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Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada 社会经济地位与获得心理保健的机会：加拿大安大略省儿童精神科用药案例
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-12-12 DOI: 10.1016/j.jhealeco.2023.102841
Janet Currie , Paul Kurdyak , Jonathan Zhang
{"title":"Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada","authors":"Janet Currie ,&nbsp;Paul Kurdyak ,&nbsp;Jonathan Zhang","doi":"10.1016/j.jhealeco.2023.102841","DOIUrl":"10.1016/j.jhealeco.2023.102841","url":null,"abstract":"<div><p>We examine differences in the prescribing of psychiatric medications to lower-income and higher-income children in the Canadian province of Ontario using rich administrative data that includes diagnosis codes and physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that ideally should be prescribed to children only under narrowly proscribed circumstances. Lower-income children are also less likely to be prescribed SSRIs, the first-line treatment for depression and anxiety conditional on diagnosis. Hence, socioeconomic differences in the prescribing of psychotropic medications to children persist even in the context of universal public health insurance and universal drug coverage.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102841"},"PeriodicalIF":3.5,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629623001182/pdfft?md5=4aa0c83a30fbb49d2efae89508c3aacc&pid=1-s2.0-S0167629623001182-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138579005","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 risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting? 在低收入、高风险的环境中，风险、时间和亲社会偏好能否预测青少年的危险性行为？
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-12-11 DOI: 10.1016/j.jhealeco.2023.102845
Ranjeeta Thomas , Matteo M. Galizzi , Louisa Moorhouse , Constance Nyamukapa , Timothy B. Hallett
{"title":"Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting?","authors":"Ranjeeta Thomas ,&nbsp;Matteo M. Galizzi ,&nbsp;Louisa Moorhouse ,&nbsp;Constance Nyamukapa ,&nbsp;Timothy B. Hallett","doi":"10.1016/j.jhealeco.2023.102845","DOIUrl":"10.1016/j.jhealeco.2023.102845","url":null,"abstract":"<div><p>Young people in sub-Saharan Africa are particularly at high risk of sexually transmitted infections. Little is known about their preferences and even less about their association with risky sexual behaviour. We conducted incentivized economic experiments to measure risk, time and prosocial preferences in Zimbabwe. Preferences measured at baseline predict biomarker and self-reported measures of risky sexual behaviour gathered 12 months later. We find robust evidence that individuals more altruistic at baseline are more likely to be Herpes Simplex Virus Type-2 (HSV-2) positive 12 months later. Analysis by sex shows this association is driven by our sample of women. Having more sexual partners is associated with greater risk tolerance amongst men and greater impatience amongst women. Results highlight heterogeneity in the association between preferences and risky sexual behaviour.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102845"},"PeriodicalIF":3.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629623001224/pdfft?md5=7523a2c01579bbf0a1d52f01b09a6832&pid=1-s2.0-S0167629623001224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568670","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
Valuing life over the life cycle 重视生命甚于生命周期。
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-12-01 DOI: 10.1016/j.jhealeco.2023.102842
Pascal St-Amour
{"title":"Valuing life over the life cycle","authors":"Pascal St-Amour","doi":"10.1016/j.jhealeco.2023.102842","DOIUrl":"10.1016/j.jhealeco.2023.102842","url":null,"abstract":"<div><p>Adjusting the valuation of life along the (i) person-specific (age, health, wealth) and (ii) mortality risk-specific (beneficial or detrimental, temporary or permanent changes) dimensions is relevant in prioritizing healthcare interventions. These adjustments are provided by solving a life cycle model of consumption, leisure and health choices and the associated Hicksian variations for mortality changes. The calibrated model yields plausible Values of Life Year between 154K$ and 200K$ and Values of Statistical Life close to 6.0M$. The willingness to pay (WTP) and to accept (WTA) compensation are equal and symmetric for one-shot beneficial and detrimental changes in mortality risk. However, permanent, and expected longevity changes are both associated with larger willingness for gains, relative to losses, and larger WTA than WTP. Ageing lowers both variations via falling resources and health, lower marginal continuation utility of living and decreasing longevity returns of changes in mortality.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102842"},"PeriodicalIF":3.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629623001194/pdfft?md5=76346da878dca6b702901f2f7a5ca2df&pid=1-s2.0-S0167629623001194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500040","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 labour market returns to sleep 劳动力市场重新进入睡眠状态。
