摘要：《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风
声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。
期刊介绍：
《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风险健康行为）、疾病不良后果、需求者、供应者和其他卫生保健机构的行为模型、政策干预的评估以及卫生政策的效率和分配等方面。该刊每年发行6期，平均每期发表文章10篇左右，2024年影响因子为3.4。
本期看点：
健康信念
●不同受访者在信念不精确性的程度上存在显著差异，而这种差异在很大程度上无法通过标准人口统计特征来解释。在新冠疫情背景下，那些认为防护可以降低负面健康结果的主观概率，而且还能减少不精确性程度的人，更倾向于采取更为积极的防护行为。
●对健康不平等的强烈厌恶会降低对女性和非吸烟者（即健康上处于优势地位群体）的福利权重，同时提高对贫困者（健康劣势群体）的福利权重。
●“时间权衡”（TTO）与“标准赌博”（SG）任务是评估健康状态效用（例如糖尿病、坐轮椅）中常用的方法。然而，重要的是，这两种方法通常会对同一健康状态产生不同的效用评估结果。人们对健康状态赋予的效用差异，可能受到注意力分配方式的影响。
政策影响
●诊断性影像必要性证书（CON）政策减少了低价值医疗服务的使用，同时不影响高价值服务。
●新冠疫情期间，返校政策对疫情的影响相对温和，返校使得新冠感染率有所上升，且这一上升在低收入县和新冠患病率较高的县中更为明显。
●实施风味电子烟销售限制政策后，青少年中电子烟使用率在短期内下降了约2至3个百分点，但这种影响在两年后会有所减弱。
●产假时长对长期健康的影响：较短的产假对健康具有保护作用，而过长的工作中断则可能诱发不良健康行为，这一影响主要是由于伴侣在生育期间缺乏财务支持所致。
●同伴效应依赖于性别，且男性学生对女性朋友的体重反应尤为明显。针对女性开展干预措施可以使整体BMI降低的效果提高8%。因此，针对女性定制的干预策略在学校肥胖防控中可能更为有效。
※ 本期目录
●Technology regulation reconsidered: The effects of Certificate of need policies on the quantity and quality of diagnostic imaging
●Imprecise health beliefs and health behavior
●Responsibility-sensitive welfare weights for health
●Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes
●Attentional processes underlying health state valuation with time trade-off and standard gamble tasks
●Absence from work and lifetime smoking behavior: Evidence from European maternal leave policies
●Heterogeneous peer effects and gender-based interventions for teenage obesity
●The effect of e-cigarette flavor bans on tobacco use
Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging
技术监管再思考：确认证书政策（CON）对诊断性影像的数量与质量影响
作者
Jill R. Horwitz（美国西北大学普利兹克法学院与范伯格医学院；美国国家经济研究局）等
摘要：Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.
对必要性证书（Certificate of Need, CON）法律在医疗服务中的影响的评估一直存在不一致的结果，可能是因为并非所有CON法律都适用于所有服务类型。本文构建了一套涵盖影像服务的CON法律原创数据集，并利用州边界处的回归不连续设计（RDD），估计CON政策对诊断性影像检查的使用和质量的影响。研究发现，在实施相关监管的州，Medicare受益人接受任何影像检查的可能性更低，接受低价值影像检查的可能性则更低；而高价值影像检查的使用未受到影响。总体而言，成像类CON政策减少了低价值医疗服务的使用，同时不影响高价值服务。
Imprecise health beliefs and health behavior
模糊健康信念与健康行为
作者
Adeline Delavande（葡萄牙新里斯本大学商学院；澳大利亚悉尼科技大学）， Emilia Del Bono（英国埃塞克斯大学）， Angus Holford（英国埃塞克斯大学）
摘要：This paper examines belief imprecision in the context of COVID-19, when uncertainty about health outcomes was widespread. We survey a sample of young adults a few months after the onset of the pandemic. We elicit individuals’ minimum and maximum subjective probabilities of different health outcomes, and define belief imprecision as the range between these values. We document substantial heterogeneity in the degree of imprecision across respondents, which remains largely unexplained by standard demographic characteristics. To assess the behavioral impact of imprecise beliefs, we ask beliefs about future outcomes under hypothetical scenarios that feature different levels of protective behaviors. We find that individuals who expect protective behaviors to reduce not only the subjective probability of a negative health outcome, but also the degree of imprecision associated with it, behave more protectively.
