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  1. Air Pollution and Student Performance in the U.S
    Autor*in: Gilraine, Michael; Zheng, Angela
    Erschienen: May 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We combine satellite-based pollution data and test scores from over 10,000 U.S. school districts to estimate the relationship between air pollution and test scores. To deal with potential endogeneity we instrument for air quality using (i)... mehr

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    Universitätsbibliothek Freiburg
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    Helmut-Schmidt-Universität, Universität der Bundeswehr Hamburg, Universitätsbibliothek
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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    We combine satellite-based pollution data and test scores from over 10,000 U.S. school districts to estimate the relationship between air pollution and test scores. To deal with potential endogeneity we instrument for air quality using (i) year-to-year coal production variation and (ii) a shift-share instrument that interacts fuel shares used for nearby power production with national growth rates. We find that each one-unit increase in particulate pollution reduces test scores by 0.02 standard deviations. Our findings indicate that declines in particulate pollution exposure raised test scores and reduced the black-white test score gap by 0.06 and 0.01 standard deviations, respectively

     
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    Schriftenreihe: NBER working paper series ; no. w30061
    Schlagworte: Luftverschmutzung; Bildungsniveau; USA; Health and Inequality; Education and Inequality; Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling
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  2. Decomposing Trends in U.S. Air Pollution Disparities from Electricity
    Autor*in: Hernandez-Cortes, Danae; Meng, Kyle C.; Weber, Paige E.
    Erschienen: July 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This paper quantifies and decomposes recent trends in U.S. PM2.5 disparities from the electricity sector using a high-resolution pollution transport model. Between 2000-2018, PM2.5 concentrations from electricity fell by 89% for the average... mehr

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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    This paper quantifies and decomposes recent trends in U.S. PM2.5 disparities from the electricity sector using a high-resolution pollution transport model. Between 2000-2018, PM2.5 concentrations from electricity fell by 89% for the average individual, more than double the decline rate in overall U.S. ambient PM2.5 concentrations. Across racial/ethnic groups, we detect a dramatic convergence: since 2000, the Black-White PM2.5 disparity from electricity has narrowed by 95% and the Hispanic-White PM2.5 disparity has narrowed by 93%, though these disparities still exist in 2018. A decomposition reveals nearly all of these disparity trends can be attributed roughly equally to improvements in emissions intensities and compositional changes in electric generators, with small contributions from scale and residential location changes. This suggests both local air pollution policies and recent coal-to-natural gas fuel switching have played major roles in reducing U.S. racial/ethnic pollution disparities from electricity. While we detect similarly large PM2.5 improvements for the average low and high income individual, PM2.5 disparities by income are relatively small, with little change over time

     
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    Schriftenreihe: NBER working paper series ; no. w30198
    Schlagworte: Luftverschmutzung; Elektrizitätswirtschaft; Elektrizität; Ethnische Gruppe; USA; Publicly Provided Goods; Health and Inequality; Environmental Economics; Valuation of Environmental Effects; Pollution Control Adoption and Costs; Distributional Effects; Employment Effects; Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling; Climate; Natural Disasters and Their Management; Global Warming
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  3. How Did Federal Aid to States and Localities Affect Testing and Vaccine Delivery?
    Autor*in: Clemens, Jeffrey; Hoxie, Philip G.; Kearns, John; Veuger, Stan
    Erschienen: July 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We estimate whether federal aid for state and local governments played a role in advancing population testing for COVID-19 and the administration of vaccines. To overcome biases that can result from the endogeneity of federal aid allocations, we use... mehr

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    Helmut-Schmidt-Universität, Universität der Bundeswehr Hamburg, Universitätsbibliothek
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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    We estimate whether federal aid for state and local governments played a role in advancing population testing for COVID-19 and the administration of vaccines. To overcome biases that can result from the endogeneity of federal aid allocations, we use an instrumental-variables estimator reliant on the substantial variation in federal aid predicted by variation in states' congressional representation. We find that federal fiscal assistance dollars had a modest if any impact on the pace of vaccine rollouts, may have improved the equitability of vaccine administration, and had a substantial impact on the volume of tests administered. Regarding the total number of vaccines delivered, we estimate that an additional $1,000 in fiscal relief per resident, which would amount to $330 billion nationwide, translated into just under 1,200 extra doses of the vaccine being delivered per 100,000 people, with the upper bound of our confidence interval suggesting that we can rule out effects in excess of 7,030 extra doses per 100,000 people. We find that federal dollars predict a smaller gap between the vaccination rates of those with a college education relative to those with a high school education. Finally, our baseline estimate implies that each $1,000 in COVID-19 relief aid per capita generated 55,850 additional tests per 100,000 people

