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Impact of primary care market mergers on quality: Evidence from the English NHS 初级保健市场合并对质量的影响：来自英国NHS的证据。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-08-27 DOI: 10.1016/j.jhealeco.2025.103050
Yuan Lyu , Zhaocheng Zhang
{"title":"Impact of primary care market mergers on quality: Evidence from the English NHS","authors":"Yuan Lyu ,&nbsp;Zhaocheng Zhang","doi":"10.1016/j.jhealeco.2025.103050","DOIUrl":"10.1016/j.jhealeco.2025.103050","url":null,"abstract":"<div><div>The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing the first empirical evidence on the effects of provider mergers on quality, using evidence from the English primary care market. Examining all provider mergers from 2014 to 2018, we find that mergers improve certain aspects of clinical quality management, but they do not translate into broader population-level clinical quality gains, and patient satisfaction declines significantly. Importantly, the effects vary by merger motivation and the size of the merging parties, rather than their geographic proximity. Survival-driven mergers help sustain care quality and patient access, whereas efficiency-driven mergers lead to greater quality deterioration. Mergers between larger practices also lead to more negative outcomes than those involving smaller practices. In contrast, we find no significant difference between within-market and cross-market mergers. An exploration of the mechanism reveals that changes in market concentration do not explain the observed quality outcomes. Instead, shifts in workforce composition, driven by the underlying merger motivations, play a key role.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103050"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092768","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 peers’ genetic predisposition to depression on own mental health 同伴抑郁遗传易感性对自身心理健康的影响。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-09-07 DOI: 10.1016/j.jhealeco.2025.103053
Yeongmi Jeong
{"title":"The effect of peers’ genetic predisposition to depression on own mental health","authors":"Yeongmi Jeong","doi":"10.1016/j.jhealeco.2025.103053","DOIUrl":"10.1016/j.jhealeco.2025.103053","url":null,"abstract":"<div><div>This paper studies how peers’ genetic predisposition to depression affects own mental health during adolescence and early adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). I exploit variation within schools and across grades in same-gender grademates’ average polygenic score—a linear index of genetic variants—for major depressive disorder (the MDD score). An increase in peers’ genetic risk for depression has immediate negative impacts on own mental health. A one standard deviation increase in same-gender grademates’ average MDD score significantly increases the probability of being depressed by 1.9 and 3.8 percentage points for adolescent girls (a 7.2% increase) and boys (a 25% increase), respectively. The effects persist into adulthood for females, but not males. I explore several potential mechanisms underlying the effects and find that an increase in peers’ genetic risk for depression in adolescence worsens friendship, increases substance use, and leads to lower socioeconomic status. These effects are stronger for females than males. Overall, the results suggest that there are important social-genetic effects in the context of mental health.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103053"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082310","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
Partial rating area offering and tests for anticompetitive market segmentation in the ACA Marketplaces ACA市场中反竞争市场分割的部分评级区域提供和测试。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-11-06 DOI: 10.1016/j.jhealeco.2025.103080
Hanming Fang , Ami Ko
{"title":"Partial rating area offering and tests for anticompetitive market segmentation in the ACA Marketplaces","authors":"Hanming Fang ,&nbsp;Ami Ko","doi":"10.1016/j.jhealeco.2025.103080","DOIUrl":"10.1016/j.jhealeco.2025.103080","url":null,"abstract":"<div><div>To limit price variation across consumers in the Health Insurance Marketplaces, the Patient Protection and Affordable Care Act (ACA) mandates that insurance plans be uniformly priced across multiple counties within the same geographic rating area. However, the ACA does not require insurers to offer plans in every county, creating the potential for <em>partial rating area offering</em>. Using data from the federally-facilitated Marketplaces, we find that selective participation is both prevalent and persistent throughout the 2016–2022 period. We investigate whether this selective offering reflects anticompetitive market segmentation. In six of the seven years, the evidence is inconsistent with collusive motives. Only in 2018, a year characterized by a particularly low number of insurers with extensive multimarket contact, do we find evidence suggesting anticompetitive motives were among the drivers of selective participation within rating areas.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103080"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497382","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
