J Health Econ
· 2026 May · PMID 41962183
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This study examines the long-run economic consequences of disability, distinguishing conditions by the activities they impair. Using linked Canadian survey and administrative tax data, I estimate the effects of disabilit...This study examines the long-run economic consequences of disability, distinguishing conditions by the activities they impair. Using linked Canadian survey and administrative tax data, I estimate the effects of disability onset on detailed income components over a ten-year horizon and assess gaps in partial income insurance across disability types. Mental-cognitive disabilities lead to larger and more persistent losses in market income than physical disabilities. Despite this, both groups experience similar levels of partial insurance and comparable declines in after-tax income. Importantly, substantial heterogeneity exists within these broad categories. Disaggregating physical and mental-cognitive disabilities into mutually exclusive activity-based subtypes reveals pronounced differences in income trajectories and access to insurance that are masked by aggregate classifications. While the tax-transfer system provides partial income protection overall, its effectiveness varies markedly across subtypes, offering especially limited support for mental health-related disabilities, particularly among younger and less-educated individuals.
J Health Econ
· 2026 May · PMID 41946275
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We study the relationship between air pollution and suicide using detailed daily cause of death data from all death certificates in the U.S. over eight years. Using a two-stage residual inclusion estimator with wind dire...We study the relationship between air pollution and suicide using detailed daily cause of death data from all death certificates in the U.S. over eight years. Using a two-stage residual inclusion estimator with wind direction as an instrument for daily pollution exposure, we estimated that a 1 μg/m increase in daily PM2.5 is associated with a 0.39% increase in daily suicides and a 50.5% increase in monthly suicide-related hospitalizations. We find relatively large effects for men, young persons, and in counties where the mean level of pollution is above the median. Our event study estimates show the relationship between pollution and suicide exposure is contemporaneous.
J Health Econ
· 2026 May · PMID 41933515
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Selective mortality and fertility issues are persistent challenges in estimating the fetal origin effect, with attempts to address these issues being notably scarce. Evidence further suggests that selective mortality is...Selective mortality and fertility issues are persistent challenges in estimating the fetal origin effect, with attempts to address these issues being notably scarce. Evidence further suggests that selective mortality is more pronounced in males than in females. This study investigates the causal effects of prenatal exposure to the Great Chinese Famine on educational attainment by addressing gender-specific selection bias. We compare exposed individuals with their unexposed, same-gender siblings, using a famine intensity measure based on county-year level excess death rates. Our findings reveal remarkably similar consequences for both genders: on average, famine exposure increased illiteracy rates by 4 percentage points and decreased years of schooling by 0.3 years for both males and females. These results contribute to our understanding of the long-term impacts of prenatal malnutrition, while accounting for gender-specific selection biases.
J Health Econ
· 2026 May · PMID 41849963
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In 2015, Brazil experienced an epidemic caused by the Zika virus. We use hundreds of millions of administrative records to document household responses to the first public health alert linking the Zika virus to the risk...In 2015, Brazil experienced an epidemic caused by the Zika virus. We use hundreds of millions of administrative records to document household responses to the first public health alert linking the Zika virus to the risk of congenital disease for those in utero. We study two margins of behavior: risk avoidance (avoiding pregnancy), and risk mitigation during pregnancy (ultrasounds and abortions). On risk avoidance, we find a 7% reduction in pregnancies post-alert, a response triggered immediately after the alert. On risk mitigation, we find a 9% increase in the use of ultrasounds in the first trimester of pregnancy, and a 5% rise in abortions, concentrated among late term abortions. We document that post-alert all households - irrespective of race or education for example - were able to reduce risks during pregnancy, in line with preventative measures not being costly. In contrast, the avoidance response is driven by more educated mothers perhaps because such households face lower costs of altering their plans around the timing of fertility. We further discuss consequent impacts on birth outcomes, supply side responses, and how our findings extend to household responses to health alerts related to other viral threats.
