J Health Econ
· 2026 Mar · PMID 41534126
·
Publisher ↗
Over a third of women in the United States experience intimate partner violence (IPV); existing research demonstrates that household finances are one important driver of such violence. We study the effects of rent contro...Over a third of women in the United States experience intimate partner violence (IPV); existing research demonstrates that household finances are one important driver of such violence. We study the effects of rent control on IPV to develop understanding of the financial causes of IPV. Rent control may lessen financial stressors within a relationship and decrease strain that leads to violence. Conversely, it may make leaving the relationship more costly, shifting the bargaining power in the relationship and leading to more violence. We leverage the 1994 expansion of rent control in San Francisco as a natural experiment to study this question. This expansion created variation across ZIP codes in the number of rental units that were newly rent controlled. We exploit this variation in a continuous difference-in-difference design. We estimate an elasticity of -0.08 between the number of newly rent controlled units and assaults on women resulting in hospitalization. This effect translates to a nearly 10% decrease in assaults on women for the average ZIP code. This relationship is not explained by changes in neighborhood composition or overall crime, consistent with the effects being driven by individual level changes in IPV.
Carneiro P, Kraftman L, Rasul I
… +2 more, Salvati F, Scott M
J Health Econ
· 2026 Mar · PMID 41529540
·
Publisher ↗
There has been a sustained rise in cash transfer programs to the poor, and burgeoning interest in interventions promoting early childhood development. We draw together these trends to study whether open enrolment interve...There has been a sustained rise in cash transfer programs to the poor, and burgeoning interest in interventions promoting early childhood development. We draw together these trends to study whether open enrolment interventions targeting cash transfers to pregnant mothers unintentionally induce those not pregnant to accelerate birth timing in order to start receiving the cash. Our study context is rural Northern Nigeria, where households have high demand for liquidity because they are reliant on volatile earnings from agriculture, are subject to frequent natural and man-made aggregate shocks, and reside in communities with imperfect credit markets. Our evidence comes from an evaluation of an intervention providing high-valued unconditional cash transfers to pregnant mothers, with four years of open enrolment. We examine how this impacts pregnancy timing among 1700 women not pregnant at baseline. We document relatively weak distortionary impacts on pregnancy timing over the four year period of open enrolment. The reasons are women retain full control over the use of cash transfers, they have productive investment opportunities in their own businesses, and they choose to invest in those rather than transfer cash to husbands. This constellation of factors allows women to internalize the marginal benefits and costs of accelerating birth timing, and place a brake on the incentives households otherwise have to accelerate birth timing. On external validity, we draw together 45 DHS surveys to classify countries into those more or less likely to see distortionary effects on birth timing from open enrolment interventions targeting cash transfers to pregnant mothers.
J Health Econ
· 2026 Mar · PMID 41512668
·
Publisher ↗
This paper studies the effects of a large-scale exit of doctors on population health outcomes, health production inputs, outputs, and health system adaptation in Brazil. Identification exploits the exogenous timing of th...This paper studies the effects of a large-scale exit of doctors on population health outcomes, health production inputs, outputs, and health system adaptation in Brazil. Identification exploits the exogenous timing of the Cuban exit from municipalities that relied more versus less on Cuban doctors within the More Doctors Program. We find persistent reductions in the care of chronic diseases, while service utilization for conditions requiring immediate care, such as maternal-related services and infections, quickly recovered. Reductions in utilization did not translate into changes in health outcomes. Supply-side response and demand diversion helped mitigate major adverse repercussions for population health at the market level.