     
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    Schriftenreihe: NBER working paper series ; no. w30206
    Schlagworte: Föderalismus; Gesundheitspolitik; Coronavirus; Impfung; Infektionsschutz; Wirkungsanalyse; USA; State and Local Government: Health; Education; Welfare; Public Pensions; Intergovernmental Relations; Federalism; Secession; Health and Inequality
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  4. Heterogeneity in Disease Resistance and the Impact of Antibiotics in the US
    Autor*in: Cook, C. Justin; Fletcher, Jason
    Erschienen: July 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We hypothesize that the impact of antibiotics is moderated by a population's inherent (genetic) resistance to infectious disease. Using the introduction of sulfa drugs in 1937, we show that US states that are more genetically susceptible to... mehr

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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    We hypothesize that the impact of antibiotics is moderated by a population's inherent (genetic) resistance to infectious disease. Using the introduction of sulfa drugs in 1937, we show that US states that are more genetically susceptible to infectious disease saw larger declines in their bacterial mortality rates following the introduction of sulfa drugs in 1937. This suggests area-level genetic endowments of disease resistance and the discovery of medical technologies have acted as substitutes in determining levels of health across the US. We also document immediate effects of sulfa drug exposure to the age of the workforce and cumulative effects on educational attainment for cohorts exposed to sulfa drugs in early life

     
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    Schriftenreihe: NBER working paper series ; no. w30269
    Schlagworte: Arzneimittel; Gesundheitsversorgung; USA; Health; Health and Inequality; Health and Economic Development; Demographic Economics
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  5. Maternal Mortality and Women's Political Power
    Autor*in: Bhalotra, Sonia; Clarke, Damian; Gomes, Joseph Flavian; Venkataramani, Atheendar S.
    Erschienen: June 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota... mehr

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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8-12 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5-8 in skilled birth attendance and 4-8 in prenatal care utilization, alongside a decline in fertility of 6-7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality

     
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    Schriftenreihe: NBER working paper series ; no. w30103
    Schlagworte: Mütter; Sterblichkeit; Frauen; Politische Partizipation; Parlament; Politische Entscheidung; Politiker; Entwicklungsländer; Health and Inequality; Health and Economic Development; Human Resources; Human Development; Income Distribution; Migration
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  6. NIH Grant Expansion, Ancestral Diversity and Scientific Discovery in Genomics Research
    Autor*in: Fu, Wei; Chou, Shin-yi; Wang, Li-San
    Erschienen: June 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    In the approaching era of genomic medicine, the underrepresentation of minority populations in human genetics and genomics research has raised growing concerns regarding the distributive justice in the translation of biomedical innovations into human... mehr

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    Helmut-Schmidt-Universität, Universität der Bundeswehr Hamburg, Universitätsbibliothek
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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    Technische Informationsbibliothek (TIB) / Leibniz-Informationszentrum Technik und Naturwissenschaften und Universitätsbibliothek
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    In the approaching era of genomic medicine, the underrepresentation of minority populations in human genetics and genomics research has raised growing concerns regarding the distributive justice in the translation of biomedical innovations into human health across populations. Quantitative assessment of public funding policy in addressing the missing diversity is imperative yet lacking. In this paper, we fill this gap by empirically answering two central questions in the context of Genome-Wide Association Studies (GWAS): whether improved funding opportunity facilitates minority health research, and how significant is the scientific value of funding science on underrepresented populations. Our identification draws on an exogenous NIH grant expansion under the American Reinvestment and Recovery Act of 2009, and exploits variations in the share of people with medical conditions among minorities relative to whites. Our main findings are threefold. First, the ARRA-NIH grant expansion contributes to an increase in the inclusion of minority ancestries in GWAS. It also facilitates the engagement of minority scientists in academic activities and promotes their role in scientific collaborations. The grant expansion fosters the discoveries of disease-associated genetic variants within minority populations. This quantitative evidence speaks to the role that public funding policy can play in advancing science

     
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    Schriftenreihe: NBER working paper series ; no. w30155
    Schlagworte: Gentechnik; Forschungsfinanzierung; Ethnische Diskriminierung; USA; Health and Inequality; Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination; Innovation and Invention: Processes and Incentives; Social Innovation; Government Policy
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  7. Machine Learning Can Predict Shooting Victimization Well Enough to Help Prevent It
    Autor*in: Heller, Sara B.; Jakubowski, Benjamin; Jelveh, Zubin; Kapustin, Max
    Erschienen: June 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This paper shows that shootings are predictable enough to be preventable. Using arrest and victimization records for almost 644,000 people from the Chicago Police Department, we train a machine learning model to predict the risk of being shot in the... mehr

