Bergschneider H, Kottmann R, Schmitz H
… +1 more, Westphal M
J Health Econ
· 2026 Jun · PMID 42391693
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We study the effects of retirement on cognitive functioning among women aged 63 to 67 by exploiting a German retirement reform that raised the early retirement age for women born after 1951 by three years, from 60 to 63....We study the effects of retirement on cognitive functioning among women aged 63 to 67 by exploiting a German retirement reform that raised the early retirement age for women born after 1951 by three years, from 60 to 63. Our indicators of cognitive functioning are objective cognitive test scores (word recall, semantic fluency, and the Stroop test) from a large biomedical dataset, as well as the diagnosis of cognitive disorders from administrative health insurance claims. We find reductions of around 13% of a standard deviation per year in retirement for measures of fluid intelligence, whereas crystallized intelligence remains unaffected. These estimates reflect the reform-induced shift in retirement duration for compliers around the eligibility cutoff. In contrast, additional years in retirement do not affect diagnosis of cognitive disorder and decrease diagnoses of dementia-related risk factors such as hypertension, depression, and sleep problems. The improvement in health outcomes suggests that cognitive decline is not driven by health deterioration but might possibly be due to reduced cognitive engagement after leaving work.
J Health Econ
· 2026 Jun · PMID 42385399
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This paper estimates the causal effect of online food delivery platforms on body weight in China. Exploiting the staggered rollout of Eleme across Chinese cities between 2010 and 2020, we find that platform entry shifts...This paper estimates the causal effect of online food delivery platforms on body weight in China. Exploiting the staggered rollout of Eleme across Chinese cities between 2010 and 2020, we find that platform entry shifts the BMI distribution rightward among urban young adults: it increases body mass index, lowers underweight prevalence, and raises the likelihood of being overweight. Effects are negligible among urban older adults, consistent with lower platform adoption in this group. Mechanism analysis points to shifts in dietary preferences toward energy-dense foods, reduced meal preparation time, and increased restaurant entry. Our findings highlight the health trade-offs associated with digital food platforms in rapidly urbanizing developing countries, where improved caloric access may coexist with greater exposure to lower-quality, energy-dense foods.
J Health Econ
· 2026 Jun · PMID 42385398
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This research studies the impact of improving access to treatment for substance use disorders by reducing wait times. Linked individual-level administrative data are used to estimate the impacts of wait times on patients...This research studies the impact of improving access to treatment for substance use disorders by reducing wait times. Linked individual-level administrative data are used to estimate the impacts of wait times on patients' treatment service utilization and employment. Potential confounding is addressed using an instrumental variables strategy that exploits exogenous variation in wait times generated by local congestion in the healthcare system. We find that longer wait times lead to increased use of treatment services in the focal treatment episode, raised re-entry into subsequent treatment episodes, and lowered employment, consistent with patients' health deteriorating while waiting for treatment. Our calculations suggest that each dollar spent on reducing wait times yields a return of between six and seven dollars. These findings demonstrate that shortening wait times for treatment can significantly reduce the economic and social burdens of addiction.
J Health Econ
· 2026 Jun · PMID 42335684
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Pharmaceutical expenditures are rising rapidly, driven in part by the innovation of highly effective but very expensive drug therapies that treat multiple diseases, implying that payers face a critical trade-off between...Pharmaceutical expenditures are rising rapidly, driven in part by the innovation of highly effective but very expensive drug therapies that treat multiple diseases, implying that payers face a critical trade-off between cost containment and access to new medicines. A key policy question is whether producers should be restricted to uniform pricing or allowed to use indication-based pricing, where prices vary across patient groups. We use a two-market model to analyse how this choice affects drug producers' incentives to invest in new indications, their pricing strategies, and the resulting surplus for health plans. In a monopoly setting, indication-based pricing yields higher profits and thus strengthens incentives to invest in new indications, while the payer prefers uniform pricing unless the fixed investment costs cannot be recouped. However, monopoly-based insights may not hold if the multi-indication producer faces therapeutic competition in one of the markets. Specifically, we identify a softening-of-competition effect, where a uniform pricing restriction serves as a credible commitment to raise prices in the competitive market. In this case, the health plan might favour indication-based pricing to reduce costs. Overall, our findings suggest that neither pricing scheme is universally optimal, underscoring the need for case-by-case assessments across drug classes.
