Health Economics Commons^™

The Effect Of Vaccine Mandates On Disease Spread: Evidence From College Covid-19 Mandates, Riley K. Acton, Wenjia Cao, Emily E. Cook, Scott A. Imberman, Michael F. Lovenheim

Research Collection School Of Economics

Nearly 700 4-year U.S. colleges mandated students receive COVID-19 vaccinations in fall 2021. Using data on college policies and county health, we estimate how mandates affect surrounding communities. Event studies from August to November 2021 show that mandates covering all colleges in a county reduced COVID-19 deaths by 5.6 per 100,000 persons, a 4.6% reduction in the U.S. total during this period. Mandates reduced COVID cases by 504 and ICU admissions by 16.2 per 100,000, though we see no statistically significant impact on hospitalizations. Impacts are larger in counties with larger college populations and low estimated ex-ante student vaccination rates.

Expanding Public Health Insurance To Parents: Effect On Parents' And Children’S Well-Being, Michelle Marcus, Xuan Zhang

Research Collection School Of Economics

Expanding public health insurance to parents may not only improve parental outcomes but also have spillover effects on their children. This paper leverages the natural experiment of the Affordable Care Act (ACA) to estimate the causal effects of expanding public health insurance to low-income parents on their well-being and that of their children. Using a difference-in-differences model and data from the 2010–2017 National Health Interview Surveys, we observe significant improvements in health care access, increased health care utilization, reduced financial burdens, and slight improvements in health status among low-income parents. For children in Medicaid expansion states, we find reductions in …

The Motherhood Penalty On Health: Evidence From China, Ang Sun, Fang Xia, Xuan Zhang

Research Collection School Of Economics

Understanding women’s physical and mental well-being following childbirth is critical for informing policies on labor market equity, family support, and fertility. Using event study methods and panel data from China, we document a persistent motherhood penalty in both physical and mental health, whereas the health impacts on fathers are minimal. While mothers experience a temporary reduction in paid work hours, they face a sustained increase in unpaid domestic labor — housework and childcare — resulting in a net increase in total work time. This additional workload likely contributes to deterioration in health. Mothers are also more likely to engage in …

Short-Term Mortality And Healthcare Utilization Consequences Of Pension Income Receipt: Evidence From South Korea, Mimi Jeon, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We examine short-term consequences of pension income receipt on mortality and healthcare utilization within the monthly payment cycle. Using the national death registry data of South Korea, we document that the mortality rate decreases by 1.2–1.4 percent in the week of the disbursement date. The mortality-reducing effects are larger for causes of death that could have been avoided through timely and effective healthcare interventions. Using healthcare claims data, we document that the number of hospital admissions increases during the disbursement week. We provide suggestive evidence of greater mortality-reducing effects from a smaller but more frequent disbursement than from a monthly …

Impacts Of U.S. Environmental Regulations On Industry, Xiao Ji, Mengyu Wang, Tianyi Zhang

Sim Kee Boon Institute for Financial Economics

This paper analyzes the impacts of U.S. environmental regulations on industry, focusing on command-and-control environmental regulations (CCER) and market-based environmental regulations (MBER). Drawing on empirical data from the Environmental Protection Agency (EPA) spanning over four decades, we examine key legislation such as the Clean Water Act (CWA), Clean Air Act (CAA), and the Resource Conservation and Recovery Act (RCRA), while also discussing more recent frameworks like the Inflation Reduction Act (IRA). Our findings suggest that although penalties under CCER contribute to immediate compliance, they often fail to elicit long-term changes in corporate behavior. In contrast, MBER, exemplified by the IRA, …

Regulatory Impacts On Us Hazardous Waste Exports, Xiaofan Ji, Mengyu Wang, Tianyi Zhang

Sim Kee Boon Institute for Financial Economics

This paper examines the impact of key domestic and international regulations on US hazardous waste exports, focusing on shifts in export destinations and waste types from 2002 to 2023. Since 2005, OECD countries and US Trade Agreement Partners have become primary destinations for US hazardous waste, with significant surges after 2018 and a notable decline in 2022. An analysis of the regulatory landscape reveals that, while international frameworks such as the Basel Convention of 2021 have had a relatively limited impact on reducing US hazardous waste exports, domestic policies—particularly those in California—have more directly influenced export behaviors. Additionally, the US …

Trust In Healthcare Ai Can’T Just Be Designed – It Must Be Felt By Clinicians And Patients, Adriana Banozic-Tang, Heng Wang

Research Collection Yong Pung How School Of Law

Trust in healthcare AI currently over-relies on system design, not lived medical realities.Continuous feedback loops are necessary to embed trust in healthcare AI that is responsive to clinician and patient needs.Initiatives in South-East Asia show how trust in technology can be extended from policy to practice.

