How Does Household Income Affect Child Personality Traits and Behaviors?

We examine the effects of a quasi-experimental unconditional household income transfer on child emotional and behavioral health and personality traits. Using longitudinal data, we find that there are large beneficial effects on children's emotional and behavioral health and personality traits during adolescence. We find evidence that these effects are most pronounced for children who start out with the lowest initial endowments. The income intervention also results in improvements in parental relationships which we interpret as a potential mechanism behind our findings.

Can Physicians Affect Patient Adherence With Medication?

Non-compliance with medication therapy remains an unsolved and expensive problem for healthcare systems around the world, yet we know little about the factors that affect a patient's decision to follow treatment recommendations. In particular, there is little evidence on the extent to which doctors can influence patient adherence behavior. This study uses a unique panel dataset comprising all prescription drug users, physicians, and all prescription drug sales in Denmark over 7 years to analyze the contributions of doctor-specific, patient-specific, and drug-specific factors to the adherence decision. We find that physicians exert substantial influence on patient compliance. Further, the quality of the match between a doctor and a patient accounts for a substantial portion of the variation in adherence outcomes. This suggests that the sorting of patients across doctors is an important mechanism that affects patient adherence beyond the effects of individual patient-specific and physician-specific factors. Copyright © 2016 John Wiley & Sons, Ltd.

Architecting Process of Care: A randomized controlled study evaluating the impact of providing nonadherence information and pharmacist assistance to physicians.

OBJECTIVE: To test the impact of connecting physicians, pharmacists, and patients to address medication nonadherence, and to compare different physician choice architectures. DATA SOURCES AND STUDY SETTING: The study was conducted with 90 physicians and 2602 of their patients on medications treating chronic illness. STUDY DESIGN: In this cluster randomized controlled trial, physicians were randomly assigned to an arm where the physician receives notification of patient nonadherence derived from real-time claims data, an arm where they receive this information and a pharmacist may contact patients either by default or by physician choice, and a control group. The primary outcome was resolving nonadherence within 30 days. We also considered physician engagement outcomes including viewing information about nonadherence and utilizing a pharmacist. DATA COLLECTION: Physician engagement was constructed from metadata from the study website; adherence outcomes were constructed from medication claims. PRINCIPAL FINDINGS: We see no differences between the treatment arms and control for the primary adherence outcome. The pharmacist intervention was 42 percentage points (95% CI: 28 pp-56 pp) more likely when it was triggered by default. CONCLUSIONS: Access to a pharmacist and real-time nonadherence information did not improve patient adherence. Physician process of care was sensitive to choice architecture.

Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

OBJECTIVE: The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. STUDY DESIGN: A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. RESULTS: The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. CONCLUSION: Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.

Does women's education affect breast cancer risk and survival? Evidence from a population based social experiment in education.

Breast cancer is a notable exception to the well documented positive education gradient in health. A number of studies have found that highly educated women are more likely to be diagnosed with the disease. Breast cancer is therefore often labeled as a "welfare disease". However, it has not been established whether the strong positive correlation holds up when education is exogenously determined. We estimate the causal effect of education on the probability of being diagnosed with breast cancer by exploiting an education reform that extended compulsory schooling and was implemented as a social experiment. We find that the incidence of breast cancer increased for those exposed to the reform.

Marriage, bereavement and mortality: the role of health care utilization.

There is ample evidence that bereavement is associated with heightened mortality. Regardless of whether this strong association is truly causal, little is known about the factors contributing to it. This study begins to unpack the black box of the bereavement-mortality puzzle by investigating the extent to which heath behaviors and health care utilization patterns vary among chronically ill elderly males living with a spouse and those who are widowed, and by asking whether these differences contribute to the well-documented correlation between widowhood and health deterioration. In order to separate the effect of health care utilization from other potential channels it uses a unique dataset of doctor-patient encounters that allows in-depth analysis of the organization and effectiveness of medical care. Changes in health care utilization attributable to bereavement have a negative effect on survival but account for a small part of the overall negative effect of widowhood on longevity.

Doctors, patients and the racial mortality gap.

Research in the health sciences reports persistent racial differences in health care access, utilization, and outcomes. This study investigates three potential sources of these disparities - differential quality of care, physician discrimination, and patient response to therapy. It uses a unique panel dataset of physician-patient encounters, the resulting medication therapies and the patients' adherence to those medical recommendations. Equalizing access to quality health care will not erase the racial differences in mortality among chronically ill patients. Targeted programs aimed at improving adherence with medication therapy among disadvantaged groups must be an integral part of any policy aimed at achieving equality in health outcomes.

Young Adult Obesity and Household Income: Effects of Unconditional Cash Transfers.

We investigate the effect of household cash transfers during childhood on young adult body mass indexes (BMI). The effects of extra income differ depending on the household's initial socioeconomic status (SES). Children from the initially poorest households have a larger increase in BMI relative to children from initially wealthier households. Several alternative mechanisms are examined. Initial SES holds up as the most likely channel behind the heterogeneous effects of extra income on young adult BMI. (JEL D14, H23, H75, I12, J13, J15).

Public vs. private provision of charity care? Evidence from the expiration of Hill-Burton requirements in Florida.

This paper explores the consequences of the expiration of charity care requirements imposed on private hospitals by the Hill-Burton Act. We examine delivery care and the health of newborns using the universe of Florida births from 1989 to 2003 combined with hospital data from the American Hospital Association. We find that charity care requirements were binding on hospitals, but that private hospitals under obligation "cream skimmed" the least risky maternity patients. Conditional on patient characteristics, they provided less intensive maternity services but without compromising patient health. When obligations expired, private hospitals quickly reduced their charity caseloads, shifting maternity patients to public hospitals. The results in this paper suggest, perhaps surprisingly, that requiring private providers to serve the underinsured can be effective.