J Health Econ
· 2026 May · PMID 41806510
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Identifying causal effects of prenatal psychological stress on birth outcomes is challenging because stressful events typically bundle psychological stress with material disruptions. The 2011 Fukushima nuclear accident p...Identifying causal effects of prenatal psychological stress on birth outcomes is challenging because stressful events typically bundle psychological stress with material disruptions. The 2011 Fukushima nuclear accident provides a unique setting to overcome this challenge: while physical radiation exposure was geographically limited and well-documented, fear of radiation spread nationwide. We exploit this geographic separation to examine how maternal anxiety independently affects fetal development. Using universal Japanese birth records linked to census data, combined with a novel Google Trends-based measure of radiation-specific anxiety, we employ three complementary identification strategies: population-level comparisons of in-utero exposed versus unexposed cohorts, within-family sibling analysis controlling for time-invariant family characteristics, and dose-response estimation exploiting geographic variation in anxiety intensity. Experiencing the accident during pregnancy increased preterm births by 17% and reduced birth weights by 22-26 grams. Birth outcomes exhibit a clear dose-response relationship with anxiety intensity, with radiation-specific anxiety accounting for 72-79% of the overall preterm birth effects and 28-37% of the overall birth weight effects. Effects are concentrated among socioeconomically disadvantaged mothers and during first-trimester exposure, with the most severe impacts on already-vulnerable infants in the very low and extremely low birth weight categories. Our findings indicate that invisible threats generate measurable intergenerational health impacts through psychological stress pathways, with implications for disaster preparedness and risk communication during contemporary crises from pandemics to climate change.
J Health Econ
· 2026 May · PMID 41791249
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This study examines the effect of financial distress within households on intimate partner violence in the United States. By leveraging the timing of bank closing days and fixed wage payment schedules, we identify months...This study examines the effect of financial distress within households on intimate partner violence in the United States. By leveraging the timing of bank closing days and fixed wage payment schedules, we identify months when households have to stretch their finances due to changes in their regular payment schedules. Using monthly records from the National Crime Victimization Survey, we find that these shocks significantly increase the likelihood of women experiencing IPV. We further corroborate the assumption of worsened household conditions during these periods by documenting changes in household behavior in terms of expenditures and time use.
J Health Econ
· 2026 May · PMID 41785616
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Most people consider parks important for their quality of life, yet systematic causal evidence is missing. We exploit exogenous variations in their use values to estimate causal effects. Using a representative household...Most people consider parks important for their quality of life, yet systematic causal evidence is missing. We exploit exogenous variations in their use values to estimate causal effects. Using a representative household panel with precise geographical coordinates of households linked to satellite images of green spaces with a nationwide coverage, we employ a spatial difference-in-differences design, comparing within-individual changes between residents living close to a green space with those living further away. We exploit Covid-19 as an exogenous shock. We find that green spaces raised overall life satisfaction while reducing symptoms of anxiety (feelings of nervousness and worry) and depression. There is also suggestive evidence for reduced loneliness. Given the number of people in their surroundings, a compensating-surplus calculation suggests that parks added substantial benefits during the period studied.
J Health Econ
· 2026 Mar · PMID 41747311
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Ownership of English general practices by physicians has been declining for many years and concentrated among fewer physicians. Non-clinical ownership may provide a sustainable alternative structure for general practice....Ownership of English general practices by physicians has been declining for many years and concentrated among fewer physicians. Non-clinical ownership may provide a sustainable alternative structure for general practice. In this study, we provide the first formal evaluation of non-clinical ownership in an English general practice setting. We compile a comprehensive dataset of general practices across eight years between 2015/16 and 2022/23 from a range of sources to investigate the impact of non-clinical ownership stakes on key primary care outcomes, including staffing levels and turnover, patient satisfaction, access, quality of care, reimbursement for non-core services and total patient list size. Employing a dynamic event study design combined with propensity-score weighting, we find practice manager partners increase direct patient care (excluding physicians and nurses), administrative staff numbers, reimbursement for non-core services and total patient list size. However, we find no statistically significant effect on any other outcome. Offering equity stakes to non-physician staff may support practice sustainability by allowing alternative ownership structures.