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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    This paper shows that shootings are predictable enough to be preventable. Using arrest and victimization records for almost 644,000 people from the Chicago Police Department, we train a machine learning model to predict the risk of being shot in the next 18 months. We address central concerns about police data and algorithmic bias by predicting shooting victimization rather than arrest, which we show accurately captures risk differences across demographic groups despite bias in the predictors. Out-of-sample accuracy is strikingly high: of the 500 people with the highest predicted risk, 13 percent are shot within 18 months, a rate 130 times higher than the average Chicagoan. Although Black male victims more often have enough police contact to generate predictions, those predictions are not, on average, inflated; the demographic composition of predicted and actual shooting victims is almost identical. There are legal, ethical, and practical barriers to using these predictions to target law enforcement. But using them to target social services could have enormous preventive benefits: predictive accuracy among the top 500 people justifies spending up to $123,500 per person for an intervention that could cut their risk of being shot in half

     
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    Schriftenreihe: NBER working paper series ; no. w30170
    Schlagworte: Künstliche Intelligenz; Prognoseverfahren; Kriminalität; Waffe; Chicago (Ill.); USA; Forecasting and Prediction Methods; Simulation Methods; State and Local Government: Health; Education; Welfare; Public Pensions; Health and Inequality; Illegal Behavior and the Enforcement of Law
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  8. Uncharted Waters
    Effects of Maritime Emission Regulation
    Autor*in: Hansen-Lewis, Jamie; Marcus, Michelle M.
    Erschienen: June 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Maritime shipping emits as much fine particulate matter as half of global road traffic. We are the first to measure the consequences of US maritime emissions standards on air quality, human health, racial exposure disparities, and behavior. The... mehr

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    Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
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    ZBW - Leibniz-Informationszentrum Wirtschaft, Standort Kiel
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    Maritime shipping emits as much fine particulate matter as half of global road traffic. We are the first to measure the consequences of US maritime emissions standards on air quality, human health, racial exposure disparities, and behavior. The introduction of US maritime emissions control areas significantly decreased fine particulate matter, low birth weight, and infant mortality. Yet, only about half of the forecasted fine particulate matter abatement was achieved by the policy. We show evidence consistent with behavioral responses among ship operators, other polluters, and individuals that muted the policy's impact, but were not incorporated in ex-ante models

     
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    Schriftenreihe: NBER working paper series ; no. w30181
    Schlagworte: Schifffahrt; Luftverschmutzung; Luftreinhaltung; Wirkungsanalyse; USA; Trade and Environment; Health and Inequality; Pollution Control Adoption and Costs; Distributional Effects; Employment Effects; Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling; Environment and Development; Environment and Trade; Sustainability; Environmental Accounts and Accounting; Environmental Equity; Population Growth
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  9. Capacity Strain and Racial Disparities in Hospital Mortality
    Autor*in: Singh, Manasvini; Venkataramani, Atheendar S.
    Erschienen: August 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    A growing literature has documented racial disparities in health care. We argue that racial disparities may be magnified when hospitals operate at capacity, when behavioral and structural conditions associated with poor patient outcomes - e.g.,... mehr

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    A growing literature has documented racial disparities in health care. We argue that racial disparities may be magnified when hospitals operate at capacity, when behavioral and structural conditions associated with poor patient outcomes - e.g., limited provider cognitive bandwidth or reliance on biased care algorithms - are aggravated. Using detailed, time-stamped electronic health record data from two large hospitals, we document that in-hospital mortality increased more for Black patients than for White patients when hospitals approached capacity. We estimate that 8.5% of Black patient deaths were capacity-driven and thus avoidable. We then investigate the extent to which differential care inputs explain our findings. While strain exacerbated wait times similarly for Black and White patients, Black patients both waited the longest at high strain and faced greater mortality consequences from prolonged wait times. Finally, the largest racial disparities in mortality were among women and uninsured patients, highlighting biases in provider behavior and hospital processes as key mechanisms driving our results

     
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    Schriftenreihe: NBER working paper series ; no. w30380
    Schlagworte: Krankenhaus; Sterblichkeit; Diskriminierung; Schwarze Menschen; USA; General; Health and Inequality; Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination
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  10. The Midlife Crisis
    Autor*in: Giuntella, Osea; McManus, Sally; Mujcic, Redzo; Oswald, Andrew J.; Powdthavee, Nattavudh; Tohamy, Ahmed
    Erschienen: September 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This paper documents a longitudinal crisis of midlife among the inhabitants of rich nations. Yet middle-aged citizens in our data sets are close to their peak earnings, have typically experienced little or no illness, reside in some of the safest... mehr

