The Economic Consequences of Hospital Admissions.

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills, and bankruptcy, and reduce earnings, income, access to credit, and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger fewer than 5 percent of all bankruptcies in our sample.

Bankruptcy as Implicit Health Insurance.

This paper examines the implicit health insurance that households receive from the ability to declare bankruptcy. Exploiting multiple sources of variation in asset exemption law, I show that uninsured households with a greater financial cost of bankruptcy make higher out-of-pocket medical payments, conditional on the amount of care received. In turn, I find that households with greater wealth at risk are more likely to hold health insurance. The implicit insurance from bankruptcy distorts the insurance coverage decision. Using a microsimulation model, I calculate that the optimal Pigovian penalties are three-quarters as large as the average penalties under the Affordable Care Act.

Changes in suicide rates in disaster-stricken areas following the Great East Japan Earthquake and their effect on economic factors: an ecological study.

OBJECTIVE: Devastating disasters may increase suicide rates due to mental distress. Previous domestic studies have reported decreased suicide rates among men following disasters. Few reports are available regarding factors associated with disasters, making it difficult to discuss how these events affect suicide rates. This study aimed to observe changes in suicide rates in disaster-stricken and neighboring areas following the Great East Japan Earthquake, and examine associations between suicide rates and economic factors. METHODS: Monthly suicide rates were observed from March 2009 to February 2013, during which time the earthquake occurred on March, 2011. Data were included from disaster-stricken (Iwate, Miyagi, and Fukushima Prefectures) and neighboring (control: Aomori, Akita, and Yamagata Prefectures) areas. The association between changes in suicide rates and economic variables was evaluated based on the number of bankruptcy cases and ratio of effective job offers. RESULTS: In disaster-stricken areas, post-disaster male suicide rates decreased during the 24 months following the earthquake. This trend differed relative to control areas. Female suicide rates increased during the first seven months. Multiple regression analysis showed that bankruptcy cases (ß = 0.386, p = 0.038) and ratio of effective job offers (ß = -0.445, p = 0.018) were only significantly associated with male post-disaster suicide rates in control areas. CONCLUSION: Post-disaster suicide rates differed by gender following the earthquake. Our findings suggest that considering gender differences might be important for developing future post-disaster suicide prevention measures. This ecological study revealed that increasing effective job offers and decreasing bankruptcy cases can affect protectively male suicide rates in control areas.

Effects of proximate foreclosed properties on individuals' weight gain in Massachusetts, 1987-2008.

OBJECTIVES: We assessed the extent to which living near foreclosed properties is associated with individuals' subsequent weight gain. METHODS: We linked health and address information on 2068 Framingham Offspring Cohort members (7830 assessments) across 5 waves (1987-2008) to records of all Massachusetts foreclosures during that period. We used counts of lender-owned foreclosed properties within 100 meters of participants' homes to predict body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) and the odds of being overweight (BMI ≥ 25), adjusted for individual and area-level covariates. RESULTS: Mean BMI increased from 26.6 in 1987-1991 to 28.5 in 2005-2008; overweight prevalence increased from 59.0% to 71.3%. Foreclosures were within 100 meters of 159 (7.8%) participants' homes on 187 occasions (1.8%), in 42 municipalities (21%). For each additional foreclosure, BMI increased by 0.20 units (95% confidence interval [CI] = 0.03, 0.36), and the odds ratio for being overweight associated with proximity to a foreclosure was 1.77 (95% CI = 1.02, 3.05). CONCLUSIONS: We found a robust association between living near foreclosures and BMI, suggesting that neighbors' foreclosures may spur weight gain.

Estimating the effects of casinos and of lotteries on bankruptcy: a panel data set approach.

Using newly-constructed estimates of state revenue or its equivalent from casino-type and lottery gambling and panel data set regression techniques, a small but statistically significant bankruptcy effect is found. Assuming a linear relationship between gambling and the rate of personal bankruptcies, casino-type gambling increases bankruptcies by about 2%. Lottery gambling, while less potent per dollar of revenue generated, has about the same total effect.

Graduate Medical Education Should Not Be A Commodity.

The demise of Hahnemann University Hospital demonstrates the need for health care and graduate medical education policy reform.

Predicting corporate credit risk: Network contagion via trade credit.

