Intergenerational health mobility is an important marker of health opportunity and equity, yet empirical research in this field remains sparse, particularly concerning the effects of public policies. We present the first...Intergenerational health mobility is an important marker of health opportunity and equity, yet empirical research in this field remains sparse, particularly concerning the effects of public policies. We present the first empirical evidence of the effects of the Earned Income Tax Credits (EITC), one of the largest and most effective anti-poverty programs in the US, on intergenerational health mobility. We use self-reported health status from the Panel Study of Income Dynamics and explore temporal, geographic, and family structure variations in childhood exposure to maximum EITC benefits. We find that the EITC generally improved intergenerational health mobility, especially upward health mobility.
This study examines the role of Artificial Intelligence (AI) in reducing medical overtreatment, a critical healthcare challenge that increases costs and patient risks. In two experiments - with 196 physicians at a hospit...This study examines the role of Artificial Intelligence (AI) in reducing medical overtreatment, a critical healthcare challenge that increases costs and patient risks. In two experiments - with 196 physicians at a hospital and 120 students at a medical school in Wuhan - we use a novel medical prescription task under three incentive schemes: flat (constant pay), progressive (pay increases with treatment quantity), and regressive (penalties for overtreatment) to estimate receptivity to AI assistance and its effects on overtreatment and treatment accuracy, and test whether effects vary with incentives. AI recommendation of a treatment is estimated to increase the probability a physician prescribes it by 25.7-28.4 percentage points (pp), with the largest effect under the flat scheme. Physicians are more receptive to AI recommendations in medical domains with which they are less familiar. We estimate that AI assistance reduces the probability a physician overtreats by 10.9-25.7 pp (15.2-80.3%), with significantly larger absolute and relative effects under the flat scheme compared to progressive and regressive schemes. AI assistance improves physicians' treatment accuracy by 9.8-13.3 pp (14.6-19.9%), with the largest absolute effect under the regressive scheme. These findings are corroborated by the medical school experiment, which reveals that factors indicative of insufficient ability account for 34% of the explained variation in overtreatment, monetary incentives account for 22%, patient welfare considerations account for 20%, and factors related to defensive medicine for 10%. These results provide valuable insights for healthcare administrators considering AI integration into healthcare systems.
This paper examines the intergenerational consequences of parental participation in government social insurance programs, using one of the largest social insurance programs in the world: sick leave. We exploit quasi-rand...This paper examines the intergenerational consequences of parental participation in government social insurance programs, using one of the largest social insurance programs in the world: sick leave. We exploit quasi-random assignment of patients to general practitioners (GPs) in Norway, who vary in their propensity to certify sick leave of different lengths, to estimate the effects of access to longer sick leave for the marginal individual. Linking administrative data on patients and their children, we show that assignment to a more lenient GP lowers children's GPA in adolescence, reduces the likelihood of completing upper secondary education, and decreases enrollment in higher education. These effects appear to operate through changes in parental trajectories: more sick leave leads to lower long-term earnings, greater reliance on welfare, and deterioration in mental health.
Both contraception and abortion result in fertility reductions, but whether they are substitutes remains an open question. In 2013, Texas passed House Bill 2 (HB2), a policy that imposed strict regulations on abortion pr...Both contraception and abortion result in fertility reductions, but whether they are substitutes remains an open question. In 2013, Texas passed House Bill 2 (HB2), a policy that imposed strict regulations on abortion providers. Using administrative outpatient records from Texas, we exploit the passage of HB2 to identify the effects of restricted abortion access on the timing and demand for intrauterine devices (IUDs) and vasectomies using an event study design. We find evidence that expectations of limited abortion access significantly increase the demand for IUDs, with no effect on the incidence of vasectomies. These findings support the hypothesis that abortion and contraception are substitutes, particularly for individuals with the capacity to become pregnant.
