Search

Begin New Search Topic Health Political Geography United States Content Type Working Paper

1. The safest time to fly: Pandemic response in the era of Fox News

Author:
Maxim Ananyev, Michael Poyker, and Yuan Tian
Publication Date:
03-2020
Content Type:
Working Paper
Institution:
Nottingham Interdisciplinary Centre for Economic and Political Research (NICEP)
Abstract:
We document a causal effect of conservative Fox News Channel in the United States on physical distancing during COVID-19 pandemic. We measure county-level mobility covering all U.S. states and District of Columbia produced by GPS pings to 15-17 million smartphones and zip-code-level mobility using Facebook location data. Then, using the historical position of Fox News Channel in the cable lineup as the source of exogenous variation, we show that increased exposure to Fox News led to a smaller reduction in distance traveled and smaller increase in the probability to stay home after the national emergency declaration in the United States. Our results show that slanted media can have a harmful effect on containment efforts during a pandemic by affecting people’s behaviour.
Topic:
Health, Media, Journalism, Public Health, Data, and COVID-19
Political Geography:
United States

2. Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs

Author:
Martin Gaynor, Nirav Mehta, and Seth Richards-Shubik
Publication Date:
05-2020
Content Type:
Working Paper
Institution:
Centre for Human Capital and Productivity (CHCP), Western University
Abstract:
We study physician agency and optimal payment policy in the context of an expensive medication used in dialysis care. Using Medicare claims data we estimate a structural model of treatment decisions, in which physicians differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we theoretically characterize the optimal unrestricted contract in this screening environment with multidimensional heterogeneity. We combine these results with the estimated model to construct the optimal contract and simulate counterfactual outcomes. The optimal contract is a flexible fee-for-service contract, which pays for reported treatments but uses variable marginal payments instead of constant reimbursement rates, resulting in substantial health improvements and reductions in costs. Our structural approach also yields important qualitative findings, such as rejecting the optimality of any linear contract, and may be employed more broadly to analyze a variety of applications.
Topic:
Economics, Government, Health, Health Care Policy, Human Capital, Productivity, and Medicare
Political Geography:
United States

3. Profits, Innovation and Financialization in the Insulin Industry

Author:
Rosie Collington
Publication Date:
03-2020
Content Type:
Working Paper
Institution:
Institute for New Economic Thinking (INET)
Abstract:
The list prices of analogue insulin medicines in the United States have soared during the past decade. In the wake of high-profile cases of prescription medicine “price-gouging”, such as Mylan’s EpiPen and Turing-acquired Daraprim, actors across the insulin supply chain are today facing growing scrutiny from US lawmakers and the wider public. For the most part, however, the role of shareholders in the insulin supply chain has been overlooked. This paper considers the relationship between profits realized from higher insulin list prices, pharmaceutical innovation, and the financial structures of the three dominant insulin manufacturing companies, which set list prices. It shows that despite claims to the contrary, insulin manufacturers extracted vast profits from the sale of insulin products in the period 2009-2018, as insulin list prices rose. Distributions to the company shareholders in the form of cash dividends and share repurchases totaled $122 billion over this period. The paper also considers the role of other actors in the insulin supply chain, such as pharmacy benefits managers (PBMs), in the determination of list prices. The data and analysis presented in the paper indicates that financialization could be considered in tension with not only the development of new drugs that will be available to patients in the future, but also the affordability of products that already exist today.
Topic:
Economics, Health, Health Care Policy, Finance, and Price
Political Geography:
United States

4. The Contributions of Socioeconomic and Opioid Supply Factors to Geographic Variation in U.S. Drug Mortality Rates

Author:
Shannon Monnat
Publication Date:
02-2019
Content Type:
Working Paper
Institution:
Institute for New Economic Thinking (INET)
Abstract:
Over the past two decades deaths from opioids and other drugs have grown to be a major U.S. population health problem, but the magnitude of the crisis varies across the U.S., and explanations for widespread geographic variation in the severity of the drug crisis are limited. An emerging debate is whether geographic differences in drug mortality rates are driven mostly by opioid supply factors or socioeconomic distress. To explore this topic, I examined relationships between county-level non-Hispanic white drug mortality rates for 2000-02 and 2014-16 and several socioeconomic and opioid supply measures across the urban-rural continuum and within different rural labor markets. Net of county demographic composition, average non-Hispanic white drug mortality rates are highest and increased the most in large metro counties. In 2014-16, the most rural counties had an average of 6.2 fewer deaths per 100,000 population than large metro counties. Economic distress, family distress, persistent population loss, and opioid supply factors (exposure to prescription opioids and fentanyl) are all associated with significantly higher drug mortality rates. However, the magnitude of associations varies across the urban-rural continuum and across different types of rural labor markets. In rural counties, economic distress appears to be a stronger predictor than opioid supply measures of drug mortality rates, but in urban counties, opioid supply factors are more strongly associated with drug mortality rates than is economic distress. Ultimately, the highest drug mortality rates are disproportionately concentrated in economically distressed mining and service sector dependent counties with high exposure to prescription opioids and fentanyl.
Topic:
Economics, Health, Inequality, Macroeconomics, and Drugs
Political Geography:
United States

