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
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.
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
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.
The general prevalence of chronic non-communicable diseases, such as diabetes mellitus is rapidly increasing while exacerbating the burden of disease on healthcare systems. Its management, as opposed to communicable diseases, is typically long term and requires ongoing healthcare interventions, such as dietary control and medication prescription, with associated costs. The prescription requires an interaction between patients and physicians, which may be sporadic or continuous, and can be used as a proxy measure for the strength of patient–doctor relationship. We hypothesize that fragmentation of care, across physician specialties and payers, plays a role on prescription behaviour, above and beyond for patient and prescription characteristics. A panel of patients’ prescriptions events with the universe of all prescriptions and dispensing in Portugal from January 2015 to October 2019 (N = 791.467) provided by Serviços Partilhados do Ministério da Saúde, EPE was considered. We measured the association between care fragmentation of care and prescription behavior of antihyperglycaemic medication using negative binomial regression models. Results suggest that Specialists play a secondary role on the prescription of DPP-4i and SGLT2i, prescribing 12.3 and 4.3
Much of the literature has associated women’s participation in household decision-making with better health outcomes. In Côte d’Ivoire, a plump body with particularly prominent hips and buttocks has long been the predominant standard of beauty for women. The prevalence of overweight is greater among women, thereby increasing their vulnerability to life-threatening illnesses. We investigated the association between women’s autonomy in household decision-making and overweight, using the most recent demographic and health survey. In our estimation models, we included region fixed effects to account for unobserved socioeconomic and cultural differences across geographic areas. Overall, we found that women with low autonomy and those with high autonomy were more likely to be overweight than those with no autonomy. Further investigations suggest no association between autonomy and overweight for women in urban areas. However, for women in rural areas, autonomy was associated with a higher likelihood of being overweight, particularly for those with no formal education. These findings suggest that programs promoting women’s autonomy in household decision-making should be accompanied by targeted health education for rural women, to raise awareness of the health risks associated with being overweight.
We develop a theoretical model where health literacy endogenously shapes healthcare spending decisions. The model predicts an inverted U-shaped relationship between literacy and spending, driven by two channels: the 'attention' effect, where increased health literacy enhances health awareness, and the 'productivity' effect, where health literacy improves health production efficiency. We empirically test these predictions based on an adult subsample of 2020 China Family Panel Studies, where individual-level health literacy is measured using a self-design questionnaire (the Chinese Health Literacy Survey) following internationally comparable and established instruments. To address the potential endogeneity, we apply Natural Language Processing on 2.16 million news articles to construct an instrumental variable for health literacy coverage. This instrument exploits province–month variation in news coverage of concepts related to understanding and navigating health information. Our quantitative analysis reveals that a 10
Preventive behaviors are crucial for controlling the spread of infectious diseases. Until now, most of the literature on the understanding of the willingness to comply with preventive behaviors at the individual level has focused on either one of those behaviors or studied several behaviors but independently. However, preventive behaviors might not be independent of each other’s and the question of the relationship between these various behaviors deserves to be further investigated. The COVID-19 pandemic represents an interesting setting to study compliance with preventive behaviors when several prophylactic measures aiming to reduce the same infection risk are available. The aim of this study is to investigate how economic and social preferences may shape the relationship between three types of COVID-19 preventive behaviors among a representative sample of the French population: (1) compliance with restrictions on movement, (2) adherence to barrier gestures and (3) COVID-19 testing. Using a Latent Class Analysis, we identify four groups of individuals with diverging patterns of compliance with preventive behaviors, differing both in terms of intensity and types of prophylactic measures followed: individuals who apply all preventive behaviors, those who reject them all, individuals that do not respect restrictions on movement but still protect themselves and others by applying barrier gestures, and those who do not use barrier gestures but comply with restrictions on movement. Our results support the existence of a risk compensation process leading some individuals to tailor their menu of preventive behaviors until they reach the risk threshold they are willing to handle. The composition of the menu of preventive behaviors appears to be linked with individuals’ economic and social preferences including risk and time preferences, prosociality, and interpersonal trust. Exploring heterogeneity in preventive behaviors may inform the design of targeted prevention and communication campaigns that are better tailored to achieve public health goals.
In Low- and Middle-Income Countries (LMICs), health shocks continue to push many households into poverty by reducing income and access to basic services. Specifically, this study investigates the effect of health shocks on multidimensional poverty in Ghana. Moreover, it examines the pathways through which health shocks influence multidimensional poverty, and lastly, it explores the extent to which health insurance moderates the effect of health shocks on multidimensional poverty. Using panel data from the 2023 Ghana Annual Household Income and Expenditure Survey covering 33,143 households, we employed Instrumental Variable Generalised Method of Moments to investigate the purpose of the study. The results reveal that health shocks significantly increase multidimensional poverty by 2.62%, mainly through increased out-of-pocket health expenditures and reduced labour hours. Female-headed households experience more severe effects (4.24% points) compared to male-headed households (1.92% points), while rural and urban areas show comparable effects (2.69 and 2.56% points, respectively). While the National Health Insurance Scheme (NHIS) reduces the poverty effect of health shocks by 35%, its effectiveness varies by gender and location. We therefore recommend that the Ministry of Health should strengthen healthcare financing through health insurance by improving benefit packages and the quality of services to accelerate progress toward the attainment of SDGs 1 and 3.