Gruber AF, Van Sandt A, Carpenter CW
… +1 more, Loveridge S
J Health Econ
· 2026 Mar · PMID 41723966
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The Nurse Practitioner (NP) workforce expanded rapidly from 2010-2023, especially in rural counties, where patients today are nearly as likely to receive care from an NP as from a physician. At the same time, rural healt...The Nurse Practitioner (NP) workforce expanded rapidly from 2010-2023, especially in rural counties, where patients today are nearly as likely to receive care from an NP as from a physician. At the same time, rural health outcomes and access to health care continue to worsen relative to urban areas. Empirical research on how NPs interact with or substitute for physicians remains limited. This paper exploits county-level openings of graduate nursing programs to test how they impact the local supply of NPs and primary care physicians. Using data from the Integrated Postsecondary Education Data System and Area Health Resource Files, we estimate staggered difference-in-differences frameworks. We show that new graduate programs lead to large increases in the local NP supply and find positive spillover effects for nearby rural counties and counties with low provider to population ratios. We find that over the decade after a program first graduates students, up to 30% of students become licensed NPs in the same county, and for rural programs, the majority of graduates add to the regional supply of NPs. We find no adverse impact of local NP increases on the number of primary care physicians, suggesting that broader access to NP education boosts the local supply of providers overall. This paper illustrates the importance of rural medical education in increasing local access to primary care providers and in addressing existing inequities in access to care.
J Health Econ
· 2026 Mar · PMID 41702345
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Expanding health insurance can either increase or decrease pregnancies and births, depending on how it affects access to contraception and the financial costs of childbearing. I study the Affordable Care Act's Medicaid e...Expanding health insurance can either increase or decrease pregnancies and births, depending on how it affects access to contraception and the financial costs of childbearing. I study the Affordable Care Act's Medicaid expansion using difference-in-differences models and state-level data on contraceptive provision, births, and abortions, synthesizing analysis of these outcomes to distinguish the role of subsidized contraception. The expansion led to a substantial increase in contraceptive provision, particularly for short-acting hormonal methods. Teen birth rates fell significantly by 5%, a reduction that owes to increased parental eligibility, while effects on overall birth rates are not distinguishable from zero. Estimated effects on abortion are imprecise but suggestive of reductions for teens. Simulations based on contraceptive provision imply that subsidized contraception led to reductions in the pregnancy and birth rate of approximately 1% to 2%. These findings indicate that Medicaid's contraceptive subsidies modestly reduced pregnancies, abortions, and births, but also suggest that financial barriers to reproductive health care are not a primary driver of fertility behavior overall.
J Health Econ
· 2026 Mar · PMID 41679127
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This study examines the long-term effects of the Rockefeller Sanitary Commission's (RSC) hookworm eradication campaign, initiated in the American South in the 1910s, on old-age longevity. Utilizing Social Security Admini...This study examines the long-term effects of the Rockefeller Sanitary Commission's (RSC) hookworm eradication campaign, initiated in the American South in the 1910s, on old-age longevity. Utilizing Social Security Administration death records linked to the 1940 full-count census, we employ a two-way fixed effect approach to examine the effects of early-life exposure to the eradication campaign on later-life outcomes. We find that individuals exposed to the RSC campaign during in-utero and early life experience an increase of approximately 1.3 months in longevity for a one-standard-deviation increase in county-level treatment intensity. The effects are substantially larger among nonwhites, children of illiterate mothers, and those born in urban areas. Moreover, we provide evidence of dynamic complementarity in the effects of hookworm eradication on longevity, with larger effects observed in counties exposed to the Rosenwald school construction movement and in states with more stringent child labor laws. Using the 1940 census and World War II enlistment data, we provide suggestive evidence of improvements in educational attainment, income, and cognitive ability as possible pathways. Our findings contribute to the literature on the lasting effects of early-life public health interventions and underscore the importance of such programs in addressing present-day global health challenges.