The increased use of nurse practitioners (NPs) to provide healthcare represents an important policy option to expand access to care. However, restrictive scope-of-practice laws limit NPs' ability to deliver care in about...The increased use of nurse practitioners (NPs) to provide healthcare represents an important policy option to expand access to care. However, restrictive scope-of-practice laws limit NPs' ability to deliver care in about half of all states. I examine the effect of relaxing these laws (by granting NPs full practice authority) on hospital discharges for conditions classified as prevention quality indicators (PQIs) across 22 states between 2010 and 2019. PQIs measure hospital admissions that may be avoidable with timely outpatient care. I find that full practice authority reduces avoidable hospitalizations for diabetes and other chronic conditions, with particularly consistent effects among privately insured patients. Hospital stays for PQI conditions become longer on average, suggesting that relatively healthier patients are more likely to avoid hospitalization. These results indicate that full practice authority improves access to outpatient care and allows for more efficient use of inpatient resources.
The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the...The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions-specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.
Existing evidence has found that abortion restrictions result in fewer and delayed abortions. Such restrictions may indirectly affect child wellbeing both through changes in births and for existing children in the home t...Existing evidence has found that abortion restrictions result in fewer and delayed abortions. Such restrictions may indirectly affect child wellbeing both through changes in births and for existing children in the home through mechanisms including substantial financial strains, negative health consequences, and intra-household power dynamics. Following the Dobbs decision, state-level abortion decisions have led to significantly greater abortion restrictions. We investigate the effects of abortion access on child welfare involvement using data from the National Child Abuse & Neglect Data System (NCANDS). We utilize pre- and post-Dobbs data from 2017-2023, and estimate both difference-in-differences and event study methods, using both distance changes and policy changes. We find that increased distance to nearest abortion care is associated with higher rates of CPS referrals. Our findings provide critical insights into the broader social and health implications of abortion restrictions in post-Dobbs.
How does the internet affect young people's mental health? We study this question using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we comb...How does the internet affect young people's mental health? We study this question using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we combine with broadband internet availability at the municipal level. Broadband internet access raises the prevalence of mental disorders among younger cohorts (born between 1985 and 1995) by 0.08 standard deviation units, but it does not impact older individuals (1974 and 1984). The adverse effects are driven by individuals who were exposed early in their lives (before the age of 20). These effects persist when examining instances of self-harm and urgent or compulsory hospitalizations, indicating that the negative outcomes are not merely a result of increased awareness and detection of these conditions. The detrimental impacts span across different pathologies, including depression, anxiety, drug abuse, and personality disorders for both genders, in addition to eating disorders for females.
This study examines the causal impact of informal caregiving on labour market outcomes and well-being using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We combine an event study desig...This study examines the causal impact of informal caregiving on labour market outcomes and well-being using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We combine an event study design with an instrumental variable (IV) strategy, leveraging exogenous variation from serious illness or injury to a family member. Event study results show that health shocks significantly increase informal caregiving, with particularly large effects for women and older individuals. These shocks also lead to reductions in employment among these groups, as well as declines in hours worked, worsening mental health, and increased reliance on government support and early retirement. To isolate the causal effect of caregiving, we instrument caregiving with the timing of the health shock. IV estimates indicate that assuming caregiving responsibilities leads to large reductions in labour supply-weekly work hours fall by 9.7 h for main carers and up to 22.5 h for carers of partners. Our findings highlight the substantial economic costs of informal caregiving, with important implications for labour force participation in an ageing society.
Dave D, Liang Y, Maclean JC
… +2 more, Muratori C, Sabia JJ
J Health Econ
· 2025 Aug · PMID 40633435
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Public health advocates warn that the rapid growth of legal markets for electronic nicotine delivery systems (ENDS) may generate a "gateway" to marijuana and harder drug consumption, particularly among teenagers. This st...Public health advocates warn that the rapid growth of legal markets for electronic nicotine delivery systems (ENDS) may generate a "gateway" to marijuana and harder drug consumption, particularly among teenagers. This study explores the effects of ENDS taxes on substance use. Analyses are based on difference-in-differences and event-study methods applied to both survey (Youth Risk Behavior Surveillance System and Behavioral Risk Factor Surveillance System) and administrative (Treatment Episode Data Set) data. Our results imply that a one-dollar increase in ENDS taxes (2023$) is associated with a 1.0 to 1.5 percentage point decline in teen marijuana use and in co-use of ENDS and marijuana. This result is consistent with e-cigarettes and marijuana being economic complements. We also find that youth responses to ENDS taxes, in terms of their ENDS use and spillovers into marijuana use, appear to moderate over the longer term. We find no evidence that ENDS taxes affect drug treatment admissions or consumption of illicit drugs other than marijuana such as cocaine, methamphetamine, or opioids.
