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This paper assesses analytical strategies that respect the bounded-count nature of health outcomes encountered often in empirical applications. Absent in the literature is a comprehensive discussion and critique of strategies for analyzing and understanding such data. The paper's goal is to provide an in-depth consideration of prominent issues arising in and strategies for undertaking such analyses, emphasizing the merits and limitations of various analytical tools empirical researchers may contemplate. Three main topics are covered. First, bounded-count health outcomes' measurement properties are reviewed and their implications assessed. Second, issues arising when bounded-count outcomes are the objects of concern in evaluations are described. Third, the (conditional) probability and moment structures of bounded-count outcomes are derived and corresponding specification and estimation strategies presented with particular attention to partial effects. Many questions may be asked of such data in health research and a researcher's choice of analytical method is often consequential. [ABSTRACT FROM AUTHOR]

This paper examines the influence of housing wealth on fertility outcomes through a regression discontinuity design based on a 2006 Chinese housing-market policy. Our analysis reveals that the positive impact of this policy on housing wealth significantly enhances the likelihood of fertility by 7.3 %. Our result implies that a 1 % increase in housing wealth can raise the fertility rate by 0.18 %. Furthermore, we observe that children born subsequent to the positive housing wealth shock exhibit improved health, not only at birth but also over the long term. Lastly, we present suggestive evidence suggesting that both parental pre-birth time allocation and parental health may help explain the documented positive effects of housing wealth on fertility rates. [ABSTRACT FROM AUTHOR]

Behavioral adjustments to mitigate increasing risk of STIs can increase or decrease the likelihood of pregnancy. This paper measures the effects of the arrival and spread of AIDS across U.S. cities in the 1980s and 1990s on births and abortions. I show that the AIDS epidemic increased the birth rate by 0.55 percent and the abortion rate by 1.77 percent. I find support for two underlying mechanisms to explain the increase in pregnancies. Some women opted into monogamous partnerships in response to the AIDS epidemic, with a corresponding increase in the marriage rate and improvement in infant health. Others switched from prescription contraceptive methods to condoms. These behavioral changes lowered the incidence of other sexually transmitted infections, but increased both planned and unplanned pregnancies. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of gifts – monetary and in-kind payments – from drug firms to US physicians on prescription behavior and drug costs. Using causal models and machine learning, we estimate physicians' heterogeneous responses to payments on antidiabetic prescriptions. We find that payments lead to increased prescription of brand drugs, resulting in a cost rise of $23 per dollar value of transfer received. Paid physicians show higher responses when they treat higher proportions of patients receiving a government-funded low-income subsidy that lowers out-of-pocket drug costs. We estimate that introducing a national gift ban would reduce diabetes drug costs by 2%. [ABSTRACT FROM AUTHOR]

Seasonal infectious diseases can cause demand and supply pressures that reduce the ability of healthcare systems to provide high-quality care. This may generate negative spillover effects on the health outcomes of patients seeking medical help for unrelated reasons. Separating these indirect burdens from the direct consequences for infected patients is usually impossible due to a lack of suitable data and an absence of population testing. However, this paper finds robust empirical evidence of excess mortality among non-COVID-19 patients in an integrated public healthcare system: the English National Health Service (NHS). Analysing the forecast error in the NHS' model for predicted mortality, we find at least one additional excess death among patients who sought medical help for reasons unrelated to COVID-19 for every 42 COVID-19-related deaths in the population. We identify COVID-19 pressures as a key driver of non-COVID-19 excess mortality in NHS hospitals during the pandemic, and characterize the hospital populations and medical conditions that were disproportionately affected. Our findings have substantive relevance in shaping our understanding of the wider burden of COVID-19, and other seasonal diseases more generally, and can contribute to debates on optimal public health policy. [ABSTRACT FROM AUTHOR]

