Using rich survey data for England we investigate whether providing parents with information about the weight status of their children reduces children’s bodyweight, improves health behaviors and cognitive test performance, or has any adverse effects. We exploit the timing of survey interview compared to the timing of sending out weight reports to parents in a difference-in-difference framework. Our analysis does not reveal any of the intended effects on body weight or health behaviors. Instead, we find adverse effects that are concentrated in disadvantaged families. Evidence based on regression discontinuity analysis suggests longer term increases in bodyweight in children classified as overweight.

Information plays a crucial role in shaping vaccine-related behaviors. However, because the timing of exposure to vaccine information can trigger responses at different margins, focusing solely on vaccination uptake risks underestimating the overall effect of information. We exploit a major information shock—the Korean government’s recognition of a causal link between the Pfizer-BioNTech vaccine and myocarditis/pericarditis—to investigate its impact on healthcare utilization after vaccination. Using the K-COV-N cohort, an administrative dataset linking vaccination records and health insurance claims, we implement a difference-in-differences framework comparing individuals vaccinated around the announcement with not-yet-vaccinated controls. We find that exposure to the announcement increased adverse event–related healthcare utilization by about one percentage point from a 4.5% baseline. The increase was concentrated in general adverse events such as headache, fever, and muscle pain. Effects were most pronounced in clinics, suggesting precautionary care-seeking rather than acute health deterioration. These results indicate that, in a context of high vaccine uptake, negative vaccine information primarily reshapes post-vaccination risk perception, highlighting the importance of considering the costs of transparency in vaccine risk communication.

Health insurers frequently impose supply-side policies in the form of ‘prior authorization’ to manage healthcare spending. Prior authorization requires providers to fill out paperwork before treatment is eligible for coverage. The stated purpose of these policies is to reduce healthcare spending by encouraging the use of lower-cost treatments of similar quality, and to ensure treat[1]ment complies with established guidelines. However, there are concerns that prior authorization may discourage needed care. Using all-payer claims data from Massachusetts in 2009-2013, we estimate the effect of prior authorization on the use of specific drugs in MassHealth, the state Medicaid fee-for-service program. Using difference-in-differences estimation, we compare Medi[1]caid beneficiaries affected by changes in prior authorization requirements to individuals in plans of a major commercial insurer unaffected by these policy changes. We find that prior authoriza[1]tions lead to large reductions in utilization of drugs that have clear substitutes. These reductions are fully offset by increases in utilization of cheaper but equally effective drugs. However, when clear substitutes are not available, there are reductions in utilization that do not lead to sub[1]stitution to similar drugs. Prior authorization reduces both high- and low-value use of drugs, suggesting that it is not well targeted.

Multi-indication drugs pose pricing challenges, affecting therapeutic benefits and patient access. We model how a manufacturer strategically chooses clinically eligible patient populations for each indication, recognizing that broader populations increase demand but reduce expected therapeutic benefits and thus allowable prices. We identify mechanisms that induce the manufacturer to maximize total benefit while ensuring profits cannot exceed benefit generated: indication-specific prices equal to expected benefits, population-weighted uniform prices, and two-part tariffs. This holds when indications are introduced simultaneously or sequentially, provided prices fully adjust as indications are added. Price caps distort patient selection, explaining empirically observed strategies.

Deprivation payments provide additional per-patient fees to health professionals in socioe[1]conomically deprived areas to compensate for higher workloads. However, their impact on health gaps remains unclear. We assess this policy by studying its adoption among Dutch community midwives. Using a discontinuity in payments based on regional deprivation scores, we find that these payments reduced the gap in birth outcomes. The improvements reflect better fetal growth and arise from enhanced prenatal care and timely referrals. We rule out relocation of mothers or midwives as key drivers. Our findings align with the fair wage-effort theory, indicating that better compensation enhances care quality.

Health care decisions are sometimes a matter of life and death, but also their financial consequences can be disastrous for many households around the world. While it is easy to imagine how the fear of making an expensive mistake may deter particularly poor households from making ottheiherwise sensible health care choices, there is almost no scientific evidence on the importance and joint role of medical and cost uncertainty. In this paper, we provide theoretical insights based on simulation exercises, introduce a novel measurement instrument for medical and cost uncertainty related to health investment choices, present data collected using this instrument from low-income households in Pakistan, and test the theoretical predictions using this data. Our analysis reveals that both medical as well as cost uncertainty in health care decisions exist to a substantial degree. The empirical results regarding the influence of beliefs are largely in line with theoretical predictions and suggest that uncertainty in the financial dimension deters health investments. These results indicated potentially large dividends to providing accurate information. Yet, our survey experiment, in which we provided such information on hypothetical health scenarios shows little effects on beliefs and decisions highlighting the difficulty to resolve these uncertainties.

