J Health Econ
· 2025 Jan · PMID 39671958
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We explore the role of epigenetic biological age in predicting subsequent health care utilisation. We use longitudinal data from the UK Understanding Society panel, capitalising on the availability of baseline epigenetic...We explore the role of epigenetic biological age in predicting subsequent health care utilisation. We use longitudinal data from the UK Understanding Society panel, capitalising on the availability of baseline epigenetic biological age measures along with data on general practitioner (GP) consultations, outpatient (OP) visits, and hospital inpatient (IP) care collected 5-12 years from baseline. Using least absolute shrinkage and selection operator (LASSO) regression analyses and accounting for participants' pre-existing health conditions, baseline biological underlying health, and socio-economic predictors we find that biological age is selected as a predictor of future GP consultations and IP care, while chronological rather than biological age is selected for future OP visits. Post-selection prediction analysis and Shapley-Shorrocks decompositions, comparing our preferred prediction models to models that replace biological age with chronological age, suggest that biological ageing has a stronger role in the models predicting future IP care as opposed to "gatekeeping" GP consultations.
J Health Econ
· 2025 Jan · PMID 39657376
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Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses' assessments of patients' conditions and investigat...Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses' assessments of patients' conditions and investigate the short- and medium-term consequences for patients. We show that triage nurses progressively become more lenient during their shifts, and identical ED patients arriving just after a shift change are thus assigned a lower priority. We show that these patients receive lower levels of care and require additional emergency care afterward. We conclude that distortions in nurses' initial assessments of urgency bias' medical staff's perceptions.
J Health Econ
· 2025 Jan · PMID 39657375
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Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the...Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the role of transitory health shocks or situational factors at explaining variations in fatal traffic accidents has been understudied. Exploring daily variation in city-specific pollen counts, this study finds novel evidence that traffic fatalities increase on days in which the local pollen count is particularly high. We find that the effects are present in accidents involving private vehicles and occur most frequently on the weekends, suggesting potentially the missed opportunity to avoid these fatalities. We do not find similar effects for fleet vehicles. These findings remain robust to alternative specifications and alternative definitions of high pollen count. Taken together, this study finds evidence that a prevalent and transitory exogenous health-shock, namely pollen allergies, increases traffic fatalities. Given our lack of evidence of avoidance, these effects are not mechanical and are likely driven by cognitive impairments that arise as a result of seasonal allergies.
J Health Econ
· 2025 Jan · PMID 39637756
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We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data...We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data Set to estimate the effect of ridesharing on admissions to substance use disorder treatment. People needing such treatment report transportation as a barrier to receiving care. We find that UberX entry into a Core Based Statistical Area has no effect on the overall number of treatment admissions. However, we find a decline in non-intensive outpatient treatment which is fully offset by an increase in intensive outpatient treatment. Given the required relative frequency of non-intensive and intensive outpatient treatment in terms of visits per week, our findings indicate that UberX helps to reduce transportation barriers to accessing healthcare. Event-studies show parallel trends in outcomes before UberX entry and results are robust to numerous sensitivity checks.
J Health Econ
· 2024 Dec · PMID 39612548
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This study examines how the undervaluation of funds in Medical Savings Accounts (MSAs) influences healthcare utilization in China. Given that MSA funds are restricted to healthcare expenses, individuals may undervalue th...This study examines how the undervaluation of funds in Medical Savings Accounts (MSAs) influences healthcare utilization in China. Given that MSA funds are restricted to healthcare expenses, individuals may undervalue these funds relative to cash, leading to potential overuse of health care. Through an event study approach using administrative data, we find significant reductions in healthcare utilization after MSA balances are depleted-outpatient care expenses drop by 49 percent, and drugstore purchases decrease by 41 percent. These effects persist across socioeconomic groups, indicating that liquidity constraints are not a major factor. Our back-of-the-envelope calculations suggest that insured individuals undervalue MSA funds by 40-70 %. This research sheds light on the behavioral impacts of MSAs and the broader implications of perceived price distortions in health insurance.
