期刊Journal of Health Economics 2025年102卷目錄及摘要｜保險(xiǎn)學(xué)術(shù)前沿

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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(píng)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)：

●寬帶互聯(lián)網(wǎng)接入使年輕群體（1985年至1995年出生）的精神障礙患病率提高了0.08個(gè)標(biāo)準(zhǔn)差單位，但對(duì)年長(zhǎng)個(gè)體（1974年至1984年出生）沒有影響。這種負(fù)面影響主要出現(xiàn)在生命早期（20歲之前）接觸互聯(lián)網(wǎng)的群體中。

●關(guān)聯(lián)尋求行為偏好與生活質(zhì)量?jī)?yōu)于財(cái)富的相對(duì)偏好，共同解釋了長(zhǎng)期護(hù)理保險(xiǎn)參保率偏低的現(xiàn)象。

●美國(guó)勞動(dòng)所得稅抵免（EITC）政策總體上促進(jìn)了代際健康流動(dòng)性的提升，特別是向上的健康流動(dòng)性。

●療養(yǎng)院工資補(bǔ)貼使人員配置水平較補(bǔ)貼前均值提升約7.4%，而醫(yī)療補(bǔ)助參保者在新入住人群中的占比較補(bǔ)貼前基準(zhǔn)下降11.5%。此外，補(bǔ)貼還加劇了療養(yǎng)院住客流動(dòng)率，并降低了新入住者的平均照護(hù)需求。

●住房資產(chǎn)并未對(duì)自付醫(yī)療支出產(chǎn)生實(shí)質(zhì)性影響。反映了部分房主無(wú)需動(dòng)用住房資產(chǎn)支付額外醫(yī)療費(fèi)用，也折射出部分群體不愿或無(wú)法動(dòng)用房產(chǎn)凈值的事實(shí)。

●在健康狀況可觀測(cè)的理想情境下，最優(yōu)保險(xiǎn)提供與醫(yī)療支出無(wú)關(guān)的一次性賠付。但當(dāng)疾病嚴(yán)重程度不可觀測(cè)時(shí)（引發(fā)事后道德風(fēng)險(xiǎn)），最優(yōu)保險(xiǎn)設(shè)計(jì)需使賠付金額隨預(yù)防性和治療性支出同步遞增，因?yàn)楦咧С黾饶軠p少信息租金，又能實(shí)現(xiàn)激勵(lì)相容。

●壽命延長(zhǎng)會(huì)促使人們?cè)黾咏逃度耄湫偷褪杖雵?guó)家的"期限三角形"收益實(shí)際上不足終身收入的百分之一。

※ 本期目錄

●Lost in the net? Broadband internet and youth mental health

●Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth

●The effects of earned income tax credits on intergenerational health mobility in the United States

●Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees

●The effect of housing wealth on health care spending

●Nonlinear reimbursement rules for preventive and curative medical care

●Longevity, Education, and Income: How large is the triangle?

Lost in the net? Broadband internet and youth mental health

迷失于網(wǎng)絡(luò)？寬帶互聯(lián)網(wǎng)與青少年心理健康

作者

Dante Donati（哥倫比亞商學(xué)院），Ruben Durante（新加坡國(guó)立大學(xué)），F(xiàn)rancesco Sobbrio（意大利羅馬第二大學(xué)），Dijana Zejcirovic（澳大利亞維也納大學(xué)）

摘要：How does the internet affect young people’s mental health? We study this question using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we combine with broadband internet availability at the municipal level. Broadband internet access raises the prevalence of mental disorders among younger cohorts (born between 1985 and 1995) by 0.08 standard deviation units, but it does not impact older individuals (1974 and 1984). The adverse effects are driven by individuals who were exposed early in their lives (before the age of 20). These effects persist when examining instances of self-harm and urgent or compulsory hospitalizations, indicating that the negative outcomes are not merely a result of increased awareness and detection of these conditions. The detrimental impacts span across different pathologies, including depression, anxiety, drug abuse, and personality disorders for both genders, in addition to eating disorders for females.