This paper analyzes the interplay between congressional politics, the actions of the executive branch, and hospitals' regulated Medicare payments. We focus on the 2003 Medicare Modernization Act (MMA) and analyze a provision in the law – Section 508 – that raised certain hospitals' regulated payments. We show, via our analysis of the Section 508 program, that Medicare payments are malleable and can be influenced by political dynamics. In the cross-section, hospitals represented by members of Congress who voted "yea" on the MMA were more likely to receive Section 508 payment increases. We interviewed the Secretary of Health and Human Services who oversaw the MMA, and he described how these payment increases were designed to win support for the law. The Section 508 payment increases raised hospitals' activity and spending. Members of Congress representing recipient hospitals received increased campaign contributions after the Section 508 payment increases were extended. Ultimately, our analysis highlights how Medicare payment increases can serve as an appealing tool for legislative leaders working to win votes for wider pieces of legislation. [ABSTRACT FROM AUTHOR]

Price transparency initiatives have recently emerged as a solution to the lack of health care price information available to consumers. This paper uses the staggered and nationwide diffusion of a leading internet-based price transparency platform to estimate the effects of price transparency on provider prices. I find a 1-4% reduction in provider prices for homogenous services, laboratory tests, but find no price response for differentiated services, office visits. Price responses are driven by active consumer use of price information. This paper demonstrates how reducing consumer search costs can spur limited firm price competition in health care markets. [ABSTRACT FROM AUTHOR]

This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community. [ABSTRACT FROM AUTHOR]

The paper estimates the causal effect of a health treatment on patients' beliefs, preferences and memories about the treatment. It exploits a natural experiment which occurred in the United Kingdom during the COVID-19 vaccination campaign. UK residents could choose to opt into the vaccination program, but not which vaccine they received. The assignment to a vaccine offered little objective information for learning about its qualities, but triggered strong psychological demand for reassuring beliefs. We surveyed a sample of UK residents about their beliefs on the different COVID-19 vaccines before and after receiving their jab. Before vaccination, individuals exhibit similar prior beliefs and stated preferences about the different vaccines. After vaccination, however, they update their beliefs overly optimistically about the safety and effectiveness of the vaccine they received, state that they would have chosen it if they could, and have distorted memories about their past beliefs. These results cannot be explained by conventional experience effects. At the aggregated level, they show that random assignment to a health treatment predicts a polarization of opinions about its quality. At the individual level, these findings provide evidence in line with the predictions of motivated beliefs and over-inference from weak signals in a real-world health setting. • We interviewed UK residents before and after they received a COVID-19 vaccine. • Individuals could not choose the type of vaccine (Pfizer or Moderna) that they received. • Right after the vaccination, they view their own vaccine as better than they used to think. • They wrongly remember that they thought well of it all along, and would have chosen it if they could. • These results cannot be explained by conventional experience effects but are consistent with motivated reasoning. [ABSTRACT FROM AUTHOR]

While many results from the treatment-effect and related literatures are familiar and have been applied productively in health economics evaluations, other potentially useful results from those literatures have had little influence on health economics practice. With the intent of demonstrating the value and use of some of these results in health economics applications, this paper focuses on one particular class of parameters that describe probabilities that one outcome is larger or smaller than other outcomes ("inequality probabilities"). While the properties of such parameters have been exposited in the technical literature, they have scarcely been considered in informing practical questions in health evaluations. This paper shows how such probabilities can be used informatively, and describes how they might be identified or bounded informatively given standard sampling assumptions and information only on marginal distributions of outcomes. The logic of these results and the empirical implementation thereof-sampling, estimation, and inference-are straightforward. Derivations are provided and several health-related applications are presented. [ABSTRACT FROM AUTHOR]

This paper considers the micro-econometric analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). GPs have a dual role with regard to elective referrals in the English NHS, advising patients and at the same time taking account of the financial implications of referral decisions on local health budgets. The paper proposes a two-stage choice model that encompasses both patient and GP level optimization. It demonstrates that estimators that do not take account of strategic pre-selection of choice sets may be biased and inconsistent. We find that GPs as patients' agents select choice options based on quality, but as agents of health authorities also consider financial implications of referrals. When considering these choice options, patients focus on tangible hospital attributes, like amenities. [ABSTRACT FROM AUTHOR]

