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Demand for personalized online tutoring in higher education is growing but there is little research on its effectiveness. We conducted an RCT offering remote peer tutoring in micro- and macroeconomics at a German university teaching online due to the Covid-pandemic. Treated students met in small groups, in alternating weeks with and without a more senior student tutor. The treatment improved study behavior and increased contact to other students. Tutored students achieved around 30% more credits and a one grade level better GPA across treated subjects. Our findings suggest that the program reduced outcome inequality. We find no impacts on mental health.

We conducted a randomized controlled trial involving nearly 700 customer-service representatives (CSRs) in a Canadian government service agency to study whether providing CSRs with performance feedback with or without peer comparison affected their subsequent organ donor registration rates. Despite having no tie to remuneration or promotion, the provision of individual performance feedback three times over one year resulted in a 25% increase in daily signups, compared to otherwise similar encouragement and reminders. Adding benchmark information that compared CSRs performance to average and top peer performance did not further enhance this effect. Registrations increased more among CSRs whose performance was already above average, and there was no negative effect on lower-performing CSRs. A post-intervention survey showed that CSRs found the information included in the treatments helpful and encouraging. However, performance feedback without benchmark information increased perceived pressure to perform.

The current health crisis has particularly affected the elderly population. Nursing homes have unfortunately experienced a relatively large number of deaths. On the basis of this observation and working with European data (from SHARE), we want to check whether nursing homes were lending themselves to excess mortality even before the pandemic. Controlling for a number of important characteristics of the elderly population in and outside nursing homes, we conjecture that the difference in mortality between those two samples is to be attributed to the way nursing homes are designed and organised. Using matching methods, we observe excess mortality in Belgium, France, Germany Luxembourg, Switzerland, Estonia and Czech Republic but no statistically significant excess mortality in Sweden, the Netherlands, Denmark, Austria, Italy or Spain. This raises the question of the organisation and management of these nursing homes, but also of their design and financing.

This paper examines the effect of e-waste dumping sites on early child health. We focus on two major dumping sites in West Africa, in Ghana and Nigeria. We observe children born before and after the creation of these dumps, and estimate a difference-in-difference specification in which we compare outcomes of those born within the vicinity of the dump to those farther away, before and after e-waste sites were created. We find that the e-waste sites increase neonatal and infant mortality, for children living in the proximity of the site. Event studies suggest that the negative effects emerge 2-3 years after the existence of the sites, consistent with the gradual and systematic build up of contaminants in the environment. By exploring routes of exposure, we find that the contamination of water and urban farming produce are among the drivers of the observed effects.

Work-related stress has reportedly increased over time. Using worker-level survey data, we build a measure of work pressure strongly associated with adverse health outcomes. In line with theories of compensating differentials, work pressure comes with a sizable earnings premium, even within narrowly defined occupations. As expected, we find no premium among civil servants who face strong labor market frictions. In complementary stated-choice experiments, we uncover a substantial willingness-to-pay to avoid work pressure. Our evidence is consistent with workers sorting into high- and low-pressure jobs. Differences in the prevalence and valuation of work pressure explain a substantial share of wage inequality.

In this paper, we develop a life cycle model in which health and longevity are threatened by infectious and chronic diseases. The model captures that the susceptibility and severity of infectious diseases depend on the accumulated health deficits (immunosenescence) and that the life history of infections affects the accumulation of chronic health deficits (inammaging). Individuals invest in their health to slow down health deficit accumulation and take measures to protect themselves from infectious diseases. We calibrate the model for an average American and explore how health expenditure, life expectancy, and the value of life depend on individual characteristics, medical technology, and the disease environment. We then use counterfactual computational experiments of the U.S. epidemiological transition 1860-2010 to show that the decline of infectious diseases caused a substantial decline of chronic diseases and contributed more to increasing life expectancy than advances in the treatment of chronic diseases. Finally, we use the model to investigate behaviour and long-term health outcomes in response to the Covid-19 pandemic. We predict that the pandemic will shorten the life expectancy of middle-aged people almost as much as that of older people because of inammaging and the self-productivity of health deficits.

Peer and cohort effects are important in health economics, and obesity may be related to social relationships, where obese individuals interact with other obese individuals. There were significant 19th century cohort effects, where BMIs were related to the cohort that an individual belonged. After accounting for individual relationships between BMI, demographic, socioeconomic, and residential characteristics, there were significant cohort effects associated with race, residence, and age. Moreover, cohort effects reduce the size of the individual relationships between BMI, race, and age, but results are mixed for BMI and residence. This indicates that historical cohort effects are important in BMI and obesity studies.