互聯(lián)網(wǎng)如何影響年輕人的心理健康？我們利用2001年至2013年間意大利醫(yī)院診斷的所有精神障礙病例的行政數(shù)據(jù)，并結(jié)合城市層級(jí)的寬帶互聯(lián)網(wǎng)覆蓋情況，對(duì)這一問題展開研究。寬帶互聯(lián)網(wǎng)接入使年輕群體（1985年至1995年出生）的精神障礙患病率提高了0.08個(gè)標(biāo)準(zhǔn)差單位，但對(duì)年長(zhǎng)個(gè)體（1974年至1984年出生）沒有影響。這種負(fù)面影響主要出現(xiàn)在生命早期（20歲之前）接觸互聯(lián)網(wǎng)的群體中。通過分析自殘行為及緊急/強(qiáng)制住院案例，我們發(fā)現(xiàn)這些影響持續(xù)存在，表明負(fù)面結(jié)果并非僅僅源于對(duì)精神健康問題認(rèn)知和篩查率的提高。這些危害性影響涵蓋不同類型的精神疾病，包括兩性均會(huì)出現(xiàn)的抑郁癥、焦慮癥、藥物濫用和人格障礙，以及女性特有的飲食失調(diào)。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000529

Explaining the long-term care insurance puzzle: The role of preferences for correlation and for quality of life over wealth

解釋長(zhǎng)期護(hù)理保險(xiǎn)之謎：相關(guān)性生活質(zhì)量偏好與優(yōu)于財(cái)富的作用

作者

David Crainich（法國(guó)IESEG高等商學(xué)院），Léontine Goldzahl（法國(guó)IESEG高等商學(xué)院），F(xiàn)lorence Jusot（巴黎第九大學(xué)），Doriane Mignon（曼徹斯特大學(xué)）

摘要：The paper investigates the role of two demand-side determinants of long-term care insurance: correlation preference and relative preference for quality of life over wealth. We model the effect of those preferences on the joint decision to buy long-term care and long-term care insurance contract. We test the model using data from a laboratory experiment in France. While the experimental results offer only partial support for the theoretical predictions—specifically, correlation aversion does not account for over-insurance, our analysis provides evidence that correlation seeking and the relative preference for quality of life over wealth explain the limited uptake of long-term care insurance.

本文探究長(zhǎng)期護(hù)理保險(xiǎn)的兩大需求側(cè)決定因素：關(guān)聯(lián)性偏好與生活質(zhì)量?jī)?yōu)于財(cái)富的相對(duì)偏好。我們建立了這些偏好對(duì)購(gòu)買長(zhǎng)期護(hù)理服務(wù)及長(zhǎng)期護(hù)理保險(xiǎn)合約聯(lián)合決策的影響模型，并采用法國(guó)實(shí)驗(yàn)室實(shí)驗(yàn)數(shù)據(jù)對(duì)模型進(jìn)行驗(yàn)證。雖然實(shí)驗(yàn)結(jié)果僅部分支持理論預(yù)測(cè)——特別是關(guān)聯(lián)厭惡無(wú)法解釋過度投保現(xiàn)象，但我們的分析證實(shí)：關(guān)聯(lián)尋求行為及生活質(zhì)量?jī)?yōu)于財(cái)富的相對(duì)偏好，共同解釋了長(zhǎng)期護(hù)理保險(xiǎn)參保率偏低的現(xiàn)象。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000657

The effects of earned income tax credits on intergenerational health mobility in the United States

美國(guó)勞動(dòng)所得稅抵免政策對(duì)代際健康流動(dòng)性的影響

作者

Katie Jajtner（?威斯康星大學(xué)麥迪遜分校），Yang Wang（?威斯康星大學(xué)麥迪遜分校）

摘要：Intergenerational health mobility is an important marker of health opportunity and equity, yet empirical research in this field remains sparse, particularly concerning the effects of public policies. We present the first empirical evidence of the effects of the Earned Income Tax Credits (EITC), one of the largest and most effective anti-poverty programs in the US, on intergenerational health mobility. We use self-reported health status from the Panel Study of Income Dynamics and explore temporal, geographic, and family structure variations in childhood exposure to maximum EITC benefits. We find that the EITC generally improved intergenerational health mobility, especially upward health mobility.