In volume 36 of this journal, using data from the National Longitudinal Study of Youth, 1997 Cohort (NLSY97), Yörük (2014) finds that the false ID laws with scanner provision (FSP laws) significantly reduce underage drinking. In a recent paper, Zheng (2018) argues that analyses based on the NLSY97 data fail falsification exercises and uses data from the Youth Risk Behavior Surveillance System (YRBSS) to estimate the effectiveness of the FSP laws. This paper replies to Zheng (2018) and provides new results from the NLSY97, which show that the FSP laws were effective reducing several indicators of alcohol consumption among minors. [ABSTRACT FROM AUTHOR]

Technological changes in medicine have created new opportunities to provide surgical care in lower cost, specialized facilities. This paper examines patient outcomes in ambulatory surgery centers (ASCs), which were developed as a low-cost alternative to outpatient surgery in hospitals. Because we are concerned that selection into ASCs may bias estimates of facility quality, we use predicted changes in federally set Medicare facility payment rates as an instrument for ASC utilization to estimate the effect of location of treatment on patient outcomes. We find that patients treated in an ASC are less likely to be admitted to a hospital or visit an emergency room a short time after outpatient surgery. The findings in this paper indicate that factors other than patient and physician heterogeneity contribute to the observed returns to specialization in the ASC market. [ABSTRACT FROM AUTHOR]

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 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. [ABSTRACT FROM AUTHOR]

This paper uses a large UK cohort to investigate the impact of early-life pollution exposure on individuals' human capital and health outcomes in older age. We compare individuals who were exposed to the London smog in December 1952 whilst in utero or in infancy to those born after the smog and those born at the same time but in unaffected areas. We find that those exposed to the smog have substantially lower fluid intelligence and worse respiratory health, with some evidence of a reduction in years of schooling. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper assesses the impacts of physician-patient race-match, especially Black patients paired with Black physicians, on patient mortality. We draw on administrative data from Florida, linking hospital encounters from mid-2011 through 2014 to information from the Florida Physician Workforce Survey. Focusing on uninsured patients experiencing unscheduled hospital admissions who are conditionally randomly assigned to physicians, we find that physician-patient race-match for Black patients reduces the likelihood of within-hospital mortality by 0.28 percentage points, a 27 % reduction relative to the overall mortality rate. An alternative identification strategy relying on instrumental variables provides a similar finding. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper studies how altruistic preferences are changed by markets and incentives. We conduct a laboratory experiment with a within-subject design. Subjects are asked to choose health care qualities for hypothetical patients in monopoly, duopoly, and quadropoly. Prices, costs, and patient benefits are experimental incentive parameters. In monopoly, subjects choose quality by trading off between profits and altruistic patient benefits. In duopoly and quadropoly, subjects play a simultaneous-move game. Uncertain about an opponent's altruism, each subject competes for patients by choosing qualities. Bayes-Nash equilibria describe subjects' quality decisions as functions of altruism. Using a nonparametric method, we estimate the population altruism distributions from Bayes-Nash equilibrium qualities in different markets and incentive configurations. Competition tends to reduce altruism, but duopoly and quadropoly equilibrium qualities are much higher than monopoly. Although markets crowd out altruism, the disciplinary powers of market competition are stronger. Counterfactuals confirm markets change preferences. [ABSTRACT FROM AUTHOR]

