J Health Econ
· 2025 May · PMID 40188536
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We present the first survey-based evidence on infant mortality in a developing country during the COVID-19 pandemic. Employing high-quality, nationally representative data from India, our analyses document a significant...We present the first survey-based evidence on infant mortality in a developing country during the COVID-19 pandemic. Employing high-quality, nationally representative data from India, our analyses document a significant rise in mortality rates among infants during a six month period in 2020 covering the pandemic and the ensuing lockdown. The difference-in-differences estimates show that mortality among infants at ages 1, 3, and 6 months increased by about 9, 13, and 16 deaths per 1000 births, corresponding to an increase of 30, 42, and 44 percent, respectively. Since COVID-19 had minimal direct impact on infant mortality, our estimates likely capture some of the indirect effects on infant mortality through income shocks, reduced healthcare access, and behavioral changes such as avoidance of hospitals for maternal care during this period.
J Health Econ
· 2025 May · PMID 40184879
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We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workp...We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening, they are more likely to remain in the labor force. However, we estimate no statistical differences in any physical or mental health outcomes, and can rule out large effects on overall healthcare utilization. Our findings imply that imposing stricter DI screening can yield large fiscal benefits, on the margin.
J Health Econ
· 2025 May · PMID 40127516
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A strong regularity of human life is Gompertz's law, which predicts a near-perfect exponential increase in mortality with age. In this paper, we take into account that chronological age is not a cause of death and decomp...A strong regularity of human life is Gompertz's law, which predicts a near-perfect exponential increase in mortality with age. In this paper, we take into account that chronological age is not a cause of death and decompose Gompertz's law into two equally strong laws: (i) an exponential increase in health deficits as measured by the frailty index, and (ii) a power law association between the frailty index and the mortality rate. We show how the increase in the frailty index can be derived from the feature of self-productivity of health deficits. We explore the robustness of the Gompertz decomposition across countries, sex, and over time and show how information about mortality rates can be used to infer the state of health of an age-structured population. Finally, we use this method to infer the biological ages of past populations, such as Australians in 1940 and Swedes in 1770.
J Health Econ
· 2025 May · PMID 40112619
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During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibl...During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.
J Health Econ
· 2025 May · PMID 40073727
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This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and ch...This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners' (GPs') working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.
J Health Econ
· 2025 May · PMID 40056863
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We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the mos...We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan's surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.
J Health Econ
· 2025 May · PMID 40054383
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We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles caus...We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes "immune amnesia", leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.
J Health Econ
· 2025 May · PMID 40020262
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The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from ma...The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.
J Health Econ
· 2025 May · PMID 39978179
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Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to...Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.
J Health Econ
· 2025 Mar · PMID 39965357
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Theories of minority stress suggest recent legislation limiting LGBT rights can reduce the health of LGBT individuals and their families. We investigate how the creation of LGBT-free zones across Poland during 2019 and 2...Theories of minority stress suggest recent legislation limiting LGBT rights can reduce the health of LGBT individuals and their families. We investigate how the creation of LGBT-free zones across Poland during 2019 and 2020 affected mental health and mortality. We find that annual suicide attempts increased by 16.5 %, or 5 attempts per 100k, deaths from external causes, including automobile accidents, suicides and other accidents and injuries increased 10.6 %, or 5.6 deaths per 100k, and suicide deaths increased 17.0 % (p = 0.108), or 1.9 deaths per 100k, in LGBT-free zones. The rise in suicide attempts was concentrated among individuals aged 13-18 and 45-49 and coincided with an 8.8 % increase in sales of prescription drugs for addictive disorders. However, there was no change in the use of psychotropic medications used to treat mental health conditions, indicative of limited access to mental health care.
J Health Econ
· 2025 Mar · PMID 39938416
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Studies indicate that mortality increases after income receipt. To explore whether this is due to increased economic activity around the period of receiving income, we examine within-month patterns in ambulance transport...Studies indicate that mortality increases after income receipt. To explore whether this is due to increased economic activity around the period of receiving income, we examine within-month patterns in ambulance transport incidents, focusing on location and timing. Using Japan's National Pension payments made every two months, we compare the number of ambulance transport incidents on the day of pension payment and on surrounding days in payment months with those in non-payment months. The results show a 4.5% increase in ambulance transport incidents on the day of pension payment, linked to increased activities such as gambling, shopping, and dining out. We show suggestive evidence that income receipt boosts economic activities by the mechanism of easing liquidity constraints. These findings have implications for healthcare system preparedness and the optimal design of public benefit payment.
J Health Econ
· 2025 Mar · PMID 39922118
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We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden. We conducted a survey exper...We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden. We conducted a survey experiment in which respondents were shown a photo of a current NIH investigator in which race (Black/White) was randomized. Sex was also randomized as a relevant benchmark. Black respondents reported 0.35 standard deviation units higher interest in participating in a clinical study led by a race concordant investigator (a 12.6% increase). Sex concordance had no effect. Further analyses indicate that perceived trustworthiness and attractiveness are the most important factors explaining these results.