Over the last decade, the U.S. Medicare program has added new billing codes to enhance the financial rewards for Chronic Care Management and Transitional Care Management. We show that the take-up of these new billing codes is gradual and exhibits substantial variations across markets and physician groups, indicating that frictions to take-up may delay the impacts of payment reforms. We show that patterns of care and billing code substitution and complementarity can be important for assessing the costs and care access impacts of payment reforms. In our particular context, we estimate that the new Transitional Care Management codes had substantial impacts on the overall provision of evaluation and management services, flu vaccinations, and other recommended services, while the new Chronic Care Management codes did not. These patterns of complementarity shape both the costs and benefits of the introduction of these payment reforms, including the effects of the new billing codes on the overall return to specializing in primary care.

This paper adds some formal research to the success of ongoing efforts to combat the COVID-19 pandemic by examining the drivers of the administration and delivery efficiency of coronavirus vaccines. For this purpose, we use data from the 50 US states and place the formal analysis in the context of socio-economic drivers of vaccinations. Results show that state economic prosperity and rural population aid vaccine administration and delivery efficiency. Delivery efficiency improves in states with more nursing homes per capita, in states with more COVID-19 deaths, and with more health workers. The subset of health workers, including physicians and nurses, did not significantly impact administration or efficiency. On the other hand, vaccination efficiency was lower in states with a centralized public health agency. States with a larger share of the elderly population and those with Democrats as governors were no different from others with regard to vaccinations. Robustness checks are performed using vaccination from a more recent period. Finally, a state’s legacy of corrupt activity, across two different time dimensions, is broadly consistent with the greasing effects of corruption. While the study uses data from a single nation that is among the first to start vaccinating its population, the findings have relevance for other nations, especially in the Global South, that are starting vaccinations or lagging behind in delivering vaccines.

The definition of inequality is complicated and difficult to assess, and there are various means by which it is evaluated. This study uses the now well-accepted measures of body mass, height, and weight to assess inequality’s relationship with current and cumulative net nutrition. Taller statures allow weight to be distributed over larger areas, and height is inversely related to body mass, however positively related to weight. Because weight increased with age and age inequality, the majority of net nutrition is beyond an individual’s control, and stature inequality is smaller than weight because it is genetically determined. Current net nutrition was positively related to age, however, inversely related to regional inequality. Subsequently, current and cumulative net nutrition are related to inequality and increased across BMI and weight distributions.

We present a general framework for Bayesian estimation and causality assessment in epidemiological models. The key to our approach is the use of sequential Monte Carlo methods to evaluate the likelihood of a generic epidemiological model. Once we have the likelihood, we specify priors and rely on a Markov chain Monte Carlo to sample from the posterior distribution. We show how to use the posterior simulation outputs as inputs for exercises in causality assessment. We apply our approach to Belgian data for the COVID-19 epidemic during 2020. Our estimated time-varying-parameters SIRD model captures the data dynamics very well, including the three waves of infections. We use the estimated (true) number of new cases and the time-varying effective reproduction number from the epidemiological model as information for structural vector autoregressions and local projections. We document how additional government-mandated mobility curtailments would have reduced deaths at zero cost or a very small cost in terms of output.

Information provided by experts is widely believed to play a key role in shaping attitudes towards policy responses to the COVID-19 pandemic. This paper uses a survey experiment to assess whether providing citizens with expert information about the health risk of COVID-19 and the economic costs of lockdown measures affects their attitudes towards these policies. Our findings show that providing respondents with information about COVID-19 fatalities among the elderly raises support for lockdown measures, while information about their economic costs decreases support. However, different population subgroups react very differently. Men and younger respondents react more sensitively to information about lockdown costs, while women and older respondents are more susceptible towards information regarding fatality rates. Strikingly, the impact of the information treatment is entirely driven by West German respondents, while East Germans do not react. Finally, our results are entirely driven by respondents who underestimate the fatality of COVID-19, who represent a clear majority.

