The EuHEA Seminar Series has been established as a key activity of EuHEA to foster exchange between health economists across different countries and institutions and present cutting-edge research in all areas of health economics. The series is organized as an online event and will take place on Tuesdays, 1:30-2:30pm, this fall, starting on September 27, 2022. A Scientific Committee chaired by Karine Lamiraud (ESSEC Paris) and Rossella Verzulli (University of Bologna) will coordinate the series in the academic year 2022/2023.
To register for the online seminar series, please click here.
27 September 2022, 1:30-2:30pm (CET)
Objectives: In social choice theory, the liberal reward principle states that if informed individuals freely make choices from a fixed choice set, resulting inequalities reflect differences in preferences, and thus are legitimate. We argue that to the extent that the shape of the choice set is beyond the individuals' responsibility, where the menu of alternatives is more favourable to individuals with certain kinds of preferences than others, a reduction of inequalities across individuals could be justified. The paper seeks to examine to what extent the liberal reward principle and the alternative find support among members of the public, in the context of lifestyles and health.
Methods: The paper proposes a way to gauge how favourable a choice set is to different kinds of preference using a measure analogous to equivalent income ('equivalent health'). A questionnaire describes several hypothetical scenarios with a health inequality between two groups of individuals who have different preferences for health-related lifestyles (some find it easy or enjoy healthy lifestyles, while others favour unhealthy lifestyles). Therefore, conditional on the same health inequality, the magnitude of the inequality in terms of equivalent health differs in each scenario. Respondents were asked to choose between allocation strategies that translate different normative principles. We also control for the prior beliefs of respondents regarding the kinds of preferences of individuals who adopt healthy and unhealthy lifestyles. The questionnaire was completed online by a representative sample of 675 members of the general public in Chile.
Results: A majority of respondents did not support the allocation strategy compatible with the liberal reward principle, and appear more willing to reduce health inequality when the magnitude of the inequality in terms of equivalent health is high. The results also highlight the importance of respondents' prior beliefs regarding the relationship between preferences and health-related behaviours over what is specified in the scenarios, in explaining the responses.
Conclusion: The study found that the liberal reward principle has little support among members of the public and that there is room for an alternative notion of reward that favours the reduction of inequalities that arise from choices from a fixed menu where individuals have different preferences. The magnitude of the inequality in terms of equivalent income between two individuals depends on the kind of preferences involved and the reference categories used. Further research could explore the attitudes of members of the public towards health inequalities, controlling for their beliefs about the preferences of individuals who adopt healthy and unhealthy lifestyles, and their implicit reference categories.
4 October 2022, 1:30-2:30pm (CET)
Investing in public water infrastructure can improve people’s well-being and health outcomes. In this paper, I study the effects of the Indonesia’s largest community-based water supply and sanitation initiative (Pamsimas) on households’ access to safe drinking water, inside house wa- ter provision and water-fetching distance. The program is a pro-poor project which targeted rural and peri-urban under-served communities in a broad geographic focus to receive water connections. To investigate the effects of the program, I employ a difference in difference (DID) combined with nearest neighbour matching (NNM) using the Indonesian Family Life Survey (IFLS) panel households from 2007 and 2014 waves. The results show that the share of house- holds access to safe drinking water among those who lived in the program communities increased between 3-5 percentage points. The share of households with improved inside-house water sup- ply also increased 9 percentage points seven years after implementation of the program which is in line with the third impact in reducing the journey to collect water by nearly 4 kilometres less in distance.
11 October 2022, 1:30-2:30pm (CET)
This study explores the long-run effects of a temporary scarcity of a consumption good on preferences towards that good once the shock is over. Specifically, we focus on individuals who were children during World War II and assess the consequences of the temporary drop in meat availability they experienced early in life. To this end, we combine hand-collected historical data on the number of livestock at the local level with microdata on eating habits and patience. By exploiting cohort and regional variation in a difference-in-differences estimation, we show that individuals who as children were more exposed to meat scarcity tend to consume more meat during late adulthood and are relatively more patient. Consistent with medical studies on the side effects of meat overconsumption, we also find that these individuals have a higher probability of being overweight and suffering from cardiovascular disease. Our results point towards a behavioral channel, where early-life shocks shape eating habits, patience, and adult health.