Does Moving From One-Story Building To Multi-Building Affect The Health Status Of The Elderly: Evidence From China’S Par Program, Lu Cao

Dissertations and Theses Collection (Open Access)

This study investigates the causal impact of relocating from single-story to multistory buildings on the health outcomes of elderly residents in China. Using China’s Poverty Alleviation Relocation (PAR) program as an exogenous policy shock, we employ instrumental variable and difference-in-differences approaches to establish causality. Our analysis of data from the China Health and Retirement Longitudinal Study (2011-2018) reveals a nuanced relationship between vertical living and elderly health. While relocation to multi-story buildings is associated with deterioration in self-reported physical health status, it significantly improves mental health conditions and life satisfaction among elderly movers. We identify two key mechanisms driving these …

The Effects Of Income On Infant Health: Evidence From The Coal Boom And Bust, Chu Gek Chew

Dissertations and Theses Collection (Open Access)

An individual’s health at birth is an important component in human capital accumulation, posing significant implications both in the short- and long-run. I investigate how infant health outcomes were impacted during a period of successive positive and negative economic shocks led by the coal industry between the 1970s to 1990s. Using exogenous variation within counties’ pre-existing coal reserves, I instrument for the changes in economic opportunities during the coal boom and bust. I find some limited evidence that an increase in income improves infant health outcomes. The incidence of low birthweight is decreasing in earnings growth, and effects are stronger …

Strategizing Towards The Future Hospital: A Systems Thinking Approach, Ashish Kumar, Sean Shao Wei Lam, Sze Ling Chan, Yingqi Xu, Yao Ge, Geoffrey Kah Tack Gui, Hiang Khoon Tan

Research Collection School Of Economics

Background: The complex systemic nature of Future Hospital design in the rapidly ageing city-state of Singapore calls for systems thinking. We apply this approach to answer two research questions: (i) What are the variables that drive the present and future dynamics of the Future Hospital system? (ii) How are these driving variables related? Methods: Causal loop diagrams (CLDs) were developed collaboratively by a cross-functional system modelling team through group modelling discussions and reviews, totalling 20 sessions. Network analysis of the resulting CLDs was used to identify dominant variables. Results: Seven interlocking CLDs (national view, cluster view, and study hospital top …

Consumption Responses To Income Shocks Through Lottery Winning, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We study the effects of lottery winning on consumption spending using newly available household survey data in Singapore. We find strong consumption responses to a transitory income shock via lottery wins. Lottery winners spend about half of their prizes within 12 months of winning. We show that consumption responses are stronger among households with more binding liquidity constraints and less risk aversion, which is consistent with the standard life-cycle model. The strong consumption response suggests that fiscal stimulus policies or other public transfer programs could be an effective means of boosting consumption spending of the economy in the short run.

The Importance Of Sampling Frequency For Estimates Of Well-Being Dynamics, Stephen James Hoskins, David W. Johnston, Johannes S. Kunz, Michael A. Shields, Kevin E. Staub

ROSA Journal Articles and Publications

Using a high-frequency panel survey, we examine the sensitivity of estimated self-reported well-being (SWB) dynamics to using monthly, quarterly, and yearly data. This is an important issue if SWB is to be used to evaluate policy. Results from autoregressive models that account for individual-level heterogeneity indicate that the estimated persistence using yearly data is near zero. However, estimated persistence from monthly and quarterly data is substantial. We estimate that persistence to shocks typically lasts around six months and has a net present value of 75–80 per cent of the contemporaneous effect. Estimates are similar for different domains of SWB.