In the beginning of the COVID-19 pandemic, governments had to rely on Non-Pharmaceutical Interventions in their struggle against the spread of the virus. The stringency of the lockdowns differed across space and time as governments had to adjust their strategy dynamically to the country-specific development of the crisis. We examine the effectiveness of lockdowns with a focus on the role of health care based upon both the between and the within-variation of our panel-data. The within-variation over time allows us to control for unobserved heterogeneity through fixed-effects. The results reveal that lockdowns had significant effects on the mortality rates associated with COVID-19. Marginal effects are estimated conditional on the state of the health care system before the crisis. Lockdowns were more efficient in countries with well-supported health care systems. Marginal effects turn insignificant when per capita health expenditure dips below the mean. We can show that both results are driven by economic development. Per capita GDP is highly correlated with public health expenditure but it is not a perfect substitute.

This paper discusses the relationship between medical innovations and ageing from a health economics perspective and surveys empirical evidence on medical R&D incentives, R&D costs of pharmaceuticals, and the cost-effectiveness of health innovations. Particular focus is on the endogeneity of medical technological progress to expected market size and on the conceptualization of ageing as an accumulation of health deficits. The paper also discusses the role of medical progress for longevity and health inequality and presents a framework to assess the effect of increased longevity on the value of life.

To limit the dramatic growth of U.S. health care expenditures, some states have mandated that medical providers publicly report their charge prices. Our study evaluates the heterogeneous effects of this price transparency policy. We use a comprehensive database that covers more than 2,000 hospitals nationwide from 1996 to 2017. We employ a flexible generalized synthetic control method that allows for heterogeneous treatment effects. We find that the price transparency policy not only reduced charge prices by 3.9% (which corresponds to savings of $1,164 per hospital stay) but also diminished negotiated prices by 15.9% and hospital costs by 4.7%. Our estimation results show that the effects on charge prices do not last as long as the impacts on negotiated prices and costs. We also find large heterogeneous responses across hospitals that depend on: (1) hospitals’ past charge prices prior to adopting the price transparency law, that is, high-price hospitals reduce charge and negotiated prices, while low-price hospitals increase charges; (2) hospital characteristics such as ownership, case mix, and payer mix; and (3) hospital size and market competition. We also conduct counterfactuals to predict price changes of non-treated states and find large reductions in negotiated prices.

This paper studies the causal effect of parental death on children's mental health. Combining several nationwide register-based data for Finnish citizens born between 1971 and 1986, we use an event study methodology to analyze hospitalization for mental health-related reasons by the age of 30. We find that there is no clear evidence of increased hospitalization following the death of a parent of a different gender, but there are significant effects for boys losing their fathers and girls losing their mothers. Depression is the most common cause of hospitalization in the first three years following paternal death, whereas anxiety and, to a lesser extent, self-harm are the most common causes five to ten years after paternal death. We also provide descriptive evidence of an increase in the use of mental health-related medications and sickness absence, as well as substantial reductions in years of schooling, employment, and earnings in adulthood for the affected children.

We ask whether epidemic exposure leads to a shift in financial technology usage within and across countries and if so who participates in this shift. We exploit a dataset combining Gallup World Polls and Global Findex surveys for some 250,000 individuals in 140 countries, merging them with information on the incidence of epidemics and local 3G internet infrastructure. Epidemic exposure is associated with an increase in remote-access (online/mobile) banking and substitution from bank branch-based to ATM-based activity. Using a machine-learning algorithm, we show that heterogeneity in this response centers on the age, income and employment of respondents. Young, high-income earners in full-time employment have the greatest propensity to shift to online/mobile transactions in response to epidemics. These effects are larger for individuals in subnational regions with better ex ante 3G signal coverage, highlighting the role of the digital divide in adaption to new technologies necessitated by adverse external shocks.

We investigate health and aging before and after retirement for specific occupational groups. We use five waves of the Survey of Health, Aging, and Retirement in Europe (SHARE) and construct a frailty index for elderly men and women from 10 European countries. Occupational groups are classified according to low vs. high education, blue vs. white collar color, and high vs. low physical or psychosocial job burden. Controlling for individual fixed effects, we find that, regardless of the used classification, workers from the first (low status) group display more health deficits at any age and accumulate health deficits faster than workers from the second (high status) group. We instrument retirement by statutory retirement ages (“normal” and “early”) and find that the health of workers in low status occupations benefits greatly from retirement, whereas retirement effects for workers in high status occupations are small and frequently insignificant. We also find that workers from low status occupations always have higher health deficits, i.e. we find evidence for an occupational health gradient that widens with increasing age, before and after retirement.

