Journal Of Health Economics[JOURNAL]
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200 papers
Prioritisation, risk selection, and illness severity in a mixed healthcare system.
Olivella P, Vera-Hernández M
J Health Econ · 2025 Dec · PMID 41092861 · Publisher ↗
We study the link between illness severity and the use of public health care services by the privately insured under a mixed healthcare system. Our theoretical model shows that this relationship depends on (1) the priori...
We study the link between illness severity and the use of public health care services by the privately insured under a mixed healthcare system. Our theoretical model shows that this relationship depends on (1) the prioritisation implemented by public healthcare providers, (2) the stringency of the gatekeeping system, (3) the skewness of the patients' severity distribution, and (4) the private sector's risk selection behaviour. Our empirical analysis reveals that the relationship between illness severity and public healthcare use is U-shaped. As our theoretical model points out, the increasing part of the U-shape is not necessarily a consequence of risk selection by private healthcare providers, but could instead reflect prioritisation within the public sector. According to our analysis, individuals in both extremes of the illness severity distribution will benefit from additional resources to shorten public sector waiting times.
Supply-side opioid restrictions and the retail pharmacy market.
Burton AM, Churchill BF
J Health Econ · 2025 Dec · PMID 41092860 · Publisher ↗
While policymakers routinely limit the sale of goods thought to be of risk to public health, relatively less is known about whether and how these policies affect firm performance. Using 2000-2018 National Establishment T...
While policymakers routinely limit the sale of goods thought to be of risk to public health, relatively less is known about whether and how these policies affect firm performance. Using 2000-2018 National Establishment Time-Series data and a difference-in-differences strategy, we show that state "pill mill" laws intended to reduce the overprescribing of opioids reduced retail pharmacy sales and employment. These reductions were most pronounced in highly competitive areas and for standalone pharmacies - two characteristics associated with pharmacy drug diversion. Meanwhile, pharmacies located across the border in states without a pill mill law experienced increases in sales and employment. Next, we show that state pill mill laws were associated with an increase in standalone pharmacy closures, though the total number of pharmacies was unchanged. Our results are consistent with these laws adversely affecting pharmacies filling inappropriate opioid prescriptions without meaningfully altering patient access to retail pharmacies.
Do doctors contribute to socioeconomic inequalities in health care provision? An audit experiment in Tunisia.
Ghouma R, Lagarde M, Powell-Jackson T
J Health Econ · 2025 Dec · PMID 41037963 · Publisher ↗
In this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit e...
In this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit experiment in Tunisia, sending standardised patients with the same symptoms to 130 public and private primary care doctors for consultation. Informed by in-depth qualitative work, we vary the attitude and appearance of the patients so that they appear to be "poor" or "middle-class". We find no evidence that doctors manage patients differently, but they respond to the socioeconomic profile of patients by prescribing fewer expensive drugs and giving out more free drugs to poorer patients. We also show significant differences in communication between patients: doctors are more likely to provide more explanation to richer patients about the diagnosis, the drugs prescribed and the treatment plan. These differences are not explained by time constraints as doctors spent comparable time with both types of patients. To the extent that differences in communication with patients can lead to differences in patients' health decisions, our results suggest that doctors could contribute indirectly to health inequalities.
The impact of PhD studies on mental health-a longitudinal population study.
Bergvall S, Fernström C, Ranehill E … +1 more , Sandberg A
J Health Econ · 2025 Dec · PMID 41033288 · Publisher ↗
Recent self-reported and cross-sectional survey evidence documents high levels of mental health problems among PhD students. We study the relationship between PhD studies and mental health care utilization using Swedish...
Recent self-reported and cross-sectional survey evidence documents high levels of mental health problems among PhD students. We study the relationship between PhD studies and mental health care utilization using Swedish administrative records of prescriptions for psychiatric medication for the full population of PhD students. We find that prior to starting their PhD studies, prospective students use psychiatric medication at a rate similar to a matched sample of individuals with a master's degree. However, following the start of their PhD studies, psychiatric medication use among PhD students increases substantially. This upward trend continues throughout the course of PhD studies, and by the fifth year medication use has increased by 40 percent compared to pre-PhD levels. After the fifth year, when most students in our sample graduate, the psychiatric medication use declines notably. Heterogeneity analyses indicate that the increase in medication use occurs broadly across different student subgroups and academic disciplines, with the exception of students in the medical and health sciences.