J Health Econ
· 2026 Jan · PMID 41478258
·
Publisher ↗
Global concerns over rising drug prices have led to regulatory efforts in the pharmaceutical industry targeting price transparency and distribution efficiency. This study examines the impact of China's Two-Invoice System...Global concerns over rising drug prices have led to regulatory efforts in the pharmaceutical industry targeting price transparency and distribution efficiency. This study examines the impact of China's Two-Invoice System (TIS), a 2016 reform aimed at reducing drug costs by streamlining the pharmaceutical distribution chain and enhancing price transparency. With a theoretical model, we examine the decision-making for pharmaceutical manufacturers and distributors on pricing and promotion activities. We predict competing effects on drug prices: while intermediary markups inflated by double marginalization are reduced, the removal of efficient distributors may elevate supply chain expenses. Using a staggered difference-in-differences approach with procurement data from 2015 to 2019, we find that the implementation of TIS led to a 1.9% increase in average drug prices, contrary to policy expectations. Price increases were more pronounced for lower-priced drugs and in wealthier regions, for which the supply chain markups are limited and the effect of efficiency disruption might dominate. We also document a significant increase in sales and marketing expenses of the manufacturers, who are supposed to have absorbed a considerable amount of promotional costs previously borne by distributors. These findings underscore the unintended inefficiencies of regulatory reforms, highlighting the need for a balanced policy design that considers both cost control and market dynamics in healthcare.
Black N, Harris A, Johnston DW
… +1 more, Trinh TA
J Health Econ
· 2026 Jan · PMID 41455410
·
Publisher ↗
To improve access to affordable mental healthcare, Australia introduced a national, publicly-funded program in 2006 to subsidise psychological services, which were previously privately funded. Theory suggests that by inc...To improve access to affordable mental healthcare, Australia introduced a national, publicly-funded program in 2006 to subsidise psychological services, which were previously privately funded. Theory suggests that by increasing demand, subsidies should incentivise providers to expand supply, either by entering the workforce or by increasing hours. However, expansion depends on supply constraints, particularly in non-metropolitan areas with pronounced workforce shortages. This study examines the program's effects on the size, work hours, demographic composition, location, and earnings of psychologists. Using an event-study design with administrative tax records and census data, we find that the program: (1) increased the supply of psychologists, with minimal effect on average hours worked per psychologist; (2) increased the likelihood of psychologists working in non-metropolitan areas, supporting broader access to mental healthcare; and (3) raised psychologists' annual personal incomes.
J Health Econ
· 2026 Jan · PMID 41447754
·
Publisher ↗
This paper examines the impact of individualized funding for disability supports on autism diagnoses. We identify these effects using the staggered roll out of the National Disability Insurance Scheme (NDIS), which provi...This paper examines the impact of individualized funding for disability supports on autism diagnoses. We identify these effects using the staggered roll out of the National Disability Insurance Scheme (NDIS), which provides individualized funding for non-medical disability interventions. We find compelling evidence that the introduction of the NDIS has led to a 32 % increase in reported autism prevalence and accounts for 47 % of new diagnoses since the introduction of the scheme. We find a significant reduction in diagnoses from government subsided healthcare professionals, accompanied by an increase in diagnoses from disability service providers. A lower threshold for autism recognition appears more consistent with our results than catch-up in historically underdiagnosed groups.
J Health Econ
· 2026 Jan · PMID 41411812
·
Publisher ↗
We study the impact of telemedicine technology on antibiotic prescription rates using linked administrative data from Australia on physicians and their patients. We classify physicians by their relative use of virtual co...We study the impact of telemedicine technology on antibiotic prescription rates using linked administrative data from Australia on physicians and their patients. We classify physicians by their relative use of virtual consultations after the introduction of government-subsidised telemedicine services and compare their antibiotic prescribing rates before and after telemedicine services became available. We find that more intense telemedicine adopters prescribe less antibiotics while keeping prescribing quality unchanged. Our results are not explained by patient sorting, doctor shopping, or changes in the intensity of consultations.
J Health Econ
· 2026 Jan · PMID 41351947
·
Publisher ↗
This paper examines the effect of nurse shortages on healthcare production. Employing novel high-frequency data, we examine what effect the absence of nursing staff has on inpatient mortality and other outcomes associate...This paper examines the effect of nurse shortages on healthcare production. Employing novel high-frequency data, we examine what effect the absence of nursing staff has on inpatient mortality and other outcomes associated with nursing care. We find significant adverse mortality impacts of shortages of nurses with degree-level qualifications: for the average ward, the absence of a nurse with university degree-equivalent level training increases the odds of a patient death by approximately 10%, while there is no effect of shortages of less qualified nursing assistants. For qualified nurses, there are returns to firm (hospital) specific human capital: increasing the average firm-specific experience among degree qualified nurses by one year is associated with an 8% reduction in the odds of a patient death, the equivalent to adding three-quarters of an extra qualified nurse to the ward. Adverse mortality impacts of shortages are particularly concentrated among patients of relatively low, rather than high, clinical severity. The largest impacts are for those diagnosed with sepsis, a condition where early detection is important for survival and where nurses have a central role in detection and subsequent control.