This paper theoretically and empirically investigates the effects of letting people choose from a menu of increasingly challenging incentive schemes. We derive the conditions under which a policy maker profits from leaving the choice to the individuals by leveraging their private information about the expected benefits from the targeted behavior. We test the theoretical predictions in a field experiment in which we pay participants monetary rewards for completing daily meditation sessions. We randomly assign some participants to one of two incentive schemes and allow others to choose between the two schemes. As predicted, participants sort into schemes in (partial) agreement with the objectives of the policy maker. In contrast to our theoretical predictions, participants who could choose complete significantly fewer meditation sessions than participants that were randomly assigned. Since the results are not driven by poor selection, we infer that letting people choose between incentive schemes may bring in psychological effects that discourage adherence.

A population’s average stature reflects cumulative net nutrition and changing long-run economic conditions facing women’s economic opportunity, inequality, and net nutrition during development. This study uses stature as a measure for cumulative net nutrition to show how female and male statures varied around the US Civil War. Male statures and net nutrition decreased more than females with industrialization, indicating that women’s net nutrition improved relative to men with emancipation and industrialization. The net nutrition of women in agricultural occupations was greater than women in other occupations; however, male stature returns associated with occupations increased more than women with the transition to free-labor.

We employ panel data from three waves of a large representative population survey carried out between June and November 2020 to assess in what regards and to what extent different groups of the German population are affected by the COVID- 19 crisis. Using common factor analysis, we demonstrate that people’s lives are mainly affected in two ways: First, a notable fraction of the population is concerned that they or their family members and friends may get infected with the coronavirus. Second, many people suffer from socio-economic consequences of the crisis, including a discontinuation of employment, a decrease in household income, and worries about financial troubles. Regressing these two factors on several socio-demographic characteristics reveals that especially the socio-economic consequences vary across population groups. Self-employed persons, marginally employed workers, low-income households, and families with children appear to be burdened over-proportionally.

Countries worldwide have implemented lockdown measures to contain the covid-19 pandemic. After more than three months of restrictions to economic activities in many countries, the question has turned to the best ways to lift lockdowns while keeping the epidemic in check. Here I use basic economic principles to shed light on the key tradeoffs. A central message is that there is no “health vs. economics” dichotomy. Rather, some degree of lockdown is typically optimal in crisis like this, balancing its economic costs against its health benefits. Moreover, the optimal lockdown is dynamic, changes over time and eventually becomes more lenient, although the path is not necessarily monotonic.

We use the UK Household Longitudinal Study and compare pre- (2017-2019) and post-COVID-19 data (April 2020) for the same group of individuals to assess and quantify changes in mental health among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed pre- and post-COVID-19, and uncover four new facts. First, ethnicity predicts mental health deterioration when interacted with gender. Among men, BAME individuals experience a higher deterioration in mental health compared to British White individuals. However, among women, the deterioration in mental health is similar for both BAME and British White individuals. Second, the gender gap in mental health deterioration is only present among British White individuals and not among BAME individuals. Third, the drop in mental health among women and BAME men is very similar. Finally, there is substantial heterogeneity across BAME groups. The BAME group of Bangladeshi, Indian and Pakistani appears to be driving the difference in the gender gap in mental health deterioration between British White and BAME individuals. We call for additional research on the effects of the COVID-19 pandemic across different ethnic groups, and urge both policy makers and researchers to allocate resources to collect larger sample sizes of minority ethnic groups.

Communities urbanize when the net benefits to urbanization exceed rural areas. Body mass, height, and weight are biological welfare measures that reflect the net difference between calories consumed and calories required for work and to withstand the physical environment. Across the United States, 19th century urban heights and weights were lower than their rural counterparts, while urban BMIs were higher. However, as the ratio of weight to height, higher urban BMIs reflect shorter urban statures, indicating there was a willingness-to-accept poorer cumulative urban health and net nutrition in exchange for urban economic opportunity. Over the late 19th and early 20th centuries, urban and rural BMIs, height, and weight were constant, and rural farmers had greater BMIs, taller statures, and heavier weights than urban farmers and workers in other occupations.

This paper provides a critical review of models of the spread of the coronavirus (SARS-CoV-2) that have been influential in recent policy discussions. It notes potentially important features of the real- world environment that the standard models do not incorporate and discusses reasons why estimating critical parameters is difficult. These limitations may bias forecasts and lead forecasters to overstate confidence in their predictions. They also provide social scientists with opportunities to advance the literature and enable improved policies. This paper also discusses how optimal policies might depend on what is learned from new data and models.