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-11-20 DOI: 10.1016/j.jhealeco.2023.102840
Joan Costa-Font , Sarah Fleche , Ricardo Pagan
{"title":"The labour market returns to sleep","authors":"Joan Costa-Font ,&nbsp;Sarah Fleche ,&nbsp;Ricardo Pagan","doi":"10.1016/j.jhealeco.2023.102840","DOIUrl":"10.1016/j.jhealeco.2023.102840","url":null,"abstract":"<div><p>Despite the growing prevalence of insufficient sleep among individuals, we still know little about the labour market return to sleep. To address this gap, we use longitudinal data from Germany and leverage exogenous fluctuations in sleep duration caused by variations in time and local sunset times. Our findings reveal that a one-hour increase in weekly sleep is associated with a 1.6 percentage point rise in employment and a 3.4% increase in weekly earnings. Such effect on earnings stems from productivity improvements given that the number of working hours decreases with longer sleep duration. We also identify a key mechanism driving these effects, namely the enhanced mental well-being experienced by individuals who sleep longer hours.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102840"},"PeriodicalIF":3.5,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167629623001170/pdfft?md5=acfcaa5d9495a1c7147301d06b441654&pid=1-s2.0-S0167629623001170-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300498","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
Reminder design and childhood vaccination coverage 提醒设计和儿童疫苗接种覆盖率
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-11-14 DOI: 10.1016/j.jhealeco.2023.102832
Jonas Cuzulan Hirani , Miriam Wüst
{"title":"Reminder design and childhood vaccination coverage","authors":"Jonas Cuzulan Hirani ,&nbsp;Miriam Wüst","doi":"10.1016/j.jhealeco.2023.102832","DOIUrl":"10.1016/j.jhealeco.2023.102832","url":null,"abstract":"<div><p><span>A major policy concern across public vaccination programs is non-compliance. Exploiting Danish population data and three national reforms in regression discontinuity designs, we document the effects of reminders for childhood </span>vaccination coverage<span><span>. Retrospective reminders are primarily effective for families with small children and when sent out close to the recommended vaccination age. Digital and postal reminders are equally effective. Prospective reminders increase timely vaccinations in later childhood and help reaching high coverage for new vaccines in increasingly complex vaccination programs. While reminders prompt additional preventive care for focal children, we find no </span>spillovers to other health behaviors or relatives.</span></p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102832"},"PeriodicalIF":3.5,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135763736","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 primary healthcare on mortality: Evidence from Costa Rica 初级保健对死亡率的影响:来自哥斯达黎加的证据
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-11-08 DOI: 10.1016/j.jhealeco.2023.102833
Claudio A. Mora-García , Madeline Pesec , Andrea M. Prado
{"title":"The effect of primary healthcare on mortality: Evidence from Costa Rica","authors":"Claudio A. Mora-García ,&nbsp;Madeline Pesec ,&nbsp;Andrea M. Prado","doi":"10.1016/j.jhealeco.2023.102833","DOIUrl":"10.1016/j.jhealeco.2023.102833","url":null,"abstract":"<div><p><span>This paper uses the gradual implementation of a primary healthcare (PHC) intervention in Costa Rica to examine the long-term effect of PHC on mortality. Nine years after opening a primary care center, known as a Health Area, there was an associated 13% reduction in age-adjusted mortality rate in the assigned patient population. The effect was highest among adults over 65 years of age and for those with </span>noncommunicable diseases, such as cardiovascular-related causes of death. We also show that as Health Areas opened, more individuals sought care at primary care clinics, while fewer sought care at emergency rooms; these changes may have partially mediated the effect of the intervention on mortality.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102833"},"PeriodicalIF":3.5,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135516533","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 demand response to utilization management 药品需求响应到使用管理
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-11-07 DOI: 10.1016/j.jhealeco.2023.102830
Oren Sarig