Recruitment Of Cxcr4+Type 1 Innate Lymphoid Cells Distinguishes Sarcoidosis From Other Skin Granulomatous Diseases, S. Sati, J. Huang, A.E. Kersh, P. Jones, O. Ahart, C. Murphy, S.M. Prouty, M.L. Hedberg, V. Jain, S.G. Gregory, Leung, Denis H. Y., J.T. Seykora, M. Rosenbach, T.H. Leung

Research Collection School Of Economics

Sarcoidosis is a multiorgan granulomatous disease that lacks diagnostic biomarkers and targeted treatments. Using blood and skin from patients with sarcoid and non-sarcoid skin granulomas, we discovered that skin granulomas from different diseases exhibit unique immune cell recruitment and molecular signatures. Sarcoid skin granulomas were specifically enriched for type 1 innate lymphoid cells (ILC1s) and B cells and exhibited molecular programs associated with formation of mature tertiary lymphoid structures (TLSs), including increased CXCL12/CXCR4 signaling. Lung sarcoidosis granulomas also displayed similar immune cell recruitment. Thus, granuloma formation was not a generic molecular response. In addition to tissue-specific effects, patients with sarcoidosis …

Essays On Aging, Health, And Labor Market, Lanjie Wang

Dissertations and Theses Collection (Open Access)

This dissertation consists of four chapters on aging, health, and labor economics.

In the first chapter, we investigate the short-term impacts of unemployment on older workers in Singapore, a setting without public unemployment insurance. Using monthly panel data, we analyze dynamic impacts on income, spending, health, and subjective well-being over two years post-unemployment. We find substantial initial earnings losses with incomplete recovery, with income remaining 46.5% below pre-unemployment levels after 24 months. Despite this persistent income gap, consumption responses are modest and comparable to countries with strong social safety nets, suggesting robust self-insurance mechanisms. We observe increased retirement among married …

Health Insurance And The Rise Of Women: Evidence From The New Cooperative Medical Scheme, Xingyu Bai

Dissertations and Theses Collection (Open Access)

Females are traditionally viewed as the primary providers of informal parental care in China, especially in rural areas. We investigate whether health insurance coverage in rural China, the New Cooperative Medical Scheme (NCMS), can unleash more female labor force participation by reducing the burden of informal parental care. Employing a heterogeneity-robust difference-in-differences estimation, we find that the NCMS has a significant positive impact on female labor supply, primarily in non-farm occupations. In contrast, we observe no significant changes in male labor supply. We explore the mechanism by showing that the NCMS significantly decreases both the provision and demand for parental …

Effect Of Catastrophic Medical Insurance On Healthcare Service Utilization And Quality, Ruiqi Ding

Dissertations and Theses Collection (Open Access)

China implemented catastrophic medical insurance (CMI) program to provide additional reimbursement for individuals requiring extensive healthcare services due to severe illnesses. This study empirically assesses the impact of the CMI program on the healthcare utilization and quality of care for severely ill patients, using medical insurance claim data from 2012 to 2018 in a capital city in China. The analysis yields the following conclusions: First, CMI decreased the medical expenditure of severe patients, but it had no impact on alleviating the financial burden. Second, CMI curbed abuse and saved medical resources, and in the meantime, it increased the use of …

Hiv Estimation Using Population-Based Surveys With Non-Response: A Partial Identification Approach, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung, Siyu Li

Research Collection School Of Economics

HIV estimation using data from the demographic and health surveys (DHS) is limited by the presence of non-response and test refusals. Conventional adjustments such as imputation require the data to be missing at random. Methods that use instrumental variables allow the possibility that prevalence is different between the respondents and non-respondents, but their performance depends critically on the validity of the instrument. Using Manski's partial identification approach, we form instrumental variable bounds for HIV prevalence from a pool of candidate instruments. Our method does not require all candidate instruments to be valid. We use a simulation study to evaluate and …

Weight Misperceptions And Health Management Via Information Nudges, Lanjie Wang, Xuan Zhang, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

