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 clinic nurses in shaping maternal and child outcomes in Finland. Using administrative healthcare, labor market, and demographic data for all first births from 2015–2019, we estimate nurse Value-Added on mental and physical health outcomes. Nurses differ substantially in their effects on maternal health, with especially pronounced variation in mental health outcomes. High mental-health Value-Added nurses generate persistent improvements for mothers, including reductions in subsequent sickness absence, while nurses with stronger effects on physical health show limited impacts beyond birth. These differences extend to children: exposure to a higher mental-health Value-Added nurse reduces developmental disorder diagnoses and mental health visits in early childhood. The findings show that frontline healthcare personnel play an important role in intergenerational health and well-being.