Prioritisation, risk selection, and illness severity in a mixed healthcare system 混合医疗保健系统中的优先级、风险选择和疾病严重程度。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-09-29 DOI: 10.1016/j.jhealeco.2025.103072
Pau Olivella , Marcos Vera-Hernández
{"title":"Prioritisation, risk selection, and illness severity in a mixed healthcare system","authors":"Pau Olivella ,&nbsp;Marcos Vera-Hernández","doi":"10.1016/j.jhealeco.2025.103072","DOIUrl":"10.1016/j.jhealeco.2025.103072","url":null,"abstract":"<div><div>We study the link between illness severity and the use of public health care services by the privately insured under a mixed healthcare system. Our theoretical model shows that this relationship depends on (1) the prioritisation implemented by public healthcare providers, (2) the stringency of the gatekeeping system, (3) the skewness of the patients’ severity distribution, and (4) the private sector’s risk selection behaviour. Our empirical analysis reveals that the relationship between illness severity and public healthcare use is U-shaped. As our theoretical model points out, the increasing part of the U-shape is not necessarily a consequence of risk selection by private healthcare providers, but could instead reflect prioritisation within the public sector. According to our analysis, individuals in both extremes of the illness severity distribution will benefit from additional resources to shorten public sector waiting times.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103072"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304186","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 time cost of a disability 残疾的时间成本。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-10-27 DOI: 10.1016/j.jhealeco.2025.103079
Daniel S. Hamermesh , Michał Myck
{"title":"The time cost of a disability","authors":"Daniel S. Hamermesh ,&nbsp;Michał Myck","doi":"10.1016/j.jhealeco.2025.103079","DOIUrl":"10.1016/j.jhealeco.2025.103079","url":null,"abstract":"<div><div>We consider how a physical disability alters patterns of time use. A disability may raise the time cost of some activities, making them differentially less worth doing; or it may make switching activities more costly. Both possibilities predict that fewer activities will be undertaken, with more time spent on each. These explanations describe our correlational findings based on non-working ATUS 2008–22 respondents ages 70+, 32 % of whom self-assess a disability. Data from the 2013 Polish Time Use Survey, where disability is medically certified, show similar results and demonstrate the same loss of variety over multiple days. Remarkably similar basic results are found using homogenized British, Canadian, French, Italian, and Spanish time diaries. Evidence from a “sesqui-difference” test on the ATUS data hints that the relationship is causal. Overall, a mobility/physical disability leads an otherwise identical person to engage in over 10 % fewer activities on a typical day. The lost variety represents extra costs equivalent in data from six countries to over twice the average annual income of older individuals.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103079"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446419","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 intergenerational health effects of child marriage bans 禁止童婚对代际健康的影响
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jhealeco.2025.103075
Dung D. Le , Teresa Molina , Yoko Ibuka , Rei Goto
{"title":"The intergenerational health effects of child marriage bans","authors":"Dung D. Le ,&nbsp;Teresa Molina ,&nbsp;Yoko Ibuka ,&nbsp;Rei Goto","doi":"10.1016/j.jhealeco.2025.103075","DOIUrl":"10.1016/j.jhealeco.2025.103075","url":null,"abstract":"<div><div>Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers’ exposure to the ban across cohorts and in “treatment intensity,” calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103075"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416386","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
Minimum legal drinking age and educational outcomes 最低法定饮酒年龄和教育成果
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jhealeco.2025.103078
Manuel Bagues , Carmen Villa