During the late 19th and early 20th century, several states mandated midwifery licensing requirements to improve midwives' knowledge, education, and quality. Previous studies point to the health benefits of midwifery quality improvements for maternal and infant health outcomes. This paper exploits the staggered adoption of midwifery laws across states using event-study and difference-in-difference frameworks. We use the universe of death records in the US over the years 1979-2020 and find that exposure to a midwifery licensing law at birth is associated with a 2.5 percent reduction in cumulative mortality rates and an increase of 0.6 months in longevity during adulthood and old age. The effects are concentrated on deaths due to infectious diseases, neoplasm diseases, and suicide mortality. We also show that the impacts are confined among blacks and are slightly larger among males. Additional analyses using alternative data sources suggest small but significant increases in educational attainments, income, measures of socioeconomic status, employment, and measures of height as potential mechanism channels. We provide a discussion on the economic magnitude and policy implication of the results. [ABSTRACT FROM AUTHOR]

This paper investigates the power of time preference to predict illness and premature mortality in adulthood. Using a unique Swedish cohort of 12,956 individuals born in 1953, interviewed in 1966, and followed with register data up to 2018, the paper reports that more patient adolescents are 17-21% less likely to die before the age of 65 years. More patient adolescents have fewer hospitalizations and diagnoses in their adult life and are less likely to be diagnosed with conditions associated with lifestyle risk factors. The investigated channels for the relationship between time preference and future health include lifestyle, education attainment, and future income. Controlling for education and income reduces the coefficient for time preference on premature mortality by one-fourth. [ABSTRACT FROM AUTHOR]

Intergenerational transmission of human capital from parents to offspring is widely documented. However, whether there are upward spillovers from children to parents remains understudied. This paper uses data from the China Health and Retirement Longitudinal Study to estimate the causal impact of educational attainment of children on various health and cognition outcomes of older parents. Identification is achieved by using the exposure of children to the compulsory education law in China and its interaction with local schooling level before law enforcement as instruments for children's years of schooling. IV estimation results demonstrate that increasing years of education of children lead to better cognitive functions, higher survival expectations and improved lung function of Chinese older parents. Further evidence suggests that children's education might shape health of older parents by providing financial support, affecting the access to resources and influencing the labor supply and psychological well-being of parents. [ABSTRACT FROM AUTHOR]

This paper examines the long-term effects of childhood disability on individuals' educational and occupational choices, late-career labor market participation, and mortality. We merge medical records on children hospitalized with poliomyelitis during the 1952 Danish epidemic to census and administrative data, and exploit quasi-random variation in paralysis incidence in this population. While childhood disability increases the likelihood of early retirement and disability pension receipt at age 50, paralytic polio survivors are more likely to obtain a university degree and to go on to work in white-collar and computer-demanding jobs than their non-paralytic counterparts. Our results are consistent with individuals making educational and occupational choices that reflect a shift in the comparative advantage of cognitive versus physical skills. We also find that paralytic polio patients from low socioeconomic status backgrounds are more likely to die prematurely than their non-paralytic counterparts, whereas there is no effect on mortality among polio survivors from more advantaged backgrounds. [ABSTRACT FROM AUTHOR]

Competition among physicians is widespread, but compelling empirical evidence on its impact on service provision is limited, mainly due to endogeneity issues. In this paper we exploit that many GPs, in addition to own practice, work in local emergency centres, where the matching of patients to GPs is random. The same GP is observed both with competition (own practice) and without (emergency centre). Using high-dimensional fixed-effect models, we find that GPs with a fee-for-service (fixed-salary) contract are 12 (8) percentage points more likely to certify sick leave at own practice than at the emergency centre. Thus, competition has a positive impact on GPs' sicklisting that is strongly reinforced by financial incentives. [ABSTRACT FROM AUTHOR]

This paper shows that early-life health is an important determinant of labor market vulnerability during macroeconomic downturns. Using data on twins during Sweden's crisis of the early 1990s, we show that individuals with higher birth weight are differentially less likely to receive unemployment insurance benefits after the crisis as compared to before it, and that this effect is concentrated among workers in the private sector. While differences in early-life health thus lead to increased inequality in employment outcomes, we also find that there is no differential effect of birth weight on total income after the crisis. This suggests that in the context of Sweden, the social safety net is able to mitigate the effects of early-life health on labor market outcomes during economic downturns. [ABSTRACT FROM AUTHOR]

