Journal of Health Economics (Volume 87, January 2023)

目录

1. 土壤缺锌与儿童发育不良：来自尼泊尔的证据

2. 药品寻租：财务激励和医生行为

3. 电子烟税对青少年烟草使用的预期和非预期效应

4. 医生利他主义的形成

5. 亲密伴侣暴力和求助：妇女被害新闻的作用

6. 健康保险，内生医疗进步，卫生费用增长和福利

7. 毒品危机和儿童生活安排

Abstract

We examine the negative child health impacts of soil zinc (Zn) deficiency in Nepal. Soil Zn deficiency limits both crop yields and the Zn concentration in food crops, leading many to speculate that it underlies human Zn deficiency and child stunting, globally and particularly in South Asia. We find strong evidence that soil Zn deficiency does have a causal impact on child stunting in Nepal’s Tarai region, the breadbasket of the country. Using causal bounds, we find that a 1 part per million increase in plant-available soil Zn – achievable with application of Zn-enriched fertilizer – decreases child stunting by between 1 and 7.5 percentage points. Multiple statistical sensitivity tests indicate that this relationship is unlikely to be manufactured by omitted, relevant variables.

我们研究了尼泊尔土壤缺锌对儿童健康的负面影响。土壤锌缺乏不但限制了农作物产量，也限制了粮食中锌的浓度，许多研究推测它构成了全球特别是南亚人群缺锌和儿童发育不良的原因。本文强有力的证据表明，在尼泊尔的粮仓——特莱地区，土壤锌缺乏确实对儿童发育迟缓有影响。利用因果界限，我们发现，植物可利用的土壤锌含量每增加百万分之一（可通过施用富锌肥料实现），儿童发育不良的概率就会下降1至7.5个百分点。多项统计敏感性测试表明，这种关系不太可能是由遗漏相关变量造成。

Abstract

We study the impact of financial incentives on the prescription behavior of physicians based on a recent reform in two large Swiss cities. The reform opened up an additional income channel for physician by allowing them to earn a markup on drugs they prescribe to their patients. We find that the reform leads to an increase in drug costs by about 4%–5% per patient translating to significantly higher physician earnings. The revenue increase can be decomposed into a substitution and rent-seeking component. Our analysis indicates that physicians engage in rent-seeking by substituting larger with smaller packages and by cherry-picking more profitable brands. Although patient health is not sacrificed, the rent-seeking behavior results in unnecessary costs for society.

基于瑞士两个大城市最近的一项改革，我们研究了经济激励对医生处方行为的影响。这项改革为医生开辟了一个额外的收入渠道，允许他们从给病人开的药中获取加成。我们发现，改革导致每位患者的药物成本增加了大约4%-5%，从而使医生的收入显著提高。收入的提高可以被分解为替代和寻租两部分。我们的分析表明，医生通过用小包装替代大包装和挑选更有利可图的品牌来进行寻租。虽然病人的健康没有被牺牲，但寻租行为却给社会带来了不必要的成本。

Abstract

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.

在过去的十年里，越来越多的青少年使用电子烟和其它电子尼古丁传送系统（ENDS），这促使州和地方政府采取激进的监管措施。2010年至2019年，有10个州和两个县征收ENDS税。我们使用两个大型的全国性调查数据（Monitoring the Future 和 the Youth Risk Behavior Surveillance System）来估计ENDS税对青少年烟草使用的影响。我们发现，ENDS税减少了青少年的ENDS消费，ENDS税的弹性为-0.06至-0.21。然而，我们估计有相当大的税收交叉效应，这意味着对青少年群体而言，香烟是ENDS的经济替代品。替代效应对于经常吸烟的人来说特别大。我们的结论是，对ENDS征税的非预期效果可能会大大削弱甚至超过任何公共卫生收益。

Abstract

We study how patient-regarding altruism is formed by medical education. We elicit and structurally estimate altruistic preferences using experimental data from a large sample of medical students (N= 733) in Germany at different progress stages in their studies. The estimates reveal substantial heterogeneity in altruistic preferences of medical students. Patient-regarding altruism is highest for freshmen, significantly declines for students in the course of medical studies, and tends to increase again for last year students, who assist in clinical practice. Also, patient-regarding altruism is higher for females and positively associated to general altruism. Altruistic medical students have gained prior practical experience in healthcare, have lower income expectations, and are more likely to choose surgery and pediatrics as their preferred specialty.

