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聲明：本系列文章基于原期刊目錄和摘要內(nèi)容整理而得，僅限于讀者交流學(xué)習(xí)。如有侵權(quán)，請聯(lián)系刪除。

期刊介紹：

《Journal of Health Economics》（《健康經(jīng)濟(jì)學(xué)雜志》）是一本專注于健康和醫(yī)療保健經(jīng)濟(jì)學(xué)領(lǐng)域的學(xué)術(shù)期刊。該期刊成立于1982年，它涉及的主題包括健康服務(wù)的生產(chǎn)和供應(yīng)、健康服務(wù)的需求和利用、健康服務(wù)的融資、健康的決定因素（包括健康投資和風(fēng)險(xiǎn)健康行為）、疾病不良后果、需求者、供應(yīng)者和其他衛(wèi)生保健機(jī)構(gòu)的行為模型、政策干預(yù)的評估以及衛(wèi)生政策的效率和分配等方面。該刊每年發(fā)行6期，平均每期發(fā)表文章10篇左右，2024年影響因子為3.4。

本期看點(diǎn)：

●交通是需要使用物質(zhì)使用障礙治療的人群獲得護(hù)理的障礙。研究結(jié)果表明，UberX（美國的一種拼車服務(wù)）有助于減少獲取醫(yī)療服務(wù)的交通障礙。

●季節(jié)性花粉過敏會增加交通事故死亡率，這種影響存在于涉及私人車輛的事故中，并且在周末最為頻繁，但沒有發(fā)現(xiàn)車隊(duì)車輛存在類似的影響。

●護(hù)士對緊急程度的初始評估中的扭曲現(xiàn)象會造成醫(yī)療人員的感知偏差。

●生物年齡是未來全科醫(yī)生咨詢和醫(yī)院住院護(hù)理的預(yù)測因子，而未來門診就診的預(yù)測因子則是日歷年齡而非生物年齡。

●陽光不足可能會對心理健康產(chǎn)生潛在的不利影響，會增加自殺率。

●競爭性健康保險(xiǎn)市場（同時(shí)存在逆選擇和道德風(fēng)險(xiǎn)）中關(guān)于最優(yōu)風(fēng)險(xiǎn)調(diào)整模型。

※ 本期目錄

●Ridesharing and substance use disorder treatment

●Driving under the influence of allergies: the effect of seasonal pollen on traffic fatalities

●Triage at shift changes and distortions in the perception and treatment of emergency patients

●Biological age and predicting future health care utilisation

●The light of life: The effects of sunlight on suicide

●Moral hazard and risk adjustment

Ridesharing and substance use disorder treatment

拼車與物質(zhì)使用障礙治療

作者

Conor Lennon（倫斯勒理工學(xué)院）, Johanna Catherine Maclean（喬治·梅森大學(xué)；美國國家經(jīng)濟(jì)研究局（NBER）；德國勞動經(jīng)濟(jì)研究所（IZA））, Keith Teltser（喬治亞州立大學(xué)）

摘要：We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data Set to estimate the effect of ridesharing on admissions to substance use disorder treatment. People needing such treatment report transportation as a barrier to receiving care. We find that UberX entry into a Core Based Statistical Area has no effect on the overall number of treatment admissions. However, we find a decline in non-intensive outpatient treatment which is fully offset by an increase in intensive outpatient treatment. Given the required relative frequency of non-intensive and intensive outpatient treatment in terms of visits per week, our findings indicate that UberX helps to reduce transportation barriers to accessing healthcare. Event-studies show parallel trends in outcomes before UberX entry and results are robust to numerous sensitivity checks.

我們研究了拼車是否為那些需要持續(xù)醫(yī)療服務(wù)的人群提供了一種有意義的交通替代方案。具體而言，我們將美國各地UberX進(jìn)入市場的變化與治療事件數(shù)據(jù)集（Treatment Episode Data Set）相結(jié)合，以估計(jì)拼車對進(jìn)入物質(zhì)使用障礙治療的入院人數(shù)的影響。需要此類治療的人群報(bào)告稱，交通是他們獲得護(hù)理的障礙。我們發(fā)現(xiàn)，UberX進(jìn)入一個(gè)基于核心的統(tǒng)計(jì)區(qū)域（Core Based Statistical Area）對治療入院的總?cè)藬?shù)沒有影響。然而，我們發(fā)現(xiàn)非密集型門診治療的入院人數(shù)有所下降，但這一下降被密集型門診治療入院人數(shù)的增加完全抵消。鑒于非密集型和密集型門診治療在每周就診次數(shù)方面的相對頻率要求，我們的研究結(jié)果表明，UberX有助于減少獲取醫(yī)療服務(wù)的交通障礙。事件研究顯示，在UberX進(jìn)入之前，結(jié)果呈現(xiàn)出平行趨勢，并且經(jīng)過多次敏感性檢驗(yàn)后，結(jié)果依然穩(wěn)健。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000869

Driving under the influence of allergies: the effect of seasonal pollen on traffic fatalities