Financial incentives and COVID-19 vaccinations: Evidence from a conditional cash transfer program.
Červený J, Hellebrandt T, Kravec P
J Health Econ · 2025 Dec · PMID 41014681 · Publisher ↗
This paper investigates the effects of a nationwide conditional cash transfer program aimed at increasing COVID-19 vaccine uptake in Slovakia. Due to relatively low vaccination rates and the overcrowding of hospitals dur...
This paper investigates the effects of a nationwide conditional cash transfer program aimed at increasing COVID-19 vaccine uptake in Slovakia. Due to relatively low vaccination rates and the overcrowding of hospitals during the COVID-19 pandemic, the Slovak government decided to offer €200 or €300 cash transfers to individuals aged 60 or older, conditional on taking any of the available vaccines at the time. The eligibility requirements resulted in a discontinuity in treatment assignment at the age threshold. Our results suggest that the program significantly increased vaccination rates in the population. However, overall costs related to the intervention do not appear to outweigh the benefits.
Polluted air, healthier diets: Household food consumption patterns in response to air quality in China.
Huang W, Xiang K, Yu X … +1 more , Zou H
J Health Econ · 2025 Dec · PMID 41014680 · Publisher ↗
This study examines how air pollution affects household food consumption using high-frequency data from over 30,000 households in 25 Chinese cities (2014-2019). Employing an instrumental variable approach based on wind d...
This study examines how air pollution affects household food consumption using high-frequency data from over 30,000 households in 25 Chinese cities (2014-2019). Employing an instrumental variable approach based on wind direction, we find that a one-standard-deviation increase in PM2.5 raises weekly expenditure on healthy foods, such as fruits, vegetables, and dairy, by 9.3 yuan, or 11 % of the within-household standard deviation. Spending on less healthy foods remains unaffected, suggesting targeted adjustments toward nutrient-dense foods. These changes improve nutrient intake but are immediate and transitory, with no evidence of lasting dietary shifts. The effects are stronger for higher-income households and those with elderly members, reflecting health concerns and financial flexibility, while lower-income households show constrained responses. Air pollution also reduces dining out expenditures, indicating a substitution toward home-prepared meals. These findings highlight air pollution's welfare costs, socioeconomic disparities, and the need for equitable public health policies.
When do supply-side drug control policies save lives? Evidence from pharmacy methadone restrictions.
Donahoe JT, Drake C
J Health Econ · 2025 Dec · PMID 41005013 · Publisher ↗
The literature commonly finds that supply-side drug control policies are an ineffective response to drug epidemics because they cause substitution to more dangerous illicit drugs. We document a policy that was implemente...
The literature commonly finds that supply-side drug control policies are an ineffective response to drug epidemics because they cause substitution to more dangerous illicit drugs. We document a policy that was implemented in response to the intertwined methadone and prescription opioid epidemics in the U.S. in the early 2000s and that sharply contradicts this. In 2008, the U.S. Drug Enforcement Administration and drug manufacturers halted shipments of highly potent methadone formulations to all pharmacies nationwide due to concerns over their involvement in rising overdose death rates. However, rather than causing substitution to illicit drugs, we show this response caused substitution to safer methadone products and prevented roughly 1,600 overdose deaths over a two-year period. Findings underscore that supply-side drug control policies can be effective responses to drug epidemics in contexts where they are appropriately targeted to push consumers towards safer rather than more harmful substances.
Seasonal allergies and mental health: Do small health shocks affect suicidality?
Abramowitz J, Danagoulian S, Fleming O
J Health Econ · 2025 Dec · PMID 40987249 · Publisher ↗
Suicide rates increased 37% in the US from 2000 to 2018; while structural factors are extensively studied, short-term triggers remain less understood. We examine the impact of small exogenous shocks - allergies triggered...
Suicide rates increased 37% in the US from 2000 to 2018; while structural factors are extensively studied, short-term triggers remain less understood. We examine the impact of small exogenous shocks - allergies triggered by seasonal pollen - on suicides. Pollen allergies diminish cognitive function and disrupt sleep-predictors of suicidality. Combining disparate datasets across 34 localities in the United States from 2006 to 2018, we use a specification with granular fixed effects to identify the effect of pollen on suicides from daily variation in each. We find that as pollen levels rise, the count of suicides in a county increases - up to 7.4% more suicides when pollen levels at their highest levels. We find that individuals with a known mental health condition or treatment have 8.6% higher incidence of suicides on days with highest pollen. We also show that this effect is not spurious - Google searches for allergy and depression symptoms increase substantively as pollen levels rise. These estimates are robust to multiple specifications. As climate change extends and intensifies the pollen season, we expect its impact to more than double the number of suicides by the end of the century. These results point toward the importance of relatively small exogenous shocks on suicidality and the potential for relatively inexpensive and routine health care measures such as allergy testing and treatment to improve mental health.