Trade credit is a payment extension granted by a selling firm to its customer. Companies typically respond to late payments from their customers by delaying payments to suppliers, thus generating a ripple through the transaction network. Therefore, trade credit is as a potential vehicle of propagation of losses in case of default events. The goal of this work is to leverage information on the trade credit among connected firms to predict imminent defaults of firms. We use a unique dataset of client firms of a major Italian bank to investigate firm bankruptcy between October 2016 to March 2018. We develop a model to capture network spillover effects originating from the supply chain on the probability of default of each firm via a sequential approach: the output of a first model component on single firm features is used in a subsequent model which captures network spillovers. While the first component is the standard econometrics way to predict such dynamics, the network module represents an innovative way to look into the effect of trade credit on default probability. This module looks at the transaction network of the firm, as inferred from the payments transiting via the bank, in order to identify the trade partners of the firm. By using several features extracted from the network of transactions, this model is able to predict a large fraction of the defaults, thus showing the value hidden in the network information. Finally, we merge firm and network features with a machine learning model to create a 'hybrid' model, which improves the recall for the task by almost 20 percentage points over the baseline.

Breast Cancer-Related Employment Disruption and Financial Hardship in the Sister Study.

Background: More than one-half of breast cancer cases are diagnosed among women aged younger than 62 years, which may result in employment challenges. This study examined whether cancer-related employment disruption was associated with increased financial hardship in a national US study of women with breast cancer. Methods: Women with breast cancer who were enrolled in the Sister or Two Sister Studies completed a survivorship survey in 2012. Employment disruption was defined as stopping work completely or working fewer hours after diagnosis. Financial hardship was defined as: 1) experiencing financial problems paying for cancer care, 2) borrowing money or incurring debt, or 3) filing for bankruptcy because of cancer. Prevalence ratios and 95% confidence intervals for the association between employment disruption and financial hardship were estimated using multivariable Poisson regression with robust variance. Results: We analyzed data from women employed at diagnosis (n = 1628). Women were a median age of 48 years at diagnosis and 5.6 years from diagnosis at survey completion. Overall, 27.3% of women reported employment disruption (15.4% stopped working; 11.9% reduced hours), and 21.0% experienced financial hardship (16.0% had difficulty paying for care; 12.6% borrowed money or incurred debt; 1.8% filed for bankruptcy). In adjusted analysis, employment disruption was associated with nearly twice the prevalence of financial hardship (prevalence ratio = 1.93, 95% confidence interval = 1.58 to 2.35). Conclusions: Women experiencing employment disruptions after breast cancer may be more vulnerable to financial hardship. Findings highlight the need to target risk factors for employment disruption, facilitate return to work or ongoing employment, and mitigate financial consequences after cancer.

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses.

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.

[Frequency and consequences of financial problems in patients undergoing outpatient psychosomatic treatment]. / Häufigkeit und Folgen finanzieller Schwierigkeiten bei Patienten in ambulanter psychosomatischer Behandlung.

OBJECTIVES: About seven million people in Germany are affected by overindebtedness and insolvency. Being severely in debt is a very stressful situation that can result in social marginalisation, reducted overall activity, and physical and mental illness. The present study investigated the frequency of financial problems and their effects on physical and mental disorders at a university psychosomatic clinic. METHODS: The study included a total of 659 patients. Their mental status was assessed with the Symptom Checklist (SCL-90-R), their physical status with the Gießener Beschwerdebogen (GBB). RESULTS: 37 percent of the subjects reported experiencing financial problems. We found that subjects with financial problems reported more physical and mental disorders than those without financial problems. Furthermore, therapists more often recommended that patients with financial problems receive inpatient therapy than patients without financial problems. CONCLUSION: The study suggests that financial problems should be included in any anamnesis, therapeutic recommendation, and actual therapy of patients in psychosomatic treatment.

The (interconnected) reasons elder Americans file consumer bankruptcy.

Since the early 1990s, the age distribution of the bankruptcy population has shifted. Specifically, the age distribution curve has flattened, due in large part to an increase in the number of elder Americans (65 and older) who are filing bankruptcy. To date, the reasons for elder bankruptcies have not been studied. Quantitative and qualitative data from 381 elder bankruptcy respondents who participated in the 2007 Consumer Bankruptcy Project suggest that overwhelming interest and fees on credit cards, illnesses and injuries, income problems, aggressive debt collectors, and housing problems are the leading reasons that elder debtors file bankruptcy. Further, the vast majority of elder bankruptcies result not from a single cause, but rather from multiple interconnected causes.