J Health Econ
· 2024 Dec · PMID 39571471
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Community water fluoridation has been named one of the 10 greatest public health achievements of the 20th century for its role in improving dental health. Fluoride has large negative effects at high doses, clear benefits...Community water fluoridation has been named one of the 10 greatest public health achievements of the 20th century for its role in improving dental health. Fluoride has large negative effects at high doses, clear benefits at low levels, and an unclear optimal dosage level. I leverage county-level variation in the timing of fluoride adoption, combined with restricted U.S. Census data that link over 29 million individuals to their county of birth, to estimate the causal effects of childhood fluoride exposure. Children exposed to community water fluoridation from age zero to five are worse off as adults on indices of economic self-sufficiency (-1.9% of a SD) and physical ability and health (-1.2% of a SD). They are also significantly less likely to graduate high school (-1.5 percentage points) or serve in the military (-1.0 percentage points). These findings challenge existing conclusions about safe levels of fluoride exposure.
Spika D, Wickström Östervall L, Gerdtham U
… +1 more, Wengström E
J Health Econ
· 2024 Dec · PMID 39571470
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We investigate the use of a highly scalable intervention to help individuals achieve their physical activity goals: self-funded commitment contracts. Using a randomised experiment, we compare the effect of soft (non-ince...We investigate the use of a highly scalable intervention to help individuals achieve their physical activity goals: self-funded commitment contracts. Using a randomised experiment, we compare the effect of soft (non-incentivised) and hard (incentivised) contracts among 1629 members of a gym in Stockholm, Sweden. We find a significant positive impact of being offered a hard contract on monthly visits to the gym and the probability of meeting one's contract goal. Relative to the control group, being offered a hard contract significantly increases gym visits by 21%, while being offered a soft contract leads to an 8% increase.
J Health Econ
· 2024 Dec · PMID 39561608
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We study the impact on children's bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to es...We study the impact on children's bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to estimate effects at different ages and durations of exposure, based on nurse-collected, population-wide health data for state school children. Exposure to universal free lunches reduces obesity prevalence and BMI among children aged 4-5 and 10-11, but older children's bodyweights are less responsive than younger children's. We find tentative evidence that effects may be cumulative, as impacts are largest for those exposed to universal free school meals throughout primary school.
J Health Econ
· 2024 Dec · PMID 39541696
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The UK Universal Credit (UC) welfare reform simplified the benefits system whilst strongly incentivising a return to sustainable employment. Exploiting a staggered roll-out, we estimate the differential effect of unemplo...The UK Universal Credit (UC) welfare reform simplified the benefits system whilst strongly incentivising a return to sustainable employment. Exploiting a staggered roll-out, we estimate the differential effect of unemployment under UC versus the former system on mental health. Groups with fewer insurance possibilities - single adults and lone parents - experience a mental health deterioration of 8.4-13.9% standard deviations which persists into the subsequent year. For couples, UC partially or fully mitigates mental health consequences of unemployment. Exploring mechanisms, for single adults and lone parents, reduced benefit income and strict job search requirements dominate any positive welfare effects of the reduced administrative burden of claiming benefits.
J Health Econ
· 2024 Dec · PMID 39541695
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Abortion restrictions affect access to reproductive health care. Research has demonstrated that abortion restrictions (policies that restrict access to abortion services or cause abortion clinics to close) result in redu...Abortion restrictions affect access to reproductive health care. Research has demonstrated that abortion restrictions (policies that restrict access to abortion services or cause abortion clinics to close) result in reductions of and delays in abortions. We leverage two population-based datasets to investigate the effects of mandatory waiting periods (MWPs), a restrictive state abortion policy, on the prevalence of intimate partner violence (IPV), one of the most common types of crime and a highly prevalent and costly public health problem, using data from the National Incident-Based Reporting System and Uniform Crime Report - Supplemental Homicide Reports. We hypothesize that MWPs increase the prevalence of IPV through changes in financial strains, negative health consequences, and intra-household power dynamics. Using difference-in-differences, event study, and methods accounting for staggered treatment timing, we find that MWPs are associated with increases in IPV. Our findings are valuable for policymakers in today's post-Dobbs environment.