We measure the economic risk of Covid-19 at a geo-spatially detailed resolution. In addition to data about the current prevalence of confirmed cases, we use data from 2014-2018 and a conceptual disaster risk model to compute measures for exposure, vulnerability, and resilience of the local economy to the shock of the epidemic. Using a battery of proxies for these four concepts, we calculate the hazard, the principal components of exposure and vulnerability to it, and of the economy’s resilience (i.e., its ability of the recover rapidly from the shock). We find that the economic risk of this pandemic is particularly high in most of Sub-Saharan Africa, South Asia, and Southeast Asia. These results are consistent when comparing an ad-hoc equal weighting algorithm for the four components of the index, an algorithm that assumes equal hazard for all countries, and one based on estimated weights using previous aggregated Disability-Adjusted Life Years losses associated with communicable diseases.

Using a registered pre-analysis plan, we survey college students during California's Stay-at-Home order to test whether compliance with social distancing requirements depends on key parameters that affect their marginal benefit from doing so. We find a quarter of students violated the order. Yet, neither risk preference, altruism, nor preexisting health conditions were predictive of compliance. Our findings raise doubt about the efficiency of minimally enforced social distancing policies, as well as commonly assumed motivations for compliance. Our results also imply that that those with pre-existing health conditions may not voluntarily comply, resulting in higher health care congestion than otherwise expected.

When other measures for material conditions are scarce or unreliable, the use of height is now common to evaluate economic conditions during economic development. However, throughout US economic development, height data by gender have been slow to emerge. Throughout the late 19th and early 20th centuries, female and male statures remained constant. Agricultural workers had taller statures than workers in other occupations, and the female agricultural height premium was over twice that of males. For both females and males, individuals with fairer complexions were taller than their darker complexioned counterparts. Gender collectively had the greatest explanatory effect associated with stature, followed by age and nativity. Socioeconomic status and birth period had the smallest collective effects with stature.

We analyze wartime prosthetic device patents to investigate how demand and procurement policy can shape medical innovation. We use machine learning tools to develop new data describing the aspects of medical and mechanical innovations that are emphasized in patent documents. Our analysis of historical patents yields three primary facts. First, we find that the U.S. Civil War and World War I led to substantial increases in the quantity of prosthetic device patenting relative to patenting in other medical and mechanical technology classes. Second, we find that the Civil War led inventors to focus broadly on improving aspects of the production process, while World War I did not, consistent with the United States applying a more cost-conscious procurement model during the Civil War. Third, we find that inventors emphasized dimensions of product quality (e.g., a prosthetic’s appearance or comfort) that aligned with differences in buyers’ preferences, as described in the historical record, across wars. We conclude that procurement environments can significantly shape the scientific problems with which inventors engage, including the choice to innovate on quality or cost.

In this paper we confront the role the EU traditionally plays in the domain of health with the urgent need for collective action triggered by the corona virus pandemic. In the face of such a crisis, we argue that the joint procurement, stockpiling and allocation of medical countermeasures is a key component of true European solidarity, besides maintaining the integrity of the Single Market. We present the first results of a survey experiment taken before the current crisis on citizens’ attitudes towards centralizing at the EU level of policies to combat infectious diseases, which indicates considerable support. We conclude that a more robust policy framework with substantial centralization of procurement, stockpiling and allocation is warranted.

We use anonymized and aggregated data from Facebook to show that areas with stronger social ties to two early COVID-19 "hotspots" (Westchester County, NY, in the U.S. and Lodi province in Italy) generally have more confirmed COVID-19 cases as of March 30, 2020. These relationships hold after controlling for geographic distance to the hotspots as well as for the income and population density of the regions. These results suggest that data from online social networks may prove useful to epidemiologists and others hoping to forecast the spread of communicable diseases such as COVID-19.

When other measures for economic welfare are scarce or unreliable, the use of biological measures are now standard in economics. This study uses late 19th and early 20th century BMI, statures, and weight to assess how net nutrition accumulated to women and men during US economic development. Throughout the late 19th and early 20th centuries, female and male BMIs, statures, and weight remained constant over time. Unskilled laborers’ BMIs were higher, their statures were taller, and their weights heavier than workers in other occupations. Women and men from the Northeast and Middle Atlantic had higher BMIs and shorter statures, while their counterparts from the South were taller and had lower BMIs, indicating that it was superior Southern cumulative net nutrition associated with lower BMIs.