The impact of parallel trade on innovation in R&D-intensive industries, such as pharmaceuticals, is a hotly debated question in antitrust and IP policy. The well-known argument that parallel trade dampens innovation by undermining firms' ability to price discriminate has been challenged by recent literature. The argument is that with endogenous price controls, parallel trade increases innovation by reducing governments' incentives to set particularly low price caps. In this paper, we show that this result crucially depends on the degree of homogeneity of the trading countries. The result only holds if consumers in poorer countries have a relatively similar demand for medication as consumers in richer countries. Instead, when countries are relatively heterogeneous, parallel trade dampens innovation and lowers welfare by exporting price cap regulation from poorer to richer countries. These findings are in line with recent case evidence. We also show that when patent length is endogenous, richer countries will tend to choose longer patent protection with parallel trade, whereas equilibrium price caps tend to be tighter in that case. [ABSTRACT FROM AUTHOR]

The conventional method for developing health care plan payment systems uses observed data to study alternative algorithms and set incentives for the health care system. In this paper, we take a different approach and transform the input data rather than the algorithm, so that the data used reflect the desired spending levels rather than the observed spending levels. We present a general economic model that incorporates the previously overlooked two-way relationship between health plan payment and insurer actions. We then demonstrate our systematic approach for data transformations in two Medicare applications: underprovision of care for individuals with chronic illnesses and health care disparities by geographic income levels. Empirically comparing our method to two other common approaches shows that the "side effects" of these approaches vary by context, and that data transformation is an effective tool for addressing misallocations in individual health insurance markets. [ABSTRACT FROM AUTHOR]

Minimum unit prices (MUPs) have been proposed on the grounds that they can reduce alcohol consumption of the heaviest drinkers, without significantly burdening moderate drinkers. This paper examines the case for MUPs in an optimal tax framework. Such a policy can improve welfare when two conditions are both satisfied. First, beverage quality and quantity should be substitutes. Second, there should be more distortion to consumption of cheaper alcohol than to more expensive varieties. The consequences of a MUP for the optimal corrective tax are explored with a calibrated numerical example. This example illustrates how the optimal tax rate might be higher when used in isolation, than when a MUP is also being used. [ABSTRACT FROM AUTHOR]

This is a comment on the paper by Irz et al. (2015) in this journal, on nutritional recommendations. Irz et al. (2015) propose to compute the cost of a nutritional constraint as the consumer loss of surplus, derived from their observed choices. Introducing behavioral biases into an extended version of their model, I show that their proposed methodology implicitly assumes that consumer dietary choices do not involve any health considerations. The cost per quality-adjusted life year that they compute should be corrected by the size of the bias of consumers to be compared with benchmark evaluations. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between self-reported health and material hardship among older Americans. Differently from income-based measures, material hardship provides a more specific description of the concrete adversities faced by the elderly. We have used the last six waves of the Health and Retirement Study to explore the relative contributions of state dependence, unobserved heterogeneity and time-specific shocks on reporting poor health, experiencing food insecurity and medication cutbacks. We have used a Latent Markov model to estimate a multivariate non-linear system of equations for panel data allowing time-varying unobserved heterogeneity. Our results reveal a high state dependence of both health and material hardship conditions. Estimated trajectories reveal that pathways of material hardship are associated differently with health. Material hardship is also spread across its dimensions. [ABSTRACT FROM AUTHOR]

This paper examines the causal effect of retirement on health and healthcare utilization using two identification strategies on Danish full population data. First, I use a reform of the statutory retirement age in an IV design. Second, I use a large discontinuity in retirement take-up at the earliest age of retirement (60) in a regression discontinuity design. The results show that early retirement leads to decreases in GP visits and hospitalizations of 8-10% in the short run. The reduction in GP visits is driven by a drop in female GP utilization, while both genders contribute equally to the decline in hospitalizations. Early retirement has no effect on health measured by comorbidities or mortality. Statutory retirement has no effect on health or healthcare utilization. The results suggest that gender, age at retirement and complier composition are important sources of heterogeneity. [ABSTRACT FROM AUTHOR]