5. The Disability Option: Labor Market Dynamics with Macroeconomic and Health Risks

Author:
Amanda Michaud and David Wiczer
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Centre for Human Capital and Productivity (CHCP), Western University
Abstract:
We evaluate the contribution of changing macroeconomic conditions and demographics to the increase in Social Security Disability Insurance (SSDI) over recent decades. Within our quantitative framework, multiple sectors differentially expose workers to health and economic risks, both of which affect individuals’ decisions to apply for SSDI. Over the transition, falling wages at the bottom of the distribution increased awards by 27% in the 1980s and 90s and aging demographics rose in importance thereafter. The model also implies two-thirds of the decline in working-age male employment from 1985 to 2013, three-fourths of which eventually goes on SSDI.
Topic:
Economics, Government, Health, Disability, Human Capital, Social Security, Insurance, Productivity, and Health Insurance
Political Geography:
United States

6. Venezuela’s Crisis Is Now a Regional Humanitarian Disaster

Author:
Moises Rendon and Mark L Schneider
Publication Date:
03-2018
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The Issue Venezuela has been subjected to an unprecedented man-made humanitarian crisis, including extreme food and medicine shortages, thousands of children dying of malnutrition, and malnourished people contracting formerly eradicated diseases. While Venezuela’s dictatorial regime has repeatedly rejected humanitarian aid from the outside, the country’s humanitarian, economic, social, and institutional collapse, along with fierce political repression, have caused 1.2 million Venezuelans to flee the country over the past two years, with hundreds of thousands more and possibly millions expected to flee in the future. Our Recommendations Encourage the United States and other like-minded countries to provide leadership on the diplomatic and assistance fronts to help respond to this crisis. Work to build consensus within the international community on the urgency of the Venezuelan humanitarian crisis and to agree on steps to address the crisis, including convening a high-level task force. Develop a comprehensive policy response that includes immediate relief efforts on Venezuela’s border with Colombia and within Venezuela using innovative mechanisms due to the current limited humanitarian access. Provide immediate technical assistance to help estimate the level of need and identify available resources. Support and engage civil society and local actors, including nongovernmental organizations (NGOs), the private sector, and entrepreneurs, as well as the Venezuelan diaspora community, to help limit the suffering of the Venezuelan people. Encourage host countries to grant temporary protected status to Venezuelans and create a broader burden-sharing arrangement in the region for processing those seeking refuge, following the recent guidelines by the UN High Commissioner for Refugees (UNHCR). Support the use of innovative technology tools, such as blockchain and digital currencies, to facilitate distribution of aid within and beyond Venezuela.
Topic:
Health, Poverty, United Nations, Food, and Humanitarian Crisis
Political Geography:
United States, South America, and Venezuela

7. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe

8. MyFitnessPal: How This Winner-Took-All by Helping People Lose

Author:
Emily Alonso
Publication Date:
03-2015
Content Type:
Working Paper
Abstract:
Up until about 10 years ago, when a person thought of fitness, health or weight loss, they did not necessarily associate those things with technology. However, as the world takes on a new digital landscape, health care industries from weight-loss to hospitals are becoming increasingly digitized. The idea behind this digitization of the health/fitness industries is that people able to quantify their health will be more likely to improve it (MacManus). Thus with the utilization of big data, big people will begin to no longer be an “epidemic” in our society. Though this is wishful thinking, digital platforms are making individual health related data processes more efficient, with quicker delivery than ever before possible and an enhanced user experience. Those willing to commit to their own positive physical change whilst utilizing assisting technologies are becoming healthier in a more efficient manner. (Chanelle)
Topic:
Health, Markets, Science and Technology, and Communications
Political Geography:
United States

9. The Health Financing Transition: A Conceptual Framework and Empirical Evidence

Author:
William Savedoff and Victoria Fan
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 percent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.
Topic:
Development, Economics, Health, and Governance
Political Geography:
United States

10. U.S.-Russia Health Engagement

Author:
Judyth L. Twigg
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Over the last few years, Russia's relationship with the United States has traveled a swift and seemingly deliberate arc from partner to pariah. The current turmoil in Ukraine and near-certain resulting isolation of Russia culminate several years' worth of deteriorating ties. The Edward Snowden mess, disagreements over Syria and Iran, dismay over the eroding human rights environment in Russia, and now Russian annexation of Crimea have led the previously heralded "reset" to an unceremonious end. What are the implications of these and related developments for U.S.-Russia collaboration in medicine and public health? Should avenues of partnership remain open, even in such a frosty political context? Should the international community support Russia's health sector when ample resources exist within Russia itself? Is it even possible anymore?
Topic:
Development, Diplomacy, Economics, Health, Human Rights, Human Welfare, and Bilateral Relations
Political Geography:
Russia, United States, and North America