Until a few years ago, moderate alcohol consumption was thought to have (mild) beneficial effects on health. However, some recent studies have suggested that “there is no safe level” of alcohol intake. Consequently, public health institutions have responded by advising against any level of alcohol use and suggesting governments a number of policies to reduce overall alcohol consumption. Nonetheless, medical studies suffer from a variety of intrinsic limitations that could undermine the reliability of their findings, especially when focusing on low-intake levels. On the one hand, we show that the literature on alcohol consumption may suffer from publication bias; such a problem is known to be present in the scientific literature in general. On the other hand, we discuss other potential sources of bias, which are inevitable due to the infeasibility of randomized controlled trials. We assess a sample of articles for the presence of omitted variable bias, miscalculation of alcohol intake, use of linear in place of non-linear models, lack of validation of Mendelian randomization assumptions, and other possible weaknesses. We conclude that the claim that “there is no safe level” of alcohol intake is not sufficiently supported based on our current scientific knowledge.

Physical inactivity is a leading cause globally of noncommunicable diseases such as diabetes, heart attacks, and strokes. Here, we present the results from a 4-week-long experimental test of a nudge designed to promote physical activity among 206 seniors in Abu Dhabi, United Arab Emirates—a population with one of the highest rates of physical inactivity in the world. We find that the “Forever Fit” nudge—a booklet containing a simple exercise program and information about the health benefits of physical activity—has a large positive effect on 93 previously inactive seniors. The nudge increases the time previously inactive participants spend being physically active from about 5 to about 15 minutes per day.

Using three waves (2011–15) of CHARLS data, we analyze the short-term effects of widowhood on cognitive function among older Chinese. Fixed-effect models show that widowhood has significant adverse effects on cognition for rural elders but not for urban ones. Furthermore, compared to rural men, rural women exhibit greater declines in cognition, especially in fluid cognition. We explore the possible mechanism from the neighborhood perspective. The results show that community sports and entertainment facilities and public services can effectively mitigate the negative impact of widowhood on cognitive function for rural widows. Sports and entertainment facilities can mainly enhance word recall ability, especially delayed word recall. Public services such as elderly health centers focusing on the healthcare function for the elderly can also improve the word recall ability of rural widows. On the other hand, family-based elderly care centers mainly increase the cognition ability of mental intactness.

Heat-related mortality risks are a substantial component of the looming costs of climate change in the United States and globally. This article presents the results from a risk-risk survey to test whether U.S. respondents place a valuation premium on mortality risks from heat relative to cancer and transportation risks. The questionnaire exploits exogenous shocks to temperatures during a heat wave and randomized elements to further test whether preferences vary with heat exposure or the age of individuals exposed to heat risks. The results provide strong evidence that there is no valuation premium in the U.S. for heat-related risks. Subjects valued cancer risks twice as highly as heat and transportation risks, the latter of which are a common benchmark for general traumatic fatalities. While there is some evidence that subjects value heat risks more when exposed to a heat shock of approximately 3–4 °C, the size of the differential is too small to establish a statistically significant heat risk premium. Finally, subjects’ responses demonstrate no differential valuation of mortality risks to seniors versus the general population based on the preferences of the general population or the senior subsample.

The standard analytical framework of insurance markets by Einav and Finkelstein (EF) focuses on the problem of welfare loss for low-risk individuals. A key assumption of this framework is that demand and cost curves are tightly linked, meaning that people are willing to pay a price equal to their expected cost plus a risk premium. Using data from the German risk-adjustment system we show that the distribution of expected health care costs is extremely skewed. We show that incorporating the extreme skewness of predictable individual health care expenses in the EF framework has important welfare consequences, which are typically overlooked when using this framework for analysing the negative welfare effects of voluntary health insurance markets with asymmetric information. Rather than the welfare loss of low-risk individuals due to underinsurance, the main problem of voluntary health insurance markets is the welfare loss of high-risk individuals not getting access to health insurance and affordable health care. We discuss that among the policy approaches to reduce this problem, mandatory health insurance with mandatory cross subsidies is likely to be the most effective, which is typically not recognised when focusing primarily on the welfare loss for low-risk individuals.

Reforms to the means tests in England for state-financed long-term care were planned for implementation in 2025. They included a lifetime limit (cap) on how much an individual must contribute to their care, with the state meeting subsequent care costs. We present projections of the costs and distributional impacts of these reforms for older people, using two linked simulation models which draw on a wide range of data. We project that by 2038 public spending on long-term care for older people in England would be about 14% higher than without the reforms. While the main direct beneficiaries of the lifetime cap would have been the better off who currently receive no state help with their care costs, the reforms also treated capital assets more generously than the current system, helping people with more modest incomes and wealth. When analysing the impacts of the reforms it is therefore important to consider the whole reform package. Our results depend on a range of assumptions, and the impacts of the reforms would be sensitive to the levels of the cap and other reformed parameters of the means test on implementation.