18 October 2022, 1:30-2:30pm (CET)
The design of health insurance contracts involves tradeoffs between different goals. Understanding how different contracts influence these goals is thus crucial for making informed choices on health insurance design. To this end, this paper develops and estimates a model of healthcare utilization using data from a large Dutch insurer. Individuals make decisions along both the extensive and intensive margins and the model explicitly accounts for within-year spending dynamics that arise from non-linear prices common to health insurance contracts. We use these estimates to study the impacts of a wide variety of counterfactual contractual arrangements across individuals with different underlying health status. Small tweaks to contracts, such as increasing the time horizon of contracts from one year to two years or allowing some amount of healthcare to be consumed freely before a deductible contract applies, seem to lead to better outcomes without increases in spending.
25 October 2022, 1:30-2:30pm (CET)
Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good; examples include e-cigarettes (substitutes for combustible cigarettes) and methadone and buprenorphine (substitutes for opioids). Harm reduction methods have proven to be controversial. Advocates argue that addicts benefit because they can switch to a less harmful substance, but opponents argue that this could increase addiction and even encourage non-users to begin using the addictive goods. This paper builds on theories of addiction to model the introduction of a harm reduction method,
and it demonstrates the conditions under which each side is correct; i.e. the conditions under which introducing a harm reduction method can lead to quitting of the original addictive good, and the conditions under which it can lead previous abstainers to begin using the harm reduction method and even the original, more harmful, addictive good. Likewise, we demonstrate the conditions under which the introduction does in fact reduce health harms, and when it backfires and results in a worsening of health harms. The three key drivers are enjoyableness and addictiveness of the harm reduction method, and substitutability with the original addictive good. Knowledge of these conditions is helpful for understanding the consequences of harm reduction methods in various markets.
8 November 2022, 1:30-2:30pm (CET)
Most Western healthcare systems rely on foreign medical staff to handle the ever rising demand for health workers. We analyze the contribution of foreign health workers to the performance of a country’s public health system. We exploit the decline of EU nurses in England’s National Health Service (NHS) after the Brexit referendum. We find hospital providers with a higher share of EU nurses before the referendum to on average face more hospital-related deaths, to conduct fewer diagnostic tests and to host less intensive care patients. Readmissions of patients within 30 days after discharge become more likely. As mechanisms, we identify a changing composition of the workforce instead of an actual deficit in the labor force. We argue that the found effects are driven by a deterioration in health care quality instead of capacity constraints.
15 November 2022, 1:30-2:30pm (CET)
Poor air quality negatively affects workers’ health and cognitive functions, but we know little about the countrywide consequences for firms. In this paper, we estimate the causal effects of fine particulate matter (PM2.5) exposure on workers’ absenteeism and firms’ monthly sales using unique employer-employee data and granular measures of air pollution in France from 2009 to 2015. We exploit variation in air pollution induced by changes in monthly wind directions at the postcode level. We find that a 10% increase in monthly PM2.5 exposure increases worker absenteeism in the same month by 1% and reduces sales in manufacturing, construction, and professional services, with different lags. Sales losses are several orders of magnitude larger than what we would expect if workers’ absenteeism was the only factor affecting firms’ performance. This suggests a potentially large effect of pollution on the productivity of non-absent workers. We estimate that reducing air pollution in France in line with the World Health Organization’s guidelines would have saved at least 0.3% of GDP annually in terms of avoided sales losses.