J Health Econ
· 2026 Jun · PMID 42330672
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This paper develops a unified framework for evaluating health outcomes that jointly incorporates equity and productivity. Extending beyond traditional QALYs, PALYs, and the more recent PQALYs, we introduce a broader clas...This paper develops a unified framework for evaluating health outcomes that jointly incorporates equity and productivity. Extending beyond traditional QALYs, PALYs, and the more recent PQALYs, we introduce a broader class of evaluation functions that integrate equity- and productivity-sensitive conditions. By imposing several normative criteria, including independence from measurement scales and Pigou-Dalton transfer principles, we obtain tractable power-form representations. In balancing equity and efficiency, the framework provides a coherent foundation for assessing interventions in contexts where both health and productive capacity are at stake.
J Health Econ
· 2026 May · PMID 42284929
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We analyse the impact of a change in the administration of social security payments, occurring in utero and early infancy, on health in early childhood. We identify this impact through the gradual rollout of the so-calle...We analyse the impact of a change in the administration of social security payments, occurring in utero and early infancy, on health in early childhood. We identify this impact through the gradual rollout of the so-called 'income management' policy in Aboriginal communities in Australia's Northern Territory in 2007. This policy changed the delivery method of social security payments but not their value - however, implementation challenges meant that many families did not receive their payments on time. Using linked administrative data, we find that children who were exposed to the policy rollout in utero or in their first three months of life (the 'fourth trimester') were at higher risk of severe infection requiring hospitalisation. These children spent, on average, 4.7 more days in hospital between birth and their 8th birthday. Most of this impact is concentrated in hospitalisations for infection, which increased by 23 percent. These admissions are driven by a range of infection types: bacterial, viral and respiratory. We link our findings to the 'immune programming hypothesis', i.e. maternal stress and poor nutrition during key stages in immune system development can permanently weaken the child's immune system. Our findings highlight the importance of attention to key phases in child development when designing policies that affect households' financial resources, even temporarily.
J Health Econ
· 2026 May · PMID 42269351
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We study the long-run consequences of fertility policy for aging and survival, exploiting the staggered provincial rollout of China's 1970s Later, Longer, Fewer campaign. Linking variation in exposure to the Chinese Long...We study the long-run consequences of fertility policy for aging and survival, exploiting the staggered provincial rollout of China's 1970s Later, Longer, Fewer campaign. Linking variation in exposure to the Chinese Longitudinal Healthy Longevity Survey (1998-2021), we find that cohorts subject to fertility restrictions experienced significantly higher late-life mortality, over 10% on average, and worse cognitive and psychological outcomes. These effects arise because smaller sibships, delayed childbearing, and wider spacing reduced both the supply and timing of intergenerational care. While the subsequent introduction of LTCI mitigated some adverse impacts, the effects were driven by in-kind benefits, whereas cash-based LTCI provided little offset, underscoring the limits of formal substitution for kin-based support. Our findings reveal a fundamental intergenerational trade-off in fertility control and highlight the enduring demographic costs of policies that reshape family structure.
J Health Econ
· 2026 Jun · PMID 42269350
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We introduce a novel approach to identify state-dependent reporting bias in subjective health measures. The central idea is that health operates as a stock, making abrupt shifts in self-reported health (SRH) following re...We introduce a novel approach to identify state-dependent reporting bias in subjective health measures. The central idea is that health operates as a stock, making abrupt shifts in self-reported health (SRH) following retirement more likely to reflect reporting bias than actual changes. To capture such shifts, our analysis integrates three key elements: (1) differentiating stock and flow outcomes based on classical health theory; (2) leveraging an identification strategy inspired by regression discontinuity design; and (3) exploiting a unique high-frequency dataset on monthly health and retirement. Traditional estimates find a decline in SRH after retirement over longer periods; however, this decline steadily diminishes as the observation window narrows, showing no evidence of state-dependent reporting bias. Our analysis of short-term health dynamics also emphasizes distinguishing stock and flow health outcomes in policy evaluations.