Endogenous public health responses include the individual behaviours, community-based organizational responses, and informal rules that resolve economic problems during public health crises. We explore the relevance of endogenous responses in Orthodox Jewish communities during the COVID-19 pandemic. We analyse Orthodox newspapers in New York City and find that (a) rabbis advised their communities on how to stay healthy and observant to their religious beliefs; (b) rabbinical councils and advisory boards provided private, public health guidance; (c) private, Jewish ambulatory services provided religiously sensitive healthcare; (d) Orthodox Jewish schools privately provided public health services; and (e) community members altered religious rules, rituals, and traditions to mitigate the spread of the virus. While these responses did not occur seamlessly or without conflict, the Orthodox community worked diligently to provide public health services to remain healthy while also observing religious traditions. Our paper provides shows how communities develop endogenous public health responses during crises.

Organisational measures to support employees who are experiencing family and domestic violence (FDV) are increasingly seen as an important policy response to mitigate the consequences of such violence and promote gender equality. However, little is known about the costs to employers of providing such workplace policies. This paper assesses the costs and benefits to Australian employers of providing 10 days of paid FDV leave to employees experiencing such violence. We draw on a case study based on the evidence presented to the Fair Work Commission which contributed to their 2023 enactment that modern award wages should include 10 days of paid FDV leave. Using a bottom-up approach and utilising individual-level data from the Australian Bureau of Statistics and Household, Income and Labour Dynamics in Australia Survey, our estimates reveal that the total annual cost to employers of providing an entitlement of 10 days of paid FDV leave to award-covered employees is between $13.1 million and $34.3 million. Our analysis highlights the role of robust economic analysis in generating evidence for policy change and offers an approach that can be applied in evaluating costs and benefits of other employer initiatives of similar nature.

Cannabis is the most commonly used illicit drug worldwide. In countries with repressive drug policies, the costs of its prohibition plausibly outweigh the benefits. We conduct a cost–benefit analysis of cannabis legalization and regulation in the Czech Republic, taking into consideration alternative scenarios designed using parameters from the known effects of cannabis legalization in selected U.S. states, Canada, and Uruguay. Our analysis focuses on tax revenues, law enforcement costs, the cost of treatment and harm reduction, and the value of Quality Adjusted Life Years (QALYs). Under all the projected scenarios, the identified benefits of legalizing cannabis for personal use exceed the potential costs. The estimated net social benefit of legalization is in the range of 34.4 to 107.6 million EUR per year (or between 3.2 and 10.1 EUR per capita), depending on the size of the cannabis market and the development of cannabis prices after legalization.

The COVID-19 pandemic presents a remarkable opportunity to put to work all of the research that has been undertaken in past decades on the elicitation and structural estimation of subjective belief distributions as well as preferences over atemporal risk, patience, and intertemporal risk. As contributors to elements of that research in laboratories and the field, we drew together those methods and applied them to an online, incentivized experiment in the United States. We have two major findings. First, the atemporal risk premium during the COVID-19 pandemic appeared to change significantly compared to before the pandemic, consistent with theoretical results of the effect of increased background risk on foreground risk attitudes. Second, subjective beliefs about the cumulative level of deaths evolved dramatically over the period between May and November 2020, a volatile one in terms of the background evolution of the pandemic.

Agency theory has established that appropriate incentives can reconcile the diverging interests of the principal and the agent. Focusing on three applications, this dissertation evaluates the empirical relevance of these results when a third party interacts with the primary contract. The analyses provided rely on either laboratory or natural experiments.

First, corruption is analyzed as a two-contract situation: a delegation contract between a Principal and an Agent and a corruption pact concluded between this Agent and a third player, called Briber. A survey of the recent microeconomic literature on corruption first highlights how corruption behavior results from the properties of those two agreements. We thereafter show that the Agent faces a conflict in reciprocities due to those two conflicting agreements. The resulting delegation effect, supported by observed behavior in our three-player experimental game, could account for the deterrence effect of wages on corruption.

Second, health care is governed by contradictory objectives: patients are mainly concerned with the health provided, whereas containing health care costs is the primary goal of health care administrators. We provide further insights into the ability of incentives to balance these two competing objectives. In this matter, our theoretical and econometric analysis evaluates how a new mixed compensation scheme, introduced in Quebec in 1999 as an alternative to fee-for-services, has affected physicians’ practice patterns. Free switching is shown to be an essential feature of the reform, since it implements screening between physicians.