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    This paper documents a longitudinal crisis of midlife among the inhabitants of rich nations. Yet middle-aged citizens in our data sets are close to their peak earnings, have typically experienced little or no illness, reside in some of the safest countries in the world, and live in the most prosperous era in human history. This is paradoxical and troubling. The finding is consistent, however, with the prediction - one little-known to economists - of Elliott Jaques (1965). Our analysis does not rest on elementary cross-sectional analysis. Instead the paper uses panel and through-time data on, in total, approximately 500,000 individuals. It checks that the key results are not due to cohort effects. Nor do we rely on simple life-satisfaction measures. The paper shows that there are approximately quadratic hill-shaped patterns in data on midlife suicide, sleeping problems, alcohol dependence, concentration difficulties, memory problems, intense job strain, disabling headaches, suicidal feelings, and extreme depression. We believe the seriousness of this societal problem has not been grasped by the affluent world's policy-makers

     
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    Schriftenreihe: NBER working paper series ; no. w30442
    Schlagworte: Altersgruppe; Generation; Lebensverlauf; Morbidität; Gesundheit; Zufriedenheit; USA; Health Behavior; Health and Inequality; General Welfare, Well-Being
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  11. Inequality and Social Distancing during the Pandemic
    Autor*in: Brown, Caitlin; Ravallion, Martin
    Erschienen: October 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We study how pre-pandemic inequalities in America influenced social distancing over the course of the COVID-19 pandemic. Richer counties tended to see more protective mobility responses in the initial (pre-pharmaceutical) phase, but less protective... mehr

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    We study how pre-pandemic inequalities in America influenced social distancing over the course of the COVID-19 pandemic. Richer counties tended to see more protective mobility responses in the initial (pre-pharmaceutical) phase, but less protective responses later. Near linearity of this income effect implies that inequality between counties contributed very little to overall mobility reductions. By contrast, higher within-county inequality and/or poverty measures came with substantially larger attenuations to non-residential mobility at given average incomes. There were also significant effects of the county's racial and age composition. Standard epidemiological covariates of contact rates were also relevant, controlling for the socioeconomic factors

     
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    Schriftenreihe: NBER working paper series ; no. w30540
    Schlagworte: Coronavirus; Epidemie; Infektionsschutz; Einkommensverteilung; Soziale Lage; USA; Health and Inequality; Health and Economic Development
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  12. Can Pollution Cause Poverty? The Effects of Pollution on Educational, Health and Economic Outcomes
    Autor*in: Persico, Claudia
    Erschienen: October 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Although pollution is widespread, there is little evidence about how it might harm children's long run outcomes. Using the detailed, geocoded data that follows national representative cohorts of children born to the National Longitudinal Survey of... mehr

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    Although pollution is widespread, there is little evidence about how it might harm children's long run outcomes. Using the detailed, geocoded data that follows national representative cohorts of children born to the National Longitudinal Survey of Youth respondents over time, I compare siblings who were gestating before versus after a Toxic Release Inventory site opened or closed within one mile of their home. I find that children who were exposed prenatally to industrial pollution have lower wages, are more likely to be in poverty as adults, have fewer years of completed education, and are less likely to graduate high school

     
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    Schriftenreihe: NBER working paper series ; no. w30559
    Schlagworte: Luftverschmutzung; Umweltbelastung; Schwangerschaft; Kinder; Gesundheit; Bildungsniveau; Bildungsabschluss; Erwerbsverlauf; Armut; USA; General; Health and Inequality; Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling
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  13. Understanding Geographic Disparities in Mortality
    Autor*in: Fletcher, Jason; Schwarz, Hans G.; Engelman, Michal; Johnson, Norman; Hakes, Jahn K.; Palloni, Alberto
    Erschienen: October 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    A rich literature shows that early life conditions shape later life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic... mehr

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    A rich literature shows that early life conditions shape later life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic place (e.g., state of residence at death), thereby potentially conflating the role of early life conditions, migration patterns, and effects of destinations. We use the newly available Mortality Disparities in American Communities (MDAC) dataset, which links respondents in the 2008 ACS to official death records and estimate consequential differences by method of aggregation; the mean absolute deviation of the difference in life expectancy at age 50 measured by state of birth versus state of residence is 0.58 (0.50) years for men and 0.40 (0.29) years for women. These differences are also spatially clustered, and we show that regional inequality in life expectancy is higher based on life expectancies by state of birth, implying that interstate migration mitigates baseline geographical inequality in mortality outcomes. Finally, we assess how state-specific features of in-migration, out-migration, and non-migration together shape measures of mortality disparities by state (of residence), further demonstrating the difficulty of clearly interpreting these widely used measures