J Health Econ
· 2026 Mar · PMID 41671894
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We examine the labour supply response of doctors in England to a reform to public sector pensions that increased the link between current labour supply and pension value. Exploiting the staggered rollout of the reform ac...We examine the labour supply response of doctors in England to a reform to public sector pensions that increased the link between current labour supply and pension value. Exploiting the staggered rollout of the reform across narrowly defined birth cohorts, we find that mid-career doctors increased their labour supply to the public healthcare system by just under 4% four years after exposure. This was driven by increases on the extensive margin of working in the public healthcare system. Our results imply an extensive margin labour supply elasticity with respect to the link between current labour supply and pension value of 0.04. Taking into account current pay we estimate an extensive margin labour supply elasticity with respect to total remuneration of 0.29. This is similar to estimates of doctor labour elasticities with respect to pay in other contexts, and suggests that delayed remuneration can be an effective tool for hospital systems to affect mid-career doctor labour supply.
J Health Econ
· 2026 Mar · PMID 41655472
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Minimum supervised driving hours (MSDH) are a key component of Graduated Driver Licensing (GDL) policy. GDL has been shown to reduce motor vehicle accidents, but its optimal design is far from clear. Exploiting two discr...Minimum supervised driving hours (MSDH) are a key component of Graduated Driver Licensing (GDL) policy. GDL has been shown to reduce motor vehicle accidents, but its optimal design is far from clear. Exploiting two discrete MSDH changes in New South Wales (the largest state in Australia), we estimate causal effects of various MSDH options, providing evidence on driver safety under different regimes. Increasing MSDH from zero to 50 h lowered the risk of a motor vehicle accident in the first year of unsupervised driving by around 23%. Further increasing the mandate to 120 h had no additional benefit.
Shui A, van den Berg GJ, Mierau JO
… +1 more, Viluma L
J Health Econ
· 2026 Mar · PMID 41653508
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A large body of literature demonstrates that exposure to major adverse events such as natural disasters affects physical and mental health. Less is known about health consequences of long-term exposure to smaller, recurr...A large body of literature demonstrates that exposure to major adverse events such as natural disasters affects physical and mental health. Less is known about health consequences of long-term exposure to smaller, recurring shocks such as mining-induced earthquakes. Leveraging data from the Dutch Lifelines Cohort Study and Biobank and the Royal Netherlands Meteorological Institute, we examine mental health effects of frequent earthquakes generated by the extraction of natural gas, which was a major source of economic revenue for the Netherlands. Long-term exposure is captured by the accumulated peak ground acceleration. We employ individual-level fixed effects models to deal with selective exposure. We find that exposure increases depression and anxiety symptoms. Our results are robust to selective migration and to varying the exposure indicator. The results support a reassessment of the societal costs of the mining of natural gas.
Dragone D, Feichtinger G, Grass D
… +4 more, Hartl RF, Kort PM, Seidl A, Wrzaczek S
J Health Econ
· 2026 Mar · PMID 41637854
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We propose a theoretical model to study individual lifestyle choices related to calorie intake and physical activity, depending on personal fitness and body weight. The model builds on the rational eating literature and...We propose a theoretical model to study individual lifestyle choices related to calorie intake and physical activity, depending on personal fitness and body weight. The model builds on the rational eating literature and can generate a variety of behaviors that are consistent with the empirical evidence. In particular, we show that engaging in periods of a sedentary lifestyle can be a rational, utility-maximizing decision-a finding that is not present in the existing literature but is empirically widespread. Additionally, we show the possible existence of multiple equilibria and multiple indifferent lifestyles. The former justifies policy interventions to help individuals exit a self-reinforcing, but unhealthy equilibrium; the latter provides a theoretical basis for remediation plans that compensate for earlier unhealthy behaviors.