This paper studies a commercial insurer-driven intervention to improve resource allocation. The insurer developed a claims-based algorithm to derive a member-level healthcare utilization risk score. Members with the highest scores were contacted by a care management team tasked with closing gaps in care. The number of members outreached was dictated by resource availability and not by severity, creating a set of arbitrary cutoff points, separating treated and untreated members with very similar predicted risk scores. Using a regression discontinuity approach, we find evidence that predictive analytics-driven interventions directed at high-risk individuals reduced emergency room and specialist visits, yet not hospitalizations. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of introducing external medical review for disability insurance (DI) in a system relying on treating physician testimony for eligibility determination. Using a unique policy change and administrative data from Switzerland, I show that medical review reduces DI incidence by 23%. Incidence reductions are closely tied to difficult-to-diagnose conditions, suggesting inaccurate assessments by treating physicians. Due to a partial benefit system, reductions in full benefit awards are partly offset by increases in partial benefits. More intense screening also increases labor market participation. Existing benefit recipients are downgraded and lose part of their benefit income when scheduled medical reviews occur. Back-of-the-envelope calculations indicate that external medical review is highly cost-effective. Under additional assumptions, the results provide a lower bound of the effect on the false positive award error rate. [ABSTRACT FROM AUTHOR]

This paper presents the results of a randomized study of a home visiting program implemented in Germany for low-income, first-time mothers. Besides improving child health and development, a major goal of the program is to improve the participants' economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, household composition, well-being, and fertility behavior. The study reveals that the intervention decreased maternal employment by 9.3 percentage points and increased subsequent births by 6.4 percentage points, in part through a reduction in abortions. [ABSTRACT FROM AUTHOR]

High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival. Complementary analyses point to learning-by-doing as an important explanation. [ABSTRACT FROM AUTHOR]

This paper estimates the effect of Medicaid prescription drug spending on mortality. I use the group- and state-specific roll out of Medicaid drug coverage to isolate plausibly exogenous variation in drug expenditures. I find that a $1 increase in Medicaid drug expenditures per resident reduces mortality from internal causes by 2.0 deaths per hundred thousand, a decline of 0.23%. I find relatively large effects for: (1) medically-treated diseases which pose an immediate risk of death, (2) impoverished areas which received a disproportionate share of state Medicaid dollars, and (3) areas with a high ratio of medical to surgical physicians. [ABSTRACT FROM AUTHOR]

This paper investigates the persistent effects of negative shocks in utero and in infancy on low-income children's health and cognitive outcomes and examines whether timing of exposure matters differentially by skill type. Specifically, I exploit the geographic intensity of extreme floods in Ecuador during the 1997-1998 El Niño phenomenon, which provides exogenous variation in exposure at different periods of early development. I show that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later. Also, children affected by the floods in the first trimester of pregnancy score lower on cognitive tests. Additionally, I explore potential mechanisms by studying health at birth and family inputs (income, consumption, and breastfeeding). I find that children exposed to El Niño floods, especially during the third trimester in utero, were more likely to be born with low birth weight. Furthermore, households affected by El Niño suffered a decline in income, total consumption, and food consumption in the aftermath of the shock. Falsification exercises and robustness checks suggest that selection concerns such as selective fertility, mobility, and infant mortality do not drive these results. [ABSTRACT FROM AUTHOR]

This paper examines whether Dutch disability insurance reforms have helped or hindered employment opportunities of workers that are facing unanticipated shocks to their health. An important component of the reforms was to make employers responsible for paying sickness benefits and to strengthen their sickness monitoring obligations. This may stimulate preventive and reintegration activities by firms. Using administrative data on hospitalizations, we conclude that both financial incentives and monitoring obligations have substantially lowered DI receipt and increased the employment of workers after a health shock. [ABSTRACT FROM AUTHOR]