Impact of primary care market mergers on quality: Evidence from the English NHS.
Lyu Y, Zhang Z
J Health Econ · 2025 Dec · PMID 40972463 · Publisher ↗
The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing th...
The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing the first empirical evidence on the effects of provider mergers on quality, using evidence from the English primary care market. Examining all provider mergers from 2014 to 2018, we find that mergers improve certain aspects of clinical quality management, but they do not translate into broader population-level clinical quality gains, and patient satisfaction declines significantly. Importantly, the effects vary by merger motivation and the size of the merging parties, rather than their geographic proximity. Survival-driven mergers help sustain care quality and patient access, whereas efficiency-driven mergers lead to greater quality deterioration. Mergers between larger practices also lead to more negative outcomes than those involving smaller practices. In contrast, we find no significant difference between within-market and cross-market mergers. An exploration of the mechanism reveals that changes in market concentration do not explain the observed quality outcomes. Instead, shifts in workforce composition, driven by the underlying merger motivations, play a key role.
The effect of peers' genetic predisposition to depression on own mental health.
Jeong Y
J Health Econ · 2025 Dec · PMID 40961878 · Publisher ↗
This paper studies how peers' genetic predisposition to depression affects own mental health during adolescence and early adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (Add Healt...
This paper studies how peers' genetic predisposition to depression affects own mental health during adolescence and early adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). I exploit variation within schools and across grades in same-gender grademates' average polygenic score-a linear index of genetic variants-for major depressive disorder (the MDD score). An increase in peers' genetic risk for depression has immediate negative impacts on own mental health. A one standard deviation increase in same-gender grademates' average MDD score significantly increases the probability of being depressed by 1.9 and 3.8 percentage points for adolescent girls (a 7.2% increase) and boys (a 25% increase), respectively. The effects persist into adulthood for females, but not males. I explore several potential mechanisms underlying the effects and find that an increase in peers' genetic risk for depression in adolescence worsens friendship, increases substance use, and leads to lower socioeconomic status. These effects are stronger for females than males. Overall, the results suggest that there are important social-genetic effects in the context of mental health.
Algorithmic decision-making in health care: Evidence from post-acute care in Medicare Advantage.
Marr J
J Health Econ · 2025 Dec · PMID 40929928 · Publisher ↗
Health insurers use predictive algorithms to determine the necessary level of care and deny services they deem unnecessary. Using a difference-in-differences design, I study the partnership of a large Medicare Advantage...
Health insurers use predictive algorithms to determine the necessary level of care and deny services they deem unnecessary. Using a difference-in-differences design, I study the partnership of a large Medicare Advantage insurer with a firm that uses a predictive algorithm to aid post-acute care coverage decisions. This partnership led to an immediate and sustained 13 percent decline in the length of skilled nursing facility stays. This effect was partially driven by large declines in longer skilled nursing facility stays (over 30 days). Despite reductions in health care use, I do not observe changes in health outcomes following the adoption of the predictive algorithm.
Longevity, Education, and Income: How large is the triangle?
Bleakley H
J Health Econ · 2025 Sep · PMID 40885078 · Full text
While health affects economic development and wellbeing through a variety of pathways, one commonly suggested channel is a "horizon" mechanism in which increased longevity induces additional education. A recent literatur...
While health affects economic development and wellbeing through a variety of pathways, one commonly suggested channel is a "horizon" mechanism in which increased longevity induces additional education. A recent literature devotes much attention to how much education responds to increasing longevity, while this study asks instead what impact this specific channel has on wellbeing (welfare). I note that death is like a tax on human-capital investments, which suggests using a standard tool of introductory economics: triangles. I estimate the (triangular) gain from reoptimization when education adjusts to lower adult mortality. Even for implausibly large responses of education to survival differences, almost all of today's low-human-development countries, if switched instantaneously to Japan's survival curve, would place a value on this channel of less than 3% of income. (This contrasts with a 40% 'rectangle' that they would gain even if education were held fixed.) Calibrating the model instead with well identified studies, I find that the horizon triangle for the typical low-income country is less than a percent of lifetime income.