     
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    Schriftenreihe: NBER working paper series ; no. w30572
    Schlagworte: Sterblichkeit; Räumliche Verteilung; USA; Health and Inequality; General
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  14. Representation and Extrapolation
    Evidence from Clinical Trials
    Autor*in: Alsan, Marcella; Durvasula, Maya; Gupta, Harsh; Schwartzstein, Joshua; Williams, Heidi
    Erschienen: October 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This article examines the consequences and causes of low enrollment of Black patients in clinical trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is more relevant for decision-making by physicians and... mehr

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    This article examines the consequences and causes of low enrollment of Black patients in clinical trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is more relevant for decision-making by physicians and patients when it is more representative of the group that is being treated. This generates the key result that the perceived benefit of a medicine for a group depends not only on the average benefit from a trial, but also on the share of patients from that group who were enrolled in the trial. In survey experiments, we find that physicians who care for Black patients are more willing to prescribe drugs tested in representative samples, an effect substantial enough to close observed gaps in the prescribing rates of new medicines. Black patients update more on drug efficacy when the sample that the drug is tested on is more representative, reducing Black-White patient gaps in beliefs about whether the drug will work as described. Despite these benefits of representative data, our framework predicts that those who have benefited more from past medical breakthroughs are less costly to enroll in the present, leading to persistence in who is represented in the evidence base

     
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    Schriftenreihe: NBER working paper series ; no. w30575
    Schlagworte: Arzneimittel; Pharmakologie; Schwarze Menschen; USA; Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making; National Government Expenditures and Related Policies; Health and Inequality
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  15. Socioeconomic Status and Access to Mental Health Care
    The Case of Psychiatric Medications for Children in Ontario Canada
    Autor*in: Currie, Janet M.; Kurdyak, Paul; Zhang, Jonathan
    Erschienen: October 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We examine differences in the prescribing of psychiatric medications to low-income and higher-income children in the Canadian province of Ontario. The analysis takes advantage of an expansion to universal public drug coverage followed by a... mehr

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    We examine differences in the prescribing of psychiatric medications to low-income and higher-income children in the Canadian province of Ontario. The analysis takes advantage of an expansion to universal public drug coverage followed by a contraction in access, coupled with rich administrative data that includes physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that should be prescribed to children only under narrowly proscribed circumstances. Low-income children are also less likely to be prescribed SSRIs, the first-line treatment for depression and anxiety. Hence universal drug coverage for children did not eliminate differences in prescribing practices between low-income and higher income children, suggesting that addressing these differences would require additional interventions including changing prescribing behaviors of individual providers

     
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    Schriftenreihe: NBER working paper series ; no. w30595
    Schlagworte: Sozialer Status; Psychische Krankheit; Arzneimittel; Gesundheitsversorgung; Kanada; Ontario (Provinz); Health and Inequality
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  16. Using Measures of Race to Make Clinical Predictions
    Decision Making, Patient Health, and Fairness
    Autor*in: Manski, Charles F.; Mullahy, John; Venkataramani, Atheendar S.
    Erschienen: December 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    The use of race measures in clinical prediction models and algorithms has become a highly contentious issue, driven by concerns that inclusion of race as a covariate exacerbates and perpetuates long-standing disparities in quality of health care... mehr

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    The use of race measures in clinical prediction models and algorithms has become a highly contentious issue, driven by concerns that inclusion of race as a covariate exacerbates and perpetuates long-standing disparities in quality of health care provided to racial and ethnic minority patients. We seek to inform and ground this debate by evaluating the inclusion of race--even if imperfectly measured--in probabilistic predictions of illness that aim to inform clinical decision making. First, adopting a utilitarian framework to formalize social welfare, our analysis reveals that patients of all races are better off when clinical decisions are jointly guided by patient race and other observable covariates. In this sense, race is not a particularly special covariate: any covariate with predictive power (i.e., one that changes conditional probabilities of illness) should be used to optimize clinical decisions. We then extend the model to a two-period setting where prevention activities that address systemic drivers of disease are relevant and find that the same basic conclusions emerge. Finally, we discuss formal non-utilitarian concepts of fairness and disparity-aversion that have been proposed to guide societal allocation of health care resources