The dynamics of the aggressive order during a crisis.

We investigate the dynamics of aggressive order in the financial market to further understand volatility. To analyze aggressive order, market orders in the order book are scrutinized. The market orders have different degrees of aggressiveness; therefore, we categorize market orders into four types: types Zero, One, A, and B, of which type B is the most aggressive. To examine the dynamics and impacts of each type of order, we use both macro- and micro-level approaches. From the macroscopic perspective, the burstiness and memory of type B is highly correlated with volatility. When traders face a financial crisis, they place bursty aggressive orders, and the orders are more predictable than usual. From the microscopic perspective, we additionally focus on the influence of the orders, particularly the price impact and resilience. The aggressive order has a greater impact than others, even when the price change of the aggressive order is smaller. Moreover, the aggressive order delivers more information on price because the aggressive order has a higher price impact than the execution cost.

A model of the indirect losses from negative shocks in production and finance.

Economies are frequently affected by natural disasters and both domestic and overseas financial crises. These events disrupt production and cause multiple other types of economic losses, including negative impacts on the banking system. Understanding the transmission mechanism that causes various negative second-order post-catastrophe effects is crucial if policymakers are to develop more efficient recovery strategies. In this work, we introduce a credit-based adaptive regional input-output (ARIO) model to analyse the effects of disasters and crises on the supply chain and bank-firm credit networks. Using real Japanese networks and the exogenous shocks of the 2008 Lehman Brothers bankruptcy and the Great East Japan Earthquake (March 11, 2011), this paper aims to depict how these negative shocks propagate through the supply chain and affect the banking system. The credit-based ARIO model is calibrated using Latin hypercube sampling and the design of experiments procedure to reproduce the short-term (one-year) dynamics of the Japanese industrial production index after the 2008 Lehman Brothers bankruptcy and the 2011 Great East Japan earthquake. Then, through simulation experiments, we identify the chemical and petroleum manufacturing and transport sectors as the most vulnerable Japanese industrial sectors. Finally, the case of the 2011 Great East Japan Earthquake is simulated for Japanese prefectures to understand differences among regions in terms of globally engendered indirect economic losses. Tokyo and Osaka prefectures are the most vulnerable locations because they hold greater concentrations of the above-mentioned vulnerable industrial sectors.

Presence of Any Medical Debt Associated With Two Additional Years of Homelessness in a Seattle Sample.

Although medical debt has been associated with housing instability, almost no research has connected homelessness to medical debt. We interviewed 60 individuals experiencing homelessness in Seattle, selected from those participating in self-governed encampments organized by a homeless advocacy organization. Most respondents reported having at least one kind of debt, with two-thirds reporting current medical debt. Almost half reported trouble paying medical bills for themselves or family members. Almost one-third believed medical debt was in part responsible for their current housing situation. More than half with medical debt incurred this debt while they were covered under insurance. People who had trouble paying medical bills experienced a more recent episode of homelessness 2 years longer than those who did not have such trouble, even after controlling for race, education, age, gender, and health status. People of color who had trouble paying medical bills reported almost 1 year more homelessness than whites.

[Financial fraud and health: a qualitative approach]. / Fraudes financieros, salud y calidad de vida: un estudio cualitativo.

During the economic crisis, developed countries have experienced financial fraud, with effects on the physical and mental health of the people affected, and on social domains. Based on the theoretical framework in literature reviews and in quantitative studies, this paper aims to obtain evidence on the effects of financial fraud on health and on the family and social environments of those affected. An intentional sample of 32 people affected by abusive and multi-currency mortgages, preferred and swap stock in Madrid was approached. In-depth interviews were conducted, and the resulting data was analysed using content analysis. Fraud-affected individuals had conditions of age, sex, educational level and occupations that possibly allowed them to accumulate economic resources throughout the course of their lives and, predictably in many cases, to take out fraudulent financial products, based on trust in the financial institutions. Financial fraud has led to the emergence of various processes of anomia and adverse health effects. The consequences on health were physical ailments (symptoms and diseases in various systems and parts of the body) and mental disorders (anxiety, depression, suicidal ideation), all affecting lifestyles, behaviour and personal and social relationships, both in affected individuals and their families. The increase in the use of medical drugs and health services serves as a final corollary to the imbalances on the affected people's health. Individuals and the Spanish society demand public health policy measures to mitigate the effects on health and the recovery of their confidence in the banking and political system.