Although mental health disorders such as anxiety and depression are common, there is little research on whether individuals in poor mental health react differently from others to financial incentives. This paper exploits an experiment from the UK Understanding Society Innovation Panel to assess how the participation response to randomly-assigned financial incentives differs by mental health status. We find that individuals in good mental health are more likely to respond when offered a higher financial incentive, whereas those in poor mental health are indifferent to the increased incentive. We find no comparable differences for physical health. [ABSTRACT FROM AUTHOR]

Targeting the Ultra-poor (TUP) is an integrated programme that combines the transfer of income-generating assets and multifaceted training on entrepreneurship, health-nutrition, and social awareness over a two-year period to graduate ultra-poor with mainstream poverty. While positive socioeconomic effects and spill-over effects are well-documented, this is the first paper to evaluate the effects of the programme on nutritional outcomes of under-5 children using data from a randomized control trial over a four-year period. We find notable improvements in nutritional outcomes of children in participating households. TUP is further seen to improve food-security, sanitation and duration of exclusive-breastfeeding. Nutrition status of children living in poor non-participant households are also positively affected though no effects were found on children from non-poor households. We conclude that programmes that combine asset transfer with multifaceted training such as TUP can have significant long-term positive health effects. [ABSTRACT FROM AUTHOR]

In this paper I unify the economic theories of addiction and health deficit accumulation and develop a life cycle theory in which individuals take into account the fact that the consumption of addictive goods reduces their health and longevity. I distinguish two types of addiction: sophisticated and naive. Individuals with sophisticated addiction perfectly control their addiction. Individuals with naive addiction, though otherwise rational and forward looking, fail to fully understand how their addiction develops. I argue that the life cycle consumption pattern predicted for naive addiction is more suitable for motivating empirically observable patterns of addictive goods consumption. I take the case of smoking as unhealthy behavior, calibrate the model with U.S. data, and apply it in order to investigate the life cycle patterns of smoking and quitting smoking and the socioeconomic gradients of unhealthy consumption and longevity. [ABSTRACT FROM AUTHOR]

Pollen is known to cause allergic reactions and affect cognitive performance in around 20% of the population. Although pollen season peaks when students take high-stakes exams, the effect of pollen allergies on school performance has received nearly no attention from economists. Using a student fixed effects model and administrative Norwegian data, this paper finds that increasing the ambient pollen levels by one standard deviation at the mean leads to a 2.5% standard deviation decrease in test scores, with potentially larger effects for allergic students. There also appear to be longer-run effects. The findings imply that random increases in pollen counts reduce test scores for allergic students relative to their peers, who consequently will be at a disadvantage when competing for jobs or higher education. This paper contributes to the literature by illuminating the interplay between individual health and human capital accumulation, which in turn can impact long-run economic growth. [ABSTRACT FROM AUTHOR]

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. [ABSTRACT FROM AUTHOR]

Controlling for socioeconomic and geographic factors, under-5 mortality (5q0) in developing countries has been declining at about 2.7% per year, a high rate of 'technical progress'. This paper adduces theoretical and empirical reasons for rejecting the usual specification of homogeneous technical progress across countries and uses a panel of 95 developing countries for the period 1970-2000 to explore the consequences of heterogeneity. Allowing country-specific rates of technical progress sharply reduces the estimated income elasticity of 5q0 and points to country variation in technical progress as the principal source of the (large) cross-country variation in 5q0 decline. Education levels and physician coverage also contribute and are less affected than income of allowing country variation in technical progress. The paper concludes by decomposing 1970-2000 5q0 decline into its different sources for each country. [ABSTRACT FROM AUTHOR]

