Research

Abstract: Long waiting times for elective surgeries are a persistent challenge in universal healthcare systems across Europe, an issue intensified by aging populations and the increasing burden of age-related conditions. This paper exploits rich administrative data on all specialist medical procedures in the Netherlands to study the costs of longer waiting times for elective surgery, specifically osteoarthritis-related hip replacement, for patients aged 50 to 65. I first study, in an event study analysis, the negative association between osteoarthritis onset and economic outcomes. Because the timing of treatment may be endogenous, I use an instrumental variables design leveraging plausibly exogenous variation in waiting times at hospitals that serve a patient's municipality. I document a decline in employment of 1 percentage point per month of waiting, an increase in unemployment insurance (UI) and sickness benefits utilization of 0.73 percentage points per month of waiting, and a significant increase in healthcare costs, but limited effects on other outcomes. Finally, in a heterogeneity analysis, I show that most of the effects are concentrated among female patients, those with a lower level of education and those without a partner or spouse, suggesting that delays in access to care can aggravate economic inequalities. The results provide valuable insights into the direct and spillover effects of longer waiting times for elective procedures.

Abstract: In the current era of effective antiretroviral therapy, HIV has become a manageable chronic condition. Little is known about the consequences of HIV on individuals’ labor market outcomes. We study the impact of an HIV diagnosis using linked clinical data (the Dutch ATHENA cohort) and administrative data. A causal effect is estimated by comparing outcomes of people with HIV diagnosed between 2010 and 2022 (n = 5960) to a matched control group (n = 59,600) in a difference-in-difference design. We find that people with HIV are less likely to be employed, work fewer hours, earn less income, and are more likely to receive disability benefits up to 7 years after diagnosis. These effects are more pronounced for those diagnosed with late-stage HIV disease. Those with a non-late stage diagnosis experience a deterioration of socioeconomic outcomes, despite being less likely to experience clinically relevant symptoms at diagnosis. These findings highlight the need for continued efforts in prevention and early detection of HIV.