代際健康流動(dòng)性是衡量健康機(jī)會(huì)與公平性的重要指標(biāo)，然而該領(lǐng)域的實(shí)證研究仍較為匱乏，尤其在公共政策影響方面。我們首次通過實(shí)證研究揭示了美國(guó)最大且最有效的反貧困計(jì)劃——?jiǎng)趧?dòng)所得稅抵免（EITC）對(duì)代際健康流動(dòng)性的影響。基于收入動(dòng)態(tài)追蹤調(diào)查中的自評(píng)健康狀況數(shù)據(jù)，我們深入分析了童年時(shí)期接觸最高EITC福利待遇在時(shí)間、地域和家庭結(jié)構(gòu)維度上的差異。研究發(fā)現(xiàn)，EITC總體上促進(jìn)了代際健康流動(dòng)性的提升，特別是向上的健康流動(dòng)性。

【注釋】：EITC，是美國(guó)聯(lián)邦政府為中低收入的工作者，尤其是有子女的家庭提供的一項(xiàng)可退還的稅收抵免政策。最大的特點(diǎn)是如果個(gè)人的EITC金額大于應(yīng)交的聯(lián)邦所得稅，政府會(huì)將差額以現(xiàn)金形式全額退還給個(gè)人。這意味著，即使個(gè)人的收入低到完全不需要繳納所得稅，仍然可以從政府獲得一筆退稅。公認(rèn)為美國(guó)最有效的反貧困計(jì)劃之一，每年為數(shù)千萬(wàn)家庭提供超過600億美元的補(bǔ)貼。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000839

Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees

療養(yǎng)院工資補(bǔ)貼與醫(yī)療補(bǔ)助參保者的護(hù)理人員配置及服務(wù)可及性之間的權(quán)衡

作者

Thomas A. Hegland（美國(guó)衛(wèi)生保健研究與質(zhì)量管理處）

摘要：Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.

工資補(bǔ)貼是提升療養(yǎng)院人員配置水平的有效工具。然而，若補(bǔ)貼促使療養(yǎng)院轉(zhuǎn)而吸引更多自費(fèi)客戶（非醫(yī)療補(bǔ)助參保者），則推動(dòng)人員配置增加可能以犧牲醫(yī)療補(bǔ)助參保者的照護(hù)可及性為代價(jià)。本研究通過分析1998至2010年間各州醫(yī)療補(bǔ)助計(jì)劃推出的工資補(bǔ)貼政策，利用不同療養(yǎng)院補(bǔ)貼額度的差異性評(píng)估政策效果。數(shù)據(jù)顯示：每增加1美元（2010年不變價(jià)）/人日的補(bǔ)貼，可使每日人均照護(hù)時(shí)長(zhǎng)增加逾10分鐘，但同時(shí)導(dǎo)致新入住者中醫(yī)療補(bǔ)助參保比例下降約1.8個(gè)百分點(diǎn)。整體平均處理效應(yīng)顯示，補(bǔ)貼使人員配置水平較補(bǔ)貼前均值提升約7.4%，而醫(yī)療補(bǔ)助參保者在新入住人群中的占比較補(bǔ)貼前基準(zhǔn)下降11.5%。此外，補(bǔ)貼還加劇了療養(yǎng)院住客流動(dòng)率，并降低了新入住者的平均照護(hù)需求。總體而言，研究結(jié)果表明：盡管工資補(bǔ)貼能有效激勵(lì)療養(yǎng)院增配人員，但亦可能引致入住群體構(gòu)成與特征的系統(tǒng)性改變。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000773