     
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    Schriftenreihe: NBER working paper series ; no. w30700
    Schlagworte: Medizinische Behandlung; Gesundheitsversorgung; Patienten; Ethnische Diskriminierung; Soziale Gerechtigkeit; General; Health and Inequality
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  17. Children and Grandchildren of Union Army Veterans
    New Data Collections to Study the Persistence of Longevity and Socioeconomic Status Across Generations
    Autor*in: Costa, Dora L.; Lewis, CoraLee; Yetter, Noelle
    Erschienen: December 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This paper introduces four new intergenerational and multigenerational datasets which follow both sons and daughters and which can be used to study the persistence of longevity, socioeconomic status, family structure, and geographic mobility across... mehr

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    This paper introduces four new intergenerational and multigenerational datasets which follow both sons and daughters and which can be used to study the persistence of longevity, socioeconomic status, family structure, and geographic mobility across generations. The data follow the children of Black and White Union Army veterans from birth to death, linking them to the available censuses. The White samples include an over-sample of children of ex-POWs. A separate collection links grandchildren of White Union Army veterans to their death records. The data were created with high quality manual linkage procedures utilizing a wide variety of records to establish links

     
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    Schriftenreihe: NBER working paper series ; no. w30747
    Schlagworte: Soldaten; Kinder; Sozialer Status; Mobilität; Gesundheit; USA; Health and Inequality; Labor Economics: General; General; Development of the Discipline: Historiographical; Sources and Methods
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  18. Racial Concordance and the Quality of Medical Care
    Evidence from the Military
    Autor*in: Frakes, Michael; Gruber, Jonathan
    Erschienen: December 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    One explanation for insufficient use of primary care in the U.S. is a lack of trust between patients and providers - particularly along racial lines. We assess the role of racial concordance between patients and medical providers in driving use of... mehr

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    One explanation for insufficient use of primary care in the U.S. is a lack of trust between patients and providers - particularly along racial lines. We assess the role of racial concordance between patients and medical providers in driving use of preventive care and the implications for patient outcomes. We use unique data from the Military Health System, where we observe providers as patients so that we can identify their race, and where moves across bases change exposure to provider race. We consider patients with four chronic, deadly, but ultimately manageable illnesses, where the relationship with the provider may have the most direct and important impact on health. We find striking evidence that racial concordance leads to improved maintenance of preventive care - and ultimately lower patient mortality. Pooling across these diseases, we estimate that a one-standard deviation increase in the share of providers who are Black leads to a 15% relative decline in Black mortality among those with these manageable illnesses. Our results further suggest that between 55 and 69% of this mortality impact arises through improved medication use and adherence, with other aspects of the provider-patient relationship accounting for the residual

     
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    Schriftenreihe: NBER working paper series ; no. w30767
    Schlagworte: Militär; Gesundheitswesen; Ethnische Gruppe; Soldaten; Gesundheitsversorgung; USA; Health Behavior; Health and Inequality; Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
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  19. Reducing Ordeals through Automatic Enrollment
    Evidence from a Health Insurance Exchange
    Autor*in: Shepard, Mark; Wagner, Myles
    Erschienen: December 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Incomplete health insurance enrollment is a persistent U.S. challenge despite large subsidies. We ask whether hassles built into enrollment systems matter for insurance take-up and targeting. Studying removal of an auto-enrollment policy, we find... mehr

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    Incomplete health insurance enrollment is a persistent U.S. challenge despite large subsidies. We ask whether hassles built into enrollment systems matter for insurance take-up and targeting. Studying removal of an auto-enrollment policy, we find that a small hassle - a requirement to actively select a health plan to enroll - reduces take-up by 33%, a major impact equivalent to $470 (57%) higher enrollee premiums. Hassles differentially screen out younger, healthier, and poorer people - groups with both low value and costs of insurance. We show that this value-cost correlation - a standard feature of insurance, where risk drives both - may undermine the classic rationale for ordeals' favorable targeting

     
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    Schriftenreihe: NBER working paper series ; no. w30781
    Schlagworte: Krankenversicherung; Private Krankenversicherung; USA; General; Analysis of Health Care Markets; Health Insurance, Public and Private; Health and Inequality; Government Policy; Regulation; Public Health
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  20. Fundamentally Reforming the DI System
    Evidence from German Notch Cohorts
    Autor*in: Fischer, Bjoern; Geyer, Johannes Micha; Ziebarth, Nicolas R.
    Erschienen: December 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We study a fundamental reform of the public Disability Insurance (DI) system in Germany. Effective 2001, cohorts born after 1960 are no longer eligible for "occupational DI." Occupational DI (ODI) implies benefit eligibility when health shocks... mehr