我们研究了医学教育如何塑造以病人为中心的利他主义。我们使用大样本（N=733）的德国医学生实验数据（这些学生处于不同的学习进展阶段），引出并从结构上估计利他偏好。估计结果显示，医学生的利他偏好存在很大的异质性。新生对病人的利他主义最高，处于医学课程学习中的学生的利他主义明显下降，而参与协助临床实践的学生的利他主义又趋于上升。此外，女性对病人的利他主义程度较高，并与一般利他主义呈正相关。先前具备临床实践经验的利他主义医学生对收入的期望较低，并且更可能选择外科和儿科作为他们的首选专业。

Abstract

Exploiting high-frequency data from the Italian anti-violence helpline, police reports of domestic abuse and maltreatments, and a unique geolocalized dataset on killings of women, we show that the news coverage of a femicide triggers an increase in help-seeking behavior. The effect is detectable in the period following the news and in the province where the femicide has occurred. Additionally, help-seeking increases more when the general interest and news coverage are higher. These findings are consistent with a model in which femicide news increase expectations about future intimate partner violence in case no action is taken. Our results imply that recurrent information campaigns and public discussion can foster help-seeking from survivors of gender-based violence.

利用意大利反暴力求助热线的高频数据、警方关于家庭暴力和虐待的报告、以及妇女被害的独特地理定位数据集，我们的研究表明，杀害女性的新闻报道引发了寻求帮助行为的增加。这种影响在新闻报道后的一段时间内以及妇女被害事件发生的省份是可以检测到的。此外，当公众兴趣和新闻报道较多时，寻求帮助的行为会增加。这些发现与一个模型是一致的，即如果不采取行动，杀害妇女的新闻会增加对未来亲密伴侣暴力的预期。我们的结果意味着，经常性的信息运动和公共讨论可以促进基于性别暴力的幸存者寻求帮助。

Abstract

We study the impact of health insurance expansion on medical spending, longevity and welfare in an OLG economy in which individuals purchase health care to lower mortality and medical progress is profit-driven. Three sectors are considered: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the subsidization of health care through health insurance creates excessive health care spending, the gains in life expectancy brought about by induced medical progress more than compensate for this.

我们研究了在一个世代交叠（OLG）的经济模型中，健康保险的扩大对医疗支出、寿命和福利的影响。OLG经济中，人们购买医疗服务是为了避免死亡，医疗进步是由利润驱动的。我们考虑了三个部门：最终产品的生产部门，向个人出售医疗服务的保健部门；以及向保健部门出售有效医疗技术的研发部门。我们根据1965年至2005年美国经济/医疗保健系统的发展对模型进行了校准，并从数值上研究了保险扩大的影响。我们发现，更广泛的健康保险在美国医疗支出的增长中占了很大的份额，但也加快了医疗进步的速度。福利分析表明，虽然通过健康保险对医疗保健的补贴造成了过度的医疗支出，但由此诱发的医疗进步所带来的预期寿命的增加足以弥补这一不足。

Abstract

We examine the impact of the US drug crisis on children's living arrangements. Because factors that lead to drug use could also alter family structure, we instrument for the intensity of the drug crisis with cross-state exposure to marketing of the prescription opioid at the epicenter of the crisis. We find that the crisis increased the likelihood that a child lives away from a parent or in a household headed by a grandparent. Our results suggest that if drug use had remained at 1996 levels, 1.5 million fewer children aged 0–16 would have lived away from a parent in 2015.

本文研究了美国毒品危机对儿童生活安排的影响。致使吸毒的因素有可能改变家庭结构，我们通过各州暴露于不同的处方阿片药物营销情况来衡量毒品危机的强度。我们发现，毒品危机增加了儿童远离父母或生活在以祖父母为户主的家庭的可能性。我们的结果表明，如果毒品使用保持在1996年的水平，2015年0-16岁远离父母生活的儿童将减少150万。