J Health Econ
· 2025 Dec · PMID 41325647
·
Full text
Vertical integration among health care providers is an increasingly common feature of U.S. health care. This study investigates the impact of vertical integration in the context of oncology practices launching in-house p...Vertical integration among health care providers is an increasingly common feature of U.S. health care. This study investigates the impact of vertical integration in the context of oncology practices launching in-house pharmacies dispensing high-cost oral cancer treatments using a stacked event study design. I find physician-pharmacy integration lowers point-of-sale drug prices paid by plans due to 1.0% lower prices at in-house pharmacies. I also find physician-pharmacy integration increases the number of patients filling new prescriptions by 6.2% and reduces time-to-fill for new prescriptions requiring prior authorization. These effects may arise because in-house pharmacies individually have limited bargaining power and because vertical integration decreases coordination costs, reflected by faster prior authorization.
J Health Econ
· 2025 Dec · PMID 41297420
·
Publisher ↗
Mental health stigma hinders access to healthcare by distorting belief formation and decision-making. Stigmatized individuals often underestimate their risk of mental illness and avoid diagnostic information. This study...Mental health stigma hinders access to healthcare by distorting belief formation and decision-making. Stigmatized individuals often underestimate their risk of mental illness and avoid diagnostic information. This study develops a decision-theoretic model that formalizes how stigma reinforces identity-congruent actions, driving belief distortion and information avoidance. By integrating insights from information preference theory and identity utility, the model explains why individuals with strong stigma-driven identity concerns are prone to optimistic bias and resist diagnostic tests to protect their self-concept. The study contributes to the literature in three key ways. First, it conceptually extends economic theory by endogenizing belief distortion, identity-congruent action, and information avoidance within a unified decision-making structure. By introducing stigma as a formally modeled individual-specific parameter - previously underexplored in economics - the framework improves our ability to capture heterogeneity in health-related decision-making and strengthens the theoretical bridge between economic modeling and clinical mental health research. Second, it provides a theoretical framework linking clinical phenomena such as denial, delayed treatment-seeking, and treatment discontinuation within a formal decision-theoretic model. Third, it offers a structured foundation for experimental and empirical research by demonstrating how stigma, a quantifiable construct, systematically influences decision-making through identity-driven actions and belief distortion.
J Health Econ
· 2025 Dec · PMID 41297419
·
Publisher ↗
In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influ...In light of growing concerns over escalating natural disaster risks and persistently low fertility rates, this paper quantifies the causal impacts of tropical cyclones and identifies the pathways through which they influence childbearing decisions among Australians of reproductive age. Using an individual fixed effects model and exogenous variation in cyclone exposure, we find a robust and substantial decline in fertility, occurring only after the most severe category 5 cyclones, with the effect weakening as distance from the cyclone's eye increases. We find no evidence of delayed cyclone effects, indicating that the fertility loss attributable to these most severe cyclones is permanent. Our findings are robust to extensive validity checks, including a falsification test and various randomization tests. The fertility decline is most pronounced among younger adults, individuals with lower educational attainment, those childless at baseline, and those lacking prior private health or residential insurance. While physical health, financial constraints, and migration appear unlikely to drive the effect, the evidence points to reduced family formation, increased marital breakdown, child mortality, cyclone-induced home damage, elevated psychological stress, and heightened risk perceptions as plausible mechanisms.
J Health Econ
· 2025 Dec · PMID 41237656
·
Publisher ↗
This paper documents an important unintended consequence of expanding contraceptive access; it reduces the rates of adverse infant health outcomes. I study a large family planning initiative in the St. Louis metropolitan...This paper documents an important unintended consequence of expanding contraceptive access; it reduces the rates of adverse infant health outcomes. I study a large family planning initiative in the St. Louis metropolitan area that provided thousands of long-acting reversible contraceptives (LARCs) to reproductive-age women at no cost. Using a synthetic difference-in-differences design, I find that the program led to substantial improvements in infant health, reducing extremely preterm births by 2.18 and infant deaths by 1.74 per 1,000 live births, reductions of approximately 20% for each outcome. I find meaningful reductions for both Black and White mothers, though the effects on Black mothers are less precisely estimated and are smaller as a percentage of the baseline rates, particularly for extremely preterm births.