J Health Econ
· 2026 Mar · PMID 41633033
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Immunotherapy is a breakthrough innovation in cancer care, but it is also among the most expensive treatments, with costs exceeding $150,000 per patient. We study the introduction of immune checkpoint inhibitors (ICIs),...Immunotherapy is a breakthrough innovation in cancer care, but it is also among the most expensive treatments, with costs exceeding $150,000 per patient. We study the introduction of immune checkpoint inhibitors (ICIs), the most widely used class of immunotherapy drugs. In 2022, ICIs accounted for 44% of the $17.5 billion Medicare Part B cancer drug spending. We focus on metastatic melanoma, the first approved indication for ICIs. While overall cancer mortality rates declined since the 1990s, melanoma mortality rates increased through the early 2010s. Following the first ICI approvals in 2011 and 2014, melanoma mortality declined sharply. Using traditional Medicare claims, we estimate the impact of the introduction of ICIs on healthcare utilization, costs, and 1-year survival for patients with metastatic melanoma, relative to metastatic colorectal cancer (CRC), where ICIs were not approved until 2017. Variation in approval timing allows us to isolate the effect of ICIs from broader cancer care trends. We find that ICIs reduced 1-year mortality by 6.2%. Since about 1 in 5 metastatic melanoma patients received ICIs, this implies a 28.0% reduction among treated patients. The introduction of ICIs also reduced chemotherapy and radiation use, but increased Medicare spending by 59.3% or about 260% among ICI-treated patients. Accounting for life expectancy gains beyond one year, the benefits of ICIs for melanoma patients appear comparable, or potentially even greater, than the substantial added Medicare costs. Nonetheless, ICI use remains relatively low given large survival benefits and few alternative treatments, suggesting that costs and other barriers limit patient access.
Bancalari A, Bernal P, Celhay P
… +2 more, Martinez S, Sánchez MD
J Health Econ
· 2026 Mar · PMID 41604805
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The overutilization of costly hospital and emergency care and the underutilization of primary care is considered a key driver of wasteful health spending. We study how a shift toward community-based primary care reshapes...The overutilization of costly hospital and emergency care and the underutilization of primary care is considered a key driver of wasteful health spending. We study how a shift toward community-based primary care reshapes care patterns across levels of the health system in El Salvador. Using data on outpatient consultations and hospitalizations across 254 municipalities, we exploit the staggered introduction of community health teams (CHTs) between 2010 and 2013 using an event-study design. We find that CHTs increased preventive care, reduced curative consultations for conditions amenable to effective primary care, and lowered preventable hospitalizations. We also document improved primary-care coverage for previously unattended chronic conditions. Together, these results suggest that strengthening primary care through CHTs can meaningfully improve the organization of care and bolster health system performance.
J Health Econ
· 2026 Mar · PMID 41579412
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This paper explores the effect of increased competition on pharmacies induced by a regime change in two Swiss cities allowing physicians to self-dispense drugs. By merging detailed sales and survey data at the pharmacy l...This paper explores the effect of increased competition on pharmacies induced by a regime change in two Swiss cities allowing physicians to self-dispense drugs. By merging detailed sales and survey data at the pharmacy level, a difference-in-differences estimation shows a significant and permanent loss of market share in prescribed drug revenue and profits. The decline is driven by drugs used for acute illnesses and is less pronounced for larger pharmacies. While generic drug sales decrease significantly, the more expensive brand-name drugs remain largely unaffected. I find evidence that pharmacies respond to increased competition by diversifying toward health services. Adding administrative physician data shows that the reform caused approximately CHF 19.5M in additional drug costs per year. My results demonstrate that more competition can result in higher drug costs for society.
J Health Econ
· 2026 Mar · PMID 41539162
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The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level vari...The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level variation in stock market wealth from 1996 to 2016, we show that exogenous wealth shocks significantly reduce the probability of LTCI coverage, without altering Medicaid eligibility among people with housing and financial assets. The effect of shocks to liquid wealth strongly dominates the effect of housing wealth changes. A $100 K increase in housing (financial) wealth reduces the likelihood of LTCI coverage by 1.24 (3.22) percentage points.