Being overweight or obese is a serious public health problem. Misperception of one's own weight status and inertia are major obstacles to weight control. To overcome these two problems, we conduct a randomized controlled trial in which participants are presented with the correct weight category based on their body mass index to remove any weight misperception, and then given six biweekly reminders about healthy diet and physical activity via SMS/email. We find that our intervention reduces individuals’ weight misperception and encourages healthier dietary choices. However, it has little impact on their physical activity. We further show that people who were …

Hiv Estimation Using Population Based Surveys With Non-Response: A Partial Identification Approach, Oyelola A Adegboye, Tomoki Fujii, Denis H. Y. Leung, Siyu Li

Research Collection School Of Economics

HIV estimation using data from the Demographic and Health Surveys (DHS) is lim-ited by the presence of non-response and test refusals. Conventional adjustments such as imputation require the data to be missing at random. Methods that use instrumental variables allow the possibility that prevalence is different between the respondents and non-respondents, but their performance depends critically on the validity of the instru-ment. Using Manski’s partial identification approach, we form instrumental variable bounds for HIV prevalence from a pool of candidate instruments. Our method does not require all candidate instruments to be valid. We use a simulation study to evaluate and …

The Need For Growth, Hian Teck Hoon, Edmund S. Phelps, Gylfi Zoega

Research Collection School Of Economics

The falling rate of productivity growth in the West has made equilibrium real rate of interest fall, causing sky-high stock prices and stagnated real wages. Eliminating or reducing impediments to growth—such as rules and regulations that protect vested interests—would lower the burden of debt, make it easier to reduce greenhouse gas emissions and increase political stability. There are also measures that strengthen institutions that encourage innovations; a healthy financial system, well-protected property rights and values that emphasize self-reliance, independence and good work ethics. While special interests are more entrenched in some developed countries than others, there is hope that current …

Heterogeneity In The Persistence Of Health: Evidence From A Monthly Micro Panel, Stephen Hoskins, David W. Joohnston, Johannes S. Kunz, Michael A. Shields, Kevin E. Staub

ROSA Journal Articles and Publications

Despite being widely used in health economics, dynamic models of health and healthcare typ ically assume that the persistence in these outcomes is the same for every individual. This paper explores individual-level heterogeneity in the persistence of health outcomes. Using simple re gression methods that do not place any restriction on the distribution of the heterogeneity in persistence, the paper documents substantial heterogeneity in health, medical expenditures, and healthcare use. We show that neglecting this heterogeneity leads to estimates that overstate the average persistence and can bias the coefficients of covariates. We find that between 75% and 87% of individuals …

Retail Pharmacies And Drug Diversion During The Opioid Epidemic, Aljoscha Janssen, Xuan Zhang

Research Collection School Of Economics

This study investigates the role of retail pharmacy ownership in the opioid epidemic. Using data of prescription opioid orders, we show that compared with chain pharmacies, independent pharmacies dispense 39.1% more opioids and 60.5% more OxyContin. After an independent pharmacy becomes a chain pharmacy, opioid dispensing decreases. Using the OxyContin reformulation, which reduced non-medical demand but not the legitimate medical demand, we show that at least a third of the difference in the amount of OxyContin dispensed can be attributed to non-medical demand. We show that differences in competitive pressure and whether pharmacists own the pharmacy drive our estimates.

Identifying Knowledge Spillovers From Universities: Quasi-Experimental Evidence From Urban China, Li Jing, Shimeng Liu, Yifan Wu

Research Collection School Of Economics

This paper studies the impact of universities on local innovation activity by exploiting a unique university expansion policy in China as a quasi-experiment. We take a geographic approach, empowered by geocoded data on patents and new products at the address level, to identify knowledge spillovers as an important channel. We obtain three main findings. First, university expansion significantly increases universities’ own innovation capacity, which results in a dramatic boom of local industry patents. Second, the impact of university expansion on local innovation activities attenuates sharply within 2 kilometers of the universities. Third, university expansion boosts nearby firms’ new products and …

Associations Of The Covid-19 Pandemic With Older Individuals' Healthcare Utilization And Self-Reported Health Status: A Longitudinal Analysis From Singapore, Sangnam Ahn, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

Background: The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Objectives: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. Method: Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. Subjects: Data were …

The Intergenerational Mortality Tradeoff Of Covid-19 Lockdown Policies, Lin Ma, Gil Shapira, Damien De Walque, Quy-Toan Do, Jed Friedman, Andrei A. Levchenko

