【保險(xiǎn)學(xué)術(shù)前沿】期刊Journal of Health Economics 2025年102卷（2）

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期刊介紹：

《Journal of Health Economics》（《健康經(jīng)濟(jì)學(xué)雜志》）是一本專注于健康和醫(yī)療保健經(jīng)濟(jì)學(xué)領(lǐng)域的學(xué)術(shù)期刊。該期刊成立于1982年，它涉及的主題包括健康服務(wù)的生產(chǎn)和供應(yīng)、健康服務(wù)的需求和利用、健康服務(wù)的融資、健康的決定因素（包括健康投資和風(fēng)險(xiǎn)健康行為）、疾病不良后果、需求者、供應(yīng)者和其他衛(wèi)生保健機(jī)構(gòu)的行為模型、政策干預(yù)的評估以及衛(wèi)生政策的效率和分配等方面。該刊每年發(fā)行6期，平均每期發(fā)表文章10篇左右，2024年影響因子為3.4。

本期看點(diǎn)：

健康信念

●不同受訪者在信念不精確性的程度上存在顯著差異，而這種差異在很大程度上無法通過標(biāo)準(zhǔn)人口統(tǒng)計(jì)特征來解釋。在新冠疫情背景下，那些認(rèn)為防護(hù)可以降低負(fù)面健康結(jié)果的主觀概率，而且還能減少不精確性程度的人，更傾向于采取更為積極的防護(hù)行為。

●對健康不平等的強(qiáng)烈厭惡會降低對女性和非吸煙者（即健康上處于優(yōu)勢地位群體）的福利權(quán)重，同時(shí)提高對貧困者（健康劣勢群體）的福利權(quán)重。

●“時(shí)間權(quán)衡”（TTO）與“標(biāo)準(zhǔn)賭博”（SG）任務(wù)是評估健康狀態(tài)效用（例如糖尿病、坐輪椅）中常用的方法。然而，重要的是，這兩種方法通常會對同一健康狀態(tài)產(chǎn)生不同的效用評估結(jié)果。人們對健康狀態(tài)賦予的效用差異，可能受到注意力分配方式的影響。

政策影響

●診斷性影像必要性證書（CON）政策減少了低價(jià)值醫(yī)療服務(wù)的使用，同時(shí)不影響高價(jià)值服務(wù)。

●新冠疫情期間，返校政策對疫情的影響相對溫和，返校使得新冠感染率有所上升，且這一上升在低收入縣和新冠患病率較高的縣中更為明顯。

●實(shí)施風(fēng)味電子煙銷售限制政策后，青少年中電子煙使用率在短期內(nèi)下降了約2至3個(gè)百分點(diǎn)，但這種影響在兩年后會有所減弱。

●產(chǎn)假時(shí)長對長期健康的影響：較短的產(chǎn)假對健康具有保護(hù)作用，而過長的工作中斷則可能誘發(fā)不良健康行為，這一影響主要是由于伴侶在生育期間缺乏財(cái)務(wù)支持所致。

●同伴效應(yīng)依賴于性別，且男性學(xué)生對女性朋友的體重反應(yīng)尤為明顯。針對女性開展干預(yù)措施可以使整體BMI降低的效果提高8%。因此，針對女性定制的干預(yù)策略在學(xué)校肥胖防控中可能更為有效。

※ 本期目錄

●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

技術(shù)監(jiān)管再思考：確認(rèn)證書政策（CON）對診斷性影像的數(shù)量與質(zhì)量影響

作者

Jill R. Horwitz（美國西北大學(xué)普利茲克法學(xué)院與范伯格醫(yī)學(xué)院；美國國家經(jīng)濟(jì)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.

對必要性證書（Certificate of Need, CON）法律在醫(yī)療服務(wù)中的影響的評估一直存在不一致的結(jié)果，可能是因?yàn)椴⒎撬蠧ON法律都適用于所有服務(wù)類型。本文構(gòu)建了一套涵蓋影像服務(wù)的CON法律原創(chuàng)數(shù)據(jù)集，并利用州邊界處的回歸不連續(xù)設(shè)計(jì)（RDD），估計(jì)CON政策對診斷性影像檢查的使用和質(zhì)量的影響。研究發(fā)現(xiàn)，在實(shí)施相關(guān)監(jiān)管的州，Medicare受益人接受任何影像檢查的可能性更低，接受低價(jià)值影像檢查的可能性則更低；而高價(jià)值影像檢查的使用未受到影響?？傮w而言，成像類CON政策減少了低價(jià)值醫(yī)療服務(wù)的使用，同時(shí)不影響高價(jià)值服務(wù)。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629625000554