Nonlinear reimbursement rules for preventive and curative medical care.
Cremer H, Lozachmeur JM
J Health Econ · 2025 Sep · PMID 40882553 · Publisher ↗
This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforeha...
This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforehand, while curative care is decided after health status is known. In an ideal scenario where health status is observable, optimal insurance provides lump-sum payments unrelated to expenditures. However, when severity is unobservable (causing ex post moral hazard), this approach is not incentive-compatible. Instead, optimal insurance designs benefits that increase with both preventive and curative care, as higher expenditures reduce informational rents and align incentives. Preventive care, though chosen before illness occurs, affects incentive constraints due to two factors: (1) it is more effective for severely ill individuals, and (2) they have lower marginal utility of income, meaning preventive expenditures impact them less. These effects shape the optimal reimbursement structure. Additionally, when individuals misperceive preventive care benefits, the main results hold, but an extra corrective (Pigouvian) term appears in the reimbursement formula to adjust for this misperception.
Using stock price movements to estimate the harm from collusive drug patent litigation settlements.
Drake KM, McGuire TG
J Health Econ · 2025 Sep · PMID 40882552 · Publisher ↗
The tradeoff between incentives to invest in R&D and efficient pricing takes a special form in the pharmaceutical sector. Brand drugs command high prices until generic competition begins, the timing of which usually depe...
The tradeoff between incentives to invest in R&D and efficient pricing takes a special form in the pharmaceutical sector. Brand drugs command high prices until generic competition begins, the timing of which usually depends on the outcome of patent infringement litigation. One potential outcome is a collusive agreement between the brand and a potential generic competitor that delays competition, with the brand sharing the profits from the delay by paying the generic challenger. Collusive patent settlements have plagued competition in pharmaceutical markets globally and especially in the U.S., the world's largest market. This paper estimates the cost of these collusive settlements to U.S. drug purchasers using stock price movements. If the brand firm's increase in profits from collusion is capitalized into stock prices, the change in value upon a settlement announcement can be used to estimate the new profit flows from higher prices to purchasers. We assembled data on 64 settlements reached during 2014-2023 and used the announcement descriptions and information that surfaced later to identify 17 potentially collusive settlements. We applied event study methods and found, consistent with prior research, that settlement announcements with no indication of collusion had no significant effect on the stock prices of brand firms implying that they tended to meet traders' expectations. Stock prices increased by approximately 3.5 %, on average, after settlements with an indication of collusion, implying they increased brand profits by delaying generic entry. These increases correspond to a total increase in U.S. purchaser spending of $3.1-$3.2 billion per year during 2014-2023. Factoring up our estimate to the entire industry implies the increase in spending may be closer to $12 billion per year.
The effect of housing wealth on health care spending.
Lovenheim MF, Yun JH
J Health Econ · 2025 Sep · PMID 40845724 · Publisher ↗
The U.S. healthcare system requires substantial out-of-pocket payments by most consumers, which can prevent some from receiving needed medical services. At the same time, housing wealth comprises a significant proportion...
The U.S. healthcare system requires substantial out-of-pocket payments by most consumers, which can prevent some from receiving needed medical services. At the same time, housing wealth comprises a significant proportion of household wealth that could be used to pay for medical care. We analyze the effects of housing wealth on out-of-pocket medical expenditures among older homeowners. Using data from the Health and Retirement Study and various measures of home price changes, we find no evidence that housing wealth impacts out-of-pocket medical spending. The estimates are universally small and precise, allowing us to rule out even modest-sized effects. Effects are zero across the expenditure distribution, for specific categories of expenditure, and for different types of homeowners split by health insurance status and SES. We present suggestive evidence that our results represent a mix of homeowners not needing to access their housing wealth for additional medical care and being unwilling or unable to access their home equity.
Firm quality and health maintenance.
Bíró A, Elek P
J Health Econ · 2025 Sep · PMID 40840086 · Publisher ↗
We estimate the impact of firm quality - primarily measured by the firm-level wage premium - on the health maintenance of employees. Using linked employer-employee administrative panel data from Hungary, we analyze the d...