過敏駕駛：季節(jié)性花粉對交通事故死亡率的影響

作者

Shooshan Danagoulian（韋恩州立大學(xué)）, Monica Deza（雪城大學(xué)，美國國家經(jīng)濟(jì)研究局NBER）

摘要：Traffic fatalities are the leading cause of mortality in the United States despite being preventable. While several policies have been introduced to improve traffic safety and their effects have been well documented, the role of transitory health shocks or situational factors at explaining variations in fatal traffic accidents has been understudied. Exploring daily variation in city-specific pollen counts, this study finds novel evidence that traffic fatalities increase on days in which the local pollen count is particularly high. We find that the effects are present in accidents involving private vehicles and occur most frequently on the weekends, suggesting potentially the missed opportunity to avoid these fatalities. We do not find similar effects for fleet vehicles. These findings remain robust to alternative specifications and alternative definitions of high pollen count. Taken together, this study finds evidence that a prevalent and transitory exogenous health-shock, namely pollen allergies, increases traffic fatalities. Given our lack of evidence of avoidance, these effects are not mechanical and are likely driven by cognitive impairments that arise as a result of seasonal allergies.

盡管交通事故死亡是可以預(yù)防的，但它仍然是美國死亡的主要原因。盡管已經(jīng)出臺了多項(xiàng)政策以改善交通安全，并且這些政策的效果也得到了充分展示，但在解釋致命交通事故的變化時(shí)，關(guān)于短暫健康沖擊或情境因素作用的研究卻不足。本研究通過探索各城市每日花粉計(jì)數(shù)的變化，發(fā)現(xiàn)了新的證據(jù)表明，在當(dāng)?shù)鼗ǚ塾?jì)數(shù)特別高的日子里，交通事故死亡率會增加。我們發(fā)現(xiàn)，這種影響存在于涉及私人車輛的事故中，并且在周末最為頻繁，這表明可能錯(cuò)失了避免這些死亡的機(jī)會。我們沒有發(fā)現(xiàn)車隊(duì)車輛存在類似的影響。這些研究結(jié)果在不同的模型設(shè)定和對高花粉計(jì)數(shù)的不同定義下仍然穩(wěn)健。綜合來看，本研究發(fā)現(xiàn)了一個(gè)普遍且短暫的外生健康沖擊——即花粉過敏——會增加交通事故死亡率。鑒于我們沒有發(fā)現(xiàn)避免行為的證據(jù)，這些影響并非機(jī)械性的，而更可能是由季節(jié)性過敏引起的認(rèn)知障礙所驅(qū)動的。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000900

Triage at shift changes and distortions in the perception and treatment of emergency patients

交接班時(shí)的分診以及對急診患者感知和治療的扭曲

作者

Simone Ferro（米蘭大學(xué)）, Chiara Serra（博科尼大學(xué)）

摘要：Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses’ assessments of patients’ conditions and investigate the short- and medium-term consequences for patients. We show that triage nurses progressively become more lenient during their shifts, and identical ED patients arriving just after a shift change are thus assigned a lower priority. We show that these patients receive lower levels of care and require additional emergency care afterward. We conclude that distortions in nurses’ initial assessments of urgency bias’ medical staff’s perceptions.

我們利用了超過200萬條急診科（ED）記錄，結(jié)合機(jī)器學(xué)習(xí)和拐點(diǎn)回歸分析，記錄了分診護(hù)士對患者病情評估中發(fā)現(xiàn)的新的扭曲現(xiàn)象，并調(diào)查了這些扭曲對患者的短期和中期影響。我們發(fā)現(xiàn)，分診護(hù)士在其工作班次中逐漸放松，因此在班次交接后，到達(dá)的同等ED患者會被分配到較低的優(yōu)先級。我們還發(fā)現(xiàn)，這些患者接受了較低水平的護(hù)理，并且之后需要額外的急診護(hù)理。我們得出結(jié)論，護(hù)士對緊急程度的初始評估中的扭曲現(xiàn)象會造成醫(yī)療人員的感知偏差。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629624000894

Biological age and predicting future health care utilisation

生物年齡與未來醫(yī)療保健利用的預(yù)測

作者

Apostolos Davillas（馬其頓大學(xué)；德國勞動經(jīng)濟(jì)研究所（IZA））, Andrew M. Jones （約克大學(xué)）

摘要：We explore the role of epigenetic biological age in predicting subsequent health care utilisation. We use longitudinal data from the UK Understanding Society panel, capitalising on the availability of baseline epigenetic biological age measures along with data on general practitioner (GP) consultations, outpatient (OP) visits, and hospital inpatient (IP) care collected 5–12 years from baseline. Using least absolute shrinkage and selection operator (LASSO) regression analyses and accounting for participants’ pre-existing health conditions, baseline biological underlying health, and socio-economic predictors we find that biological age is selected as a predictor of future GP consultations and IP care, while chronological rather than biological age is selected for future OP visits. Post-selection prediction analysis and Shapley-Shorrocks decompositions, comparing our preferred prediction models to models that replace biological age with chronological age, suggest that biological ageing has a stronger role in the models predicting future IP care as opposed to “gatekeeping” GP consultations.

