Research

Early childhood education programmes are expected to improve child conditions including educational attainment, labour, and health outcomes. This study evaluates the effect of a Spanish universal preschool programme, which implied a large-scale expansion of full-time high-quality public preschool for three-year-olds in 1991, on long-term health. Using a difference-in-differences approach, I exploit the timing of the policy and the differential initial speed of implementation of public preschool expansion across regions. I compare long-term health of cohorts aged three before to those aged three after the start of the policy residing in regions with varying initial implementation intensity of the programme. The results show that the policy does not affect long-term health outcomes and use of healthcare services, except for two outcomes. A greater initial intensity in public preschool expansion by 10 percentage points decreases the likelihood of being diagnosed with asthma by 2.1 percentage points, but hospitalisation rates increase by 2.7%. The findings indicate that the effect on asthma is larger for men, hospitalisation rates are higher for pregnant women, and disadvantaged children benefit the most in terms of a lower probability of taking medicines and being diagnosed with asthma and mental health disorders.

In contemporary households, women often shoulder most organisation and caregiving responsibilities leading them to play a crucial role in family dynamics. While previous research has established that public early childcare affects child outcomes and maternal employment, less attention has been given to its effects on maternal health despite its relevance within the household. This study investigates the impact of public early childcare on maternal shortand long-term health. Based on administrative health records covering 90% of the German population over a decade, we leverage the exogenous variation in childcare coverage rates across counties and time induced by a major German early childcare expansion. Our results reveal an intra-household transmission of communicable diseases: mothers experience 4–8% more infections and 2–4% more respiratory diseases for a 10 percentage point rise in childcare coverage rates when their children are 1–2 years old. In contrast, mothers benefit from reductions in obesity and anaemia, and heterogeneity analyses show a lower prevalence of moodand stress-related disorders for multiparous and older mothers. The policy implications of our findings extend beyond the health impacts of early childcare on mothers and shed light on the broader dynamics within families. 

The Covid-19 pandemic had a profound impact on the management and delivery of acute healthcare. To tackle the pandemic, hospitals redesigned their organisational models to provide a rapid increase in acute care assessment and treatment capacity for patients with Covid-19 whilst also trying to maintain delivery of care for patients with non-Covid-19 healthcare needs. This capacity to adjust and recover after Covid-19 might be shaped by both measures taken by acute hospitals and wider hospital pre-pandemic characteristics. The aim of this study is to examine how hospital characteristics in acute care are associated with recovery of elective activity after the height of the Covid-19 pandemic compared to pre-pandemic levels. Using patient-level data from Hospital Episode Statistics aggregated at monthly-trust level for all English National Health Service (NHS) acute hospital trusts in 2019 and 2021, we estimate the associations between hospital recovery rate and hospital pre-pandemic characteristics by employing linear regressions of the proportional change over time in elective activity against a set of explanatory variables related to supply factors (e.g., hospital size, workforce, type of hospital, regional location), demand factors (e.g., population need, patient case-mix) and time factors. On average, English NHS acute hospital trusts did not fully recover from the Covid-19 pandemic in 2021. The results show that the explanatory variables are not systematically associated with hospital recovery rate, excepting regional differences. Hospital trusts not located in London, especially in the North of England, are associated with a lower recovery (less resilience) of total elective activity and orthopaedic and vascular surgical elective activity. The implication for policy development is that the evolution of hospital recovery rates in elective activity varied across English regions, especially for high-volume and high-risk elective specialties, with better recovery in London than elsewhere.