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    We study a fundamental reform of the public Disability Insurance (DI) system in Germany. Effective 2001, cohorts born after 1960 are no longer eligible for "occupational DI." Occupational DI (ODI) implies benefit eligibility when health shocks prevent employees from working in their previous occupation. For the affected "notch cohorts", the new DI eligibility rules require work disability in any job. Using administrative data, we first show that the reform significantly reduced the inflow of new DI beneficiaries by more than 30% in the long-run. Next, we validate these findings using representative SOEP household panel data comprised of the entire underlying population. The second part studies interaction effects with the private ODI market. Using representative data, we do not find much evidence that the notch cohorts purchased individual private ODI policies at significantly higher rates to compensate for the reduced generosity of the public DI system. To explain such low take-up, we employ a general equilibrium model featuring the roles of the social safety net, administrative costs, and asymmetric information. These driving forces help explain three stylized facts in the individual experience-rated private market for ODI policies: (1) low private ODI take-up and interaction effects with the public system---despite a high lifecycle work disability risk, (2) strong and positive income and health gradients in private ODI take-up, and (3) inversely related income and health gradients in the lifecycle work disability risk. Simulations illustrate that policy reforms to lower administrative costs have the greatest potential to foster take-up and flatten its income and health gradients

     
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    Schriftenreihe: NBER working paper series ; no. w30812
    Schlagworte: Behindertenpolitik; Behinderte Arbeitskräfte; Erwerbsminderungsrente; Reform; Privatversicherung; Deutschland; Government Expenditures and Welfare Programs; Social Security and Public Pensions; General; Health and Inequality; Government Policy; Regulation; Public Health; Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination; Labor Force and Employment, Size, and Structure; Retirement; Retirement Policies
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  21. Do Pandemics Change Healthcare? Evidence from the Great Influenza
    Autor*in: Esteves, Rui Pedro; Mitchener, Kris; Nencka, Peter; Thomasson, Melissa A.
    Erschienen: November 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Using newly digitized U.S. city-level data on hospitals, we explore how pandemics alter preferences for healthcare. We find that cities with higher levels of mortality during the Great Influenza of 1918-1919 subsequently expanded hospital capacity by... mehr

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    Using newly digitized U.S. city-level data on hospitals, we explore how pandemics alter preferences for healthcare. We find that cities with higher levels of mortality during the Great Influenza of 1918-1919 subsequently expanded hospital capacity by more than cities experiencing less influenza mortality: cities in the top half of the mortality distribution increased their count of hospitals by 8-10 percent in the years after the pandemic. This effect persisted to 1960 and was driven by increases in non-governmental hospitals. Growth responded most in richer cities, exacerbating existing inequalities in access to healthcare. We do not find evidence that government-run hospitals or other types of city-level spending related to healthcare responded to pandemic intensity, suggesting that large health shocks do not necessarily lead to increased public provision of health services

     
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    Schriftenreihe: NBER working paper series ; no. w30643
    Schlagworte: Infektionskrankheit; Epidemie; Sterblichkeit; Wirkungsanalyse; Gesundheitsversorgung; Krankenhaus; USA; Analysis of Health Care Markets; Health and Inequality; General; U.S.; Canada: 1913-
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  22. The Gift of a Lifetime
    The Hospital, Modern Medicine, and Mortality
    Autor*in: Hollingsworth, Alex; Karbownik, Krzysztof; Thomasson, Melissa A.; Wray, Anthony
    Erschienen: November 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    The past century witnessed a dramatic improvement in public health, the rise of modern medicine, and the transformation of the hospital from a fringe institution to one essential to the practice of medicine. In this paper, we explore how access to... mehr

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    The past century witnessed a dramatic improvement in public health, the rise of modern medicine, and the transformation of the hospital from a fringe institution to one essential to the practice of medicine. In this paper, we explore how access to the hospital and modern medicine affects mortality. We do so by leveraging a combination of novel data and a unique quasi-experiment: a large-scale hospital modernization program introduced by The Duke Endowment in the early twentieth century. The Endowment helped communities build and expand hospitals, obtain state-of-the-art medical technology, attract qualified medical personnel, and refine management practices. We find that access to a Duke-supported hospital reduced infant mortality by 10%, saving one life for every $20,000 (2017 dollars) spent. Effects were larger for Black infants (16%) than for White infants (7%), implying a reduction in the Black-White infant mortality gap by one-third. We show that the effect of Duke support persisted into later life with a 9% reduction in mortality between the ages of 56 and 65. We further provide evidence on the mechanisms that enabled these effects, finding that Endowment-supported hospitals attracted higher-quality physicians and were better able to take advantage of new medical innovations

