A hard pill to swallow? Parental health shocks and children's mental health.

Based on comprehensive administrative health record data from Austria, this study examines how children's mental health responds to a severe parental health shock. To account for the endogeneity of a serious parental illness, our sample is restricted to children who experience the health shock of a parent at some point in time and we exploit the timing of shocks in a dynamic DID setting. We find a positive causal effect of parental health shocks on children's mental health care utilization. Affected children have higher medical attendance for the treatment of mental illnesses, consume more psychotropic drugs, and are more likely to be hospitalized with mental and behavioral disorders. A significant increase in the utilization of antidepressants, anxiolytics, and sedatives can be observed for older children, girls and children with a white-collar family background. Our findings have important policy implications for children's access to psychotherapies and mental health care after experiencing a traumatic household event.

Hospitals and the generic versus brand-name prescription decision in the outpatient sector.

Health care payers try to reduce costs by promoting the use of cheaper generic drugs. We show strong interrelations in drug prescriptions between the inpatient and outpatient sectors by using a large administrative dataset from Austria. Patients with prior hospital visits have a significantly lower probability of receiving a generic drug in the outpatient sector. The size of the effect depends on both the patient and doctor characteristics, which could be related to the differences in hospital treatment and heterogeneity in the physicians' adherence to hospital choices. Our results suggest that hospital decisions create spillover costs in health care systems with separate funding for inpatient and outpatient care.

The Effectiveness of Health Screening.

Using a matched insurant-general practitioner panel data set, we estimate the effect of a general health-screening program on individuals' health status and health-care cost. To account for selection into treatment, we use regional variation in the intensity of exposure to supply-determined screening recommendations as an instrumental variable. We find that screening participation increases inpatient and outpatient health-care costs up to 2 years after treatment substantially. In the medium run, we find cost savings in the outpatient sector, whereas in the long run, no statistically significant effects of screening on either health-care cost component can be discerned. In sum, screening participation increases health-care cost. Given that we do not find any statistically significant effect of screening participation on insurants' health status (at any point in time), we do not recommend a general health-screening program. However, given that we find some evidence for cost-saving potential for the sub-sample of younger insurants, we suggest more targeted screening programs.

Birth weight and family status revisited: evidence from Austrian register data.

In this paper, we study the socio-economic determinants of birth weight, with a focus on the mother's family status. We use Austrian birth register data covering all births between 1984 and 2007 and find that a mother's marriage is associated with a higher birth weight of the newborn, in the range of 40 to 60 g. The significant impact is retained if we include mother fixed effects or use an instrumental variable approach to account for unobserved mother heterogeneity. However, the magnitude of the causal effect (37 g) clearly indicates the importance of selection into marriage. Divorce around pregnancy results in significantly lower birth weights than the birth weights of babies born to single mothers. Family status effects in the 2000s are stronger than they were in the 1980s, and quantile regressions suggest that family effects are more pronounced at the lower quantiles of the birth weight distribution and less pronounced at higher quantiles. We conclude that the life situation of expectant mothers has an important influence on the birth weight of newborns, especially at the lower tail of the birth weight distribution.

Timing effects in health valuations.

This paper analyzes the impact of external sources of information, conveyed by the frequency of risky events that vary across time, on the individual willingness to pay (WTP) for a reduction of mortality risk. We collected data from a contingent valuation (CV) exercise conducted in two waves (fall and winter) to examine whether individual WTP varied across periods that differed in the predominance of fatal accidents. Risk valuations were based on fatal snow avalanche accidents, that is, a type of risk with seasonal differences in occurrence. We found slightly lower but statistically significant mean WTP figures in the winter than in the fall sample because of time-varying individual risk attitudes and, therefore, recommend controlling for these factors in risk assessment CV surveys.

Complexities of health and acceptance of electronic health records for the Austrian elderly population.

We examine the personal health situation and how the complexities thereof affect the elderly Austrians' willingness to accept electronic health records (EHR). Using data from the sixth wave of the SHARE survey in Austria, we find the complexity of individual health problems and the social integration of individuals influencing the acceptance of EHR. The higher the degree of multimorbidity, the more medication is prescribed, and the higher the number of hospital admissions, the higher is the acceptance of EHR. Having a chronical illness has a positive effect on EHR acceptance, whereas a pessimistic attitude and lack of joy in life, as indicators of depressive mood, have a negative impact. The results are mainly driven by women and younger patients aged between 50 and 70. People with poor social connection express lower acceptance of EHR.

Looking into the black box of "Medical Innovation": rising health expenditures by illness type.

There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last 4 years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005-2018. Our results indicate that among decedents in particular, the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical innovation for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth, and also for treatment of mental and behavioral disorders. We discuss whether these findings contradict the widespread interpretation of cost-increasing innovations as "medical progress" and offer some policy recommendations.