Saxby K, Buchmueller T, de New SC
… +1 more, Petrie D
J Health Econ
· 2025 Aug · PMID 40627940
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Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities,...Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72 % and 19 % of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related Emergency Department presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions.
Lee D, Basu A, Dugan JA
… +1 more, Karaca-Mandic P
J Health Econ
· 2025 Aug · PMID 40609169
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The paper examines whether, among inpatient psychiatric admissions in California, for-profit (FP) hospitals engage in cream skimming, i.e., selecting patients for some characteristic(s) other than their need for care, wh...The paper examines whether, among inpatient psychiatric admissions in California, for-profit (FP) hospitals engage in cream skimming, i.e., selecting patients for some characteristic(s) other than their need for care, which enhances the profitability of the provider. We propose a novel approach to identifying cream skimming using cost outcomes. Naïve treatment effect estimates of hospital ownership type consist of the combined effects of differential patient case mix (selection) and hospital cost containment strategies (execution). In contrast, an instrumental variable (IV) approach can control for case mix and establish the causal effects of ownership type due to its execution. We interpret the difference between the naïve and IV treatment effects to be driven by FP hospitals' selection based on unobserved patient case mix. Our findings on patient selection show that FP hospitals are more likely than their not-for-profit (NFP) counterparts to admit higher-cost patients (who tend to be less profitable under the existing inpatient psychiatric care payment systems), providing no evidence of cream skimming by FP hospitals. Furthermore, our estimates of hospital execution indicate that FP hospitals are more likely than NFP hospitals to deliver inpatient services at lower costs. These results may alleviate concerns about the recent proliferation of FP psychiatric hospitals, particularly regarding cream skimming in this market.
J Health Econ
· 2025 Aug · PMID 40602200
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This paper explores the role of gender heterogeneity in the social diffusion of obesity among adolescents and its policy implications. We propose a social interaction model which allows for gender-dependent heterogeneity...This paper explores the role of gender heterogeneity in the social diffusion of obesity among adolescents and its policy implications. We propose a social interaction model which allows for gender-dependent heterogeneity in peer effects. Our empirical approach is consistent with the best response functions of a non-cooperative model where social interactions stem from the channel of pure spillover or pure conformity. We estimate the model using data on adolescent Body Mass Index and network-based interactions. Our approach allows us to account for network endogeneity. Our results show that peer effects are gender-dependent, and male students are particularly responsive to the weight of their female friends. According to simulations, reaching out to women results in an 8% increase in effectiveness in reducing overall BMI, based on the most conservative scenario. Thus, female-tailored interventions are likely to be more effective than a gender-neutral approach to fighting obesity in schools.
Cotti C, Courtemanche C, Liang Y
… +3 more, Maclean JC, Nesson E, Sabia JJ
J Health Econ
· 2025 Aug · PMID 40602199
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Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Beha...Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Behavioral Risk Factor Surveillance Survey, and Population Assessment of Tobacco and Health), this study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. We find robust evidence that the adoption of an ENDS flavor restriction reduces short-run frequent and everyday ENDS use among youths by approximately two-to-three percentage-points. Some evidence suggests that this effect weakens after two years. We also document reductions in ENDS use among young adults aged 18-30 that appear to strengthen after two years. Finally, evidence suggests substitution from flavored ENDS to unflavored ENDS and cigarettes among certain age groups.
J Health Econ
· 2025 Aug · PMID 40602198
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The provision of public health insurance through regulated markets requires a dynamic procurement of insurers over time. Using data from Medicaid managed care bids, I study the impacts of regulators' decision to drop an...The provision of public health insurance through regulated markets requires a dynamic procurement of insurers over time. Using data from Medicaid managed care bids, I study the impacts of regulators' decision to drop an insurer from the market on health care use among affected enrollees, who must switch to another health plan. Using a difference-in-differences framework, I find that after a plan is replaced, enrollees from the exiting plan have fewer visits to primary care physicians, lower utilization of prescription drugs, including those for chronic conditions, and more hospital admissions. These disruptions disproportionately affect sicker enrollees, particularly children and non-white beneficiaries. In the year following the exit, insurers' spending on enrollees from exiting plans is 7% lower than the pre-exit baseline. Changes in provider networks and drug formularies may serve as mechanisms.