Lorko M, Servátka M, Slonim R
… +1 more, Ďuriník M
J Health Econ
· 2026 May · PMID 42250437
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Many volunteer markets, and most prominently markets for substances of human origin, feature dynamic coordination problems where volunteering today can temporarily restrict volunteering later. We show that, unsurprisingl...Many volunteer markets, and most prominently markets for substances of human origin, feature dynamic coordination problems where volunteering today can temporarily restrict volunteering later. We show that, unsurprisingly, these restrictions reduce market surplus compared to no restrictions. We examine whether providing volunteers with demand or supply information improves market surplus without and with intertemporal restrictions. We show theoretically that, without restrictions, providing demand or supply information increases market surplus, while with restrictions, providing supply rather than demand information causes higher market surplus. Experimental results support most predictions and further show that supply information especially improves market surplus when intertemporal restrictions exist. Overall, comparative static inferences in an environment without intertemporal restrictions do not carry over to an environment with restrictions. Thus, policies based on analyses of static conditions will not necessarily be effective in situations featuring dynamic spillovers.
J Health Econ
· 2026 Jun · PMID 42241957
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This paper examines how expanding the legal definition of sexual assault affects fertility and sexual behavior, using a panel of European countries. I find that switching to tacit consent-based legislation reduces fertil...This paper examines how expanding the legal definition of sexual assault affects fertility and sexual behavior, using a panel of European countries. I find that switching to tacit consent-based legislation reduces fertility by about 4% relative to the mean. This effect is driven by a decrease in couple formation and an increase in abortion rates. Supporting evidence is consistent with a behavioral channel in which more risk-averse individuals withdraw from dating and partner markets following the reform, altering the composition of those who remain active toward a pool that is less precautionary. Consistent with this compositional shift, contraceptive use rises among younger women but declines among older age groups, while condom use falls among young men. Finally, an analysis of appeals court verdicts in Sweden following the adoption of consent-based legislation shows a decline in unanimous guilty verdicts, indicating challenges in assessing tacit consent. These results are consistent with a simple framework in which heterogeneity in risk perceptions and precautionary behavior in dating and partner markets, including reduced participation by some individuals, helps explain the observed decline in fertility following the reform.
J Health Econ
· 2026 May · PMID 42184725
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Plan standardization policies aim to help consumers assess plan value by limiting variation in cost-sharing and directing attention towards premiums, networks, and formularies. They may also intensify issuer competition...Plan standardization policies aim to help consumers assess plan value by limiting variation in cost-sharing and directing attention towards premiums, networks, and formularies. They may also intensify issuer competition and lower premiums. We study one such policy-the introduction of standardized "Simple Choice" plans alongside non-standardized options in the 2017 ACA marketplaces-and estimate its effect on premiums. Across multiple identification strategies and robustness checks, we find that Simple Choice plans reduced premiums for bronze, silver, and gold tiers, including a 7.3% reduction in the benchmark premium.
J Health Econ
· 2026 May · PMID 42176587
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Patients experiencing acute health symptoms often face uncertainty about how and where to receive care. We study patients who call a nurse advice line and receive one of four recommendations: emergency department (ED), u...Patients experiencing acute health symptoms often face uncertainty about how and where to receive care. We study patients who call a nurse advice line and receive one of four recommendations: emergency department (ED), urgent care (UC), primary care (PC), or self-care (Home). Leveraging an extension of examiner designs that recovers margin-specific effects for each pair of adjacent recommendations (ED-UC, UC-PC, PC-Home), we estimate the impact of nurse recommendations on both patient decisions and their subsequent health outcomes. We find that recommendations have large impacts on patient decisions at each margin. We then show that UC recommendations reduce 28-day healthcare costs by $404 relative to ED recommendations and by $247 relative to PC recommendations, suggesting substantial potential for cost savings through improved triage.