We explore the role of social capital in the spread of the recent Covid-19 pandemic in independent analyses for Austria, Germany, Italy, the Netherlands, Sweden, Switzerland and the UK. Exploiting within-country variation, we show that a one standard deviation increase in social capital leads to 12% and 32% fewer Covid-19 cases per capita accumulated from mid-March until mid-May. Using Italy as a case study, we find that high-social-capital areas exhibit lower excess mortality and a decline in mobility. Our results have important implications for the design of local containment policies in future waves of the pandemic.

We examine the relationship between contemporaneous fine particulate matter exposure and COVID-19 morbidity and mortality using an instrumental variable approach based on wind direction. Harnessing daily changes in county-level wind direction, we show that arguably exogenous fluctuations in local air quality impact the rate of confirmed cases and deaths from COVID-19. In our preferred high dimensional fixed effects specification with state-level policy and social distancing controls, we find that a one μg/m3 increase in PM 2.5 increases the number of confirmed cases by roughly 2% from the mean case rate in a county. These effects tend to increase in magnitude over longer time horizons, being twice as large over a 3-day period. Meanwhile, a one μg/m3 increase in PM 2.5 increases the same-day death rate by 3% from the mean. Our estimates are robust to a host of sensitivity tests. These results suggest that air pollution plays an important role in mediating the severity of respiratory syndromes such as COVID-19, for which progressive respiratory failure is the primary cause of death, and that policy levers to improve air quality may lead to improvements in COVID-19 outcomes.

A population’s weight conditioned on height reflects its current net nutrition and demonstrates health variation during economic development. This study builds on the use of weight as a measure for current net nutrition and uses a difference-in-decompositions technique to illustrate how black and white current net nutrition varied with the transition to free-labor. Adult black age-related weight gain was greater with the transition to free-labor yet was not as large as the adult white age related weight gain. Agricultural worker’s current net nutrition was better than workers in other occupations, and agricultural workers’ net nutrition was better than workers in other occupations but was worse-off with the transition to free labor. Nativity had the greatest effect with weight changes and the transition to free-labor. Within-group weight variation was greater than across-group variation.

When other measures for economic welfare are scarce or unreliable, the body mass index (BMI) is a biological measure that reflects current net nutrition. This study uses a difference-in-decompositions framework to analyze how women's BMIs varied with the advent of early 20th century social feminism. Late 19th and early 20th century US economic development improved the relative status of women relative to both men before and after the transition to social feminism. Twentieth century women's BMIs were higher than 19th century women relative to men with the rise of social feminism. The primary source of female-male across-group variation was height and nativity, indicating there was net nutritional progress for women relative to men associated with changing cumulative net nutrition. The primary source of female-male within-group variation was nativity and socioeconomic status, indicating there was net nutritional progress relative to women born before the transition for women born after the rise of social feminism association with socioeconomic status.

There are two types of prescription drug cost offsets. The first type of cost offset—from prescription drug use—is primarily about the effect of changes in drug quantity (e.g. due to changes in out-of-pocket drug costs) on other medical costs. The second type of cost offset—the cost offset from prescription drug innovation—is primarily about the effect of prescription drug quality on other medical costs. Two previous studies found that pharmaceutical innovation reduced hospitalization, and that the reduction in hospital cost from the use of newer drugs was considerably greater than the innovation-induced increase in pharmaceutical expenditure. In this study, we reexamine the impact that pharmaceutical innovation has had on hospitalization, employing a different type of 2-way fixed effects research design. We estimate the impact that new drug launches that occurred during the period 1982-2015 had on hospitalization in 2015 for 67 diseases in 15 OECD countries. Our models include both country fixed effects and disease fixed effects, which control for the average propensity of people to be hospitalized in each country and from each disease. The number of hospital discharges and days of care in 2015 is significantly inversely related to the number of drugs launched during 1982-2005, but not significantly related to the number of drugs launched after 2005. (Utilization of drugs during the first few years after they are launched is relatively low, and drugs for chronic conditions may have to be consumed for several years to achieve full effectiveness.) The estimates imply that, if no new drugs had been launched after 1981, total days of care in 2015 would have been 163% higher than it actually was. The estimated reduction in 2015 hospital expenditure that may be attributable to post-1981 drug launches was 5.3 times as large as 2015 expenditure on those drugs.