{"title":"Pharmaceutical demand response to utilization management","authors":"Oren Sarig","doi":"10.1016/j.jhealeco.2023.102830","DOIUrl":"10.1016/j.jhealeco.2023.102830","url":null,"abstract":"<div><p>Prescription drug insurance increasingly imposes prior authorization (requiring providers to request coverage before claim approval) to manage utilization. Prior authorization has been criticized because of its administrative burden on providers. The primary alternative to managing utilization is imposing out-of-pocket (OOP) payment to incentivize beneficiaries to seek lower-cost care, effectively providing beneficiaries with partial insurance. Would beneficiaries prefer indirectly paying for prior authorization through higher premiums; or would they prefer prior authorization was replaced by higher OOP costs? This tradeoff depends on how much OOP costs could be displaced by prior authorization, which depends on their relative impact on demand. I estimate the effect of prior authorization and OOP costs on pharmaceutical demand in Medicare Part D, addressing endogeneity caused by unobserved drug quality and selection into plans. Despite criticism of prior authorization, I find that Medicare beneficiaries would prefer higher premiums to pay for prior authorization, over higher OOP costs.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"93 ","pages":"Article 102830"},"PeriodicalIF":3.5,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509934","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
How do hospitals respond to input regulation? Evidence from the California nurse staffing mandate 医院如何应对输入监管？来自加利福尼亚州护士配置授权的证据。
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-11-06 DOI: 10.1016/j.jhealeco.2023.102826
Chandni Raja
{"title":"How do hospitals respond to input regulation? Evidence from the California nurse staffing mandate","authors":"Chandni Raja","doi":"10.1016/j.jhealeco.2023.102826","DOIUrl":"10.1016/j.jhealeco.2023.102826","url":null,"abstract":"<div><p>Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 min increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients “quicker and sicker”, rather, AMI patients recovered more quickly due to an improvement in care quality per day.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"92 ","pages":"Article 102826"},"PeriodicalIF":3.5,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523164","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
Do minimum wage laws affect employer-sponsored insurance provision? 最低工资法是否影响雇主赞助的保险条款？
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-10-27 DOI: 10.1016/j.jhealeco.2023.102825
Mark K. Meiselbach , Jean M. Abraham
{"title":"Do minimum wage laws affect employer-sponsored insurance provision?","authors":"Mark K. Meiselbach ,&nbsp;Jean M. Abraham","doi":"10.1016/j.jhealeco.2023.102825","DOIUrl":"10.1016/j.jhealeco.2023.102825","url":null,"abstract":"<div><p>Employers may respond to minimum wage increases by adjusting their health benefits. We examine the impact of state minimum wage increases on employer health benefit offerings using the 2002–2020 Medical Expenditure Panel Survey – Insurance/Employer Component data. Our primary regression specifications are difference-in-differences models that estimate the relationship between within-state changes in employer-sponsored insurance and minimum wage laws over time. We find that a $1 increase in minimum wages is associated with a 0.92 percentage point (p.p.) decrease in the percentage of employers offering health insurance, largely driven by small employers and employers with a greater share of low-wage employees. A $1 increase is also associated with a 1.83 p.p. increase in the prevalence of plans with a deductible requirement, but we do not find consistent evidence that other benefit characteristics are affected. We find no consequent change in uninsurance, likely explained by an increase in Medicaid enrollment.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"92 ","pages":"Article 102825"},"PeriodicalIF":3.5,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66784537","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
Physician responses to Medicare reimbursement rates 医生对医疗保险报销率的反应
IF 3.5 2区 经济学
Journal of Health Economics Pub Date : 2023-10-24 DOI: 10.1016/j.jhealeco.2023.102816
Aileen M. Devlin , Grace McCormack
{"title":"Physician responses to Medicare reimbursement rates","authors":"Aileen M. Devlin ,&nbsp;Grace McCormack","doi":"10.1016/j.jhealeco.2023.102816","DOIUrl":"https://doi.org/10.1016/j.jhealeco.2023.102816","url":null,"abstract":"<div><p>This paper investigates how office-based physicians respond to Medicare reimbursement changes. Using variation from an Affordable Care Act policy that increased reimbursements for office-based care in four states, we use a triple difference analysis, comparing physicians with higher and lower reimbursement changes in treated states to similar physicians in untreated states. We find two mechanisms through which physicians respond. First, the reimbursement change affected integration—physicians with larger increases in office-based reimbursement were less likely to vertically integrate with hospitals and more likely to continue providing office-based care than physicians with smaller reimbursement increases. Second, we find some evidence that physicians who continued practicing in an office setting increased the volume of services provided.</p></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"92 ","pages":"Article 102816"},"PeriodicalIF":3.5,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49818513","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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