22 November 2022, 1:30-2:30pm (CET)
Relying on a survey conducted with more than 4,500 Italian women in July 2020, we address the link between gender stereotypes and perceptions of domestic violence (i.e., its spread, severity, causes, and hypothetical advices offered to victims). We define a new measure of stereotypes at the individual level and show that women with stronger stereo- types are less likely to declare that violence is common in their area of residence and are more likely to classify physical violence as less severe than control over a victim’s inter- personal contacts or access to financial resources. They are also more likely to attribute violent behaviours to event-specific circumstances (e.g., economic distress) rather than personal characteristics of abusers (e.g., psychological issues), and to advise a hypotheti- cal victim not to react to DV rather than to look for formal help. The results hold when we include area-of-residence fixed effects and controls for a broad set of individual and neighborhood characteristics, including social norms in the birth region and the impact of the first wave of the COVID-19 pandemic on the respondents’ personal and economic conditions. Several transformations of our stereotype index do not affect our findings. It appears that the tendency to perceive physical violence as less severe is associated with a victim-blaming approach among respondents with more stereotypical beliefs on gender roles
29 November 2022, 1:30-2:30pm (CET)
In years of growing pharmaceutical spending, the adoption of new health technologies faces several regulatory hurdles. Such policies are typically studied at the country level, even though there are explicit and implicit channels that link decisions made in different countries. This can be relevant in the EU, where external reference pricing is widely adopted. This work exploits the IMS pricing database of cancer drugs approved by the European Medicine Agency between 2007 and 2017 to assess the impact of a pharmaceutical pricing regulation change that occurred in Germany in 2011 (the AMNOG bill) on foreign pharmaceutical prices. We show that the impact on foreign prices depends on whether the foreign country adopts external reference pricing policies and whether it includes Germany in its basket of reference countries and, symmetrically, if it enters Germany’s reference set. In particular, our diff-in-diff approach shows that AMNOG led to a price reduction for products launched in countries that refer to Germany (indirect spillover effect), whereas products launched in countries referenced by Germany experienced a 5.48% price increase (strategic spillover effect).
6 December 2022, 1:30-2:30pm (CET)
Industrial mining can be a boon or a bane for communities living in the vicinity of production sites. We assess the effects of mining-induced pollution on health outcomes in Sub-Saharan Africa using the DHS micro-data from 1986-2018 in 26 countries matched with geocoded data of industrial mining sites. Through a staggered difference-in-difference strategy, we exploit the variation of the opening of a mine and the relative topographic position of surrounding villages, comparing upstream and downstream villages. Being downstream of an open mine increases by 2.3 percentage points the 24-month mortality rate, corresponding to a 27% increase. This effect is mainly driven by the consumption of plain water, corroborating the mechanism of water pollution. The effect on mortality is not driven by a change in women's fertility, nor by a change in the access to piped water or other facilities, nor by in-migration. The effect is concentrated while the mine is active and when commodity prices are high, is larger in areas with high mining density and fades out with distance. It is robust to the estimator of de Chaisemartin and D'Haultffuille  and using a balanced sample, to measurement errors, to a spatial and a temporal randomization inference tests as well as placebo disease tests.
13 December 2022, 1:30-2:30pm (CET)
This paper treats Brazil as a case study to document the causal effects of health spending on infant mortality. By leveraging the variation in health spending prompted by Brazil’s 29th Constitutional Amendment of 2000, we are able to document not only the effects of health spending on infant mortality, but also the links in the chain connecting spending to health outcomes. We show that (a) a constitutional amendment mandating minimum health spending effectively changes spending patterns both for municipalities which were previously below spending floors as well as those that were above spending floors; (b) these increases in health spending translate into greater primary care coverage, higher supply of hospitals and low-skilled professionals, and; (c) that spending increases in low-spending municipalities bring about moderate reductions in infant mortality within 24 hours and due to perinatal conditions, as well as long term reductions in total infant mortality and infant mortality amenable to primary care (among other causes). Our results contribute to the literature on the impacts of health spending by providing one of the first well-identified causal parameters of the relationship between spending and health outcomes.
The EuHEA Seminar Series in the academic year 2022/2023 is coordinated by:
- Karine Lamiraud, ESSEC Business School (Chair)
- Rossella Verzulli, University of Bologna (Co-Chair)
- Francesca Barigozzi, University of Bologna
- Stefan Boes, University of Lucerne
- Fabrice Etile, Paris School of Economics
- Geir Godager, University of Oslo
- Mathias Kifmann, University of Hamburg
- Shiko Maruyama, Jinan University
- Nuria Mas, IESE Business School
- Helen Mason, Glasgow Caledonian University
- Paolo Pertile, University of Verona
- Pedro Pita Barros, Universidade Nova de Lisboa
- Katrin Zocher, University of Linz