     
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    Schriftenreihe: NBER working paper series ; no. w30663
    Schlagworte: Gesundheitsversorgung; Medizintechnik; Krankenhaus; Wirkungsanalyse; Sterblichkeit; Schätzung; North Carolina; USA; Health and Inequality; Fertility; Family Planning; Child Care; Children; Youth; U.S.; Canada: 1913-
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  23. Maternal and Infant Health Inequality
    New Evidence from Linked Administrative Data
    Autor*in: Kennedy-Moulton, Kate; Miller, Sarah; Persson, Petra; Rossin-Slater, Maya; Wherry, Laura R.; Aldana, Gloria
    Erschienen: November 2022
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to... mehr

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    We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution

     
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    Schriftenreihe: NBER working paper series ; no. w30693
    Schlagworte: Mütter; Kinder; Gesundheit; Sterblichkeit; Kindersterblichkeit; Einkommensverteilung; USA; Health; Health and Inequality; General
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  24. Information and Disparities in Health Care Quality
    Evidence from GP Choice in England
    Autor*in: Brown, Zach Y.; Hansman, Christopher; Keener, Jordan; Veiga, Andre F.
    Erschienen: March 2023
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    Why do low income patients tend to go to lower quality health care providers, even when they are free? We show that differential information about provider quality is an important determinant of this disparity. Our empirical strategy exploits the... mehr

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    Why do low income patients tend to go to lower quality health care providers, even when they are free? We show that differential information about provider quality is an important determinant of this disparity. Our empirical strategy exploits the temporary presence of a website that publicly displayed summary star ratings of general practitioner (GP) offices in England. Regression discontinuity estimates show that patient demand responds sharply to the information on the website, and that this response is almost entirely driven by residents of low income neighborhoods. The results are consistent with high income patients having better private information about quality. We incorporate our estimates into a structural model of demand that allows for heterogeneity in information, preferences, and consumer inertia. We find that information differences explain 24 percent of the relationship between income and GP quality and reinforce disparities in access to care

     
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    Schriftenreihe: NBER working paper series ; no. w31033
    Schlagworte: Gesundheitsversorgung; Ärzte; Dienstleistungsqualität; Niedrigeinkommen; Diskriminierung; Großbritannien; Search; Learning; Information and Knowledge; Communication; Belief; Unawareness; Analysis of Health Care Markets; Health and Inequality; Information and Product Quality; Standardization and Compatibility
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  25. From Syringes to Dishes
    Improving Food Security through Vaccination
    Autor*in: Aslim, Erkmen Giray; Fu, Wei; Tekin, Erdal; You, Shijun
    Erschienen: March 2023
    Verlag:  National Bureau of Economic Research, Cambridge, Mass

    This paper examines the impact of COVID-19 vaccination on food insecurity in the United States, using data from the Household Pulse Survey. Our primary research design exploits variation in vaccine eligibility across states over time as an... mehr

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    This paper examines the impact of COVID-19 vaccination on food insecurity in the United States, using data from the Household Pulse Survey. Our primary research design exploits variation in vaccine eligibility across states over time as an instrumental variable to address the endogeneity of vaccination decision. We find that vaccination had a substantial impact on food hardship by reducing the likelihood of food insecurity by 24%, with even stronger effects among minority and financially disadvantaged populations. Our results are robust to alternative specifications and the use of regression discontinuity as an alternative identification strategy. We also show that vaccine eligibility had a positive spillover impact on food assistance programs, specifically by reducing participation in the Supplemental Nutrition Assistance Program (SNAP), which suggests that vaccination policy can be effective in alleviating the fiscal burden of the pandemic on the government. Furthermore, our analysis indicates that vaccinated individuals exhibit increased financial optimism, as measured by expectations about future loss of employment and income as well as ability to make mortgage and debt payments. Based on the point estimates, the implied elasticity of food insecurity with respect to financial optimism is between -0.57 and -0.86. Our findings suggest that the COVID-19 vaccination program has implications that extend beyond the direct health benefits. Taken together, our results underscore the critical role of medical innovations and health interventions in improving economic optimism and food security, especially among vulnerable populations, during public health crises

     
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    Schriftenreihe: NBER working paper series ; no. w31045
    Schlagworte: Coronavirus; Infektionskrankheit; Impfung; Ernährungspolitik; Ernährungssicherung; USA; Health and Inequality; Government Policy; Regulation; Public Health
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