本文研究了在新冠疫情背景下当人们对健康结果存在广泛的不确定性时，人们健康信念的不精确性。我们在疫情爆发几个月后，对一组年轻成年人进行了调查。我们引导受访者给出他们对不同健康结果的最低和最高主观概率，并将信念不精确性定义为这两个值的差异幅度。我们发现，不同受访者在信念不精确性的程度上存在显著差异，而这种差异在很大程度上无法通过标准人口统计特征来解释。为了评估信念不精确性对行为的影响，我们询问了受访者在设定了不同防护行为水平的假设场景下，对未来健康结果的信念。我们发现，那些认为防护行为不仅可以降低负面健康结果的主观概率，而且还能减少与之相关的不精确性的人，更倾向于采取更积极的防护行为。
Responsibility-sensitive welfare weights for health
责任敏感的健康福利权重
作者
Matthew Robson（荷兰鹿特丹伊拉斯姆斯大学经济学院，丁伯根研究所），Owen O’Donnell（荷兰鹿特丹伊拉斯姆斯大学经济学院与健康政策与管理学院，丁伯根研究所），Tom Van Ourti（荷兰鹿特丹伊拉斯姆斯大学健康政策与管理学院、经济学院，丁伯根研究所）
摘要：We estimate welfare weights for health to facilitate program evaluation allowing for aversion to health inequality and to health inequity by three non-health characteristics. In a UK general population sample, 569 online experiment participants distribute constrained resources to determine the health of hypothetical individuals distinguished by randomly generated resource productivity as well as sex, income and smoking (41,460 observations). We elicit beliefs about responsibility for income and smoking, and use their associations with the allocations to estimate responsibility-sensitive weights for health by those two characteristics. We find weak prioritisation of females’ health, moderate prioritisation of the health of poorer individuals and strong prioritisation of the health of non-smokers over that of smokers. Substantial aversion to health inequality lowers weights on females and non-smokers, who are health-advantaged, and raises the weight on the poor, who are health-disadvantaged. As beliefs about responsibility for income and smoking strengthen, weights on the poor decrease and weights on non-smokers significantly increase.
我们估算了健康的福利权重，以便在项目评估中能够体现出人们对健康不平等以及由三种非健康特征引起的健康不公平的厌恶。在英国的一项面向普通人群的样本中，569名在线实验参与者对受限资源进行分配，以决定一组虚拟个体的健康水平，这些个体依据随机生成的资源生产力、性别、收入和是否吸烟进行区分（总计41,460个观测值）。我们调查了参与者关于收入和吸烟责任归属的信念，并利用这些信念与资源分配之间的关联，估算出与责任敏感性相关的健康福利权重。我们发现，参与者对女性健康的优先考虑较弱，对贫困个体健康的优先考虑适中，而对非吸烟者的健康则有显著优先于吸烟者的倾向。对健康不平等的强烈厌恶会降低对女性和非吸烟者（即健康上处于优势地位群体）的权重，同时提高对贫困者（健康劣势群体）的权重。随着人们对收入和吸烟责任归属的信念增强，对贫困者的权重下降，而对非吸烟者的权重显著上升。
Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes
重返校园：新冠疫情期间返校对疫情结果的影响
作者
Dena Bravata（美国斯坦福大学初级保健与结果研究中心），Jonathan Cantor（美国加州圣塔莫尼卡兰德公司），Neeraj Sood（美国南加州大学；美国国家经济研究局），Christopher Whaley（美国布朗大学，罗德岛州普罗维登斯市）
摘要：The effects of school closures on COVID-19 transmission remain unclear, even after the conclusion of the national Public Health Emergency. We use healthcare claims data from 130 million household-week observations linked to smartphone mobility data to measure the effects of changes in county-level visits to schools on COVID-19 outcomes. We use a triple-differences approach that leverages within-county differences in exposure between families with and without school-age children and find modest impacts. We find increases in COVID-19 infection rates, with larger differences in low-income and higher COVID-19 prevalence counties.