J Health Econ
· 2024 Dec · PMID 39531752
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This study provides the first population-representative quasi-experimental estimates on the impact of housing upgrades on occupant health. We analyze the exceptional period of renovations in East Germany following the Ge...This study provides the first population-representative quasi-experimental estimates on the impact of housing upgrades on occupant health. We analyze the exceptional period of renovations in East Germany following the German reunification during the 1990s. Triggered by one of the largest governmental loan programs in history, 3.6 million dwellings were renovated, focussing on upgrades to the building insulation, windows and heating systems. Using rich survey data based on the Socio-Economic Panel (SOEP) as well as administrative records of hospital admissions in Germany, we consistently show that housing weatherization upgrades sustainably reduce the demand for health care among the elderly sample of the population.
J Health Econ
· 2024 Dec · PMID 39509803
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Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the h...Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference-in-differences techniques across outcomes from restricted-use microdata on the universe of US births. I find that TRAP laws lead to 11-16 % increased rates of hypertensive disorders of pregnancy. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion.
Barteska P, Dobkowitz S, Olkkola M
… +1 more, Rieser M
J Health Econ
· 2023 Oct · PMID 39491080
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We show that the first nationwide mass vaccination campaign against measles increased educational attainment in the United States. Our empirical strategy exploits variation in exposure to the childhood disease across sta...We show that the first nationwide mass vaccination campaign against measles increased educational attainment in the United States. Our empirical strategy exploits variation in exposure to the childhood disease across states right before the Measles Eradication Campaign of 1967-68, which reduced reported measles incidence by 90 percent within two years. Our results suggest that mass vaccination against measles increased the years of education on average by about 0.1 years in the affected cohorts. We also find tentative evidence that the college graduation rate of men increased.
J Health Econ
· 2024 Dec · PMID 39447306
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Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and bupr...Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and buprenorphine (substitutes for opioids). These have proven to be controversial. Advocates argue that people struggling with addiction benefit because they can switch to a less harmful substance, but opponents argue that this could encourage abstainers to begin using the harm-reduction method or even, eventually, the original addictive good. This paper builds on theories of addiction to model the introduction of a harm reduction method, and demonstrates the conditions under which each side is correct.
J Health Econ
· 2024 Dec · PMID 39426121
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While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrume...While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrumental variable strategy to estimate the effect of cumulative eligibility gain on cognitive and behavioral outcomes measured at three points during childhood. Our analysis leverages substantial variation in cumulative eligibility due to the dramatic public insurance expansions between the 1980s and 2000s. We find that increased eligibility improves child cognitive skills and present suggestive evidence on better behavioral outcomes. There are notable heterogeneous effects across the subgroups of interest. Both prenatal eligibility and childhood eligibility are important for driving gains in the test scores at older ages. Improved child health is found to be a mediator of the impact of increased eligibility.
J Health Econ
· 2024 Dec · PMID 39405807
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We use data from the Population Assessment of Tobacco Use and Health (PATH), a longitudinal data set including self-reported and biomarker measures of tobacco use, to examine the effects of state-level tobacco 21 (T21) l...We use data from the Population Assessment of Tobacco Use and Health (PATH), a longitudinal data set including self-reported and biomarker measures of tobacco use, to examine the effects of state-level tobacco 21 (T21) laws on smoking and vaping. T21 laws reduce self-reported cigarette smoking among 18-to-20 year olds, concentrated in males. Initial non-users who "age-out" of treatment are less likely to subsequently initiate self-reported smoking or vaping. Treated smokers are less likely to buy their own cigarettes and more likely to buy cigarettes in a different state. Biomarker results are mixed, and we find some evidence of a reduction in nicotine exposure but less evidence for a reduction in exposure to tobacco. Finally, we test for non-classical measurement error. T21 laws reduce the probability that clinically identified likely cigarette smokers self-report as smokers, which may increase the apparent effect of T21 laws on cigarette smoking as measured by self-reports.
