本期推送 NBER 2023年 3月份与健康经济学相关的 6 篇工作论文。
目录
医疗服务的市场规模与贸易 医疗保健质量的信息和差异：来自英国全科医生选择的证据 使用卫星图像和机器学习对联合国人类发展指数的全球高分辨率估计 长寿的代际相关性 从注射器到餐具：通过疫苗接种改善粮食安全 退休时的长寿、健康和住房风险管理
1 Market Size and Trade in Medical Services
Jonathan I. Dingel, Joshua D. Gottlieb, Maya Lozinski, and Pauline Mourot #31030 Abstract: We measure the importance of increasing returns to scale and trade in medical services. Using Medicare claims data, we document that “imported” medical care——services produced by a medical provider in a different region——constitute about one-fifth of US healthcare consumption. Larger regions specialize in producing less common procedures, which are traded more. These patterns reflect economies of scale: larger regions produce higher-quality services because they serve more patients. Because of increasing returns and trade costs, policies to improve access to care face a proximity-concentration tradeoff. Production subsidies and travel subsidies can impose contrasting spillovers on neighboring regions. 摘要：我们衡量增加医疗服务规模和贸易回报的重要性。使用医疗保险索赔数据，我们发现“进口”医疗保健（即由不同地区的医疗服务提供者提供的服务）约占美国医疗保健消费的五分之一。更大的地区专门生产不太常见的程序，这些程序的交易量更大。这些模式反映了规模经济：更大的地区会提供更高质量的服务，因为它们为更多的患者提供服务。由于回报和贸易成本不断增加，改善医疗服务可及性的政策面临着邻近性与集中性的权衡。生产补贴和旅游补贴会对邻近地区产生截然不同的溢出效应。
2 Information and Disparities in Health Care Quality: Evidence from GP Choice in England
Zach Y. Brown, Christopher Hansman, Jordan Keener, and Andre F. Veiga #31033 Abstract: Why do low income patients tend to go to lower quality health care providers, even when they are free? We show that differential information about provider quality is an important determinant of this disparity. Our empirical strategy exploits the temporary presence of a website that publicly displayed summary star ratings of general practitioner (GP) offices in England. Regression discontinuity estimates show that patient demand responds sharply to the information on the website, and that this response is almost entirely driven by residents of low income neighborhoods. The results are consistent with high income patients having better private information about quality. We incorporate our estimates into a structural model of demand that allows for heterogeneity in information, preferences, and consumer inertia. We find that information differences explain 24 percent of the relationship between income and GP quality and reinforce disparities in access to care. 摘要：为什么低收入的患者倾向于选择质量较低的医疗保健提供者，即使他们是免费的？我们认为，有关提供者质量的差异信息是这种差异的重要决定因素。我们的实证策略利用了一个网站的临时存在，该网站公开显示了英国全科医生（GP）办公室的星级评级。断点回归估计表明，患者需求对网站上的信息反应迅速，而且这种反应几乎完全由低收入社区的居民驱动。结果与高收入患者拥有更好的关于质量的私人信息是一致的。我们将我们的估计纳入需求结构模型，该模型允许信息、偏好和消费者惯性的异质性。我们发现信息差异解释了24% 的收入与 GP 质量之间的关系，并加剧了获得医疗服务方面的差异。
3 Global High-Resolution Estimates of the United Nations Human Development Index Using Satellite Imagery and Machine-learning
Luke Sherman, Jonathan Proctor, Hannah Druckenmiller, Heriberto Tapia, and Solomon M. Hsiang #31044 Abstract: The United Nations Human Development Index (HDI) is arguably the most widely used alternative to gross domestic product for measuring national development. This is in large part due to its multidimensional nature, as it incorporates not only income, but also education and health. However, the low country-level resolution of the global HDI data released by the Human Development Report Office of the United Nations Development Programme (N=191 countries) has limited its use at the local level. Recent efforts used labor-intensive survey data to produce HDI estimates for first-level administrative units (e.g., states/provinces). Here, we build on recent advances in machine learning and satellite imagery to develop the first global estimates of HDI for second-level administrative units (e.g., municipalities/counties, N = 61,591) and for a global 0.1 × 0.1 degree grid (N=806,361). To accomplish this we develop and validate a generalizable downscaling technique based on satellite imagery that allows for training and prediction with observations of arbitrary shape and size. This enables us to train a model using provincial administrative data and generate HDI estimates at the municipality and grid levels. Our results indicate that more than half of the global population was previously assigned to the incorrect HDI quintile within each country, due to aggregation bias resulting from lower resolution estimates. We also illustrate how these data can improve decision-making. We make these high resolution HDI estimates publicly available in the hope that they increase understanding of human wellbeing globally and improve the effectiveness of policies supporting sustainable development. We also make available the satellite features and software necessary to increase the spatial resolution of any other global-scale administrative data that is detectable via imagery. 摘要：联合国人类发展指数（HDI）可以说是衡量国家发展的最广泛使用的替代国内生产总值的指标。这在很大程度上是由于其多维性质，因为它不仅包括收入，还包括教育和健康。然而，联合国开发计划署人类发展报告办公室（N=191个国家）发布的全球人类发展指数数据仅在国家层面，限制了其在地方层面的使用。最近的研究使用劳动密集型调查数据来生成一级行政单位（例如，州/省）的 HDI 估计值。本文中，我们基于机器学习和卫星图像的最新进展，为二级行政单位（例如，市/县，N = 61,591）和全球 0.1 × 0.1 度网格（N = 806,361）开发了第一个全球人类发展指数估计值。为实现这一目标，我们开发并验证了一种基于卫星图像的通用降尺度技术，该技术允许使用任意形状和大小的观测值进行训练和预测。这使我们能够使用省级行政数据训练模型，并在市级和网格级别生成 HDI 估计值。我们的结果表明，由于较低分辨率估计导致的汇总偏差，全球一半以上的人口之前被分配到每个国家不正确的 HDI 五分位数。我们还说明了这些数据如何改进决策。我们公开这些高维度的人类发展指数估计值，希望它们能增加对全球人类福祉的了解，并提高支持可持续发展的政策的有效性。我们还提供必要的卫星功能和软件，以提高可通过图像检测到的任何其他全球规模行政数据的空间分辨率。
4 Intergenerational Correlations in Longevity
Sandra E. Black, Neil Duzett, Adriana Lleras-Muney, Nolan G. Pope, and Joseph Price #31034 Abstract: While there is substantial research on the intergenerational persistence of economic outcomes such as income and wealth, much less is known about intergenerational persistence in health. We examine the correlation in longevity (an overall measure of health) across generations using a unique dataset containing information about more than 26 million families obtained from the Family Search Family Tree. We find that the intergenerational correlation in longevity is 0.09 and rises to 0.14 if we consider the correlation between children and the average of their parents' longevity. This intergenerational persistence in longevity is much smaller than that of persistence in socio-economic status and lower than existing correlations in health. Moreover, this correlation remained low throughout the 19th and early 20th centuries despite dramatic changes in longevity and its determinants. We also document that the correlations in longevity and in education are largely independent of each other. These patterns are likely explained by the fact that stochastic factors play a large role in the determination of longevity, larger than for other outcomes. 摘要：尽管现有研究对收入和财富等经济后果的代际持续性进行了大量研究，但对健康的代际持续性知之甚少。我们使用包含从 Family Search Family Tree 获得的超过 2600 万个家庭的信息的独特数据集来检验几代人之间寿命（健康的总体衡量标准）的相关性。我们发现长寿的代际相关性是 0.09，如果我们考虑子女与其父母平均寿命之间的相关性，则上升到 0.14。这种长寿的代际持续性远小于社会经济地位的持续性，也低于现有的健康相关性。此外，尽管寿命及其决定因素发生了巨大变化，但在整个 19 世纪和 20 世纪初，这种相关性仍然很低。我们还记录了长寿和教育的相关性在很大程度上相互独立的。这些模式可能是由于随机因素在决定长寿方面发挥着重要作用，比其他结果更大。
5 From Syringes to Dishes: Improving Food Security through Vaccination
