RESEARCH

PEER-REVIEWED PUBLICATIONS

(5) "Parental nonemployment in childhood and children's health later in life". 2023. Economics and Human Biology, Vol:49, Pages 1-23. doi: 10.1016/j.ehb.2023.101241 

While the effects of joblessness on the health of the non-employed are well-documented, its long-term spillover consequences on the health of their relatives, especially children, remain poorly understood. This research explores the long-term associations of parental nonemployment spells experienced during early, mid and late childhood on children’s mental and physical health. The analysis exploits data drawn from the British Household Panel Survey (BHPS) and the UK Household Longitudinal Study (UKHLS), linking detailed parental socioeconomic information with their children between the years 1993 and 2013. This paper employs a Correlated Random Effects (CRE) probit model that allows accounting for unobserved heterogeneity as well as a non-linear Generalized Estimating Equations (GEE) random effects estimator accounting in addition for the dependency structure of the data. Results indicate that experiencing parental nonemployment during early and late childhood has a negative association on the children’s likelihood of suffering from long-standing illnesses later in life, while experiencing parental nonemployment during middle childhood negatively affects the young adult’s mental health. Moreover, experiencing parental nonemployment during late childhood increases the probability of both reporting poor or fair self-assessed health and the likelihood of consuming prescribed medicines in early adulthood. However, there seems to be a considerable effect heterogeneity by family socioeconomic status, parents’ gender, and frequencies of parental nonemployment spells. Current adulthood circumstances, such as level of educational attainment, job situation and household demographics, are used to explore the potential mechanisms affecting results. These findings may help policymakers shape appropriate responses to mitigate the psychological and physical burden derived from parental nonemployment, especially among already disadvantaged households. 

Media coverage: IB knowledge; NIHR SPHR blog

(4) "Impact of new guidance on survival for 22-week births in England and Wales: A population-based cohort", with Lucy K Smith, Emily van Blankenstein, Grenville Fox, Sarah E Seaton, Stavros Petrou, Cheryl Battersby. 2023. BMJ Medicine. doi: 10.1136/bmjmed-2023-000579 

Survival estimates inform national recommendations for the provision of survival-focused care of babies born at 22 weeks gestation. However, cautious interpretation is necessary due to different approaches to care and biased population denominators e.g. live births. We explored the impact of changes in national recommendations from an extremely selective approach to a more widespread recommendation of survival-focused care in England and Wales using robust denominators. Using population-based cohort data we present rates of survival-focused care provision and outcomes in 2018-2019 and 2020-2021 for babies alive at the onset of labour. There were 1001 babies alive at the onset of labour at 22+0-22+6 weeks. For these babies, survival-focused care increased three-fold from 11% to 38% (2018-2019: 59/524; 2020-2021: 183/477); admissions to neonatal units increased four-fold (7%(39/524) to 28%(134/477)) and survival to discharge from neonatal care increased three-fold (2.5%(13/524) to 8.2%(39/477)). More babies of lower birthweight and early gestational age received survival-focused care in 2020-2021. A change in national guidance has led to a three-fold increase in babies born at 22 weeks receiving survival-focused care. Survival has remained low at 2 in 10 for those receiving survival-focused care and 3 in 10 for those admitted to neonatal care. Increased care provision has the potential to provide time to gather more information on a baby’s prognosis through their response to treatment, and to offer a palliative approach if severe life-limiting complications develop. However, greater understanding of the consequences of this approach for babies, families and healthcare professionals is needed.

Media coverage: The Times; Medicalxpress; iNews; myScience; ICL Newsletter; BAPM blog

(3) "Coping with COVID-19: The role of hospital care structures and capacity expansion in five countries", with Czypionka T., Reiss M., Hagen T., Löblová O., Murauskienė L., Or Z., Vrangbæk K. 2023.  Health Economics, Policy and Law, 1-18. doi:10.1017/S1744133122000275 

This article examines the responses of five different health systems in the first wave of the Covid-19 pandemic: Denmark, Germany, Israel, Spain, and Sweden. The aim is to understand to what extent these crisis responses were resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralized hospital care structures, more sophisticated concepts for providing specialized services, and greater integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralized governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen healthcare system resilience in pandemic situations and beyond.

(2) "The effect of changes in cost sharing on the consumption of prescription and over-the-counter medicines in Catalonia". Martínez-Jiménez, Mario; García-Gómez, Pilar; Puig-Junoy, Jaume. 2021. International Journal Environmental Research & Public Health 18, no. 5: 2562. doi: 10.3390/ijerph18052562

Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population—co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners—from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits—from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume. 