This paper reports the results from a statistical analysis of pharmaceutical price negotiations in Germany, where the pricing system was changed in 2011 in order to tie prices more to the benefits of the pharmaceuticals. A multiple linear regression of 187 pharmaceuticals which were assessed from 2011 to 2017 suggests that, despite the change, the manufacturers' launch strategy (freely chosen first year price) still has a major impact on pricing while the impact of the additional benefit remains comparably small. Moreover, the data suggest that the assessment of the Federal Joint Committee - while not yet existing at the point - best explains the manufacturer's launch strategy, indicating that manufacturers know more than they reveal.

When traditional measures for material and economic welfare are scarce or unreliable, height and the body mass index (BMI) are now widely accepted measures that represent cumulative and current net nutrition in development studies. However, as the ratio of weight to height, BMI does not fully isolate the effects of current net nutrition. After controlling for height as a measure for current net nutrition, this study uses the weight of a sample of international men in US prisons. Throughout the late 19th and early 20th centuries, individuals with darker complexions had greater weights than individuals with fairer complexions. Mexican and Asian populations in the US had lower weights and reached shorter statures. Black and white weights stagnated throughout the late 19th and early 20th centuries. Agricultural workers’ had greater weights than workers in other occupations.

Although preterm births are the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of such births later in life is limited. Using Swedish population register data on cohorts born 1982-1994 (N=1,087,750), we examine the effects of preterm births on school grades using sibling fixed effect models which compare individuals with their non-preterm siblings. We test for heterogeneous effects by degree of prematurity, as well as whether family socioeconomic resources and school characteristics can compensate for any negative effects of premature births. Our results show that preterm births can have negative effects on school grades, but these negative effects are largely confined to children born extremely preterm (

While World War II (WWII) is often employed as natural experiment to identify long-term effects of adverse early-life and prenatal conditions, little is known about the short-term effects. We estimate the short-term impact of the onset of WWII on newborn health using a unique data set of historical birth records ranging from December 1937 to September 1941. Furthermore we investigate the heterogeneity of this effect with respect to health at birth and for different social groups. To evaluate potential channels for our results, we explore how birth procedures changed. While we do not find any effects on birth weight and asphyxia, perinatal mortality increases immediately after the onset of WWII. The mortality effect is driven by live births and strongest for very low birth weight infants. A decline in quality of medical care due to the sudden conscription of trained physicians to military service is the most likely mechanism for our findings.

Through changing the connection between insurance and employment, the Affordable Care Act (ACA) has affected people’s incentives to obtain education. We employ a triple-difference strategy comparing counties with different levels of uninsurance pre-ACA and in states with different Medicaid expansion decisions across time to investigate changes in enrollment in different types of higher education institutions. We find that enrollment in less than 2-year for-profit colleges increased more between high- and low-uninsurance counties in states that expanded Medicaid relative to states that didn’t, with nearly all the increase taking place after the 2012 Supreme Court decision that gave states the right to choose not to expand Medicaid. Differential enrollment is at for all other comparable college types. We find this differential increase in less than 2-year for-profit college enrollment to be remarkably general across various demographic groups, although the effect is statistically and economically more significant for Hispanics. Studying effects on certificates awarded, we find strong evidence that the increase in enrollment led to an increase in certificates awarded, most prominently in vocational fields. This pattern is consistent with the notion that by relaxing job-lock, the ACA encouraged individuals to seek training in vocational fields that would facilitate employment in low-insurance industries. Our results are robust to controlling for confounders such as the differential impact of the Great Recession, changes in state appropriations for higher education, differences in age composition across counties, thus ruling out the role of the young adult provision of the ACA in contributing to our results, and survive a plethora of sensitivity checks.

In this paper we set up an overlapping generations model of gerontological founded human aging that takes the interaction between R&D-driven medical progress and access to health care into account. We use the model to explore potential futures of human health and longevity. For the baseline policy scenario of health care access, the calibrated model predicts substantial future increases in health and life expectancy, associated with rising shares of health expenditure in GDP. Freezing the expenditure share at the 2020 level by rationing access to health care severely reduces potential gains in health, longevity and welfare. These losses are greatest in the long run due to reduced incentives for medical R&D. For example, rationing is predicted to reduce potential gains of life-expectancy at age 65 by about 4 years in the year 2050. Generally, and perhaps surprisingly, young individuals (i.e. those who save the most health care contributions through rationing) are predicted to suffer the greatest losses in terms of life expectancy and welfare.

