J Health Econ
· 2025 Aug · PMID 40544523
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This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individ...This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individuals' minimum and maximum subjective probabilities of different health outcomes, and define belief imprecision as the range between these values. We document substantial heterogeneity in the degree of imprecision across respondents, which remains largely unexplained by standard demographic characteristics. To assess the behavioral impact of imprecise beliefs, we ask beliefs about future outcomes under hypothetical scenarios that feature different levels of protective behaviors. We find that individuals who expect protective behaviors to reduce not only the subjective probability of a negative health outcome, but also the degree of imprecision associated with it, behave more protectively.
Horwitz JR, Nichols A, Yu A
… +2 more, Colla CH, Cutler DM
J Health Econ
· 2025 Aug · PMID 40543423
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Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws an...Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.
J Health Econ
· 2025 Aug · PMID 40540757
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In this study, we examine the inter-generational effects of the 1994 Female Secondary School Stipend Program (FSSSP) on child health inputs and child health outcomes in Bangladesh. Prior studies have shown that the FSSSP...In this study, we examine the inter-generational effects of the 1994 Female Secondary School Stipend Program (FSSSP) on child health inputs and child health outcomes in Bangladesh. Prior studies have shown that the FSSSP significantly increased secondary schooling among rural girls. Applying a difference-in-differences model based on differential exposure to FSSSP by birth cohort and rural residence, we find that full immunization rates increased by 4.2 percentage points among children of mothers eligible for a stipend for 5 years relative to children of mothers who were not eligible, but there were no significant effects for children of mothers eligible for a stipend for only 2 years. We also find improvements in other health inputs (e.g., antenatal care) and in child health outcomes (e.g., mortality). We also explore changes in marriage, fertility, autonomy, labor supply, and media exposure, which may contribute to the observed improvements in child health.
J Health Econ
· 2025 Aug · PMID 40532383
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Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and in...Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.
J Health Econ
· 2025 Aug · PMID 40499331
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Although ordinal health outcome values are categories like "poor" health or "moderate" depression, they are often assigned values 1,2,3,… for convenience. We provide results on interpretation of subsequent analysis based...Although ordinal health outcome values are categories like "poor" health or "moderate" depression, they are often assigned values 1,2,3,… for convenience. We provide results on interpretation of subsequent analysis based on ordinary least squares (OLS) regression. For description, unlike for prediction, the OLS estimand's interpretation does not require that the 1,2,3,… are cardinal values: it is always the "best linear approximation" of a summary of the conditional survival functions. Further, for Blinder-Oaxaca-type decomposition, the OLS-based estimator is numerically equivalent to a certain counterfactual-based decomposition of the survival function, again regardless of any cardinal values. Empirically, with 2022 U.S. data for working-age adults, we estimate a higher incidence of depression in the rural population, and we decompose the rural-urban difference. Including a nonparametric estimator that we describe, estimators agree that 33%-39% of the rural-urban difference is statistically explained by income, education, age, sex, and geographic region. The OLS-based detailed decomposition shows this is mostly from income.
Arenas-Arroyo E, Fernandez-Kranz D, Nollenberger N
J Health Econ
· 2025 Aug · PMID 40480010
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We exploit variations in fiber optic (FTTH) deployment to assess the impact of high-speed internet access on adolescent mental health. Our findings reveal that FTTH access increases addictive Internet usage and reduces t...We exploit variations in fiber optic (FTTH) deployment to assess the impact of high-speed internet access on adolescent mental health. Our findings reveal that FTTH access increases addictive Internet usage and reduces time allocated to sleep, homework, as well as social interactions with family and friends. Access to FTTH increases mental health diagnoses in hospitals and contributes to a notable rise in adolescent suicide rates, particularly among girls. As new platforms and apps gain traction among adolescents, understanding the impact of connectivity improvement becomes important. This is especially relevant given the current FTTH growth replacing older broadband technologies.
J Health Econ
· 2025 Aug · PMID 40466290
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This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence w...This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence with increased attention to so-called "deaths of despair." The main takeaway is that although declining psychological health has likely contributed to adverse mortality trends-especially among prime-age non-Hispanic Whites-its overall impact is limited and not well captured by standard definitions of "deaths of despair." Five key findings support this conclusion. First, mental health deteriorated between 1993 and 2019 for all population groups examined. Second, these declines are associated with higher predicted death rates and help explain worsening mortality trends for prime-age non-Hispanic Whites and, to a lesser extent, non-Hispanic Blacks between 1999 and 2019. Third, while these correlations lend some support to the broader idea of "deaths of despair," the specific causes comprising them appear to be both more expansive and different from those previously emphasized. Fourth, heterogeneity in how worsening mental distress affects mortality-rather than in mental health trends themselves-is more important in explaining Black-White disparities in its overall impact. Finally, in the primary specifications, deteriorating mental health accounts for an estimated 9 % to 29 % of the rise in mortality rates among prime-age Whites in recent years.