J Health Econ
· 2026 May · PMID 42172997
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Poor health and unstable housing are closely linked. Most research has focused on how housing shapes health, with little empirical study of whether and how health events can lead to future residential mobility or housing...Poor health and unstable housing are closely linked. Most research has focused on how housing shapes health, with little empirical study of whether and how health events can lead to future residential mobility or housing instability. This paper uses high-frequency administrative data on residential location and health among Medicaid enrollees in New York City to test whether adverse health events trigger housing mobility or insecurity, independent of the financial toll of medical bills. Using an event study design, I find that health shocks - or, sudden hospitalizations after two hospital-free years - immediately increase residential mobility (21-35 % relative increase) and the probability of living in shelters or on the street (6-10 % relative increase). These increased rates of mobility and instability persist above expected levels for at least two years. For unplanned or urgent hospital admissions, the impact of health events is even greater. These estimates imply that, in their immediate aftermath, adverse health events could be a tipping point for approximately 80,000 additional moves and 20,000 additional cases of homelessness among the U.S. Medicaid-insured population annually. The effects of health events on residential mobility are smaller for those with subsidized housing, a usual source of outpatient care, higher-quality inpatient care, and social support, suggesting potential areas for policy interventions to break the relationship between health problems and housing outcomes, from both inside and outside of health systems. This work also contributes to our understanding of the long tail of social consequences of adverse health events.
J Health Econ
· 2026 May · PMID 42119453
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We estimate the long-run labor market and health effects of breast cancer among Austrian women. Compared to a random sample of same-aged non-affected women, those diagnosed with breast cancer face a 22.8 percent increase...We estimate the long-run labor market and health effects of breast cancer among Austrian women. Compared to a random sample of same-aged non-affected women, those diagnosed with breast cancer face a 22.8 percent increase in health expenses, 9 percent lower unconditional earnings, 5.8 lower employment probability, and an earnings penalty conditional on employment of 6.4 percent five years after diagnosis. We discuss changes in job quality, hours, incapacitation, and employer discrimination as potential mechanisms behind these labor market adjustments.
J Health Econ
· 2026 May · PMID 42085728
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Equitable healthcare access for mobile, informally employed populations remains elusive in many developing contexts. We examine the impact of the first phase of China's cross-regional instant reimbursement (CRIR) reform-...Equitable healthcare access for mobile, informally employed populations remains elusive in many developing contexts. We examine the impact of the first phase of China's cross-regional instant reimbursement (CRIR) reform-a province-level reform-on enrollment in health insurance and healthcare utilization. Informed by a theoretical model, we implement a triple-differences design leveraging CRIR's staggered rollout to identify causal effects. Results show that CRIR substantially increased local UEBMI enrollment (by 8%) and healthcare visits (by 14%), while reducing out-of-pocket spending (by 22%). These gains stem from lower administrative frictions and strengthened financial protection. Low-income, less-educated, and more informally employed migrants benefit the most, underscoring the reform's role in promoting inclusive development. Our findings highlight the importance of portable social insurance in improving healthcare access for mobile populations and offer insights for similar reforms in other developing settings.
J Health Econ
· 2026 May · PMID 42068730
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Billions of people worldwide still lack access to healthy diets, with a high concentration in rural areas of developing countries. This paper examines how major transportation investments can improve dietary quality amon...Billions of people worldwide still lack access to healthy diets, with a high concentration in rural areas of developing countries. This paper examines how major transportation investments can improve dietary quality among rural households, leveraging the staggered rollout of the "Five Vertical and Seven Horizontal" National Trunk Highway System (5V7H), the country's largest expressway network completed by 2007. Using a staggered difference-in-differences design, we find that the 5V7H access increases the Dietary Diversity Score (DDS) and Chinese Healthy Eating Index (CHEI) of rural residents by 0.326 and 2.197 points, respectively. These benefits are more prominent among households with more children, access to refrigerators, or meal preparers with better nutrition knowledge, and less so among households with more diversified agricultural production. We further show that the 5V7H connection improves rural residents' dietary quality primarily through demand-side channels, including promoting off-farm employment, raising household income, and enhancing dietary literacy. In contrast, the contributions of supply-side channels, such as improved market access or lower food prices, are modest. Overall, our findings highlight the benefits of large-scale transportation infrastructure in facilitating the transition to healthier diets in rural areas of developing countries.