Erkmen G. Aslim, Wei Fu, Erdal Tekin, and Shijun You #31045 Abstract: This paper examines the impact of COVID-19 vaccination on food insecurity in the United States, using data from the Household Pulse Survey. Our primary research design exploits variation in vaccine eligibility across states over time as an instrumental variable to address the endogeneity of vaccination decision. We find that vaccination had a substantial impact on food hardship by reducing the likelihood of food insecurity by 24%, with even stronger effects among minority and financially disadvantaged populations. Our results are robust to alternative specifications and the use of regression discontinuity as an alternative identification strategy. We also show that vaccine eligibility had a positive spillover impact on food assistance programs, specifically by reducing participation in the Supplemental Nutrition Assistance Program (SNAP), which suggests that vaccination policy can be effective in alleviating the fiscal burden of the pandemic on the government. Furthermore, our analysis indicates that vaccinated individuals exhibit increased financial optimism, as measured by expectations about future loss of employment and income as well as ability to make mortgage and debt payments. Based on the point estimates, the implied elasticity of food insecurity with respect to financial optimism is between -0.57 and -0.86. Our findings suggest that the COVID-19 vaccination program has implications that extend beyond the direct health benefits. Taken together, our results underscore the critical role of medical innovations and health interventions in improving economic optimism and food security, especially among vulnerable populations, during public health crises. 摘要：本文使用家庭脉搏调查的数据研究了 COVID-19 疫苗接种对美国粮食不安全的影响。我们的主要研究设计利用各州疫苗资格随时间的变化作为工具变量来解决疫苗接种决策的内生性。我们发现，疫苗接种通过将粮食不安全的可能性降低 24% 对粮食困难产生了重大影响，对少数民族和经济弱势群体的影响甚至更大。我们的结果在使用替代变量和使用断点回归作为替代识别策略时依然稳健。我们还表明，疫苗资格对食品援助计划有积极的溢出影响，特别是通过减少对补充营养援助计划（SNAP）的参与，这表明疫苗接种政策可以有效减轻 COVID-19 给政府带来的财政负担。此外，我们的分析表明，接种疫苗的人表现出更高的财务乐观情绪，这是用对未来失业和收入损失以及偿还抵押贷款和债务的能力的预期来衡量的。根据点估计，粮食不安全对金融乐观情绪的隐含弹性介于 -0.57 和 -0.86 之间。我们的研究结果表明，COVID-19 疫苗接种计划的影响超出了直接健康收益。总而言之，我们的结果强调了在公共卫生危机期间，医学创新和健康干预措施在改善经济乐观情绪和粮食安全方面的关键作用，尤其是在弱势人群中的作用。
6 Longevity, Health and Housing Risks Management in Retirement
Pierre-Carl Michaud and Pascal St. Amour #31038 Abstract: Annuities, long-term care insurance and reverse mortgages remain unpopular to manage longevity, medical and housing price risks after retirement. We analyze low demand using a life-cycle model structurally estimated with a unique stated-preference survey experiment of Canadian households. Low risk aversion, substitution between housing and consumption and low marginal utility when in poor health explain most of the reduced demand. Bequests motives are found to be a luxury good and play a limited role. The remaining disinterest is explained by information frictions and behavioural status-quo biases. We find evidence of strong spousal co-insurance motives motivating LTCI and of responsiveness to bundling with a near doubling of demand for annuities when reverse mortgages can be used to annuitize, instead of consuming home equity. 摘要：年金、长期护理保险和反向抵押贷款在管理退休后的长寿、医疗和房价风险方面仍然不受欢迎。我们使用生命周期模型分析低需求，该模型通过加拿大家庭的独特陈述偏好调查实验进行结构估计。低风险规避、住房和消费之间的替代以及健康状况不佳时的低边际效用解释了需求减少的大部分。遗赠动机被发现是一种奢侈品，作用有限。剩下的可以用信息摩擦和行为现状偏见来解释。我们的证据表明，当反向抵押贷款可用于年金化而不是消耗房屋净值时，强烈的配偶共同保险动机会激励 LTCI 以及对捆绑年金需求的响应几乎翻了一番。
撰文：CLJ（ZJU）
校对：Alexander（XTU）
