International Journal of Health Economics and Management最新文献

This paper investigates the effects of exposure to the long-term care insurance (LTCI) on labor supply of the middle-aged and older adult in China, using data from the China Health and Retirement Longitudinal Study from 2011 to 2018. We address the potential endogeneity of LTCI exposure with the difference-in-differences estimator. The results indicate that LTCI exposure has negative impacts on labor supply. Respondents in the pilot cities with LTCI reduce approximately 1.984 working hours per week. They also tend to have a 3.9% lower probability of working. In particular, the proportion of respondents in pilot cities engage in informal work increased by 1.6%. The impacts of LTCI exposure on labor supply are particularly pronounced for caregivers and respondents with functional limitations. The expected income effect seems to be the suggestive mechanism through which LTCI exposure affects labor supply. Our results highlight the spillover effects of LTCI in aging societies.

This article analyzes the economic responses of household heads confronted with SARS-CoV-2 symptoms during the partial lockdown period imposed in Cameroon in 2020. By isolating the specific effect of the individual symptomatic shock from that of general health restrictions, it fills a gap that the literature on the economic effects of COVID-19 has not yet directly addressed. The data come from a household survey conducted in Cameroon, and five economic responses are analyzed, namely over-indebtedness, active occupational mobility, and reductions in health, education, and sanitary protection expenditures. To address endogeneity, two complementary strategies are employed, namely the kinky least squares (KLS) method, which corrects endogeneity bias without resorting to an external instrument, and the recursive bivariate probit with instrumental variable, which jointly models binary treatment and outcome while accounting for the correlation between their unobserved error terms. Kinky least squares estimates establish a positive and statistically significant relationship between SARS-CoV-2 symptomatic manifestations and all of the selected economic responses. The recursive bivariate probit confirms these results, with the exception of active occupational mobility, whose coefficient remains positive but loses its statistical significance once non-linearity and the correlation of unobserved disturbances are fully accounted for. The decomposition of average treatment effects indicates that SARS-CoV-2 symptomatic manifestations increase the probability of reducing sanitary protection expenditures by 37.3% across the entire population (ATE) and by 38.1% among household heads who were actually affected (ATET). For education expenditures, these effects are 28.6% and 25.6%, respectively. For health expenditure reductions, these effects are 23.2% and 18.6%, respectively. These findings argue in favor of the free distribution of sanitary protection devices, the subsidization of medical consultations and community drug stockpiles, the maintenance of school transfer payments, and zero-interest emergency credit lines for informal workers experiencing temporary work incapacity. These measures will nonetheless remain insufficient as long as the health coverage system remains critically underdeveloped.

This paper examines the direct and indirect or vicarious (i.e., experienced through a partner's unemployment) relationship between unemployment and psychological well-being, shedding more light on why unemployment patterns may differ between women and men. To accomplish this, we tackle the potential endogeneity concern by employing an identification strategy designed to explore the associations between unemployment and mental health while reducing biased results. To our knowledge, this study is the first to employ this strategy to analyse both direct and indirect relationships. We utilize individual and household data from Spain across the years 2006, 2011, and 2017, representing the first study about this topic for this country. The results indicate a detrimental link between unemployment and personal well-being. By sex, a significant association with unemployment was only observable in men, while among women, it became significant only when disaggregated by parental status, specifically among those without children. A similar pattern emerges for the vicarious association: male unemployment is associated with worse psychological well-being among their female partners, especially in couples without children. By contrast, female unemployment is not significantly associated with the psychological well-being of their male partners.

Frailty among older adults is a critical determinant of economic choices and individual behavior. While risk and time preferences are key factors in decision-making, their relationship with frailty remains unexplored. This study addresses this gap by examining how frailty influences attitudes toward risk and intertemporal choices. We collected data from older adults in two regions of Côte d'Ivoire, using a gambling-based method to measure risk and time preferences, along with a 30-item frailty questionnaire. A copula-based endogenous treatment effect model is employed to account for potential endogeneity between frailty and behavioral outcomes. Our findings show that frailty makes older adults less risk-averse and more focused on immediate rewards. These results suggest that reducing frailty could also influence economic choices and improve long-term well-being for aging populations.

