096","url":null,"abstract":"<div><div>We study the impact of telemedicine technology on antibiotic prescription rates using linked administrative data from Australia on physicians and their patients. We classify physicians by their relative use of virtual consultations after the introduction of government-subsidised telemedicine services and compare their antibiotic prescribing rates before and after telemedicine services became available. We find that more intense telemedicine adopters prescribe less antibiotics while keeping prescribing quality unchanged. Our results are not explained by patient sorting, doctor shopping, or changes in the intensity of consultations.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"105 ","pages":"Article 103096"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783731","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":"Individualized disability support schemes and their impact on autism diagnoses","authors":"Maathumai Ranjan, Robert Breunig","doi":"10.1016/j.jhealeco.2025.103100","DOIUrl":"10.1016/j.jhealeco.2025.103100","url":null,"abstract":"<div><div>This paper examines the impact of individualized funding for disability supports on autism diagnoses. We identify these effects using the staggered roll out of the National Disability Insurance Scheme (NDIS), which provides individualized funding for non-medical disability interventions. We find compelling evidence that the introduction of the NDIS has led to a 32 % increase in reported autism prevalence and accounts for 47 % of new diagnoses since the introduction of the scheme. We find a significant reduction in diagnoses from government subsided healthcare professionals, accompanied by an increase in diagnoses from disability service providers. A lower threshold for autism recognition appears more consistent with our results than catch-up in historically underdiagnosed groups.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"105 ","pages":"Article 103100"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835146","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}
Nicole Black, Anthony Harris, David W. Johnston, Trong-Anh Trinh
{"title":"Workforce impacts of subsidised mental healthcare: Evidence on supply, geographic distribution, and earnings","authors":"Nicole Black, Anthony Harris, David W. Johnston, Trong-Anh Trinh","doi":"10.1016/j.jhealeco.2025.103102","DOIUrl":"10.1016/j.jhealeco.2025.103102","url":null,"abstract":"<div><div>To improve access to affordable mental healthcare, Australia introduced a national, publicly-funded program in 2006 to subsidise psychological services, which were previously privately funded. Theory suggests that by increasing demand, subsidies should incentivise providers to expand supply, either by entering the workforce or by increasing hours. However, expansion depends on supply constraints, particularly in non-metropolitan areas with pronounced workforce shortages. This study examines the program’s effects on the size, work hours, demographic composition, location, and earnings of psychologists. Using an event-study design with administrative tax records and census data, we find that the program: (1) increased the supply of psychologists, with minimal effect on average hours worked per psychologist; (2) increased the likelihood of psychologists working in non-metropolitan areas, supporting broader access to mental healthcare; and (3) raised psychologists’ annual personal incomes.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"105 ","pages":"Article 103102"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840948","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":"When do supply-side drug control policies save lives? Evidence from pharmacy methadone restrictions","authors":"J. Travis Donahoe , Coleman Drake","doi":"10.1016/j.jhealeco.2025.103067","DOIUrl":"10.1016/j.jhealeco.2025.103067","url":null,"abstract":"<div><div>The literature commonly finds that supply-side drug control policies are an ineffective response to drug epidemics because they cause substitution to more dangerous illicit drugs. We document a policy that was implemented in response to the intertwined methadone and prescription opioid epidemics in the U.S. in the early 2000s and that sharply contradicts this. In 2008, the U.S. Drug Enforcement Administration and drug manufacturers halted shipments of highly potent methadone formulations to all pharmacies nationwide due to concerns over their involvement in rising overdose death rates. However, rather than causing substitution to illicit drugs, we show this response caused substitution to safer methadone products and prevented roughly 1,600 overdose deaths over a two-year period. Findings underscore that supply-side drug control policies can be effective responses to drug epidemics in contexts where they are appropriately targeted to push consumers towards safer rather than more harmful substances.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103067"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158637","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}
Dhaval Dave , Christine Piette Durrance , Bilge Erten , Yang Wang , Barbara Wolfe
{"title":"Abortion restrictions and intimate partner violence in the Dobbs Era","authors":"Dhaval Dave , Christine Piette Durrance , Bilge Erten , Yang Wang , Barbara Wolfe","doi":"10.1016/j.jhealeco.2025.103074","DOIUrl":"10.1016/j.jhealeco.2025.103074","url":null,"abstract":"<div><div>In overturning <em>Roe v. Wade</em> and triggering laws in many states that ban or severely restrict abortion, the Supreme Court’s landmark 2022 <em>Dobbs</em> decision dramatically altered the landscape of reproductive health in the U.S. Prior research has highlighted the far-reaching impact of abortion restrictions for women and families, which extend beyond their proximate effects on abortions, births, and fertility. We provide some of the first causal evidence on how abortion restrictions in the post-<em>Dobbs</em> era have impacted women’s risk of exposure to intimate partner violence (IPV). IPV is the most common form of violence experienced by women, and changes in access to abortion may generate unintended effects on various inputs (economic resources, stress, intra-household bargaining) that could affect relationship dynamics and raise the risk of IPV. Leveraging information on IPV incidents reported to law enforcement from 2017–2023 combined with post-<em>Dobbs</em> changes in county-level travel distance to abortion facilities, analyses are based on a generalized difference-in-differences approach. We find that abortion restrictions – alternately measured by the increase in travel distance and by the pres- ence of a near-total ban – significantly increased the rate of IPV for reproductive-age women in treated counties by about seven to 10 percent. These estimates imply at least 9000 additional incidents of IPV among women in the treated “trigger ban” states, which is predicted to add over $1.24 billion in social costs.