(1) "Effects of macroeconomic fluctuations on mental health and psychotropic medicine consumption". Martínez-Jiménez, M., Vall Castelló, J. 2020. International Journal of Health Economics and Management. 20, p. 277–297. 21 p. doi: 10.1007/s10754-020-09281-3

Our aim in this paper is to understand the impact of macroeconomic fluctuations on mental health and psychotropic medicine consumption. In order to do that we exploit differences in the fluctuations of business cycle conditions across regional units in Catalonia. Our findings suggest that, in general, economic fluctuations at the local level had no significant effect on the consumption of psychotropic medicines. However, we show that a deterioration in local labour market conditions is associated with a reduction in the consumption of anxiolytics medicines. We also report an increase in the consumption of anxiolytics in regions with a softer deterioration in the economic situation. Although we report mild improvements in both mental and physical health for some sub-groups of the population, we also find significant reductions on the probability of sleeping 6h or more. Thus, these elements point towards potential negative effects of local labour market conditions on health in the medium/long term. 

WORKING PAPERS (available upon request)

"Temporary Employment, Fertility and Health at Birth", with Judit Vall Castello (submitted)

We investigate the effect of temporary employment on fertility behaviour and perinatal health. The research question is based on the hypothesis that fixed-term contracts and their inherent employment instability imply a worse career path that may have spillover impacts on subsequent fertility and perinatal outcomes. To tackle endogeneity concerns, we use the 1984 labour market reform as a natural experiment; this reform led to an extensive liberalisation in the regulation of the fixed-term contract in Spain. We thus compare fertility decision-making and perinatal outcomes using the father´s occupational status between low- and high-skilled ones before and after the 1984 reform. This is so because we expect the reform to have less effect on skilled fathers. Our data comes from the years 1980-2017 of the Childbirth Statistics Bulletin provided by the Spanish National Statistics Office (INE). We apply a cohort regression discontinuity difference-indifference strategy (RDD-DiD) to identify the reform’s within-cohort effects, where the treatment and the control differ only in the father’s professional status and month of birth. We find that the fixed-term contract regulation reduces the mean number of childbirths, and decreases the birth rates for low-skilled fathers. Also, for low-skilled fathers compared to their skilled counterparts, the reform leads to a reduction in the mean of birth weight and gestational age, as well as, increases the risk of preterm birth for their first child. This pattern helps to shed light on the trends of fertility rates and perinatal outcomes in Spain.

"Health, Retirement and Economics Shocks", with Bruce Hollingsworth & Eugenio Zucchelli

We explore the effects of retirement on both physical and mental ill-health and whether these change in the presence of economic shocks. We employ inverse probability weighting regression adjustment to examine the mechanisms influencing the relationship between retirement and health and a difference-in-differences approach combined with matching to investigate whether the health effects of retirement are affected by the Great Recession. We estimate these models on data drawn from the English Longitudinal Study of Ageing (ELSA) and find that retirement leads to a deterioration in both mental and physical health, however there seems to be considerable effect heterogeneity by gender and occupational status. Our findings also suggest that retiring shortly after the Great Recession appears to improve mental and physical health, although only among individuals working in the most affected regions. Overall, our results indicate that the health effects of retirement might be influenced by the presence of economic shocks.

"Socioeconomic Deprivation, Mental Health and Access to Healthcare among Millenial Adolescents", with Bruce Hollingsworth & Eugenio Zucchelli (submitted)

This study estimates and decomposes components of different measures of inequality in health and access to health care among millennial adolescents, a sizeable cohort of individuals at risk of experiencing disparities in health. Administrative data from the UK Health Episode Statistics are linked to Next Steps, a longitudinal survey including a cohort of millennials born in 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Income-related and small-area deprivation level inequalities in psychological distress and disability/long-term illness are measured using the income deprivation affecting children index and the index of multiple deprivation. Erreygers’ corrected concentration index and Shapley-Shorrocks decomposition techniques are used to identify the relative contributions of childhood circumstances to adolescents’ health and healthcare utilisation. Results show that deprivation at small-area and income levels lead to significant inequalities in health among millennials. There are also pro-rich inequalities in the utilisation of specific outpatient hospital services (e.g., orthodontic and mental health care), while pro-poor disparities are found in the use of emergency care services. These findings shed light on the main drivers of health inequalities during a critical stage of human development and have potentially important implications on human capital formation across the life-cycle.

"Did Austerity Increase Inequalities in Healthcare Use and Waiting Times Among Millenials?, with Bruce Hollingsworth & Eugenio Zucchelli (submitted)

This paper examines the effect of the Great Recession and subsequent austerity policies on healthcare use and waiting times among millennials in England. We focus on access to emergency and outpatient hospital care using rich administrative data from the Health Episode Statistics linked to Next Steps, a longitudinal survey including a cohort of individuals born in 1990. Results from interrupted time-series suggest that the number of appointments for outpatient hospital care increased after the Great Recession, with heterogenous effects depending on levels of area deprivation and treatment speciality. However, visits to emergency departments appear to have decreased due to austerity policies alongside only negligible increases in waiting times for treatment, especially in the most deprived areas. These findings indicate that while macroeconomic shocks and austerity policies might have increased the use of hospital care among millennials living in the most deprived areas, waiting times do not appear to be greatly affected.

WORK IN PROGRESS