Health Economics
Lightning Round SessionSunday, Jan. 5, 2025 1:00 PM - 3:00 PM (PST)
- Chair: Marianne Bitler, University of California-Davis
Beyond the Weight: Relative Obesity, Mental Health, and the Long-term Economic Consequences
Abstract
This paper examines the economic consequences of relative obesity during adolescence. Using a representative survey of middle school students in China and random class assignments, we find that students with larger body sizes compared to their peers suffer from worse mental health and academic records. Using another longitudinal dataset, we find that these impacts persist into adulthood, leading to reduced educational attainment, labor market participation, and wage income. Notably, the impacts are consistently more pronounced among females. In addition, we provide evidence that the adverse impacts can be attributed to self-image through social comparison, behavioral responses in study efforts, and perceptions of the future, yet can be potentially mitigated by the supportive family and school environment.Demand for Spousal Health
Abstract
This paper explores the importance of health for marital transitions and as a dimension for assortative mating. We present new empirical patterns on marriage, divorce, and assortative mating in relation to health, constructed over time and by race using US data from 1996-2023. We document that high fractions of unhealthy individuals are single, lack health insurance, and relatively small fractions have healthy spouses. Unhealthy men have become significantly more likely to be single over time. Unhealthy individuals are also more likely to be divorced and remain single. When married, unhealthy individuals have high rates of unhealthy spouses (40-45%), higher probabilities of “marrying down” in terms of education, and women have husbands with lower incomes (conditional on everything else) compared to their healthy counterparts. These findings have important implications for the design of health and social insurance programs which interact closely with intra-household insurance. Preliminary analysis shows the ACA is associated with a lower penalty of bad health in the marriage market. Finally, the gain to marriage for females with low education but good health surpasses that of females with high education but poor health. Conversely, the gain to marriage for males exhibit the opposite pattern. This asymmetry was noticeable in the mid-’90s but has since diminished in recent years. We develop a multidimensional matching model of education and health status to reveal the driving forces behind changes in the demand for spousal health.The Formation of Economic Preferences
Abstract
We use unique panel data on children’s economic preferences to study preference formation before the onset of adulthood. Our data encompass incentivized experiments eliciting time, risk, and social preferences as well as IQ tests with more than 4,500 children and adolescents aged 7-18 and their parents. We go beyond previous cross-sectional evidence by studying the dynamic, within-individual development of children’s preferences over time, demonstrating preference persistence already at young ages. Building on the model of skill formation (Cunha and Heckman 2007), we provide first evidence on self-productivity and cross-fertilization of children’s preferences and IQ. Moreover, we demonstrate that family members, parental investments, and local shocks are important sources of the substantial heterogeneity in children’s preference trajectories. Given the critical role of preferences and IQ in shaping behaviors and outcomes, our findings offer an explanation for social immobility.Give Your Baby the Best Start: The Life-Saving Power of Childhood Immunization
Abstract
This study uses the restrcited data from the National Vital Statistics System and ChildVaxView program, covering individual births from 2011 to 2019, to examine the association between first-dose Hepatitis B virus (HBV) vaccination in newborns and neonatal mortality rates.Using an instrumental variable approach with the immunization rate of randomly assigned adjecent's adjacent counties, we find that a one percent rise in the HBV vaccination rate is associated with an apprximately 4.7-6\% reduction in the neonatal mortality rate. These results suggest that postponing or denying this recommended vaccine, which bolsters the infant's immune system, is harmful to their survival. Additionally, estimating the heterogenous impacts by income and race we find that this effect is more significant among infants from low-income families and is especially pronounced among Asians compared to other racial groups.
How Information Shapes Individual Vaccination Decisions: Experimental Evidence from Germany and Bangladesh
Abstract
Vaccine hesitancy poses a significant obstacle to global immunization efforts. This study aims to address three key questions that are pivotal in understanding the dynamics of vaccine acceptance. Firstly, the research explores the potential consequences of exposing individuals to information about rumors and disinformation, followed by debunking their inclination to accept a specific vaccine. Secondly, it investigates how the availability of information regarding the effectiveness and source of a particular vaccine brand influences individuals' vaccination preferences. Lastly, the study examines how the impact of misinformation, debunking rumors, and disseminating authentic vaccine efficacy-related information on vaccine preferences varies between individuals from developed and developing countries.To delve into these inquiries, we conducted an experiment eliciting respondents' vaccine acceptance inclinations amidst the presence of vaccine-related rumors, misinformation, and doubts about effectiveness. The sample was randomly disaggregated into three groups: one receiving information debunking COVID-19 vaccine rumors from authentic sources, another receiving information about the efficacy of different vaccine types, and a third remaining untreated (control group). The study, conducted in January 2021 using the online experiment platform Limesurvey, involved participants from Germany and Bangladesh, predating the widespread availability of COVID-19 vaccines in both countries.