In the United States as in other developed countries, the take-up of Long-Term Care (LTC) insurance remains very low, suggesting that many individuals underestimate their future needs for professional LTC services. This paper examines the relationship between subjective expectations and LTC insurance demand, with a particular focus on miscalibration of survival beliefs. Using 12 waves of the Health and Retirement Study (1996-2018), we estimate various random effects linear probability models of LTC insurance take-up among individuals aged 50-75 years. We rely on two self-reported expectation measures: the probability of survival and the probability of nursing home entry. We then classify individuals into three groups - consistent, positive deviation, and negative deviation - based on the difference between subjective survival beliefs and life-table benchmarks. Robustness analyses are carried using alternative miscalibration measures, age groups and control variables. Our findings reveal strong heterogeneity. Individuals whose beliefs are consistent with life-table probabilities purchase more LTC insurance when they expect to live longer, in line with higher anticipated old-age expenditures. By contrast, individuals who substantially overestimate survival ("positive deviation" group) display no systematic response to either type of expectation, which could be related to cognitive difficulties in projecting future needs. Those who underestimate survival ("negative deviation" group) are responsive to nursing home expectations but less so to survival, indicating that they may anticipate short-term care needs but not long-term expenditures. Taken together, these results suggest that miscalibration of survival beliefs is an important determinant of insurance demand. They highlight that underestimation and overestimation reflect different mechanisms - potential private health information in the former case and cognitive limitations in the latter - ultimately contributing to the persistently low take-up of LTC insurance in the U.S.
Indonesia’s National Health Insurance (JKN) introduced the Performance-Based Capitation scheme (Kapitasi Berbasis Komitmen, KBK) in 2015–2016 as a supplement to the existing capitation system and scaled it nationally in 2019. This study evaluates the impact of KBK on Diabetes Mellitus (DM)-related primary care utilization using 2015–2020 BPJS Kesehatan sample data, as DM alone accounted for IDR 8.23 trillion (USD 499 million) in JKN claims in 2022, raising concerns about the JKN financial sustainability. We employ a Regression Discontinuity in Time (RDiT) design to estimate causal effects, using a donut hole specification to address anticipation bias, applying alternative bandwidths for sensitivity analysis, and conducting placebo tests to assess robustness. Our findings indicate modest but significant improvements in primary care utilization at Puskesmas, particularly in contact rates (3.3
We study the design of optimal (private and/or social) insurance schemes for formal home care and institutional care. We consider a three period model. Individuals are either in good health, lightly dependent or heavily dependent. Lightly dependent individuals can buy formal home care which reduces the severity of dependency and reduces the probability to become severely dependent in the next period. Severely dependent individuals pay for nursing home care. In both states of dependency individuals can receive a (private or public) insurance benefit (transfers). These benefits can be flat or depend on the formal care consumed (or a combination of the two). These benefits are financed by a premium (or a tax). Individuals may be alive until the end of the last period or die at the beginning of one of the last two periods with a certain probability, which may depend on their state of health. The laissez faire is inefficient because individuals consume a too low level of formal home care and are not insured. The first-best insurance scheme requires a transfer to lightly dependent individuals that, (under some conditions) increases with the amount of formal home care consumed. Severely dependent individuals, on the other hand, must receive a flat transfer (from private or social insurance). The theoretical analysis is illustrated by a calibrated numerical example which show that the expressions have the expected signs under plausible conditions.
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).
The study aims to analyze the impact of Medicaid Expansion on hospital finances. Medicaid eligibility may increase hospital reimbursements and lower uncompensated care costs if patients are moving from no insurance coverage to Medicaid. However, if patients taking up Medicaid are moving from a private insurance plan to Medicaid, then it is also possible that hospital reimbursements may be lower under Medicaid expansion. Medicaid expansion increased the eligibility for Medicaid coverage to a broader group of people and raised the income threshold to 138% of the federal poverty level. Some states chose to expand Medicaid while others did not. Using a natural experiment, I compare hospital revenues and uncompensated care costs in Eastern Washington, which chose to expand Medicaid in 2014, and in Idaho, which chose not to expand until 2020. Medicaid expansion may be associated with lower net revenues, higher Medicaid received, and lower uncompensated care costs per hospital bed, ceteris paribus. I find no significant impact on operating margins. This study adds to the current literature looking at Medicaid Expansion and hospital finances by looking at a different region than has been previously studied. This region offers similar demographic and economic situations in both states. These areas are more rural areas and have less populated cities, which allows for a unique perspective and contributes to the understanding of how Medicaid Expansion may impact hospital finances.