Objectives: Violence against women carries severe health and socioeconomic costs for individuals and societies worldwide. Childbearing is a particularly vulnerable moment, with higher rates of violence and long-lasting consequences for women and their children. This paper investigates how paternity leave impacts intimate partner violence (IPV). Paternity leave policies are being implemented in several countries to enhance gender equality. They have the potential to change within-family dynamics—such as time use and caregiving roles—during this especially sensitive period around childbirth, which may affect household conflict and exposure to violence. Methods: I use individual administrative health records to simultaneously detect paternity leave eligibility—based on the date of birth—and cases of abuse—identified using ICD codes The dataset covers all women giving birth within the Catalan public health system. I exploit the quasi-natural experiment resulting from a 2019 reform in Spain that extended the duration of paternity leave and made part of it mandatory, requiring new parents to spend time together right after birth. The policy increased fathers’ take-up by 30%. I apply a local difference-in-differences method, comparing women who gave birth around the reform date. Results: I find a decrease of 0.3–0.7 percentage points in the most severe IPV cases—those treated in emergency rooms—for women in eligible families. This represents around a 50% reduction compared to the baseline number of cases. The results are not driven by changes in healthcare usage or reporting behaviour. The effect persists for up to three years after birth and is more pronounced among younger, non-Spanish, and low-SES mothers. Using the Labour Force Survey, I investigate potential mechanisms behind the reduction in IPV and find evidence of an increase in separations among eligible couples. This suggests that the new paternity leave provides information to new mothers about their partners, enabling them to exit bad relationships before severe violence occurs. Discussion: Identifying spillover effects of paternity leave policies is key to informing policymakers. In this paper, I rule out an unintended spike in intimate partner violence caused by increased exposure to violent men after making paternity leave mandatory. Instead, I find a higher probability of separation among eligible families. These results suggest that gender norms might limit the effectiveness of public policies, as their impact interacts with existing family dynamics.

Objectives Recently, NHS England (NHSE) launched the High-Volume Low-Complexity (HVLC) surgical hubs programme as part of the elective recovery plan. HVLC hubs were designed to separate elective surgery from other hospital activities, protecting procedures from emergency care disruptions. We examine the extent to which productivity improvements in the delivery of elective care can be identified and attributed to the introduction of HVLC hubs. Method We take advantage of the staggered roll-out of hubs across England by implementing a Difference-in-Differences approach that is robust to treatment effect heterogeneity, drawing on the estimator proposed by Borusyak et al. (2024). Our analysis uses administrative data from NHS England’s Hospital Episode Statistics (HES) Admitted Patient Care dataset, and health care cost data from the National Cost Collection, for the period April 2014 to March 2023. We focus on two surgical specialties, prioritised under the HVLC programme: Trauma & Orthopaedics (T&O) and Urology. We exclude NHS hospital trusts with pre-existing hubs and private-sector providers. The final sample includes 27 hospitals that implemented a surgical hub between April 2020 and March 2023, and 60 NHS hospital trusts without hubs. Hospital productivity is measured using two metrics: (1) procedures per consultant per month, and (2) cost-weighted procedures per consultant per month. Results In T&O, hubs increased consultant productivity by 0.51 procedures per month, contributing 10.2% of the average productivity level after hub implementation. Hospital trusts with integrated and standalone hubs experience improved productivity, with standalone hubs driving greater gains. Multi-specialty hubs improved productivity, unlike single-specialty hubs. Hospital trusts gained productivity regardless of the number of hubs they operate. In Urology, although the overall productivity effect is not statistically significant, we find a positive significant impact among hospital trusts adopting ring-fenced hubs. A causal interpretation of these findings is supported by the strength of the empirical design. We find no evidence of differential pre-trends or anticipatory effects, suggesting that the constructed counterfactual outcomes offer a credible basis for estimating the treatment effects. Moreover, the estimated effects are directionally consistent across alternative specifications, including the standard TWFE model and the DiD estimator proposed by Callaway and Sant’Anna (2021). While both models yield statistically insignificant estimates, this is not unexpected given the relatively small number of treated units and the limitations inherent in each approach. Conclusion Productivity was declining even before COVID-19. While overall productivity still fell after hub rollout, surgical hubs slowed this decline, preventing a sharper drop.

The link between financial well-being and health is one of the few undisputed claims in health economics. Studies have shown that housing wealth has favourable long-term health benefits, and many people consider homeownership an important achievement in life. However, homeownership involves time-sensitive trade-offs: many housing pur[1]chases are mortgage-financed, increasing household dependence on steady cash flows and temporary susceptibility to employment shocks. While wealth is a cushion that absorbs economic shocks, debt may erode economic resilience and result in mental health problems and premature mortality. In this paper, we use large population-wide linked registry data from Finland between 2001 and 2019 to identify households who experienced job loss events under mortgage strain following housing purchases. We use a quasi-causal event study design to estimate whether debt temporarily offsets the protective effect of homeownership on mental health. We find that while mortgage strain may impede mental health in the run-up to a job loss event, this higher health risk subsides quickly, and the health benefits of homeownership accumulate over time.