Finally, the demand for underground work departs from the traditional Beckerian approach to illegal behavior, due to the dependence of benefits from illegality on competitors’ behavior. We set up a theoretical model in which the demand for underground work from all producers competing on the same output market is analyzed simultaneously. We first show that competition drastically undermines the individual benefits of tax evasion. At equilibrium, each firm nonetheless chooses evasion with a positive probability, strictly lower than one. This Bertrand curse could then account for the “tax evasion puzzle” i.e. the overprediction of evasion in models that ignore market interactions. We thereafter show that allowing firms to denounce competitors’ evasion is not likely to solve this curse—by providing a credible threat against price cuts, it fosters illegal work. Empirical evidence from a laboratory experiment confirms these predictions. Without denunciation, experimental firms often choose evasion whereas evasion benefits are canceled out by competition. When introduced, denunciation is rarely used by firms, but the threat makes evasion profitable.

Healthcare technologies are often appraised under considerable ambiguity over the size of incremental benefits and costs, and thus how decision-makers combine unclear information to make recommendations is of considerable public interest. This paper provides a conceptual foundation for such decision-making under ambiguity, formalizing and differentiating the decision problems of a representative policy-maker reviewing the results from an economic evaluation. A primary result is that presenting information to regulators in an incremental cost-effectiveness ratio or cost-effectiveness analysis (CEA) format instead of a net monetary benefit or cost–benefit analysis (CBA) framework may induce errors in decision-making when there exists ambiguity in incremental benefits and decision-makers use well-known decision rules to combine information. Ambiguity in incremental costs or the value of the cost-effectiveness threshold does not distort decision-making under these rules. In reasonable contexts, I show that the CEA framing may result in the approval of fewer technologies relative to CBA framing. I interpret these results as predictions on how the presentation of information from economic evaluations to regulators may frame and distort recommendations. All the results extend to non-healthcare contexts.

A BioBlitz is a rapid and intensive survey of a specific geographic area that brings together experts and often lay participants to assess biodiversity, typically of macrobiota that are easily observed and identifiable on-site. This concept has become popular across taxonomic fields, attracting interest globally to increase knowledge of local biodiversity. Inspired by the success of the approach, we undertook a ‘ParasiteBlitz’ at an unexplored locality (Stono Preserve, Charleston, South Carolina, USA) to determine its feasibility for parasites, whose assessment of diversity is largely neglected worldwide. We assembled a team of parasitologists with complementary expertise. Over 12 days (3 days in each habitat) in April 2023, we intensively screened fishes and aquatic invertebrates for parasites, and sampled sediment and water for environmental DNA (eDNA) metabarcoding from four aquatic habitats: wetland, freshwater pond, brackish impoundment, and tidal creek. We incorporated assistance from non-parasitologists and students. Details on methodologies and results are provided in individual papers in this Special Collection. Traditional methods revealed the presence of ca. 100 species of seven major metazoan parasite taxa, and the eDNA survey yielded over 1,000 amplicon sequence variants identified as parasites, most with sequences unmatched in GenBank, and resulting in only a few species identified as named species in the one-year post-Blitz timeframe we imposed upon ourselves for identification. Limitations and challenges of the ParasiteBlitz are discussed, and our results support that this approach can be effective for rapid discovery of the dimensions of parasite assemblages in an understudied environment and contribute to parasitology knowledge.

Supplemental Nutrition Assistance Program (SNAP) makes an exception to its rules, which allows elderly and/or disabled individuals, their spouses, as well as homeless beneficiaries, to buy hot prepared food from restaurants if they live in a state that participates in the Restaurant Meals Program (RMP). Using the staggered countywide adoption timeline in California, coupled with a stacked difference-in-differences empirical strategy, I examine the intent-to-treat (ITT) nutritional effects of RMP on the elderly population. Overall, I find no evidence that obesity rates for the elderly are any different in counties with RMP versus those without RMP. I can statistically rule out moderate effects. Additional evidence from some of the early-adopting counties suggests that RMP is associated with a reduction in food insecurity among the elderly.

Offline volunteering was faced with new challenges during the COVID-19 pandemic. Using a survey experiment with 1207 student participants, we test the impact of informing subjects about blood donation urgency (shortage information), and secondly, the effect of providing information about measures taken to reduce SARS-CoV-2 transmission at blood donation centers (hygiene information), on their inclination to donate during and after the COVID-19 lockdown. The results show that shortage information increases extensive-margin willingness to donate for non-donors by 15 percentage points (pp), on average, and increases the willingness to donate quickly for all respondents. Hygiene information, however, reduces prior donors’ intention to donate again by 8pp, on average, and reduces the willingness of non-donors to donate quickly.