Much of the increase in the prevalence of overweight and obesity has been in developing countries with a history of famines and malnutrition. This paper is the first to examine overweight among adult grandsons of grandfathers exposed to starvation during developmental ages. I study grandsons born to grandfathers who served in the Union Army during the US Civil War (1861-5) where some grandfathers experienced severe net malnutrition because they suffered a harsh POW experience. I find that male-line but not female-line grandsons of grandfathers who survived a severe captivity during their growing years faced a 21% increase in mean overweight and a 2% increase in mean BMI compared to grandsons of non-POWs. Male-line grandsons descended from grandfathers who experienced a harsh captivity faced a 22%–28% greater risk of dying every year after age 45 relative to grandsons descended from non-POWs, with overweight accounting for 9%–14% of the excess risk. [ABSTRACT FROM AUTHOR]

This paper evaluates the causal effect of drug decriminalization on unintentional drug overdose deaths in a context with relatively poor access to drug treatment services. Using the synthetic control method, I find that when Oregon decriminalized small amounts of drugs in February 2021, it caused 182 additional unintentional drug overdose deaths to occur in Oregon in 2021. This represents a 23% increase over the number of unintentional drug overdose deaths predicted if Oregon had not decriminalized drugs. [ABSTRACT FROM AUTHOR]

A major factor weighing down the long-term finances of state and local governments is the obligation to fund retiree benefits. While state and local government pension obligations have been analyzed in great detail, much less attention has been paid to the costs of the other major retiree benefit provided by these governments: retiree health insurance. The first portion of the paper uses the information contained in the annual actuarial reports for public retiree health plans to reverse engineer the cash flows underlying the liabilities given in the report. Obtaining the cash flows allows us to construct liability estimates which are consistent across governments in terms of the discount rate, actuarial method and assumptions concerning medical cost inflation and mortality. We find that the total unfunded accrued liability of state and local governments for the provision of retiree health care exceeds $1 trillion, or about ⅓ of total state and local government revenue. Relative to pension obligations discounted at the same rate, we find that unfunded retiree health care liabilities are ½ the size of unfunded pension obligations. We also find that using assumptions concerning the growth in health care costs that are arguably more realistic than those employed by most states actually reduces the size of the liability in most cases. Pushing in the opposite direction, we find that using plausibly more realistic mortality assumptions increases the size of liability. The second portion of the paper places retiree health care obligations into context by examining the budget pressures associated with retiree health on a continuing, largely pay-as-you go basis. We find that much of the projected increase in retiree health obligations as a share of revenue is the result of health care cost growth. On average, states could put their retiree health obligations into long-run fiscal balance by contributing an additional ¾ percent of total revenue toward the benefit each year. There is, however, wide variation across the states, with the majority of states requiring little in the way of additional financing, but some states requiring a significantly larger increase. [ABSTRACT FROM AUTHOR]

In light of the ongoing debate over tighter firearm regulations, this paper considers the relationship between gun prevalence and suicide. I exploit a reform in Switzerland that reduced the prevalence of military-issued guns in private households. In Switzerland, military service is compulsory for men, and military-issued guns account for nearly half of the total number of firearms available. The results show that the firearm suicide rate decreases by 9% for a reduction in gun prevalence of 1000 guns per 100,000 inhabitants. The elasticity of gun suicides with respect to firearm prevalence is +0.48, but converges towards zero for low levels of gun prevalence. The overall suicide rate is negatively and significantly related to firearm prevalence, which indicates that non-gun methods of suicide are not perfect replacements for firearms. [ABSTRACT FROM AUTHOR]

This paper compares mortality between Gold and Silver medalists in Olympic Track and Field to study how achievement influences health. Contrary to conventional wisdom, winners die over one year earlier than losers. I find strong evidence of differences in earnings and occupational choices as a mechanism. Losers pursued higher-paying occupations than winners according to individual Census records. I find no evidence consistent with selection or risk-taking. How people respond to success or failure in pivotal life events may produce long-lasting consequences for health. [ABSTRACT FROM AUTHOR]