J Health Econ
· 2025 Aug · PMID 40460756
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We estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a...We estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a destination country. Using a standard Difference-in-Differences model, we estimate a decline between 60% and 70% in voluntary pregnancy termination (VPT) rates for the new EU citizens from the two Eastern countries. We also introduce a novel framework to separate the total effect of the enlargement into a "citizenship" effect due to (legal or illegal) migrants already present in Italy and a "selection" effect due to new flows of immigrants. We show that the findings are robust to several alternative explanations. The drop in abortions points to legal status as a way to empower immigrant women.
J Health Econ
· 2025 Aug · PMID 40449250
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Patient referrals from primary care physicians (PCPs) to specialists are common in the American health care industry, but are typically made without any knowledge of relative specialist costs. In this study, I estimate t...Patient referrals from primary care physicians (PCPs) to specialists are common in the American health care industry, but are typically made without any knowledge of relative specialist costs. In this study, I estimate the effect of providing such information to PCPs on referral patterns. Implementing a field experiment with an Independent Practice Association (IPA), I sent a list of average costs for new ophthalmology referrals to randomly chosen primary care medical practices. Using administrative referral data, I find that PCPs increased referral share to less costly ophthalmology practices during the first two months after treatment by 4.6 percentage points for each reduction in costliness rank (e.g., each rank closer to the least expensive). Effects were only found for patients for whom the PCPs had cost reduction incentives, and dissipated over the following four months. For the patients whose referrals were affected, I estimate that the expected cost to the IPA of a referral to ophthalmology fell during the first two months by about $80 (45% of pre-intervention referral cost).
Yu S, Lui K, Fiebig DG
… +5 more, Travadi J, Homer CS, Sinclair L, Scarf V, Viney R
J Health Econ
· 2025 Aug · PMID 40398123
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Advances in evidence-based neonatal care have led to large improvements in the survival rates of high-risk newborns. Yet studies have documented wide variation in the care of more prevalent moderate-risk infants, who com...Advances in evidence-based neonatal care have led to large improvements in the survival rates of high-risk newborns. Yet studies have documented wide variation in the care of more prevalent moderate-risk infants, who comprise a much larger proportion of admissions to neonatal care. In this study, we build on a small literature which uses quasi-experimental design to understand the impact of neonatal care, and for the first time, examine this moderate-risk cohort of infants. We use individual-level data on the full population of births in the state of New South Wales, Australia to examine the impact of neonatal care on the healthcare use of moderate-risk infants in the first two years of life. We implement a regression discontinuity design exploiting admission protocols based on birthweight among neonatal units of three different and explicit levels of capability. Unlike previous studies, which examine differences in outcomes across the high-risk cut-off at 1500 g, our study examines differences for moderate-risk infants born near birthweight cut-offs closer to normal birth weight (2500 g). While admission to the neonatal unit jumps across the cut-off, we find modest impacts on downstream healthcare use, including both in-hospital and out-of-hospital care. However, we identify heterogeneous effects across varying capability levels. Moderate risk infants admitted to lower capability neonatal units received more cost-intensive care, resulting in reduced healthcare use following discharge from hospital, while the same was not observed for those admitted to the highest capability units. We suggest that this is due to more aggressive clinical management at lower capability units, and leave this as a priority for future research.
J Health Econ
· 2025 Aug · PMID 40378686
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The share of female physicians has risen in OECD countries in recent decades, but we know little about the effects of physician gender on patient health care use. We exploit quasi-random assignment of primary care provid...The share of female physicians has risen in OECD countries in recent decades, but we know little about the effects of physician gender on patient health care use. We exploit quasi-random assignment of primary care providers (PCPs) to existing PCP practices and patients and estimate the causal effect of female PCPs on health care provision. Using Austrian register data and a difference-in-differences strategy, we find that female PCPs generate 15% less revenue and see 7% fewer patients than male PCPs. Shifting the focus to patient-level outcomes, we observe that health care utilization remains largely unchanged following assignment to a female physician. However, results show that patients are more likely to leave PCP practices with female successors. Our results do not support the idea that the decision to change PCP is driven by preferences against being treated by female physicians. Instead, our analysis suggests that the observed differences are partly explained by female PCPs working fewer hours, especially those facing working time restrictions. As the share of female physicians continues to rise, measures to increase work flexibility may be necessary to maintain broad access to outpatient health care.
J Health Econ
· 2025 Aug · PMID 40347654
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This paper studies the impact of price transparency on healthcare prices, using a natural experiment involving the gradual disclosure of medical procedure prices on a state-run website. The study finds that negotiated al...This paper studies the impact of price transparency on healthcare prices, using a natural experiment involving the gradual disclosure of medical procedure prices on a state-run website. The study finds that negotiated allowed amounts decreased by 5.1% for surgical procedures and 9.1% for radiology procedures, which have higher average allowed amounts and attracted more price requests on the website. In contrast, for lab procedures, the evidence is mixed and does not point to a clear effect. The observed reductions are primarily driven by provider-insurer negotiations rather than patient price shopping. Price reductions were consistent across all providers and insurers, regardless of whether their prices were listed on the transparency website, and extended to providers in neighboring states.