Prior to the No Surprises Act (NSA), numerous states passed laws protecting patients from surprise medical bills from out-of-network (OON) hospital-based physicians supporting elective treatment in in-network hospitals. Even in non-emergency situations, patients have little ability to choose physicians such as anaesthesiologists, pathologists or radiologists. Using a comprehensive, multi-payer claims database, we estimated the effect of these laws on hospital-based physician reimbursement, charges, network participation and potential surprise billing episodes. Overall, the state laws were associated with a reduction in anaesthesiology prices and charges, but an increase in pathology and radiology prices. The price effects for each state exhibit substantial heterogeneity. California and New Jersey experienced increases in network participation by anaesthesiologists and pathologists and reductions in potential surprise billing episodes, but, overall, we find little evidence of changes in network participation across all of the states implementing surprise billing laws. Our results suggest that the effects of the NSA may vary across states.

Work-related stress is a major occupational health and safety (OHS) issue that has industrial relations origins. Aside from the moral and human rights imperatives to improve the corporate climate for worker psychological health (as per psychosocial safety climate, PSC), there are strong economic costs for not doing so. PSC refers to worker perceptions of the corporate safety system to protect and promote workers’ psychological health and wellbeing. It is a leading indicator of working conditions, which in turn affect workers’ health and work engagement. In this study, we estimate the attributable economic cost of low PSC due to sickness absence and turnover. Data were collected from a multinational company using survey at Time 1 (T1) and objective company data (i.e., sickness absence and turnover) after one year (T2). Using regression analysis and a matched sample of 617 responses, PSC was negatively related to future sickness absence. A binomial logistic regression with 1268 respondents (i.e., all responses at T1) showed that PSC was negatively related to future voluntary turnover. An economic analysis suggests that improving OHS via PSC could save an organisation with 5000 employees USD 0.6–2.7 million per year. Building PSC to protect and promote workers’ psychological health is a likely economic saving on organisational productivity.

We use Benford's law to examine the non-random elements of health care costs. We find that as health care expenditures increase, the conformity to the expected distribution of naturally occurring numbers worsens, indicating a tendency towards inefficient treatment. Government insurers follow Benford's law better than private insurers indicating more efficient treatment. Surprisingly, self-insured patients suffer the most from non-clinical cost factors. We suggest that cost saving efforts to reduce non-clinical expenses should be focused on more severe, costly encounters. Doing so focuses cost reduction efforts on less than 10% of encounters that constitute over 70% of dollars spent on health care treatment.

This study examines disparities in health and nutrition among native and Syrian refugee children in Turkey. To understand the need for targeted programs addressing child well-being among the refugee population, we analyze the Turkey Demographic and Health Survey (TDHS) – which provides representative data for a large refugee and native population. We find no evidence of a difference in infant or child mortality between refugee children born in Turkey and native children. However, refugee infants born in Turkey have lower birthweight and age-adjusted weight and height than native infants. When we account for a rich set of birth and socioeconomic characteristics that display substantial differences between natives and refugees, the gaps in birthweight and age-adjusted height persist, but the gap in age-adjusted weight disappears. Moreover, the remaining gaps in birthweight and anthropometric outcomes are limited to the lower end of the distribution. The observed gaps are even larger for refugee infants born before migrating to Turkey, suggesting that the remaining deficits reflect conditions in the source country before migration rather than deficits in access to health services within Turkey. Finally, comparing children by the country of their first trimester, we find evidence of the detrimental effects of stress exposure during pregnancy.

This article discusses the difference between benefit–cost analysis (BCA) and social welfare analysis in the evaluation of pandemic preparedness policies. Two social welfare approaches are considered: utilitarianism and prioritarianism. BCA sums the individuals’ monetary equivalents of the pandemic impacts. Social welfare analysis aggregates individuals’ well-being impacts. The aggregation rule identifies the normative judgments about what is fair. This article shows that the two methods yield very different estimates of the value of avoiding a future pandemic similar to the COVID-19 one. Compared to BCA, considerations about the distribution of the costs of the hypothetical intervention play a major role in the estimate of both utilitarian and prioritarian pandemic burdens: The more progressive the distribution of the costs is, the larger the net benefits of preventing the pandemic. In contrast, the BCA pandemic burden is indifferent to the distribution of the intervention costs. In addition, BCA tends to underestimate the burden suffered by low-income countries compared to social welfare analysis.