J Health Econ
· 2024 Dec · PMID 39368123
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Housing instability and drug misuse are two of the United States' most pressing challenges, each bearing profound health and societal consequences. A crucial yet largely underexplored question is the extent to which the...Housing instability and drug misuse are two of the United States' most pressing challenges, each bearing profound health and societal consequences. A crucial yet largely underexplored question is the extent to which the opioid crisis has intensified housing instability. Our study ventures into this relatively uncharted nexus, investigating how the OxyContin reformulation, a pivotal moment in the U.S. opioid epidemic, impacted eviction rates. Employing a dose-response Difference-in-Differences model and analyzing eviction data from 2004 to 2016, we demonstrate that the OxyContin reformulation precipitated a significant increase in evictions, especially in areas with weak eviction protections or limited access to psychiatric treatment resources. Channel analyses reveal increased marijuana initiation and heightened mental and physical health issues following the reformulation. Moreover, the OxyContin reformulation leads to greater reliance on the Supplemental Nutrition Assistance Program, signaling an escalated financial strain on governmental resources. Finally, we find evidence of increased marital disruption post-reformulation. Our findings underscore the urgent need for collaborative efforts between public health and housing authorities to address both the opioid and housing crises.
J Health Econ
· 2024 Dec · PMID 39366133
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This paper provides an institutional economics framework for analyzing medical ethics. An ethical policy partitions the set of physician actions into (un)ethical subsets, with unethical actions then unavailable. Individu...This paper provides an institutional economics framework for analyzing medical ethics. An ethical policy partitions the set of physician actions into (un)ethical subsets, with unethical actions then unavailable. Individual physicians' preferences over policies combined with a political process determine equilibrium constraints. I show that physicians' concern for colleagues' patients uniquely motivates their support for ethics which restrict behavior under strong assumptions. Without these assumptions, even identical physicians might ban actions they would otherwise select for reasons varying from protecting patients to differences in the costs of maintaining ethical policies. Interestingly, heightened altruism for colleagues' patients makes the former reasoning less credible. Novel applications for 'Provide Free Care to Physicians' and 'Duty to Treat in a Pandemic' demonstrate: (i) rising physician income can explain long-run weakening of both formal ethics in the United States; and (ii) the duty to treat can deteriorate as fewer physicians are required to improve pandemic outcomes.
J Health Econ
· 2024 Dec · PMID 39277926
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Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variabl...Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variables approach, we conduct the first study on the causal effect of Medicare reimbursement for advance care planning (ACP)-the process of discussing and recording patient preferences for goals of care-on care utilization, spending, and mortality outcomes for critically ill Medicare patients. We find that billed ACP services substantially increase hospice use and hospice spending within a year, accompanied by corresponding increase in one-year mortality. The impacts of ACP services on hospice use and spending are especially prominent among patients with dementia and those of lower socioeconomic status. Among decedents, death is significantly less likely to occur in the hospital, and total and inpatient spending within the last 30 days of life fall significantly. Our findings suggest that paying for ACP services can be effective in improving hospice use for critically ill Medicare patients, with the (possibly intended) consequence of increased one-year mortality.
J Health Econ
· 2024 Dec · PMID 39265232
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This paper theoretically studies pharmaceutical innovation collaborations, where heterogeneous firms compete for heterogeneous academics. At an interim stage, the firm evaluates the project, which allows it to monitor ac...This paper theoretically studies pharmaceutical innovation collaborations, where heterogeneous firms compete for heterogeneous academics. At an interim stage, the firm evaluates the project, which allows it to monitor academics and decide whether to terminate the project to avoid the loss from a future failure. This paper explores the contract, project termination strategy, and collaboration matching. The firm's innovation strategy (exploitations or explorations) determines the evaluation structure, which may affect the market equilibrium. By considering different innovation strategies, this paper shows that in each case, the equilibrium matching is unique (either positive or negative assortative). Consequently, the chosen innovation strategy plays a pivotal role in shaping equilibrium matching outcomes. These findings provide theoretical insights into pharma-academic alliances, shed light on the observed positive or negative assortative properties in the market, and advocate for the consideration of innovation strategies and evaluation structures in future research endeavors. Moreover, this paper also provides several empirical and policy implications.