J Health Econ
· 2025 Mar · PMID 39908648
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One in nine Americans smokes cigarettes, and a disproportionate share of smokers suffer from mental illness. Despite this correlation, there exists little rigorous evidence on the effects of smoking cessation on mental h...One in nine Americans smokes cigarettes, and a disproportionate share of smokers suffer from mental illness. Despite this correlation, there exists little rigorous evidence on the effects of smoking cessation on mental health. We re-use data from a randomized trial of a smoking cessation treatment to estimate short and long-term impacts on previously un-analyzed measures of mental distress. We find that smoking cessation increases short-run mental distress, while reducing milder forms of long-run distress. We provide suggestive evidence on mechanisms including physical health, marriage, employment and substance use. Our results suggest that cessation efforts and mental health supports are complementary interventions in the short run and provide new evidence of welfare gains from cessation in the long run.
J Health Econ
· 2025 Mar · PMID 39854793
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Over 2005-2019, the number of neonatal intensive care units (NICUs) grew by 10%, and the number of NICU beds increased by 30%. This expansion in intensive care has raised concerns over unwarranted intensive care admissio...Over 2005-2019, the number of neonatal intensive care units (NICUs) grew by 10%, and the number of NICU beds increased by 30%. This expansion in intensive care has raised concerns over unwarranted intensive care admissions. In this study, we examine whether the greater supply of NICUs causally raises admission rates. Our event-study results show that an additional NICU opening in a county raises the share of newborns admitted to the NICU by 8%. The majority of new NICU admissions come from healthier newborns (2,500 grams and over) rather than very premature newborns (<1,500 grams). Admission for the smallest newborns (those under 1,500 grams) only increases in counties with limited NICU access. In these areas, greater NICU supply also reduces mortality, but only for very small newborns (<1,500 grams). Together, our findings suggest a tradeoff, where higher NICU supply reduces neonatal mortality for the most vulnerable infants while also raising admission for healthier newborns.
J Health Econ
· 2025 Mar · PMID 39733519
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We conduct a randomized experiment (n = 600) to evaluate a Supported Employment (SE) program that, through intensive job coaching and follow-along support, aims to increase work activity of Belgian Disability Insurance (...We conduct a randomized experiment (n = 600) to evaluate a Supported Employment (SE) program that, through intensive job coaching and follow-along support, aims to increase work activity of Belgian Disability Insurance (DI) recipients with mental health conditions. The control group gets regular vocational rehabilitation. After a 30-month follow-up period, we find that SE increases the probability of working while claiming DI by 7.5 percentage points and reduces the amount of DI benefit received by 110 euros per month (-9.5 percent).
J Health Econ
· 2025 Mar · PMID 39731994
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Policies that increase contraceptive access for young women and their partners are a potentially low-cost way of reducing unintended pregnancies and improving later life outcomes. Several states have recently implemented...Policies that increase contraceptive access for young women and their partners are a potentially low-cost way of reducing unintended pregnancies and improving later life outcomes. Several states have recently implemented laws that allow pharmacists to prescribe contraceptives to women without the need to see a physician. We study the effect of these state laws on fertility rates. Using US Natality files for 2014-2020, we employ a difference-in-differences strategy using the 13 states that had enacted a law until the first quarter of 2020 as the treated group, and the 15 policy-implementing states post-2020 quarter 1 as the control group. We find approximately 0.5 fewer births per 1000 women aged 15-49 per quarter occur post law implementation, compared to control states. The effect of the policy appears to be focused among women aged 25-34 and 40-44 and women with a high school education or less.
J Health Econ
· 2025 Jan · PMID 39674046
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We analyse a model of optimal risk adjustment in competitive health-insurance markets which suffer from both ex-ante adverse selection and ex-post moral hazard. We find, firstly, that, unlike in an adverse-selection-only...We analyse a model of optimal risk adjustment in competitive health-insurance markets which suffer from both ex-ante adverse selection and ex-post moral hazard. We find, firstly, that, unlike in an adverse-selection-only market, in an environment where also moral hazard is important, removing insurers' selection incentives requires risk-adjustment payments that do not fully equalize costs among consumer types. Current practice of attempting to correct for all predictable cost differences among consumers is then misguided. Secondly, if the sponsor of the risk-adjustment system is not only concerned with eliminating selection distortions, but also wants to redistribute towards high-risk consumers, the required higher risk-adjustment payments will introduce selection distortions in high-risk consumers' contracts. This leads to excessive equilibrium provision of care for those suffering severe health shocks. Finally, insurer market power creates countervailing incentives, helping the risk adjuster to combat selection distortions but working against a risk-adjustment regulation that also cares about redistribution.
J Health Econ
· 2025 Jan · PMID 39671959
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This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that i...This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.