This paper examines the long-term and multi-generational benefits of skilled birth attendance (SBA), which involves having a trained midwife or doctor present at delivery to safely perform normal deliveries using aseptic techniques and provide first-line emergency obstetric care. Using data on the county-by-county rollout of SBA in China from the 1930s to the 1970s, our research first demonstrates that the SBA reform substantially reduced neonatal mortality. We then show that exposure to skilled delivery during birth leads to a 1.5% increase in adult income. Moreover, we discovered that the benefits of exposure to SBA in previous generations extend to subsequent offspring. Children with at least one parent who experienced SBA have a 2.6% higher monthly income in adulthood than those whose parents did not have access to SBA. This effect is more pronounced when the mother, rather than the father, was exposed to SBA. We also present evidence of several underlying mechanisms, including improved physical and mental health, better educational outcomes, and enhanced cognitive abilities. Our findings indicate that having skilled health professionals attend childbirths can result in significant long-term and multi-generational benefits.

Pharmaceutical innovation policies bundle heterogeneous incentive mechanisms whose distinct effects on R&D activities and equity remain poorly understood. We assemble a disease–country–year panel covering 42 countries from 2000–2021, linking over 1,100 policy introductions and more than 1.9 million R&D grants to seven underlying policy mechanisms. Using multiple identification strategies, we estimate both the direct (“own-country”) effects of each mechanism and the cross-country spillovers they generate within disease areas. Four findings emerge. First, financial benefits—especially those embedded in non-grant instruments such as tax credits—substantially increase R&D but disproportionately steer activity toward commercially attractive diseases and operate more effectively in high-income countries, widening domestic and global inequities. Second, mechanisms that ease regulatory or informational frictions such as time-saving pathways and scientific or regulatory knowledge-sharing platforms, produce large, persistent gains in innovation, particularly in LMICs and in diseases with weak market incentives; both also generate positive spillovers, and time benefits improve alignment with domestic (though not global) disease burden. Third, IP-sharing requirements depress innovation, most sharply in LMICs with weak appropriability regimes and in rare diseases where returns hinge on strong IP protection. Fourth, rewards conditioned on R&D success yield more projects advancing through the pipeline than unconditional rewards. Overall, incentive effectiveness is highly contextual: mechanisms that reduce regulatory or informational barriers deliver the strongest and most equitable gains, whereas financial instruments require careful targeting to avoid reinforcing disparities. Coordinated incentive design offers a promising path to improving innovation productivity and global health equity.

The paper exploits a natural experiment, through the phased roll-out of Egypt’s Universal Health Insurance (UHI), to assess the impact of UHI on out-of-pocket (OOP) health spending and catastrophic health spending. Using synthetic control methodology, findings indicate that the introduction of UHI led to a statistically significant decline in household per-capita OOP health spending by about 6 percent and on the incidence of catastrophic health spending by almost 37 percent. Heterogeneous analysis indicates that a statistically significant effect is only observed for out-of-pocket health spending for the early-treated governorate.

Pay-for-delay agreements occur when a branded pharmaceutical firm pays a generic competitor to delay market entry, artificially extending its monopoly. This raises concerns about competition and consumer welfare. This paper investigates the welfare impact of delayed generic entry in the U.S. Testosterone Replacement Therapy market, focusing on the pay-for-delay agreement that postponed generic competition for the drug AndroGel from 2006 until 2015. I propose a method to quantify the damages consumers suffer from these agreements by estimating a two-level nested logit demand model using weekly product-level data and simulating a counterfactual scenario in which generics enter the market earlier. This “no-delay” scenario is constructed by artificially introducing generics into the demand system prior to 2015. The results show that early generic entry would have reduced mean market prices by approximately 60 percent in the affected product forms. Welfare gains are particularly large in segments such as topical drugs, where AndroGel was present and effectively prevented competition. These findings highlight the significant cost of delayed competition and quantify the consumer harm imposed by anticompetitive agreements in pharmaceutical markets.

Starting in 2011, Zhejiang Province allowed land-expropriated farmers to voluntarily upgrade from low-premium, low-benefit pension and health insurance programs to high-premium, high-benefit schemes. Using administrative data from City C, we document evidence of adverse selection in both pension and health insurance. Leveraging an instrumental variable design, we estimate demand, average cost, and marginal cost curves to quantify the resulting welfare losses. We then develop a random-coefficient logit model and show that offering subsidies for individual programs rather than the bundled option, an anti-bundling approach, achieves a Pareto improvement. This occurs because, counterintuitively, pension and health costs are positively correlated through the individual medical account component.