J Health Econ
· 2025 Dec · PMID 41218254
·
Publisher ↗
To limit price variation across consumers in the Health Insurance Marketplaces, the Patient Protection and Affordable Care Act (ACA) mandates that insurance plans be uniformly priced across multiple counties within the s...To limit price variation across consumers in the Health Insurance Marketplaces, the Patient Protection and Affordable Care Act (ACA) mandates that insurance plans be uniformly priced across multiple counties within the same geographic rating area. However, the ACA does not require insurers to offer plans in every county, creating the potential for partial rating area offering. Using data from the federally-facilitated Marketplaces, we find that selective participation is both prevalent and persistent throughout the 2016-2022 period. We investigate whether this selective offering reflects anticompetitive market segmentation. In six of the seven years, the evidence is inconsistent with collusive motives. Only in 2018, a year characterized by a particularly low number of insurers with extensive multimarket contact, do we find evidence suggesting anticompetitive motives were among the drivers of selective participation within rating areas.
J Health Econ
· 2025 Dec · PMID 41205355
·
Publisher ↗
Many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 over the past decades. These policies often comprise a bundle of reforms including restrictions on alcohol sales to minors, venue ac...Many European countries have raised the minimum legal drinking age (MLDA) from 16 to 18 over the past decades. These policies often comprise a bundle of reforms including restrictions on alcohol sales to minors, venue access limitations, and advertising controls. We provide novel evidence of the impact of MLDA changes on educational outcomes by exploiting their staggered timing across Spanish regions. Alcohol consumption among adolescents aged 14-17 decreased by 7 to 17% and exam performance improved by 4% of a standard deviation. We also observe a 10% decrease in the use of anxiolytics and hypnosedatives, suggesting improved mental health. There are no significant changes in the use of other substances, leisure habits or study effort. These findings are consistent with neurobiological evidence that alcohol directly impairs cognitive development and increases anxiety-related behaviours. Reducing teenage alcohol consumption represents a substantial opportunity to improve educational outcomes in Europe, where youth drinking rates remain notably high.
J Health Econ
· 2025 Dec · PMID 41197225
·
Publisher ↗
This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variat...This paper examines the long-term impact of West German television exposure on smoking behavior in East Germany, with a focus on gender-specific responses. Using data from 1989 and 2002 and leveraging quasi-random variation in West German TV signal availability across East German regions, we find that TV exposure led to a substantial increase in smoking among women - by 9.5 percentage points in smoking probability and 68% in cigarette consumption - while having no measurable effect on men. This asymmetric effect reflects divergent pre-reunification norms: under socialism, female smoking was heavily stigmatized, and exposure to Western media relaxed these social constraints. The behavioral shift persisted over time, with exposed women reporting worse physical and mental health and higher healthcare utilization in 2002. Back-of-the-envelope calculations suggest a sizable increase in smoking-related mortality and healthcare costs. Our findings highlight how cultural integration through media can alter health behaviors and generate significant public health externalities in transitional societies.
Dave D, Durrance CP, Erten B
… +2 more, Wang Y, Wolfe B
J Health Econ
· 2025 Dec · PMID 41197224
·
Publisher ↗
In overturning Roe v. Wade and triggering laws in many states that ban or severely restrict abortion, the Supreme Court's landmark 2022 Dobbs decision dramatically altered the landscape of reproductive health in the U.S....In overturning Roe v. Wade and triggering laws in many states that ban or severely restrict abortion, the Supreme Court's landmark 2022 Dobbs decision dramatically altered the landscape of reproductive health in the U.S. Prior research has highlighted the far-reaching impact of abortion restrictions for women and families, which extend beyond their proximate effects on abortions, births, and fertility. We provide some of the first causal evidence on how abortion restrictions in the post-Dobbs era have impacted women's risk of exposure to intimate partner violence (IPV). IPV is the most common form of violence experienced by women, and changes in access to abortion may generate unintended effects on various inputs (economic resources, stress, intra-household bargaining) that could affect relationship dynamics and raise the risk of IPV. Leveraging information on IPV incidents reported to law enforcement from 2017-2023 combined with post-Dobbs changes in county-level travel distance to abortion facilities, analyses are based on a generalized difference-in-differences approach. We find that abortion restrictions - alternately measured by the increase in travel distance and by the pres- ence of a near-total ban - significantly increased the rate of IPV for reproductive-age women in treated counties by about seven to 10 percent. These estimates imply at least 9000 additional incidents of IPV among women in the treated "trigger ban" states, which is predicted to add over $1.24 billion in social costs.