The body mass index (BMI) reflects current net nutrition and health during economic development. This study introduces a difference-in-decompositions approach to show that although 19th century African-American current net nutrition was comparable to working class whites, it was made worse-off with the transition to free-labor. BMI reflects net nutrition over the life-course, and like stature, slave children’s BMIs increased more than whites as they approached entry into the adult slave labor force. Agricultural worker’s net nutrition was better than workers in other occupations but was worse-off under free-labor and industrialization. Within-group BMI variation was greater than across-group variation, and white within-group variation associated with socioeconomic status was greater than African-Americans.

In 1893, Frederick Jackson Turner proposed that America’s Western frontier was an economic ‘safety-valve,’ a place where settlers could migrate when conditions in eastern states and Europe crystalized against their upward economic mobility. However, recent studies suggest the Western frontier’s material conditions may not have been as advantageous as Jackson proposed because settlers lacked the knowledge and human capital to succeed on the Plains and Far Western frontier. This study illustrates that current and cumulative net nutrition on the Central Plains improved during the late 19th and early 20th centuries, indicating that recent challenges to the Turner hypothesis are not well supported by net nutrition studies. Net nutrition improve with agricultural innovations and biotechnologies on the western frontier, and rural agricultural workers net nutrition was better than from elsewhere within the US.

This study estimates the causal effect of working hours on health. We deal with the endogeneity of working hours through instrumental variables techniques. In particular, we exploit exogenous variation in working hours from statutory workweek regulations in the German public sector as an instrumental variable. Using panel data, we run two-stage least squares regressions controlling for individual-specific unobserved heterogeneity. We find adverse consequences of increasing working hours on subjective and several objective health measures. The effects are mainly driven by women and parents of minor children who generally face heavier constraints in organizing their workweek.

We document the relationship of a set of individual choices - including parenthood, marital state, and income - with an individual’s cause of death. Using the data set of the Office for National Statistics Longitudinal Study (ONS-LS) which follows one percent of the population of England and Wales along five census waves 1971, 1981, 1991, 2001, and 2011, our competing risks analysis yields several striking results. 1) Females have only a 28% chance to die of cancer when they have children (compared to childless females); 2) males have a 71% increased chance of dying from cancer when they are married (compared to unmarried males); 3) females with children have only a 34% risk to die of heart disease and 4) a 53% chance of dying from infections (compared to females without children); 5) married men have an increased expectation of 23% to die of heart disease (compared to unmarried men); 6) high income and house ownership always is associated with higher survival but less so than having children.

This paper investigates the effect of physicians on infant mortality, stillbirths and the incidence of common childhood diseases. We construct a new panel data set covering German municipalities from 1928 to 1936 based on historical sources. The endogeneity of health care supply is addressed by using the expulsion of Jewish physicians from health insurance schemes by the Nazi government in 1933 as a source of exogenous variation in regional physician density. The results indicate substantial mortality effects due to changes in physician density. One additional physician per 1,000 of population reduces infant mortality by 23% and stillbirths by 16%. We find similar negative effects for gastrointestinal diseases and the incidence of measles, influenza and bronchitis. To investigate diminishing returns to health care provision, we develop a semiparametric control function approach. Our results indicate that the marginal returns to physicians are highly nonlinear and decreasing.

Previous analyses of the 2016 Brexit referendum used region-level data or small samples based on polling data. The former might be subject to ecological fallacy and the latter might suffer from small-sample bias. We use individual-level data on thousands of respondents in Understanding Society, the UK’s largest household survey, which includes the EU referendum question. We find that voting Leave is associated with older age, white ethnicity, low educational attainment, infrequent use of smartphones and the internet, receiving benefits, adverse health and low life satisfaction. These results coincide with corresponding patterns at the aggregate level of voting areas. We therefore do not find evidence of ecological fallacy. In addition, we show that prediction accuracy is geographically heterogeneous across UK regions, with strongly pro-Leave and strongly pro-Remain areas easier to predict. We also show that among individuals with similar socioeconomic characteristics, Labour supporters are more likely to support Remain while Conservative supporters are more likely to support Leave.

Average stature reflects cumulative net nutrition and health during economic development. This study introduces a difference-in-decompositions approach to show that although 19th century African-American cumulative net nutrition was comparable to working class whites, it was made worse-off with the transition to free-labor. Average stature reflects net nutrition over the life-course, and slave children’s BMIs increased more with age than whites as they approached entry into the adult slave labor force. Agricultural worker’s net nutrition was better than workers in other occupations but was worse-off under free-labor and industrialization. Within-group stature variation was greater than across-group variation, and white within-group stature variation associated with socioeconomic status was greater than African-Americans.