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Humlum MK, Morthorst MO, Thingholm PR. Sibling spillovers and the choice to get vaccinated: Evidence from a regression discontinuity design. JOURNAL OF HEALTH ECONOMICS 2024; 94:102843. [PMID: 38211459 DOI: 10.1016/j.jhealeco.2023.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
We investigate the effects of introducing population-wide free-of-charge Human Papillomavirus (HPV) vaccination programs on the targeted adolescent cohorts and their siblings. For identification, we rely on regression discontinuity designs and high-quality Danish administrative data to exploit that date of birth determines program eligibility. We find that the programs increased the HPV vaccine take-up of both the targeted children (53.2 percentage points for girls and 36.0 percentage points for boys) and their older same-sex siblings (4.5 percentage points for sisters and 3.5 percentage points for brothers). We show that while the direct effects of the programs reduced HPV vaccine take-up inequality, the spillover effects, in contrast, contributed to an increase in vaccine take-up inequality highlighting the potential importance of spillover effects in the determination of distributional consequences of public health programs. Finally, we find some evidence of cross-vaccine spillovers.
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Affiliation(s)
- Maria Knoth Humlum
- Department of Economics and Business Economics, Aarhus University, Denmark; IZA, Germany.
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2
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Garrouste C, Juet A, Samson AL. Direct and crowding-out effects of a Hepatitis B vaccination campaign. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101279. [PMID: 37567047 DOI: 10.1016/j.ehb.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
We evaluate the direct and spillover causal effects of a Hepatitis B (HB) vaccination campaign in French schools on the vaccination adherence of the targeted pupils. Using a regression discontinuity design, we show that this campaign created an exogenous shock on vaccination behavior, increasing the HB vaccination rate for children aged 11 and above. At the same time, we show a drop in the measles, mumps, and rubella (MMR) vaccination rate of the targeted pupils and an increase in the parental belief that measles is a benign disease. We interpret these results as a salience effect: the focus on HB vaccination leads to a decrease in the belief that other vaccines are as important. The effect on MMR vaccination was relatively unexpected and may imply a negative externality. Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further, raising the question of the net effect of the HB vaccination campaign on the well-being of the population.
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Affiliation(s)
- Clémentine Garrouste
- Université de Lille, CNRS, IESEG School of Management, UMR 9221 - LEM - Lille Économie Management, F-59000 Lille, France.
| | - Arthur Juet
- Université Paris-Dauphine, PSL Research University, CNRS, IRD, LEDa, LEGOS; Place du Maréchal de Lattre de Tassigny, 75016 Paris, France.
| | - Anne-Laure Samson
- Université Paris-Panthéon Assas, LEMMA, 4 rue Blaise Desgoffe, 75006 Paris, France.
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Liebman E, Lawler EC, Dunn A, Ridley DB. Consequences of a shortage and rationing: Evidence from a pediatric vaccine. JOURNAL OF HEALTH ECONOMICS 2023; 92:102819. [PMID: 37857116 DOI: 10.1016/j.jhealeco.2023.102819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
Shortages and rationing are common in health care, yet we know little about the consequences. We examine an 18-month shortage of the pediatric Haemophilus Influenzae Type B (Hib) vaccine. Using insurance claims data and variation in shortage exposure across birth cohorts, we find that the shortage reduced uptake of high-value primary doses by 4 percentage points and low-value booster doses by 26 percentage points. This suggests providers largely complied with rationing recommendations. In the long-run, catch-up vaccination occurred but was incomplete: shortage-exposed cohorts were 4 percentage points less likely to have received the ir booster dose years later. We also find that the shortage and rationing caused provider switches, extra provider visits, and negative spillovers to other care.
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Affiliation(s)
- Eli Liebman
- University of Georgia, 620 South Lumpkin Street, Athens, GA 30602, United States.
| | - Emily C Lawler
- University of Georgia and National Bureau of Economic Research, 355 South Jackson Street, Athens, GA 30602, United States.
| | - Abe Dunn
- Bureau of Economic Analysis, 1441 L Street NW, Washington, DC 20230, United States.
| | - David B Ridley
- Duke University, Fuqua School of Business, Durham, NC 27708, United States.