J Health Econ
· 2025 Aug · PMID 40570596
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We provide new evidence on how child-related career interruptions affect long-term health behaviors by examining the impact of maternal leave duration on smoking habits across 14 European countries. Linking data on mater...We provide new evidence on how child-related career interruptions affect long-term health behaviors by examining the impact of maternal leave duration on smoking habits across 14 European countries. Linking data on maternity and parental leave policies from 1960 to 2010 with survey data on mothers' health behaviors, birth, and employment histories, we identify the effects of absence from work due to child birth on lifetime smoking in an instrumental variable framework based on within- and between-country variations in policies. We find that a one-month increase in leave duration raises the probability of a mother smoking later in life by 1.2 percentage points. Additionally, a one-month increase in child-related absence from work extends the lifetime duration of smoking by 7 months, the number of cigarettes smoked per day by 0.2 cigarettes, and the number of pack years by 0.6. We document potential non-linearities in these effects, suggesting that shorter leave durations may have a protective effect, while very long absence from work could promote harmful health behaviors. Heterogeneity analyses reveal that the observed effects are mediated by the partners' lack of financial support around childbirth, while employment status and other socio-demographic characteristics do not play a significant role.
J Health Econ
· 2025 Aug · PMID 40554857
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The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked...The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts. We find increases in COVID-19 infection rates, with larger differences in low-income and higher COVID-19 prevalence counties.
J Health Econ
· 2025 Aug · PMID 40554856
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Time Trade-Off (TTO) and Standard Gamble (SG) tasks are commonly used methods to measure utilities for health states (e.g., diabetes, being in a wheelchair). Importantly, however, the two methods have been shown to typic...Time Trade-Off (TTO) and Standard Gamble (SG) tasks are commonly used methods to measure utilities for health states (e.g., diabetes, being in a wheelchair). Importantly, however, the two methods have been shown to typically yield discrepant utilities for a given health state. Here we examine the cognitive processes underlying this utility gap by analyzing individuals' attentional patterns when evaluating health states in the TTO and SG tasks. In an online experiment, each respondent completed both a TTO and an SG task and we used the process-tracing methodology Mouselab to record respondents' attention allocation to the tasks' attributes: health states and their durations (in both TTO and SG), and probabilities (in SG only). In the TTO task, attention was approximately balanced between the health state and duration attributes, whereas in the SG task, attention was focussed on the probability and the health state attributes. Individuals who paid more attention to the task-specific trade-off attribute (i.e., duration and probability in TTO and SG, respectively) seemed to be less willing to make those trade-offs, leading to higher utilities for the health states. Notably, the utility gap was associated with individual differences in attention allocation: respondents who adjusted their attention allocation less to the task-specific trade-offs produced more discrepant utilities between the TTO and SG tasks. Our findings underscore the key role of attentional processes in preference construction, highlighting that differences in the utilities people assign to health states could potentially be influenced by altering attention allocation.
J Health Econ
· 2025 Aug · PMID 40550185
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We estimate welfare weights for health to facilitate program evaluation allowing for aversion to health inequality and to health inequity by three non-health characteristics. In a UK general population sample, 569 online...We estimate welfare weights for health to facilitate program evaluation allowing for aversion to health inequality and to health inequity by three non-health characteristics. In a UK general population sample, 569 online experiment participants distribute constrained resources to determine the health of hypothetical individuals distinguished by randomly generated resource productivity as well as sex, income and smoking (41,460 observations). We elicit beliefs about responsibility for income and smoking, and use their associations with the allocations to estimate responsibility-sensitive weights for health by those two characteristics. We find weak prioritisation of females' health, moderate prioritisation of the health of poorer individuals and strong prioritisation of the health of non-smokers over that of smokers. Substantial aversion to health inequality lowers weights on females and non-smokers, who are health-advantaged, and raises the weight on the poor, who are health-disadvantaged. As beliefs about responsibility for income and smoking strengthen, weights on the poor decrease and weights on non-smokers significantly increase.