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103074"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460465","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":"Seasonal allergies and mental health: Do small health shocks affect suicidality?","authors":"Joelle Abramowitz , Shooshan Danagoulian , Owen Fleming","doi":"10.1016/j.jhealeco.2025.103069","DOIUrl":"10.1016/j.jhealeco.2025.103069","url":null,"abstract":"<div><div>Suicide rates increased 37% in the US from 2000 to 2018; while structural factors are extensively studied, short-term triggers remain less understood. We examine the impact of small exogenous shocks – allergies triggered by seasonal pollen – on suicides. Pollen allergies diminish cognitive function and disrupt sleep—predictors of suicidality. Combining disparate datasets across 34 localities in the United States from 2006 to 2018, we use a specification with granular fixed effects to identify the effect of pollen on suicides from daily variation in each. We find that as pollen levels rise, the count of suicides in a county increases – up to 7.4% more suicides when pollen levels at their highest levels. We find that individuals with a known mental health condition or treatment have 8.6% higher incidence of suicides on days with highest pollen. We also show that this effect is not spurious – Google searches for allergy and depression symptoms increase substantively as pollen levels rise. These estimates are robust to multiple specifications. As climate change extends and intensifies the pollen season, we expect its impact to more than double the number of suicides by the end of the century. These results point toward the importance of relatively small exogenous shocks on suicidality and the potential for relatively inexpensive and routine health care measures such as allergy testing and treatment to improve mental health.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103069"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109323","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}
Dhaval Dave , Bilge Erten , Pinar Keskin , Shuo Zhang
{"title":"From addiction to aggression: The spillover effects of opioid policies on intimate partner violence","authors":"Dhaval Dave , Bilge Erten , Pinar Keskin , Shuo Zhang","doi":"10.1016/j.jhealeco.2025.103073","DOIUrl":"10.1016/j.jhealeco.2025.103073","url":null,"abstract":"<div><div>Substance abuse is a major risk factor for intimate partner violence (IPV). We investigate how a key supply-side intervention – the abuse-deterrent reformulation of a widely-diverted opioid, OxyContin – affected IPV. Our results indicate counties with greater baseline rates of prescription opioid usage experienced relatively larger declines in IPV after OxyContin’s reformulation. The reformulation reduced IPV only in states with smaller illicit drug markets, while states with larger illicit drug markets experienced increased heroin-involved IPV due to substitution towards illicit opioids. Our results underscore the importance of identifying populations at high risk of substitution to illicit opioids and moderating this risk with evidence-based policies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103073"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410279","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":"Supply-side opioid restrictions and the retail pharmacy market","authors":"Anne M. Burton , Brandyn F. Churchill","doi":"10.1016/j.jhealeco.2025.103071","DOIUrl":"10.1016/j.jhealeco.2025.103071","url":null,"abstract":"<div><div>While policymakers routinely limit the sale of goods thought to be of risk to public health, relatively less is known about whether and how these policies affect firm performance. Using 2000–2018 National Establishment Time-Series data and a difference-in-differences strategy, we show that state “pill mill” laws intended to reduce the overprescribing of opioids reduced retail pharmacy sales and employment. These reductions were most pronounced in highly competitive areas and for standalone pharmacies – two characteristics associated with pharmacy drug diversion. Meanwhile, pharmacies located across the border in states without a pill mill law experienced increases in sales and employment. Next, we show that state pill mill laws were associated with an increase in standalone pharmacy closures, though the total number of pharmacies was unchanged. Our results are consistent with these laws adversely affecting pharmacies filling inappropriate opioid prescriptions without meaningfully altering patient access to retail pharmacies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103071"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304201","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":"Optimal mental health belief formation with information avoidance: A decision-theoretic model","authors":"Daehyun Kim","doi":"10.1016/j.jhealeco.2025.103084","DOIUrl":"10.1016/j.jhealeco.2025.103084","url":null,"abstract":"<div><div>Mental health stigma hinders access to healthcare by distorting belief formation and decision-making. Stigmatized individuals often underestimate their risk of mental illness and avoid diagnostic information. This study develops a decision-theoretic model that formalizes how stigma reinforces identity-congruent actions, driving belief distortion and information avoidance. By integrating insights from information preference theory and identity utility, the model explains why individuals with strong stigma-driven identity concerns are prone to optimistic bias and resist diagnostic tests to protect their self-concept. The study contributes to the literature in three key ways. First, it conceptually extends economic theory by endogenizing belief distortion, identity-congruent action, and information avoidance within a unified decision-making structure. By introducing stigma as a formally modeled individual-specific parameter — previously underexplored in economics — the framework improves our ability to capture heterogeneity in health-related decision-making and strengthens the theoretical bridge between economic modeling and clinical mental health research. Second, it provides a theoretical framework linking clinical phenomena such as denial, delayed treatment-seeking, and treatment discontinuation within a formal decision-theoretic model. Third, it offers a structured foundation for experimental and empirical research by demonstrating how stigma, a quantifiable construct, systematically influences decision-making through identity-driven actions and belief distortion.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103084"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617885","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}