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Hair NL, Gruber A, Urban C. Personal belief exemptions for school-entry vaccinations, vaccination rates, and academic achievement. JOURNAL OF HEALTH ECONOMICS 2021; 78:102464. [PMID: 33964652 DOI: 10.1016/j.jhealeco.2021.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Nonmedical exemptions from school-entry vaccine mandates are receiving increased policy and public health scrutiny. This paper examines how expanding the availability of exemptions influences vaccination rates in early childhood and academic achievement in middle school. We leverage 2003 legislation that granted personal belief exemptions (PBE) in Texas and Arkansas, two states that previously allowed exemptions only for medical or religious regions. We find that PBE decreased vaccination coverage among Black and low-income preschoolers by 16.1% and 8.3%, respectively. Furthermore, we find that those cohorts affected by the policy change in early childhood performed less well on standardized tests of academic achievement in middle school. Estimated effects on test scores were largest for Black students and economically disadvantaged students.
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Affiliation(s)
- Nicole L Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States.
| | - Anja Gruber
- University of Colorado at Boulder, United States
| | - Carly Urban
- Montana State University, United States; Institute for Labor Studies (IZA), Germany.
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Hair NL, Gruber A, Urban CJ. Pneumococcal Vaccination Mandates for Child Care: Impact of State Laws on Vaccination Coverage at 19-35 Months. Am J Prev Med 2021; 60:e269-e276. [PMID: 33795181 DOI: 10.1016/j.amepre.2021.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Vaccination mandates for elementary and middle school attendance have been shown to increase vaccination rates and decrease the burden of vaccine-preventable diseases. Fewer studies have evaluated similar requirements for child care attendance. This study provides robust, quasi-experimental estimates of the effect of state laws mandating the pneumococcal conjugate vaccine for child care attendance on vaccination coverage among children aged 19-35 months. METHODS Using provider-verified immunization histories from the 2001-2018 waves of the National Immunization Survey-Child and leveraging the staggered implementation of vaccination requirements across states, a generalized difference-in-differences approach was implemented to compare regression-adjusted changes in vaccination coverage among children in states with and without a child care mandate for the pneumococcal conjugate vaccine. The dynamics of estimated treatment effects were analyzed using an event study analysis. All data analyses were conducted in 2019‒2020. RESULTS State adoption of a child care mandate for the pneumococcal conjugate vaccine increased the likelihood that resident children aged 19-35 months completed the 4-dose pneumococcal conjugate vaccine series by 3.12 percentage points (p<0.01). Statistically significant gains in pneumococcal conjugate vaccine coverage were identified in the first year following policy implementation and were found to persist over a period of ≥7 years. CONCLUSIONS Results indicate that state adoption of a child care mandate for the pneumococcal conjugate vaccine leads to an increase in the proportion of resident children aged 19-35 months who are up to date with pneumococcal conjugate vaccine.
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Affiliation(s)
- Nicole L Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Anja Gruber
- Department of Agricultural Economics and Economics, Montana State University, Bozeman, Montana
| | - Carly J Urban
- Department of Agricultural Economics and Economics, Montana State University, Bozeman, Montana; IZA Institute of Labor Economics, Bonn, Germany
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Shen Y, Noguchi H. Impacts of anticancer drug parity laws on mortality rates. Soc Sci Med 2021; 272:113714. [PMID: 33545495 DOI: 10.1016/j.socscimed.2021.113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.
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Affiliation(s)
- Yichen Shen
- Graduate School of Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
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Brilli Y, Lucifora C, Russo A, Tonello M. Vaccination take-up and health: Evidence from a flu vaccination program for the elderly. JOURNAL OF ECONOMIC BEHAVIOR & ORGANIZATION 2020; 179:323-341. [PMID: 33012930 PMCID: PMC7524524 DOI: 10.1016/j.jebo.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
We analyze the effects of a vaccination program providing free flu vaccine to individuals aged 65 or more on take-up behavior and hospitalization. Using both administrative and survey data, we implement a regression discontinuity design around the threshold at age 65, and find that the effect of the program on take-up ranges between 70% and 90% of the average vaccination rate for individuals aged less than 65. We show that this effect is not entirely driven by an income channel, but also depends on the expected benefits of vaccination. The results on health outcomes provide suggestive evidence that the program reduces the likelihood of emergency hospitalization.