J Health Econ
· 2026 May · PMID 42008871
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Heavy workloads facing health care providers may lead to changes in care processes that, in turn, affect quality of care and patient outcomes. Using direct observations of vaginal deliveries in three high-volume Kenyan h...Heavy workloads facing health care providers may lead to changes in care processes that, in turn, affect quality of care and patient outcomes. Using direct observations of vaginal deliveries in three high-volume Kenyan hospitals, we study how workload affects care in maternity wards - a high-stress environment where hard-to-schedule patient admissions and uncertainty around labor progression can result in unexpected fluctuations in workload throughout the day. We first document that these facilities are persistently understaffed relative to international staffing benchmarks, implying high baseline workloads. Exploiting short-run variations in provider workload in this environment, we find that workload has little to no effect on quality, as measured by provider adherence to clinical guidelines and disrespectful care. We show that coping strategies employed by providers, such as using clinical interventions to speed up labor and delegating tasks to less qualified team members, may have weakened the relationship between workload and the quality measures we examine. However, these coping mechanisms could have negative implications for other (unmeasured) aspects of quality. Drawing on anecdotal and other evidence, we propose additional hypotheses for why quality may not be sensitive to workload in this setting.
J Health Econ
· 2026 May · PMID 41999670
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We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We find that the survey-based preference measures collected by Cu...We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We find that the survey-based preference measures collected by Cutler et al. (2019) (CSSW) predict variations in utilization that are same-signed, though substantially muted, relative to the strong relationships CSSW uncovered for both treatment and expenditure for Medicare beneficiaries. Additionally, regions with aggressive practice styles receive sufficiently lower reimbursements from commercial insurers that variations in practice preferences have weak correlations with expenditures in the commercial market. We present a parsimonious model of commercial insurers' pricing that can rationalize this fact pattern.
Chuo T, Cotti C, Courtemanche C
… +3 more, Maclean JC, Nesson E, Sabia JJ
J Health Econ
· 2026 May · PMID 41980494
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Electronic nicotine delivery systems (ENDS) use among lesbian, gay, bisexual, and questioning (LGBQ) teenagers is nearly 50 percent higher than among their heterosexual counterparts. Yet little is known about how recent...Electronic nicotine delivery systems (ENDS) use among lesbian, gay, bisexual, and questioning (LGBQ) teenagers is nearly 50 percent higher than among their heterosexual counterparts. Yet little is known about how recent efforts to curb nicotine vaping through tobacco control policies impact sexual minorities. The minority stress hypothesis (MSH) suggests that LGBQ teens may use nicotine to mediate unique stressors, which could lead LGBQ teens to be less responsive to state policies designed to curtail use of nicotine products. This study explores this question using data from the 2015-2023 State Youth Behavior Surveys and a generalized difference-in-differences identification strategy. We consider the importance of four common policies in the U.S.: ENDS taxes, cigarette taxes, ENDS minimum legal sales ages, and ENDS flavor bans. We document heterogeneous responses to ENDS taxes and MLSA laws that are consistent with the MSH: ENDS taxes and MLSA laws reduce vaping among heterosexual youth but not among LGBQ youth, despite substantially higher baseline ENDS use in the latter group. We also find that LGBQ teens without mental health stressors respond strongly to ENDS taxes and flavor bans, whereas those with such stressors do not, also consistent with the MSH. Cigarette taxes are largely unrelated to ENDS use among teens.