{"title":"Minimum legal drinking age and educational outcomes","authors":"Manuel Bagues ,&nbsp;Carmen Villa","doi":"10.1016/j.jhealeco.2025.103078","DOIUrl":"10.1016/j.jhealeco.2025.103078","url":null,"abstract":"<div><div>Many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 over the past decades. These policies often comprise a bundle of reforms including restrictions on alcohol sales to minors, venue access limitations, and advertising controls. We provide novel evidence of the impact of MLDA changes on educational outcomes by exploiting their staggered timing across Spanish regions. Alcohol consumption among adolescents aged 14–17 decreased by 7 to 17% and exam performance improved by 4% of a standard deviation. We also observe a 10% decrease in the use of anxiolytics and hypnosedatives, suggesting improved mental health. There are no significant changes in the use of other substances, leisure habits or study effort. These findings are consistent with neurobiological evidence that alcohol directly impairs cognitive development and increases anxiety-related behaviours. Reducing teenage alcohol consumption represents a substantial opportunity to improve educational outcomes in Europe, where youth drinking rates remain notably high.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103078"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466382","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 West German television on smoking and health: A natural experiment from German reunification 西德电视对吸烟和健康的影响：德国统一后的自然实验。
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-10-20 DOI: 10.1016/j.jhealeco.2025.103077
Andrea Bernini , Sven A. Hartmann
{"title":"The effect of West German television on smoking and health: A natural experiment from German reunification","authors":"Andrea Bernini ,&nbsp;Sven A. Hartmann","doi":"10.1016/j.jhealeco.2025.103077","DOIUrl":"10.1016/j.jhealeco.2025.103077","url":null,"abstract":"<div><div>This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women — by 9.5 percentage points in smoking probability and 68% in cigarette consumption — while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103077"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460430","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
Financial incentives and COVID-19 vaccinations: Evidence from a conditional cash transfer program 财政激励与COVID-19疫苗接种：来自有条件现金转移支付计划的证据
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-09-19 DOI: 10.1016/j.jhealeco.2025.103063
Jakub Červený , Tomáš Hellebrandt , Peter Kravec
{"title":"Financial incentives and COVID-19 vaccinations: Evidence from a conditional cash transfer program","authors":"Jakub Červený ,&nbsp;Tomáš Hellebrandt ,&nbsp;Peter Kravec","doi":"10.1016/j.jhealeco.2025.103063","DOIUrl":"10.1016/j.jhealeco.2025.103063","url":null,"abstract":"<div><div>This paper investigates the effects of a nationwide conditional cash transfer program aimed at increasing COVID-19 vaccine uptake in Slovakia. Due to relatively low vaccination rates and the overcrowding of hospitals during the COVID-19 pandemic, the Slovak government decided to offer €200 or €300 cash transfers to individuals aged 60 or older, conditional on taking any of the available vaccines at the time. The eligibility requirements resulted in a discontinuity in treatment assignment at the age threshold. Our results suggest that the program significantly increased vaccination rates in the population. However, overall costs related to the intervention do not appear to outweigh the benefits.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103063"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158636","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
Polluted air, healthier diets: Household food consumption patterns in response to air quality in China 空气污染，饮食健康：中国家庭食物消费模式对空气质量的响应
IF 3.6 2区 经济学
Journal of Health Economics Pub Date : 2025-12-01 Epub Date: 2025-09-16 DOI: 10.1016/j.jhealeco.2025.103068
Wei Huang , Keyan Xiang , Xi Yu , Hong Zou
{"title":"Polluted air, healthier diets: Household food consumption patterns in response to air quality in China","authors":"Wei Huang ,&nbsp;Keyan Xiang ,&nbsp;Xi Yu ,&nbsp;Hong Zou","doi":"10.1016/j.jhealeco.2025.103068","DOIUrl":"10.1016/j.jhealeco.2025.103068","url":null,"abstract":"<div><div>This study examines how air pollution affects household food consumption using high-frequency data from over 30,000 households in 25 Chinese cities (2014–2019). Employing an instrumental variable approach based on wind direction, we find that a one-standard-deviation increase in PM2.5 raises weekly expenditure on healthy foods, such as fruits, vegetables, and dairy, by 9.3 yuan, or 11 % of the within-household standard deviation. Spending on less healthy foods remains unaffected, suggesting targeted adjustments toward nutrient-dense foods. These changes improve nutrient intake but are immediate and transitory, with no evidence of lasting dietary shifts. The effects are stronger for higher-income households and those with elderly members, reflecting health concerns and financial flexibility, while lower-income households show constrained responses. Air pollution also reduces dining out expenditures, indicating a substitution toward home-prepared meals. These findings highlight air pollution’s welfare costs, socioeconomic disparities, and the need for equitable public health policies.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103068"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158635","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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