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Affiliation(s)
- Ylenia Brilli
- University of Verona, Via Cantarane 24, Verona 37129, Italy
- University of Gothenburg, Sweden
| | - Claudio Lucifora
- Catholic University-Milan, Via Necchi 5, Milano 20123, Italy
- IZA, Germany
| | - Antonio Russo
- Agency for Health Protection of Milan, Epidemiologic Unit, Corso Italia 19, Milano 20122, Italy
| | - Marco Tonello
- Bank of Italy, Territorial Economic Research Division, Via dell'Oriuolo 37/39, Firenze 50122, Italy
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Schaller J, Schulkind L, Shapiro T. Disease outbreaks, healthcare utilization, and on-time immunization in the first year of life. JOURNAL OF HEALTH ECONOMICS 2019; 67:102212. [PMID: 31323339 DOI: 10.1016/j.jhealeco.2019.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/30/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
This paper examines the determinants of parental decisions about infant immunization. Using the exact timing of vaccination relative to birth, we estimate the effects of local pertussis outbreaks occurring in utero and during the first two months of life on the likelihood of on-time initial immunization for pertussis and other diseases. We find that parents respond to changes in perceived disease risk: pertussis outbreaks within a state increase the rate of on-time receipt of the pertussis vaccine at two months of age, particularly among low-socioeconomic status (SES) subgroups. In addition, we find that pertussis outbreaks increase the likelihood of immunization against other vaccine-preventable diseases. Spillover effects in low-SES subgroups are as large as direct effects and are present only for vaccines given during the same visit as the pertussis vaccine, which suggests that provider contact may be a key factor in infant vaccination decisions in poor families.
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Affiliation(s)
- Jessamyn Schaller
- University of Arizona, Eller College of Management, Department of Economics, 1130 E Helen Street Suite 401, Tucson, AZ 85721-0108, United States; Claremont McKenna College, Robert Day School of Economics and Finance, 500 East Ninth Street, Claremont, CA 91711, United States.
| | - Lisa Schulkind
- University of North Carolina at Charlotte, Belk College of Business, Department of Economics, 9201 University City Blvd, Charlotte, NC 28223-0001, United States.
| | - Teny Shapiro
- Slack, Inc., 500 Howard Street, San Francisco, CA 94105, United States.
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Chang LV. Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy. HEALTH ECONOMICS 2018; 27:1043-1062. [PMID: 29717799 DOI: 10.1002/hec.3645] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 01/05/2018] [Accepted: 01/12/2018] [Indexed: 05/09/2023]
Abstract
In the wake of strong, although later refuted, claims of a link between autism and the measles-mumps-rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take-up with other vaccines, I find that the MMR-autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more-educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.
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Affiliation(s)
- Lenisa V Chang
- Department of Economics, University of Cincinnati, Cincinnati, OH, USA
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Dieke AC, Mehta A, Kissin DM, Nangia AK, Warner L, Boulet SL. Intracytoplasmic sperm injection use in states with and without insurance coverage mandates for infertility treatment, United States, 2000–2015. Fertil Steril 2018; 109:691-697. [DOI: 10.1016/j.fertnstert.2017.12.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/15/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
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Lawler EC. Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine. JOURNAL OF HEALTH ECONOMICS 2017; 52:45-62. [PMID: 28183000 DOI: 10.1016/j.jhealeco.2017.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 01/03/2017] [Accepted: 01/10/2017] [Indexed: 06/06/2023]
Abstract
I provide novel evidence on the effectiveness of two vaccination policies - simple non-binding recommendations to vaccinate versus mandates requiring vaccination prior to childcare or kindergarten attendance - in the context of the only disease whose institutional features permit a credible examination of both: hepatitis A. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points. These policies also significantly reduced population hepatitis A incidence. My results suggest a range of policy options for addressing suboptimally low population vaccination rates.
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Affiliation(s)
- Emily C Lawler
- Vanderbilt University, Department of Economics, 2301 Vanderbilt Place, Nashville, TN 37235, United States.
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