We estimate the impact of firm quality - primarily measured by the firm-level wage premium - on the health maintenance of employees. Using linked employer-employee administrative panel data from Hungary, we analyze the dynamics of healthcare use before and after moving to a new firm. We show that moving to a higher-paying firm leads to higher consumption of drugs for cardiovascular conditions and more diagnostic and primary care visits, without evidence of deteriorating physical health, and, among men and older workers, to lower consumption of medications for mental health conditions. The results are robust to using alternative firm quality indicators based on productivity and worker flows, and to controlling for firm size, individual wage, and possible peer effects. The results suggest that higher-paying firms provide beneficial health-related amenities via the detection of previously undiagnosed chronic physical illnesses and improved mental health. Plausible mechanisms include higher-quality occupational health check-ups and less stressful working conditions.
Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan's local government response to national policy.
Oikawa M, Otake T, Awatani T … +2 more , Noguchi H, Kawamura A
J Health Econ · 2025 Sep · PMID 40834513 · Publisher ↗
This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the heal...
This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the health outcomes and behaviors of self-employed and unemployed populations, which have been largely overlooked by previous research. To address this, we applied a dosing difference-in-differences (DID) estimation method, exploiting variation in treatment intensity across municipalities. The DID estimation reveals that the SHC-SHG introduction led to a reduction in the proportion of people diagnosed with lifestyle-related diseases in the municipalities that required significant increases in per-capita health checkup program expenses to comply with the new program, with a more pronounced impact on those with multiple diagnoses compared to those with a single diagnosis. A subgroup analysis indicates that health improvements following the SHC-SHG introduction were observed among self-employed workers and homeowners, whereas such improvements were not evident among the unemployed and renters. Moreover, we identify significant behavioral changes among the population in the high-expansion municipalities following the policy introduction. A back-of-the-envelope calculation demonstrates the municipal response to the SHC-SHG introduction is cost-effective.
The effects of state paid sick leave mandates on parental childcare time.
Maclean JC, Pabilonia SW
J Health Econ · 2025 Sep · PMID 40819518 · Full text
The U.S. lacks a federal paid sick leave policy. To date, 18 states and the District of Columbia have adopted or announced paid sick leave mandates that require employers to provide up to seven days of paid leave per yea...
The U.S. lacks a federal paid sick leave policy. To date, 18 states and the District of Columbia have adopted or announced paid sick leave mandates that require employers to provide up to seven days of paid leave per year that can be used for family responsibilities and healthcare. Using time diaries from the 2004-2023 American Time Use Survey and difference-in-differences methods, we estimate the effects of these state paid sick leave mandates on parents' time spent providing childcare. We find that post-mandate, parental time spent providing primary childcare time increases by 5.8%, with effects being driven by women with younger children. Parents also increase their total time with children by 3.4%, and fathers living with school-aged children only increase their time supervising children while participating in leisure activities by 11.9%. Overall, our findings suggest that paid sick leave mandates allow working parents to better balance work and childcare responsibilities.
Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees.
Hegland TA
J Health Econ · 2025 Sep · PMID 40812202 · Publisher ↗
Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to at...
Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.
Prescribing power and equitable access to care: Evidence from pharmacists in Ontario, Canada.
Hoagland A, Wang G
J Health Econ · 2025 Sep · PMID 40812201 · Publisher ↗
Allowing pharmacists to directly treat patients may increase equitable access to healthcare and improve patient outcomes, but raises concerns about supply-side moral hazard or patient substitution away from regular physi...
Allowing pharmacists to directly treat patients may increase equitable access to healthcare and improve patient outcomes, but raises concerns about supply-side moral hazard or patient substitution away from regular physician-based care. We study the effects of a 2023 policy allowing pharmacists to prescribe for minor ailments in Ontario, Canada. We use Advan foot traffic data to measure how this policy affected visits to pharmacies and generated spillover effects on visits to non-pharmacy medical facilities (Research, 2022). Allowing pharmacists to prescribe led to a 16% increase in total visits to pharmacies and a 3% increase in visits to other providers. These increases were concentrated in materially deprived neighborhoods and benefited non-minority, non-immigrant populations the most. We use the policy as exogenous variation to identify substitution elasticities between pharmacy visits and traffic to other medical facilities. Overall, 20% of the increase in traffic to pharmacies spills over into increased use of outpatient-based care. Pharmacy traffic is a substitute for visits to hospitals and emergency departments, potentially as patients rely on pharmacists for triaging rather than emergency care.
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