Research Collection School Of Economics

In lower-income countries, the economic contractions that accompany lockdowns to contain COVID-19 transmission can increase child mortality, counteracting the mortality reductions achieved by the lockdown. To formalize and quantify this effect, we build a macro-susceptible-infected-recovered model that features heterogeneous agents and a country-group-specific relationship between economic downturns and child mortality and calibrate it to data for 85 countries across all income levels. We find that in some low-income countries, a lockdown can produce net increases in mortality. The optimal lockdown that maximizes the present value of aggregate social welfare is shorter and milder in poorer countries than in rich ones.

Three Essays On Development Economics And Human Capital, Arpita Khanna

Dissertations and Theses Collection (Open Access)

In the first chapter, we estimate the impact of exposure to the 2015 Nepal Earthquake on intimate partner violence with two rounds of Demographic and Health Surveys data. Using differences-in-differences estimation, we find that exposure to the earthquake lead to a statistically and economically significant increase in intimate partner violence in the urban areas but not in the rural areas. This is possibly due to an increase in the stress felt by the victims. We also offer some evidence that the impact heterogeneity between the urban and rural areas is attributable to the differences in the reconstruction processes and assistance …

The Effects Of The Affordable Care Act Dependent Coverage Mandate On Parents’ Labor Market Outcomes, Kim, Koh Kanghyock

Research Collection School Of Economics

We examine the labor market impacts of the Affordable Care Act dependent mandate (ACA-DM), which has significantly increased dependent children's health insurance coverage through parents’ employer-sponsored health benefits. Using data from the American Community Survey, we find that the ACA-DM reduced parents’ annual wages by about $2,600. However, the probability of employment and working hours only decreased marginally. The back-of-the-envelope calculation indicates that the magnitude of the estimated wage impact is similar to the increased insurance premium of a family plan due to the ACA-DM. These findings imply that a deadweight loss associated with the expansion of dependent health coverage …

The Effects Of Physician Retirement On Patient Outcomes: Anticipation And Disruption, Xuan Zhang

Research Collection School Of Economics

The physician retirement rate in the United States is increasing as the population ages. I use an event study model allowing for anticipation to evaluate the effects of primary care physician (PCP) retirement on elderly adults’ health care utilization and quality of care. I find that, despite moderate anticipatory effects, PCP retirement results in an approximately $572 increase in total Medicare costs per beneficiary in the first 1.5 years post-retirement and an over 10% increase in detection of new chronic conditions. Heterogeneity analyses show that the increase in costs is disproportionately driven by the retirement of solo practitioners; Medicare beneficiaries …

Health Insurance And Subjective Well-Being: Evidence From Two Healthcare Reforms In The United States, Seonghoon Kim

Research Collection School Of Economics

We study the role of access to health insurance coverage as a determinant of individuals' subjective well-being (SWB) by analyzing large-scale healthcare reforms in the United States. Using data from the Behavioral Risk Factor Surveillance System and Panel Study of Income Dynamics, we find that the 2006 Massachusetts reform and 2014 Affordable Care Act Medicaid expansion improved the overall life satisfaction of Massachusetts residents and low-income adults in Medicaid expansion states, respectively. The results are robust to various sensitivity and falsification tests. Our findings imply that access to health insurance plays an important role in improving SWB. Without considering psychological …

High-Frequency Internet Survey Of A Probability Sample Of Older Singaporeans: The Singapore Life Panel, Rhema Vaithianathan, Bryce Hool, Michael D. Hurd, Susann Rohwedder

Research Collection School Of Economics

Facing a rapidly ageing population, Singapore is presented with urgent policy challenges. Yet there is very little data on the economic, health and family circumstances of older Singaporeans. In response, the Centre for Research on the Economics of Ageing (CREA) at Singapore Management University has been collecting monthly data on a panel of Singaporeans aged between 50 and 70 years. We detail the methodology by which the Singapore Life Panel® (SLP) was constructed using a population-representative sampling frame from the Singapore Department of Statistics. Contact was made with 25,000 households through postal, phone and in-person canvassing. More than 15,200 respondents …