We observed a significant influence of knowledge regarding vaccine efficacy rate on vaccine preferences. Exposure to information about mid-efficacy vaccines led to a notable 11.9 percentage point decrease in acceptance. While debunking vaccination-related rumors did not show a significant impact on overall willingness to get vaccinated, there was a noteworthy 22.3 percentage point increase in vaccine acceptance in the German sample. These findings provide valuable insights for the design of targeted immunization programs tailored to specific environments. The study contributes significantly to the existing literature by focusing on vaccination acceptance and decision-making, delving into the distinct socioeconomic contexts of Germany and Bangladesh.
Immunity-driven Comparative Advantage and its Palliative Effect on Social Health and Inequality – A New Perspective on Comparative Advantage
Abstract
We propose a model of “trade” between high income and low-income groups where the rich being scared of the spread ofinfection hires the poor to engage them in exposure-intensive outdoor activities as workers in the household industry. People
who endure hardships and sustain exposure to unhygienic conditions may develop stronger immunity to fight the ongoing
pandemic than members of the privileged class. The low-income group has greater endowment of immunity to income and for
the rich it is lower. If such exchange takes place, essentially less immune people are withdrawn from exposure intensive
activities and are being substituted by more immune workers. Thus, the spread and fatality will reduce with such a trade. The
greater is the inequality, the more would be demand for labor for such work resulting in greater volume of such trade between
low income and high-income workers. Thus, spread of the disease will be lower for countries where inequality is high. Later
under a general equilibrium setting, we show that, ceteris paribus, a pandemic with a significant threat of infection and fatality
would mean greater demand for poor workers; their income would rise and inequality would decline. If the pandemic increases
demand for the top skilled, such as the case with virtual activities and derived demand for low skilled, relative wage for the top
and bottom would increase.
More Ado about Nothing? Questioning the Short and Long-term Effects of Data Breaches on Hospital Finances
Abstract
This study examines the financial impact of hospital data breaches, distinguishing between their static and dynamic effects. By analyzing hospital cost data and data breach reports available from the US Department of Health and Human Services, this research identifies immediate financial losses following breaches but demonstrates recuperation within a few years. This pattern challenges the prevailing notion of escalating long-term financial damages from breaches. Findings suggest that existing recovery mechanisms, such as insurance and liability funds, effectively mitigate long-term financial impacts. This study contributes a nuanced understanding of the economic resilience of hospitals against data breaches, informing more balanced healthcare policy analysis.Patient and Provider Concordance: Do Patients Prefer Physicians of their Own Race or Ethnicity?
Abstract
Matching doctors and patients on similarity of race or ethnicity as a potential way to reduce racial disparities has been popular for decades. The evidence in support of patient preferences for race- or ethnicity-concordance, however, tends to depend on self-reported measures which are not as reliable as measures derived using a controlled experiment. We conducted a randomized controlled field experiment to better assess racial and ethnic concordance preferences among patients and then considered how these preferences translate into demand for providers by group (N=2,187). Respondents faced a choice between a White physician profile and the profile of a non-White physician (Black, Hispanic, South Asian, or East Asian), signaled by name. White respondents preferred White physicians by 10 percentage points (ppts) (95% CI: 0.048 to 0.157, p<0.01). Hispanic respondents favored Hispanic physicians by 27 ppts (95% CI: 0.148 to 0.398, p<0.01), while Black respondents favored Black physicians by 15 ppts (95% CI: -0.013 to 0.395, p=0.07). East and South Asian respondents did not prefer racially concordant physicians. Overall, White physicians were preferred by 4.8 ppts (95% CI: 0.004 to 0.092, p=0.030) at the expense of Asian physicians who were less preferred by 9.2 ppts (95% CI: -0.187 to 0.003, p=0.06). These results highlight challenges to diversifying the physician labor market given patient preferences and distributions.Like Father, Like Son? Uncovering the Intergenerational Health Effects of Job Insecurity
Abstract
This paper investigates the intergenerational health effects of job insecurity, using China's State-Owned Enterprise (SOE) reform in the late 1990s as a natural experiment. Before the reform, SOE workers and government employees enjoyed similar levels of job security and benefits. However, the reform led to massive layoffs in the SOE sector, increasing job insecurity among SOE workers while leaving government employees unaffected. Exploiting this variation in job insecurity across sectors and time, we employ a difference-in-differences approach to estimate the impact of parental job insecurity on children's smoking behavior and related outcomes.Our results show that children with parents employed in the SOE sector during the reform period are more likely to smoke compared to those with parents in the government sector. We explore potential mechanisms, including changes in parental smoking behavior, educational attainment, age at first employment, and time use. We also examine the differential impact of paternal and maternal job insecurity, considering the substantial gender differences in smoking prevalence in China.
We find that paternal job insecurity has a larger effect on children's smoking behavior than maternal job insecurity. Furthermore, we provide evidence suggesting that changes in family environment and parental smoking play a role in children's smoking initiation. Children with SOE parents also tend to have lower educational attainment and start working at a younger age, which may contribute to their increased smoking propensity.
Our findings highlight the long-lasting consequences of job insecurity on the health of future generations and underscore the importance of considering intergenerational effects when designing policies to address economic shocks. This paper contributes to the literature on the intergenerational transmission of health behaviors and the effects of economic uncertainty on individual and family outcomes.
JEL Classifications
- I1 - Health