Birth order, parental health investment, and health in childhood.

We analyze the relationship between birth order, parental health investment and children's health using administrative data from Austria. We show that later-born children have better health endowments at birth. They are less likely born preterm or with a low birth weight, and less likely hospitalized for perinatal conditions. We also find significant birth order differences in parental health investment in early childhood. Later-born children are less likely to participate in preventive medical screenings and their vaccine uptake rates are lower. Our analysis indicates that these birth order differences in parental health investments are not driven by children's health endowments. Thus, we do not find evidence for compensatory behavior of parents. We discuss alternative explanations, such as the role of resource constraints. Furthermore, we show, that the initial health inequalities extend into middle childhood. Later-born children show a better health status in school health checks, they consume less medication and are less often hospitalized.

The company you keep: health behavior among work peers.

There is widespread agreement that behavior crucially influences one's health. However, little is known about what actually determines health-related behavior. We explore the impact of the place where many people spend most of their time, at work, and analyze whether an individual's decision to participate in health screening is related to the observed behavior of peers at work. We use linked employer-employee data and exploit the transitions of workers to new jobs. We find that the health behavior of co-workers highly correlated. A comparison of individuals moving into new firms shows that participation in general health checks, mammography screening, and prostate-specific antigen tests increases with the share of work peers attending these screenings. To differentiate between peer effects and common influences at the workplace, we further separate the peer groups within firms and show that workers with similar characteristics tend to have a stronger effect on individual screening participation.

Cutting fertility? Effects of cesarean deliveries on subsequent fertility and maternal labor supply.

Despite the growing incidence of cesarean deliveries (CDs), procedure costs and benefits continue to be controversially discussed. In this study, we identify the effects of CDs on subsequent fertility and maternal labor supply by exploiting the fact that obstetricians are less likely to undertake CDs on weekends and public holidays and have a greater incentive to perform them on Fridays and days preceding public holidays. To do so, we adopt high-quality administrative data from Austria. Women giving birth on different days of the week are pre-treatment observationally identical. Our instrumental variable estimates show that a non-planned CD at parity 0 decreases lifecycle fertility by almost 13.6%. This reduction in fertility translates into a temporary increase in maternal employment.

Stress perception and commuting.

This paper analyzes the determinants of the perceived stress level of workers with a special focus on the effects of commuting, while controlling for personal and work-related characteristics. Using ordered logistic regression we find that several dimensions of the commuting situation, such as impedance, control and predictability of commuting, significantly influence the perceived stress level. Therefore, stress and stress-related health problems should be taken into consideration when analyzing the economic costs of commuting.

Cost savings of developmental screenings: Evidence from a nationwide program.

Early intervention is considered the optimal response to developmental disorders in children. We evaluate a nationwide developmental screening program for preschoolers in Austria and the resulting interventions. Identification of treatment effects is determined by a birthday cutoff-based discontinuity in the eligibility for a financial incentive to participate in the screening. Assigned preschoolers are 14.5 percentage points more likely to participate in the program. For participants with high socio-economic status (SES), we find little evidence for interventions and consistently no effect on healthcare costs in the long run. For low SES preschoolers, we find evidence for substantial interventions, but only weak evidence for cost savings in the long run.

Old boys' network in general practitioners' referral behavior?

We analyzed the impact of social networks on general practitioners' (GPs) referral behavior based on administrative panel data from 2,684,273 referrals to specialists made between 1998 and 2007. For the definition of social networks, we used information on the doctors' place and time of study and their hospital work history. We found that GPs referred more patients to specialists within their personal networks and that patients referred within a social network had fewer follow-up consultations and less inpatient days thereafter. The effects on patient outcomes (e.g. waiting periods, days in hospital) of referrals within personal networks and affinity-based networks differed. Specifically, whereas empirical evidence showed a concentration on high-quality specialists for referrals within the personal network, suggesting that referrals within personal networks overcome information asymmetry with respect to specialists' abilities, the empirical evidence for affinity-based networks was different and less clear. Same-gender networks tended to refer patients to low-quality specialists.

Warm glow, free-riding and vehicle neutrality in a health-related contingent valuation study.

Criticism of contingent valuation (CV) stresses warm glow and free-riding as possible causes for biased willingness to pay figures. We present an empirical framework to study the existence of warm glow and free-riding in hypothetical WTP answers based on a CV survey for the measurement of health-related Red Cross services. Both in conventional double-bounded and spike models we do not find indication of warm glow phenomena and free-riding behaviour. The results are very robust and insensitive to the applied payment vehicles. Theoretical objections against CV do not find sufficient empirical support.