J Health Econ
· 2025 Dec · PMID 41187470
·
Publisher ↗
We consider how a physical disability alters patterns of time use. A disability may raise the time cost of some activities, making them differentially less worth doing; or it may make switching activities more costly. Bo...We consider how a physical disability alters patterns of time use. A disability may raise the time cost of some activities, making them differentially less worth doing; or it may make switching activities more costly. Both possibilities predict that fewer activities will be undertaken, with more time spent on each. These explanations describe our correlational findings based on non-working ATUS 2008-22 respondents ages 70+, 32 % of whom self-assess a disability. Data from the 2013 Polish Time Use Survey, where disability is medically certified, show similar results and demonstrate the same loss of variety over multiple days. Remarkably similar basic results are found using homogenized British, Canadian, French, Italian, and Spanish time diaries. Evidence from a "sesqui-difference" test on the ATUS data hints that the relationship is causal. Overall, a mobility/physical disability leads an otherwise identical person to engage in over 10 % fewer activities on a typical day. The lost variety represents extra costs equivalent in data from six countries to over twice the average annual income of older individuals.
J Health Econ
· 2025 Dec · PMID 41175685
·
Publisher ↗
Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers' exposure to the ban across cohorts and in "treatment...Using data from 17 countries, we investigate the effects of child marriage bans on child mortality in the next generation. We use within-country variation in mothers' exposure to the ban across cohorts and in "treatment intensity," calculated based on region-level child marriage prevalence and marriage age prior to the ban. We find that child marriage bans reduced under-5 mortality, with an effect of 19.7 percent corresponding to a one standard deviation change in treatment intensity. Increases in age at first marriage and first birth, which may have led to improved health-related decisions around the time of birth, appear to be the main drivers of the mortality reductions documented.
J Health Econ
· 2025 Dec · PMID 41167126
·
Full text
Substance abuse is a major risk factor for intimate partner violence (IPV). We investigate how a key supply-side intervention - the abuse-deterrent reformulation of a widely-diverted opioid, OxyContin - affected IPV. Our...Substance abuse is a major risk factor for intimate partner violence (IPV). We investigate how a key supply-side intervention - the abuse-deterrent reformulation of a widely-diverted opioid, OxyContin - affected IPV. Our results indicate counties with greater baseline rates of prescription opioid usage experienced relatively larger declines in IPV after OxyContin's reformulation. The reformulation reduced IPV only in states with smaller illicit drug markets, while states with larger illicit drug markets experienced increased heroin-involved IPV due to substitution towards illicit opioids. Our results underscore the importance of identifying populations at high risk of substitution to illicit opioids and moderating this risk with evidence-based policies.
J Health Econ
· 2025 Dec · PMID 41151146
·
Publisher ↗
This paper uses original panel data from Senegal to evaluate the effect of elderly household members' deaths on the educational attainment of female children. Using a triple-difference strategy with child fixed-effects,...This paper uses original panel data from Senegal to evaluate the effect of elderly household members' deaths on the educational attainment of female children. Using a triple-difference strategy with child fixed-effects, I show that the death of a co-resident aged 60 or older is associated with 20% additional education completed over a period of 4 years by affected girls. I present evidence that changes in demand for informal caregiving among adolescent girls within the household are one of the mechanisms at play. These results highlight the central role of female teenagers in caregiving activities and suggest that policies that increase the availability of formal care for the elderly could reduce gender inequalities in education in contexts similar to Senegal.