J Health Econ
· 2025 May · PMID 40273508
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Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redi...Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redistributing from low-risk to high-risk individuals in period 1 can increase social welfare, even when the high-risk are not financially penalized. Temporally risk-averse individuals value reductions in the risk to their lifetime utility brought by illness, such as increased morbidity and mortality. A social insurance can achieve this by taxing the low-risk and subsidizing the high-risk. I calibrate a multi-period life-cycle model for breast cancer and Huntington's disease and quantify the optimal redistribution. For these two conditions, which are rare, substantial transfers to the high-risk can be achieved with minimal taxation on the low-risk. Thus, the welfare of the high-risk is substantially improved with little impact on the low-risk.
J Health Econ
· 2025 May · PMID 40253873
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This paper investigates the impact of severe health shocks on labor supply decisions and domestic production within German households. We draw from the German Socio-Economic Panel (SOEP), focusing on individuals aged 25...This paper investigates the impact of severe health shocks on labor supply decisions and domestic production within German households. We draw from the German Socio-Economic Panel (SOEP), focusing on individuals aged 25 to 55 at the time of their first observed health shock. After the health shock, we find that affected individuals suffer a persistent loss in annual gross labor income of around 4,000 euros. This effect results mostly from adjustments at the extensive margin, with labor market participation declining by about 16%. We observe a reduction in full-time employment, but no significant effect on part-time employment. At the household level, a combination of public transfers and added worker effect effectively compensates for the income loss. Finally, individuals experiencing a health shock, particularly women, spend more time on domestic production.
J Health Econ
· 2025 May · PMID 40250027
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International procurement institutions play an important role in drug supply. We study price, delivery, and procurement lead time of drug products for major infectious diseases (antiretrovirals, antimalarials, antituberc...International procurement institutions play an important role in drug supply. We study price, delivery, and procurement lead time of drug products for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007-2017 across procurement institution types. We find that pooled procurement lowers prices: pooling internationally is most effective for small buyers and concentrated markets, while pooling within-country is most effective for large buyers and unconcentrated markets. Pooling can reduce delays, but at the cost of longer anticipated procurement lead times. Finally, pooled procurement is more effective for older drugs, compared to patent pooling institutions that target newer drugs. Our findings are robust to alternative fixed effects specifications, instrumental variable estimation, selection-on-unobservables tests, and additional analyses accounting for heterogeneity in demand elasticities across buyers and interactions with major global health initiatives.
J Health Econ
· 2025 May · PMID 40239324
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This paper examines the long-term impacts of growth and development monitoring in early childhood. For this purpose, we evaluate a public health program, the Systematic Management of Children (SMC), which offers growth a...This paper examines the long-term impacts of growth and development monitoring in early childhood. For this purpose, we evaluate a public health program, the Systematic Management of Children (SMC), which offers growth and development monitoring through routine health checkups for all young children (0-6 years) in China. Using data on the program's county-by-county rollout, we find that full exposure to the SMC from birth increases adult income by 5%. We further provide evidence that the introduction to the SMC leads to improved physical and mental health, better educational outcomes, increased cognitive skills, and sustained use of routine health checkups among adolescents.
J Health Econ
· 2025 May · PMID 40220740
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The sharp growth in physician groups being purchased by hospitals has sparked extensive policy debate, with little evidence on the merits of such integration. We fill the gap by examining care-coordination under integrat...The sharp growth in physician groups being purchased by hospitals has sparked extensive policy debate, with little evidence on the merits of such integration. We fill the gap by examining care-coordination under integration. We exploit the fact that integration varies across MSAs and focus on PPO patients with employment-based moves between MSAs. We develop a mover-stayer model with heterogenous effects to examine whether vertically integrated practices treat patients differently, or whether they just treat different patients. Moving to a more integrated market causes an increase in care coordination indices. Specifically, moving to an area with more specialty care integration causes an increase in team referrals between primary and specialty care, less lab and imaging use, less out-of-network care, and reductions in spending. That is, systems are able to narrow the scope of specialty services overall, hence creating greater social efficiencies. Moving to a market with more integrated primary care causes an increase in preventive care, decreased inpatient use by women, but an increase in spending. JEL I11, L14, C22.
J Health Econ
· 2025 May · PMID 40215827
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We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans' health outcomes using a restricted version of the National Health Interview Survey 1974-2013 and employing the draft lotte...We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans' health outcomes using a restricted version of the National Health Interview Survey 1974-2013 and employing the draft lotteries as an instrumental variable. We conduct inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the "compliers"), as well as for those who volunteer for enlistment (the "always takers"). The causal analysis for volunteers, who represent over 70% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ sharp nonparametric bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 38 years after the end of the Vietnam War. We do not find consistent statistical evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear around 10 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service.