We use rich longitudinal administrative medical records to examine the separate roles of mothers and fathers in children's health care use. We do so distinguishing between different types of care and child sex. Overall, we find limited evidence of an association between parents' education and their children's health care use. Mothers' health care use appears in general more strongly associated than fathers' health care use with that of their children. On the other hand, for some types of care (GP and specialist visits), these associations in health care use are stronger within the same-sex parent-child dyads. These results are not (fully) explained by parental nor children's health needs and health behaviors and are robust to the inclusion of GP fixed effects. These associations remain after controlling for unobserved time-invariant factors suggesting that non-health related family shocks also play a role. Our findings have potentially important policy implications, as patterns of health care seeking are established early in life, which the literature shows have long-lasting effects over people's life course.

Costly new technology, while often beneficial, has been identified as one of the principal drivers of healthcare spending growth. Recent literature has shown high deductible health plans (HDHPs) can have an immediate negative impact on levels of healthcare spending, but their effects on spending growth remain unknown. Analyzing a panel of multiple-employer-group claims data from a national insurer that is extensive enough to identify long run effects on spending growth, we find that enrollment in HDHPs for four or more years is not associated with lower total health care spending growth (or lower growth in medical services spending) compared to persistent enrollment in low deductible health plans (LDHP).

Economic shocks have been shown to affect social and political outcomes. Here, I show that U.S. counties that faced greater economic shocks within the last 30 years were less likely to comply with the advice/orders of public health officials during the COVID-19 pandemic. Analyzing county-level vaccination rates and then compliance rates with stay-at-home orders, I show that compliance with these initiatives was lower in counties that had experienced trade exposure to China, excess unemployment from the Great Recession, and a greater risk of job automation. These shocks are comparable in importance to factors such as income, age, and education.

Community-based health insurance (CBHI) is increasingly recognized as an effective mechanism for protecting low-income populations from health-related financial shocks and advancing universal health coverage (UHC) in developing countries. This study evaluates the effect of CBHI on healthcare utilization and out-of-pocket (OOP) health expenditures in the Tigray region of Ethiopia. To evaluate this effect, a cross-sectional survey was conducted in 2020 among 800 households (400 CBHI members and 400 non-members) selected through multistage random sampling. In the first stage, three woredas were purposively chosen, followed by stratified simple random sampling to select households. Data were analyzed using logistic regression and propensity score matching (PSM) in Stata version 17. The findings showed that CBHI membership was significantly associated with increased healthcare utilization and reduced OOP expenditure. Insured households reported 3.36 more outpatient visits (95% CI: 2.15–4.57) and 0.66 more inpatient visits (95% CI: 0.23–1.09) annually compared to non-members, who averaged 3.03 outpatient visits and 0.82 inpatient admissions. Admissions to public health institutions increased by 0.69 (95% CI: 0.35–1.03), while usage of private healthcare facilities showed no significant change. Annual OOP spending was 1,080.87 birr lower among members (95% CI: − 1,624.08 to − 537.66), with outpatient costs reduced by 867.39 birr (95% CI: − 1,223.95 to − 510.84). Additionally, CBHI membership was associated with a reduction of 0.08 in the incidence of catastrophic health expenditure (CHE) (95% CI: − 0.14 to − 0.23). In conclusion, CBHI significantly improves access to public healthcare and alleviates the financial burden by lowering OOP spending and reducing CHE. However, its limited effect on inpatient OOP costs and private healthcare utilization underscores the need for expanded benefit packages and better integration across healthcare providers.

Non-pharmaceutical intervention (NPI) and prevailing health infrastructure play an inevitable part in the current scenario of pandemics in the world. However, in emerging economies, the infection burden of many health crises outstrips the resources available to treat all individuals. This study sought to provide preliminary empirical evidence on the contingency implications of resource allocation on personal protective equipment (PPE), health infrastructure and public health performance. A survey of 198 public health managers across Ghana was modelled via covariance-based structures using AMOS graphics version 23. The results show that the links between PPE, health infrastructure, quality health delivery and cost containment were statistically significant. In addition, resource allocation was found to moderate the relationships among PPE, health infrastructure, quality health delivery and cost containment. When decisions on resource allocation align with NPIs and prevailing health infrastructure, their associations with quality health delivery and cost containment strengthen in the Ghanaian context. Misalignment of resources with NPIs suggests that health managers have not yet fully adapted their resources to the NPIs being implemented. To enhance performance in a crisis, managers should ensure that the allocation of resources and health infrastructure are in a state of equilibrium with NPI implementation.