Imprecise health beliefs and health behavior

模糊健康信念與健康行為

作者

Adeline Delavande（葡萄牙新里斯本大學(xué)商學(xué)院；澳大利亞悉尼科技大學(xué)）， Emilia Del Bono（英國埃塞克斯大學(xué)）， Angus Holford（英國埃塞克斯大學(xué)）

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當(dāng)人們對健康結(jié)果存在廣泛的不確定性時(shí)，人們健康信念的不精確性。我們在疫情爆發(fā)幾個(gè)月后，對一組年輕成年人進(jìn)行了調(diào)查。我們引導(dǎo)受訪者給出他們對不同健康結(jié)果的最低和最高主觀概率，并將信念不精確性定義為這兩個(gè)值的差異幅度。我們發(fā)現(xiàn)，不同受訪者在信念不精確性的程度上存在顯著差異，而這種差異在很大程度上無法通過標(biāo)準(zhǔn)人口統(tǒng)計(jì)特征來解釋。為了評估信念不精確性對行為的影響，我們詢問了受訪者在設(shè)定了不同防護(hù)行為水平的假設(shè)場景下，對未來健康結(jié)果的信念。我們發(fā)現(xiàn)，那些認(rèn)為防護(hù)行為不僅可以降低負(fù)面健康結(jié)果的主觀概率，而且還能減少與之相關(guān)的不精確性的人，更傾向于采取更積極的防護(hù)行為。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629625000384

Responsibility-sensitive welfare weights for health

責(zé)任敏感的健康福利權(quán)重

作者

Matthew Robson（荷蘭鹿特丹伊拉斯姆斯大學(xué)經(jīng)濟(jì)學(xué)院，丁伯根研究所），Owen O’Donnell（荷蘭鹿特丹伊拉斯姆斯大學(xué)經(jīng)濟(jì)學(xué)院與健康政策與管理學(xué)院，丁伯根研究所），Tom Van Ourti（荷蘭鹿特丹伊拉斯姆斯大學(xué)健康政策與管理學(xué)院、經(jīng)濟(jì)學(xué)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.

我們估算了健康的福利權(quán)重，以便在項(xiàng)目評估中能夠體現(xiàn)出人們對健康不平等以及由三種非健康特征引起的健康不公平的厭惡。在英國的一項(xiàng)面向普通人群的樣本中，569名在線實(shí)驗(yàn)參與者對受限資源進(jìn)行分配，以決定一組虛擬個(gè)體的健康水平，這些個(gè)體依據(jù)隨機(jī)生成的資源生產(chǎn)力、性別、收入和是否吸煙進(jìn)行區(qū)分（總計(jì)41,460個(gè)觀測值）。我們調(diào)查了參與者關(guān)于收入和吸煙責(zé)任歸屬的信念，并利用這些信念與資源分配之間的關(guān)聯(lián)，估算出與責(zé)任敏感性相關(guān)的健康福利權(quán)重。我們發(fā)現(xiàn)，參與者對女性健康的優(yōu)先考慮較弱，對貧困個(gè)體健康的優(yōu)先考慮適中，而對非吸煙者的健康則有顯著優(yōu)先于吸煙者的傾向。對健康不平等的強(qiáng)烈厭惡會降低對女性和非吸煙者（即健康上處于優(yōu)勢地位群體）的權(quán)重，同時(shí)提高對貧困者（健康劣勢群體）的權(quán)重。隨著人們對收入和吸煙責(zé)任歸屬的信念增強(qiáng)，對貧困者的權(quán)重下降，而對非吸煙者的權(quán)重顯著上升。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000530

Back to school: The effect of school visits during COVID-19 on COVID-19 outcomes

重返校園：新冠疫情期間返校對疫情結(jié)果的影響

作者

Dena Bravata（美國斯坦福大學(xué)初級保健與結(jié)果研究中心），Jonathan Cantor（美國加州圣塔莫尼卡蘭德公司），Neeraj Sood（美國南加州大學(xué)；美國國家經(jīng)濟(jì)研究局），Christopher Whaley（美國布朗大學(xué)，羅德島州普羅維登斯市）

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.