This research conducts the first comprehensive analysis of how prenatal economic fluctuations affect postpartum depression and documents its counter-cyclicality. Using population-based claims data, we examine outpatient utilization related to mental disorders among women in Taiwan during the six-month, nine-month, and one-year postpartum periods from 1998 to 2012. The results indicate that medical utilization for postpartum depression within the six-month and nine-month postpartum periods is influenced by economic conditions during the second trimester of pregnancy. This study also aims to understand the mediating channels behind the relationship between postpartum depression and prenatal economic activity. We find that negative prenatal economic shocks lead to higher outpatient expenses for conditions such as excessive weight gain, nutritional deficiency, depressive disorders, hypertension, and sleep disorders during pregnancy, all of which can deteriorate maternal postpartum mental health. Furthermore, our study highlights that postpartum depression medical utilization among low-income mothers is particularly sensitive to prenatal economic fluctuations. These findings suggest that low-income mothers, who may have limited resilience and fewer resources during economic downturns, are more likely to experience nutritional deficiencies and increased maternal stress, ultimately leading to a deterioration in postpartum mental health.
This study applies econometric methodologies to conduct a quantitative assessment of the overall impact of occupational accidents on changes in firms' labor productivity. In particular, it examines whether the magnitude of this impact varies according to the technological intensity required for production and further explores the mechanisms through which occupational accidents affect productivity, as well as the duration of these effects. The empirical results demonstrate that increases in occupational accident rates are significantly associated with declines (1%p increase in the accident rate reduces 3.9% in the average labor productivity) in labor productivity, with such adverse effects evident in both very low- and very high-technology firms. Moreover, the analysis identifies a self-reinforcing vicious cycle for approximately 3 to 4 years, wherein higher accident rates lead to productivity deterioration, exacerbating accident incidence. The findings also indicate that a substantial period (about 2 to 3 years) is required for firms to recover from productivity losses attributable to occupational accidents. Our findings catalyze firms to undertake proactive and voluntary measures to prevent occupational accidents and will provide an empirical foundation for policy interventions targeting vulnerable groups that are disproportionately affected by productivity losses resulting from such incidents.
French legislation requires large and medium-sized hospitals to publicly report their greenhouse gas (GHG) emissions. Yet, many hospitals fail to comply with this regulation, while others report voluntarily. The organizational drivers behind this behavior remain underexplored. This study examines whether hospitals disclose their GHG emissions as part of a broader strategy to differentiate themselves-similar to how they report patient satisfaction scores to signal quality. We explore whether carbon reporting is used as a vertical differentiation strategy in the French healthcare system. We used a mixed-methods approach. First, we analyzed national administrative data to test whether reporting GHG emissions is associated with reporting patient satisfaction scores. Second, we conducted semi-structured interviews with hospital managers to understand the motivations behind emissions reporting. Quantitatively, we found no significant association between the two types of reporting. Hospitals do not appear to use GHG emissions disclosure and patient satisfaction scores as part of the same signaling strategy. Qualitative findings confirmed that GHG reporting is primarily driven by internal factors such as executive leadership, process improvement, and organizational values, rather than external differentiation or patient demand. Carbon reporting in French hospitals is not currently used as a differentiation strategy. Stronger regulatory enforcement is needed to ensure compliance. In addition, hospitals require support-through methodological guidance, training, and the development of dedicated sustainability roles-to integrate environmental performance into their management systems and contribute meaningfully to healthcare decarbonization.
OBJECTIVE:To quantify socioeconomic inequities of complete continuity of maternal healthcare service over time using Ethiopian Demography and Health Survey data from 2011 to 2019. METHODS:A total of 10,768 women who had at least one antenatal care visit during their most recent childbirth were included for the analysis. Concentration index and concentration curve were used to assess wealth-based inequities. A generalized linear model with binomial distribution and a logit link function was used to decompose the Erreygers concentration index and measure each determinant's contribution. RESULTS:Complete continuum of maternal health service utilization in 2011, 2016, and 2019 among the wealthiest women were 25.9%, 33.7%, and 50.8%, respectively. In contrast, the corresponding continuum of maternal health service utilisation was 3.0%, 6.1%, and 11.2% among the lowest wealth categories. The Erreygers concentration indices of complete continuum of maternal health service utilization in 2011, 2016, and 2019 surveys were 0.203, 0.195, and 0.311, respectively, with the highest inequity observed in 2019. Concentration curves in each survey showed a pro-rich distribution of complete continuum of maternal health service utilisation. A unit percentage change in women's education, early initiation of antenatal care, being informed about pregnancy-related complications, and blood pressure monitoring during pregnancy increased their probability of completing continuum of maternal health service utilization. Specifically, a 1% increase in the proportion of secondary or higher education corresponded to a 0.02%, 0.01%, and 0.07% increase in the probability of completing continuum of maternal health service utilisation in 2011, 2016, and 2019, respectively. Conversely, in 2011, a 1% increase in the proportion of rural women and those with more than four parities led to a 0.11% and 0.05% decrease in the probability of completing continuum of maternal health service utilisation, respectively. CONCLUSION:Complete continuum of maternal health service utilization was more likely amongst women without disadvantage, demonstrating wealth-based inequities in continuum of maternal health service utilization continue in Ethiopia. In this analysis, continuum of maternal health service utilisation remains inelastic across all surveys highlightsits the service is an essential form of care for women. Provision of maternal healthcare services targeting women from low household wealth status, residing in rural communities, and uneducated women must be prioritised by policymakers.