我們探討了表觀遺傳生物年齡在預(yù)測隨后醫(yī)療保健利用中的作用。我們使用了來自英國Understanding Society小組的縱向數(shù)據(jù)，利用了基線時(shí)的表觀遺傳生物年齡測量數(shù)據(jù)，以及在基線后5至12年收集的有關(guān)全科醫(yī)生（GP）咨詢、門診（OP）就診和醫(yī)院住院（IP）護(hù)理的數(shù)據(jù)。通過采用LASSO回歸分析，并考慮到參與者預(yù)先的健康狀況、基線時(shí)的生物基礎(chǔ)健康狀況以及社會經(jīng)濟(jì)預(yù)測因素，我們發(fā)現(xiàn)生物年齡是未來GP咨詢和IP護(hù)理的預(yù)測因子，而未來OP就診的預(yù)測因子則是日歷年齡而非生物年齡。在選擇后的預(yù)測分析和Shapley-Shorrocks分解中，將我們首選的預(yù)測模型與用日歷年齡替換生物年齡的模型進(jìn)行比較，結(jié)果表明，生物衰老在預(yù)測未來IP護(hù)理的模型中扮演了更強(qiáng)的角色，而不是在“守門人”角色的GP咨詢中。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629624001012

The light of life: The effects of sunlight on suicide

生命之光：陽光對自殺的影響

作者

Shinsuke Tanaka（康涅狄格大學(xué)）, Tetsuya Matsubayashi（大阪大學(xué)）

摘要：This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.

本研究考察了陽光暴露對自殺率的因果影響。利用1979年至2004年美國的縣月年數(shù)據(jù)，分析了太陽輻射與自殺率之間的關(guān)系，首次提供了強(qiáng)有力的證據(jù)表明，陽光不足會增加自殺率。我們還發(fā)現(xiàn)，陽光不足會增加包含抑郁語言的谷歌搜索量，這表明陽光不足可能會對心理健康產(chǎn)生潛在的不利影響。重要的是，我們的研究結(jié)果更傾向于支持生物途徑，而不是其他替代機(jī)制。陽光對自殺的影響估計(jì)值，通常在幅度上超過了其他干預(yù)措施，為陽光作為自殺發(fā)生率的一個(gè)重要風(fēng)險(xiǎn)因素提供了新的見解。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000924

Moral hazard and risk adjustment

道德風(fēng)險(xiǎn)與風(fēng)險(xiǎn)調(diào)整

作者

Gijsbert Zwart（格羅寧根大學(xué)、經(jīng)濟(jì)與財(cái)政研究所（EEF）和金融與銀行研究所（FEBRI））

摘要：We analyse a model of optimal risk adjustment in competitive health-insurance markets which suffer from both ex-ante adverse selection and ex-post moral hazard. We find, firstly, that, unlike in an adverse-selection-only market, in an environment where also moral hazard is important, removing insurers’ selection incentives requires risk-adjustment payments that do not fully equalize costs among consumer types. Current practice of attempting to correct for all predictable cost differences among consumers is then misguided. Secondly, if the sponsor of the risk-adjustment system is not only concerned with eliminating selection distortions, but also wants to redistribute towards high-risk consumers, the required higher risk-adjustment payments will introduce selection distortions in high-risk consumers’ contracts. This leads to excessive equilibrium provision of care for those suffering severe health shocks. Finally, insurer market power creates countervailing incentives, helping the risk adjuster to combat selection distortions but working against a risk-adjustment regulation that also cares about redistribution.

我們分析了一個(gè)在競爭性健康保險(xiǎn)市場中關(guān)于最優(yōu)風(fēng)險(xiǎn)調(diào)整的模型，這些市場既存在事前的逆向選擇，也存在事后的道德風(fēng)險(xiǎn)。我們發(fā)現(xiàn)，首先，與僅存在逆向選擇的市場不同，在道德風(fēng)險(xiǎn)也有重要影響的環(huán)境中，要消除保險(xiǎn)公司的選擇激勵(lì)，需要的風(fēng)險(xiǎn)調(diào)整支付并不能完全使不同消費(fèi)者類型之間的成本相等。那么，目前試圖糾正消費(fèi)者之間所有可預(yù)測的成本差異的做法就是錯(cuò)誤的。其次，如果風(fēng)險(xiǎn)調(diào)整系統(tǒng)的發(fā)起者不僅關(guān)心消除選擇扭曲，還希望向高風(fēng)險(xiǎn)消費(fèi)者進(jìn)行再分配，那么所需的更高的風(fēng)險(xiǎn)調(diào)整支付將引入高風(fēng)險(xiǎn)消費(fèi)者合同中的選擇扭曲。這導(dǎo)致對于那些遭受嚴(yán)重健康沖擊的人來說，均衡狀態(tài)下提供的醫(yī)療服務(wù)過多。最后，保險(xiǎn)公司的市場力量創(chuàng)造了相反的激勵(lì)，幫助風(fēng)險(xiǎn)調(diào)整者對抗選擇扭曲，但與同樣關(guān)心再分配的風(fēng)險(xiǎn)調(diào)整監(jiān)管相悖。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629624001000

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