即便在全國公共衛(wèi)生緊急狀態(tài)結(jié)束后，學(xué)校關(guān)閉對新冠病毒傳播的影響仍不明確。我們使用了來自1.3億個(gè)家庭每周觀察的醫(yī)療索賠數(shù)據(jù)，并將其與智能手機(jī)移動數(shù)據(jù)相結(jié)合，以衡量縣一級返校變化對新冠疫情結(jié)果的影響。我們采用三重差分（triple-differences）方法，利用同一縣內(nèi)有學(xué)齡兒童家庭與無學(xué)齡兒童家庭之間的暴露差異進(jìn)行識別，發(fā)現(xiàn)返校對疫情的影響相對溫和。我們觀察到新冠感染率有所上升，且這一上升在低收入縣和新冠患病率較高的縣中更為明顯。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629625000608

Attentional processes underlying health state valuation with time trade-off and standard gamble tasks

健康狀態(tài)評估中的注意力機(jī)制：基于時(shí)間權(quán)衡與標(biāo)準(zhǔn)賭博任務(wù)的實(shí)驗(yàn)研究

作者

Stefan A. Lipman（荷蘭鹿特丹伊拉斯謨大學(xué)健康政策與管理學(xué)院、健康經(jīng)濟(jì)研究中心）， Thorsten Pachur（德國慕尼黑工業(yè)大學(xué)；德國柏林馬克斯·普朗克人類發(fā)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.

“時(shí)間權(quán)衡”（TTO）與“標(biāo)準(zhǔn)賭博”（SG）任務(wù)是評估健康狀態(tài)效用（例如糖尿病、坐輪椅）中常用的方法。然而，重要的是，這兩種方法通常會對同一健康狀態(tài)產(chǎn)生不同的效用評估結(jié)果。本文通過分析個(gè)體在TTO與SG任務(wù)中評估健康狀態(tài)時(shí)的注意力模式，探究導(dǎo)致這一效用差異的認(rèn)知過程。在一項(xiàng)在線實(shí)驗(yàn)中，每位受訪者都完成了TTO和SG兩種任務(wù)，我們采用過程追蹤方法“Mouselab”記錄他們在任務(wù)屬性上的注意力分配：包括健康狀態(tài)和持續(xù)時(shí)間（適用于TTO與SG），以及概率（僅適用于SG）。結(jié)果顯示，在TTO任務(wù)中，受訪者在健康狀態(tài)與持續(xù)時(shí)間兩個(gè)屬性之間的注意力分配較為均衡，而在SG任務(wù)中，注意力更集中于概率和健康狀態(tài)屬性上。那些在任務(wù)中特別關(guān)注權(quán)衡屬性（即TTO中的持續(xù)時(shí)間和SG中的概率）的人，更不愿意進(jìn)行權(quán)衡，從而對健康狀態(tài)給出了更高的效用評分。值得注意的是，效用差異與個(gè)體注意力分配的差異密切相關(guān)：那些在不同任務(wù)中較少調(diào)整注意力分配的受訪者，TTO與SG任務(wù)中產(chǎn)生的效用差異更大。研究結(jié)果強(qiáng)調(diào)了注意力過程在偏好建構(gòu)中的核心作用，表明人們對健康狀態(tài)賦予的效用差異，可能受到注意力分配方式的影響。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S016762962500061X

Absence from work and lifetime smoking behavior: Evidence from European maternal leave policies

工作中斷與終身吸煙行為：來自歐洲產(chǎn)假政策的證據(jù)

作者

Anna-Theresa Renner（奧地利維也納工業(yè)大學(xué)財(cái)政與基礎(chǔ)設(shè)施政策系），Mujaheed Shaikh（德國柏林赫蒂學(xué)院），Sonja Spitzer（奧地利維也納大學(xué)，維特根斯坦人口與人力資本中心）

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.