即便在全国公共卫生紧急状态结束后，学校关闭对新冠病毒传播的影响仍不明确。我们使用了来自1.3亿个家庭每周观察的医疗索赔数据，并将其与智能手机移动数据相结合，以衡量县一级返校变化对新冠疫情结果的影响。我们采用三重差分（triple-differences）方法，利用同一县内有学龄儿童家庭与无学龄儿童家庭之间的暴露差异进行识别，发现返校对疫情的影响相对温和。我们观察到新冠感染率有所上升，且这一上升在低收入县和新冠患病率较高的县中更为明显。
Attentional processes underlying health state valuation with time trade-off and standard gamble tasks
健康状态评估中的注意力机制：基于时间权衡与标准赌博任务的实验研究
作者
Stefan A. Lipman（荷兰鹿特丹伊拉斯谟大学健康政策与管理学院、健康经济研究中心）， Thorsten Pachur（德国慕尼黑工业大学；德国柏林马克斯·普朗克人类发展研究所）
摘要：Time Trade-Off (TTO) and Standard Gamble (SG) tasks are commonly used methods to measure utilities for health states (e.g., diabetes, being in a wheelchair). Importantly, however, the two methods have been shown to typically yield discrepant utilities for a given health state. Here we examine the cognitive processes underlying this utility gap by analyzing individuals’ attentional patterns when evaluating health states in the TTO and SG tasks. In an online experiment, each respondent completed both a TTO and an SG task and we used the process-tracing methodology Mouselab to record respondents’ attention allocation to the tasks’ attributes: health states and their durations (in both TTO and SG), and probabilities (in SG only). In the TTO task, attention was approximately balanced between the health state and duration attributes, whereas in the SG task, attention was focussed on the probability and the health state attributes. Individuals who paid more attention to the task-specific trade-off attribute (i.e., duration and probability in TTO and SG, respectively) seemed to be less willing to make those trade-offs, leading to higher utilities for the health states. Notably, the utility gap was associated with individual differences in attention allocation: respondents who adjusted their attention allocation less to the task-specific trade-offs produced more discrepant utilities between the TTO and SG tasks. Our findings underscore the key role of attentional processes in preference construction, highlighting that differences in the utilities people assign to health states could potentially be influenced by altering attention allocation.
“时间权衡”（TTO）与“标准赌博”（SG）任务是评估健康状态效用（例如糖尿病、坐轮椅）中常用的方法。然而，重要的是，这两种方法通常会对同一健康状态产生不同的效用评估结果。本文通过分析个体在TTO与SG任务中评估健康状态时的注意力模式，探究导致这一效用差异的认知过程。在一项在线实验中，每位受访者都完成了TTO和SG两种任务，我们采用过程追踪方法“Mouselab”记录他们在任务属性上的注意力分配：包括健康状态和持续时间（适用于TTO与SG），以及概率（仅适用于SG）。结果显示，在TTO任务中，受访者在健康状态与持续时间两个属性之间的注意力分配较为均衡，而在SG任务中，注意力更集中于概率和健康状态属性上。那些在任务中特别关注权衡属性（即TTO中的持续时间和SG中的概率）的人，更不愿意进行权衡，从而对健康状态给出了更高的效用评分。值得注意的是，效用差异与个体注意力分配的差异密切相关：那些在不同任务中较少调整注意力分配的受访者，TTO与SG任务中产生的效用差异更大。研究结果强调了注意力过程在偏好建构中的核心作用，表明人们对健康状态赋予的效用差异，可能受到注意力分配方式的影响。
Absence from work and lifetime smoking behavior: Evidence from European maternal leave policies
工作中断与终身吸烟行为：来自欧洲产假政策的证据
作者
Anna-Theresa Renner（奥地利维也纳工业大学财政与基础设施政策系），Mujaheed Shaikh（德国柏林赫蒂学院），Sonja Spitzer（奥地利维也纳大学，维特根斯坦人口与人力资本中心）
摘要：We provide new evidence on how child-related career interruptions affect long-term health behaviors by examining the impact of maternal leave duration on smoking habits across 14 European countries. Linking data on maternity and parental leave policies from 1960 to 2010 with survey data on mothers’ health behaviors, birth, and employment histories, we identify the effects of absence from work due to child birth on lifetime smoking in an instrumental variable framework based on within- and between-country variations in policies. We find that a one-month increase in leave duration raises the probability of a mother smoking later in life by 1.2 percentage points. Additionally, a one-month increase in child-related absence from work extends the lifetime duration of smoking by 7 months, the number of cigarettes smoked per day by 0.2 cigarettes, and the number of pack years by 0.6. We document potential non-linearities in these effects, suggesting that shorter leave durations may have a protective effect, while very long absence from work could promote harmful health behaviors. Heterogeneity analyses reveal that the observed effects are mediated by the partners’ lack of financial support around childbirth, while employment status and other socio-demographic characteristics do not play a significant role.