In this paper, we examine the impact of non-preventable, non-communicable chronic diseases. Using rich Austrian administrative data, we analyze the healthcare utilization and labor market participation of patients, comparing them to unaffected individuals of the same age. Healthcare expenditures increase sharply around the time of diagnosis and remain persistently high even five years later. Labor market participation decreases, with temporary increases in sick leave, but limited substitution with unemployment. Next, we examine the role of new medications for chronic diseases. Through a case study, we demonstrate that, following the approval of a new drug, the employment probability of the treated group increases, while the control group remains unaffected.

We study gender discrimination in medical care using a within-provider randomised audit experiment. We send otherwise identical male and female standardised patients presenting symptoms of heart disease to providers in Nairobi, isolating the causal effect of patient gender on provider behaviour. The same healthcare workers exert less effort when treating women, provide less essential advice, and are less likely to deliver guideline-recommended care. Results are hard to reconcile with statistical and taste-based discrimination but instead point to biased beliefs, as gaps are concentrated amongst male providers and those holding negative gender stereotypes. A randomised training intervention fails to combat discrimination.

Disruptions of the patient-general practitioner (GP) relationship due to GP exits affect patient outcomes in various ways. The literature suggests that the loss of a trusted professional can have negative effects, but also points at the benefits of being examined by a new GP. We study the impact of GP exits in the Swedish primary care setting, in which care is provided in group practices and even those patients who have a main GP usually see different GPs. Since the practice is responsible for organizing a replacement GP after an exit, we expect the transition between GPs to be relatively smooth for patients. Using two different control groups we are able to separate the effects of being affected by the loss of ones main GP from the reduction of a practices’ workforce. Our results show that GP exits have a negligible effect on patients health care utilization in the Swedish setting. We do observe some shifts in health care utilization patterns, however, this is not driven by the loss of the main GP but rather practice level disruptions. These findings suggest that in organizational settings such as in Sweden - where continuity of care is maintained at practice rather than GP level - patient outcomes are less dependent on individual GPs. Importantly, this conclusion holds even for patients with high baseline continuity of care.

Malaria remains a major constraint on economic development, yet the mechanisms linking disease prevalence to macroeconomic outcomes are poorly understood. We examine the impact of malaria case incidence on total factor productivity, leveraging a panel dataset covering 30 malaria-endemic countries from 2000 to 2019. Using a novel shift–share instrumental variable that combines time-invariant sickle-cell trait (HbS) prevalence with time-varying climate shocks and Mendelian Randomisation, we address endogeneity in malaria exposure. Our findings show that a  10% increase in malaria incidence reduces TFP by 0.38–1.16%. The implied annual GDP loss is $2.9 trillion (2017 USD), and the benefit–cost ratio of eradication exceeds 280. Human capital depletion mediates roughly half of the total effect. These results highlight malaria eradication as a high-return development investment with substantial long-run productivity gains.

This study explores the impact of general practitioners’ practice styles on patients’ health and labor market outcomes after hospitalization events. We exploit administrative data from the Netherlands from 2009 to 2020, linked to Nivel data on GP practice for each patient. We construct a GP practice-specific measure of prescribing propensity, focusing on benzodiazepines, opioids, antidepressants, and antibiotics, to create a generalized measure of doctors’ practice styles. Through a non-parametric event study approach, we compare patients’ outcomes before and after hospitalization exposed to GPs with propensity to prescribe below and above the median, accounting for individual and time fixed effects. Preliminary findings confirm significant economic impacts of hospitalization, with a notable increase in medication consumption post-hospitalization. Patients treated by GPs with a higher propensity to prescribe medications experience worse labor market outcomes post-hospitalization, particularly a reduction in income from work and gross income. These effects are driven by younger patients, who experience a hospitalization earlier in their life before their careers have taken off.

We study the role of maternity care nurses in improving maternal mental health and its further implications for maternal and child outcomes. We estimate nurse value-added to maternal mental health, measured by their effectiveness in preventing mental health diagnoses during the year of birth. We combine linked nurse-mother-child health and demographic data, with within-clinic quasi-random assignment of mothers to nurses to estimate variation in nurse quality. We find substantial variation in nurses' value-added on maternal mental health. High value-added nurses generate persistent improvement in maternal labour market outcomes, and reduction in subsequent sickness benefit claims. These effects also extend to children: exposure to a higher mental health value-added nurse reduces diagnoses of developmental disorders and mental health-related healthcare visits in early childhood. Our findings highlight the critical role of frontline healthcare workers in delivering effective mental health support at scale, particularly in settings where formal mental health services are under-utilised.