本文提供了關(guān)于與育兒相關(guān)的職業(yè)中斷如何影響長期健康行為的新證據(jù)，研究了在14個(gè)歐洲國家中，產(chǎn)假時(shí)長對吸煙習(xí)慣的影響。我們將1960年至2010年的產(chǎn)假和育兒假政策數(shù)據(jù)與關(guān)于母親健康行為、出生與就業(yè)歷史的調(diào)查數(shù)據(jù)相結(jié)合，利用各國及國內(nèi)政策變動，構(gòu)建工具變量框架，識別由于生育引起的工作中斷對終身吸煙行為的影響。我們發(fā)現(xiàn)，產(chǎn)假每延長一個(gè)月，會使母親在其后人生階段吸煙的概率提高1.2個(gè)百分點(diǎn)。此外，與孩子相關(guān)的每一個(gè)月的工作中斷，會將終身吸煙總時(shí)長延長7個(gè)月，每天多吸0.2支煙，累計(jì)煙齡增加0.6包年。我們還記錄到了這種影響的可能非線性趨勢：較短的產(chǎn)假可能具有保護(hù)作用，而過長的工作中斷則可能誘發(fā)不良健康行為。異質(zhì)性分析表明，這一影響主要是由于伴侶在生育期間缺乏財(cái)務(wù)支持所致，而就業(yè)狀況及其他社會人口學(xué)特征并未起到顯著作用。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000396

Heterogeneous peer effects and gender-based interventions for teenage obesity

青少年肥胖中的異質(zhì)性同伴效應(yīng)與性別定制干預(yù)

作者

Margherita Comola（法國巴黎薩克雷大學(xué)；巴黎經(jīng)濟(jì)學(xué)院），Rokhaya Dieye（加拿大德勤；拉瓦爾大學(xué)經(jīng)濟(jì)系），Bernard Fortin（加拿大拉瓦爾大學(xué)經(jīng)濟(jì)系、風(fēng)險(xiǎn)、經(jīng)濟(jì)問題與公共政策研究中心；跨大學(xué)組織分析研究中心）

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.

本文探討了性別異質(zhì)性在青少年肥胖的社會傳播中的作用及其政策含義。我們提出了一個(gè)允許同伴效應(yīng)存在性別依賴異質(zhì)性的社會互動模型。我們的實(shí)證方法與非合作模型的最佳反應(yīng)函數(shù)一致，在該模型中，社會互動源于純粹外溢效應(yīng)或純粹從眾效應(yīng)。我們利用青少年的身體質(zhì)量指數(shù)（BMI）和基于網(wǎng)絡(luò)的互動數(shù)據(jù)來估計(jì)該模型。該方法能夠控制網(wǎng)絡(luò)內(nèi)生性問題。研究結(jié)果表明，同伴效應(yīng)依賴于性別，且男性學(xué)生對女性朋友的體重反應(yīng)尤為明顯。根據(jù)模擬結(jié)果，在最保守的情境下，針對女性開展干預(yù)措施可以使整體BMI降低的效果提高8%。因此，與性別中立的方法相比，針對女性定制的干預(yù)策略在學(xué)校肥胖防控中可能更為有效。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S016762962500058X

The effect of e-cigarette flavor bans on tobacco use

電子煙風(fēng)味禁令對煙草使用的影響

作者

Chad Cotti（美國密歇根州立大學(xué)農(nóng)業(yè)、食品與資源經(jīng)濟(jì)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.

關(guān)于電子煙風(fēng)味銷售限制的支持者認(rèn)為，風(fēng)味吸引年輕人，從而導(dǎo)致其走向尼古丁成癮之路。本文利用多個(gè)調(diào)查數(shù)據(jù)（包括青少年風(fēng)險(xiǎn)行為調(diào)查、行為風(fēng)險(xiǎn)因素監(jiān)測系統(tǒng)調(diào)查、煙草與健康狀況評估）進(jìn)行分析，是首批系統(tǒng)評估州和地方政府對風(fēng)味電子尼古丁傳輸系統(tǒng)（ENDS）產(chǎn)品銷售限制政策對青少年和青年煙草使用行為影響的研究之一。研究發(fā)現(xiàn)，實(shí)施風(fēng)味電子煙銷售限制后，青少年中高頻或每日ENDS使用率在短期內(nèi)下降了約2至3個(gè)百分點(diǎn)。不過，也有證據(jù)表明，這種影響在兩年后可能有所減弱。相反，18-30歲青年群體的ENDS使用下降趨勢在兩年后則更為顯著。此外，研究還發(fā)現(xiàn)部分年齡群體出現(xiàn)了從風(fēng)味電子煙轉(zhuǎn)向無風(fēng)味電子煙或傳統(tǒng)卷煙的替代行為。

原文鏈接：https://www.sciencedirect.com/science/article/abs/pii/S0167629625000487

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