本文提供了关于与育儿相关的职业中断如何影响长期健康行为的新证据，研究了在14个欧洲国家中，产假时长对吸烟习惯的影响。我们将1960年至2010年的产假和育儿假政策数据与关于母亲健康行为、出生与就业历史的调查数据相结合，利用各国及国内政策变动，构建工具变量框架，识别由于生育引起的工作中断对终身吸烟行为的影响。我们发现，产假每延长一个月，会使母亲在其后人生阶段吸烟的概率提高1.2个百分点。此外，与孩子相关的每一个月的工作中断，会将终身吸烟总时长延长7个月，每天多吸0.2支烟，累计烟龄增加0.6包年。我们还记录到了这种影响的可能非线性趋势：较短的产假可能具有保护作用，而过长的工作中断则可能诱发不良健康行为。异质性分析表明，这一影响主要是由于伴侣在生育期间缺乏财务支持所致，而就业状况及其他社会人口学特征并未起到显著作用。
Heterogeneous peer effects and gender-based interventions for teenage obesity
青少年肥胖中的异质性同伴效应与性别定制干预
作者
Margherita Comola（法国巴黎萨克雷大学；巴黎经济学院），Rokhaya Dieye（加拿大德勤；拉瓦尔大学经济系），Bernard Fortin（加拿大拉瓦尔大学经济系、风险、经济问题与公共政策研究中心；跨大学组织分析研究中心）
摘要：This paper explores the role of gender heterogeneity in the social diffusion of obesity among adolescents and its policy implications. We propose a social interaction model which allows for gender-dependent heterogeneity in peer effects. Our empirical approach is consistent with the best response functions of a non-cooperative model where social interactions stem from the channel of pure spillover or pure conformity. We estimate the model using data on adolescent Body Mass Index and network-based interactions. Our approach allows us to account for network endogeneity. Our results show that peer effects are gender-dependent, and male students are particularly responsive to the weight of their female friends. According to simulations, reaching out to women results in an 8% increase in effectiveness in reducing overall BMI, based on the most conservative scenario. Thus, female-tailored interventions are likely to be more effective than a gender-neutral approach to fighting obesity in schools.
本文探讨了性别异质性在青少年肥胖的社会传播中的作用及其政策含义。我们提出了一个允许同伴效应存在性别依赖异质性的社会互动模型。我们的实证方法与非合作模型的最佳反应函数一致，在该模型中，社会互动源于纯粹外溢效应或纯粹从众效应。我们利用青少年的身体质量指数（BMI）和基于网络的互动数据来估计该模型。该方法能够控制网络内生性问题。研究结果表明，同伴效应依赖于性别，且男性学生对女性朋友的体重反应尤为明显。根据模拟结果，在最保守的情境下，针对女性开展干预措施可以使整体BMI降低的效果提高8%。因此，与性别中立的方法相比，针对女性定制的干预策略在学校肥胖防控中可能更为有效。
The effect of e-cigarette flavor bans on tobacco use
电子烟风味禁令对烟草使用的影响
作者
Chad Cotti（美国密歇根州立大学农业、食品与资源经济系）等
摘要：Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. Using data from a variety of surveys (Youth Risk Behavior Surveys, Behavioral Risk Factor Surveillance Survey, and Population Assessment of Tobacco and Health), this study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. We find robust evidence that the adoption of an ENDS flavor restriction reduces short-run frequent and everyday ENDS use among youths by approximately two-to-three percentage-points. Some evidence suggests that this effect weakens after two years. We also document reductions in ENDS use among young adults aged 18-30 that appear to strengthen after two years. Finally, evidence suggests substitution from flavored ENDS to unflavored ENDS and cigarettes among certain age groups.
关于电子烟风味销售限制的支持者认为，风味吸引年轻人，从而导致其走向尼古丁成瘾之路。本文利用多个调查数据（包括青少年风险行为调查、行为风险因素监测系统调查、烟草与健康状况评估）进行分析，是首批系统评估州和地方政府对风味电子尼古丁传输系统（ENDS）产品销售限制政策对青少年和青年烟草使用行为影响的研究之一。研究发现，实施风味电子烟销售限制后，青少年中高频或每日ENDS使用率在短期内下降了约2至3个百分点。不过，也有证据表明，这种影响在两年后可能有所减弱。相反，18-30岁青年群体的ENDS使用下降趋势在两年后则更为显著。此外，研究还发现部分年龄群体出现了从风味电子烟转向无风味电子烟或传统卷烟的替代行为。
来源：13个精算师
