Recession Depression: Mental Health Effects of the 2008 Stock Market Crash by Melissa McInerney, Jennifer Mellor, and Lauren Hersch Nicholas (Journal of Health Economics)
Do sudden, large wealth losses affect mental health? We use exogenous variation in the interview dates of the 2008 Health and Retirement Study to assess the impact of large wealth losses on mental health among older U.S. adults. We compare cross-wave changes in wealth and mental health for respondents interviewed before and after the October 2008 stock market crash. We find that the crash reduced wealth and increased feelings of depression and use of antidepressant drugs, and that these effects were largest among respondents with high levels of stock holdings prior to the crash. These results suggest that sudden wealth losses cause immediate declines in subjective measures of mental health. However, we find no evidence that wealth losses lead to increases in clinically-validated measures of depressive symptoms or indicators of depression.
Profit or Patients’ Health Benefit? Exploring the Heterogeneity in Physician Altruism by Geir Godager (Journal of Health Economics)
This paper investigates physician altruism toward patients’ health benefit using behavioral data from Hennig-Schmidt et al.’s (2011) laboratory experiment. In the experiment, medical students in the role of physicians decide on the provision of medical services. The experimental setup allows us to identify the influence of profits and patients’ health benefit on the choice of medical treatment. We estimate physician altruism, the weight individuals attach to patients’ health benefit, by fitting mixed logit and multinomial logit regression models to the experimental data. Estimation results provide evidence for physician altruism. We find, however, substantial variation in the degree of physician altruism. We also discuss some implications of our results for the design of physician payment schemes in the light of the theoretical literature.
Exploring The Intergenerational Persistence Of Mental Health: Evidence From Three Generations by David W. Johnston, Stefanie Schurer, and Michael A. Shields (Journal of Health Economics)
This paper uses data from the 1970 British Cohort Study to quantify the intergenerational persistence of mental health, and the long-run economic costs associated with poor parental mental health. We find a strong and significant intergenerational correlation that is robust to different covariate sets, sample restrictions, model specifications and potential endogeneity. Importantly, the intergenerational persistence is economically relevant, with maternal mental health associated with lasting effects on the child’s educational attainment, future household income and the probability of having criminal convictions. These results do not disappear after controlling for children’s own childhood and adulthood mental health.
Do fixed patent terms distort innovation? Evidence from cancer clinical trials by Eric Budish, Benjamin Roin, and Heidi Williams (National Bureau of Economic Research)
Patents award innovators a fixed period of market exclusivity, e.g., 20 years in the United States. Yet, since in many industries firms file patents at the time of discovery (“invention”) rather than first sale (“commercialization”), effective patent terms vary: inventions that commercialize at the time of invention receive a full patent term, whereas inventions that have a long time lag between invention and commercialization receive substantially reduced – or in extreme cases, zero – effective patent terms. We present a simple model formalizing how this variation may distort research and development (R&D). We then explore this distortion empirically in the context of cancer R&D, where clinical trials are shorter – and hence, effective patent terms longer – for drugs targeting late-stage cancer patients, relative to drugs targeting early-stage cancer patients or cancer prevention. Using a newly constructed data set on cancer clinical trial investments, we provide several sources of evidence consistent with fixed patent terms distorting cancer R&D. Back-of-the-envelope calculations suggest that the number of life-years at stake is large. We discuss three specific policy levers that could eliminate this distortion – patent design, targeted R&D subsidies, and surrogate (non-mortality) clinical trial endpoints – and provide empirical evidence that surrogate endpoints can be effective in practice.
The Impact of Mothers’ Earnings on Health Inputs and Infant Health by Naci Mocan, Christian Raschke, and Bulent Unel (National Bureau of Economic Research)
This paper investigates the impact of mothers’ earnings on birth weight and gestational age of infants. It also analyzes the impact of earnings on mothers’ consumption of prenatal medical care, and their propensity to smoke and drink during pregnancy. The paper uses census-division- and year-specific skill-biased technology shocks as an instrument for mothers’ earnings and employs a two-sample instrumental variables strategy. About 14 million records of births between 1989 and 2004 are used from the Natality Detail files along with the CPS Annual Demographic Files from the same period. The results reveal that an increase in weekly earnings prompts an increase in prenatal care of low-skill mothers (those who have at most a high school degree) who are not likely to be on Medicaid, and that earnings have a small positive impact on birth weight and gestational age of the newborns of these mothers. An increase in earnings does not influence the health of newborns of high-skill mothers (those with at least some college education). Variations in earnings have no impact on birth weight for mothers who are likely to be on Medicaid.
Service Use at the End-of-Life in Medicare Advantage Versus Traditional Medicare by David Stevenson, John Ayanian, Alan Zaslavsky, Joseph Newhouse, and Buruce Landon (Medical Care)
Relative to traditional fee-for-service Medicare, managed care plans caring for Medicare beneficiaries may be better positioned to promote recommended services and discourage bur- densome procedures with little clinical value at the end of life. […] For a national cohort of Medicare decedents continuously enrolled in MA-HMOs or TM in their year of death, 2003–2009, we obtained hospice enrollment information and individual-level Healthcare Effectiveness Data and Information Set utilization measures for MA-HMO decedents for up to 1 year before death. […] Relative to comparable TM decedents in the same local areas, MA-HMO decedents more frequently enrolled in hos- pice and used fewer inpatient and emergency department services, demonstrating that MA plans provide less end-of-life care in hospital settings.
Do Changes in Hospital Outpatient Payments Affect the Setting of Care? by Daifeng He and Jennifer M. Mellor (Health Services Research)
Objective: To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting . […] Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions. Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare’s efforts to contain hospital outpatient costs.
Adoption of Evidence-Based Clinical Innovations: The Case of Buprenorphine Use by Opioid Treatment Programs by Christina Andrews, Thomas D’Aunno, Harold Pollack, and Peter Friedmann (Medical Care)
This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and characteristics of staff; organizations’ technical and social support for the innovation; local market dynamics and competition; and state policies governing the innovation. Results indicate that buprenorphine use increased 24% for detoxification and 47% for maintenance therapy between 2005 and 2011. Buprenorphine use was positively related to reliance on private insurance and availability of state subsidies to cover its cost and inversely related to the percentage of clients who injected opiates, county size, and local availability of methadone. The results indicate that financial incentives and market factors play important roles in opioid treatment programs’ decisions to adopt evidence-based clinical innovations such as buprenorphine use.
The End of Hospital Cost Shifting and the Quest for Hospital Productivity by Austin Frakt (Health Services Research)
State Politics and the Fate of the Safety Net by Katherine Neuhausen, Michael Spivey, and Arthur L. Kellermann (New England Journal of Medicine)