The effect of housing wealth on health care spending

住房財(cái)富對(duì)醫(yī)療支出的影響

作者

Michael F. Lovenheim（康奈爾大學(xué)），Jun Hyun Yun（韓國(guó)勞動(dòng)研究院協(xié)調(diào)辦公室）

摘要：The U.S. healthcare system requires substantial out-of-pocket payments by most consumers, which can prevent some from receiving needed medical services. At the same time, housing wealth comprises a significant proportion of household wealth that could be used to pay for medical care. We analyze the effects of housing wealth on out-of-pocket medical expenditures among older homeowners. Using data from the Health and Retirement Study and various measures of home price changes, we find no evidence that housing wealth impacts out-of-pocket medical spending. The estimates are universally small and precise, allowing us to rule out even modest-sized effects. Effects are zero across the expenditure distribution, for specific categories of expenditure, and for different types of homeowners split by health insurance status and SES. We present suggestive evidence that our results represent a mix of homeowners not needing to access their housing wealth for additional medical care and being unwilling or unable to access their home equity.

美國(guó)醫(yī)療體系要求大多數(shù)消費(fèi)者承擔(dān)高額的自付費(fèi)用，這可能導(dǎo)致部分人群無(wú)法獲得必要的醫(yī)療服務(wù)。與此同時(shí)，住房資產(chǎn)作為家庭財(cái)富的重要組成部分，理論上可用于支付醫(yī)療費(fèi)用。我們通過分析健康與退休研究數(shù)據(jù)，結(jié)合多種房?jī)r(jià)波動(dòng)測(cè)量指標(biāo)，考察了住房資產(chǎn)對(duì)老年房主自付醫(yī)療費(fèi)用的影響。研究發(fā)現(xiàn)：住房資產(chǎn)并未對(duì)自付醫(yī)療支出產(chǎn)生實(shí)質(zhì)性影響。所有估計(jì)值均呈現(xiàn)微小而精確的特征，足以排除任何中等程度影響的存在。這種零效應(yīng)普遍存在于支出分布的各個(gè)區(qū)間、不同支出類別，以及按醫(yī)療保險(xiǎn)狀況和社會(huì)經(jīng)濟(jì)地位劃分的各類房主群體中。初步證據(jù)表明，該結(jié)果既反映了部分房主無(wú)需動(dòng)用住房資產(chǎn)支付額外醫(yī)療費(fèi)用，也折射出部分群體不愿或無(wú)法動(dòng)用房產(chǎn)凈值的事實(shí)。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000542

Nonlinear reimbursement rules for preventive and curative medical care

預(yù)防性與治療性醫(yī)療服務(wù)的非線性報(bào)銷規(guī)則

作者

Helmuth Cremer（法國(guó)圖盧茲城公立大學(xué)），Jean-Marie Lozachmeur（法國(guó)國(guó)家科研中心）

摘要：This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforehand, while curative care is decided after health status is known.

In an ideal scenario where health status is observable, optimal insurance provides lump-sum payments unrelated to expenditures. However, when severity is unobservable (causing ex post moral hazard), this approach is not incentive-compatible. Instead, optimal insurance designs benefits that increase with both preventive and curative care, as higher expenditures reduce informational rents and align incentives.

Preventive care, though chosen before illness occurs, affects incentive constraints due to two factors: (1) it is more effective for severely ill individuals, and (2) they have lower marginal utility of income, meaning preventive expenditures impact them less. These effects shape the optimal reimbursement structure.

Additionally, when individuals misperceive preventive care benefits, the main results hold, but an extra corrective (Pigouvian) term appears in the reimbursement formula to adjust for this misperception.

本研究探討二級(jí)預(yù)防性與治療性醫(yī)療服務(wù)的非線性報(bào)銷規(guī)則。個(gè)體可能處于健康或患病狀態(tài)，疾病嚴(yán)重程度決定其事后類型。預(yù)防性服務(wù)在事前選擇，而治療性服務(wù)在健康狀況明確后決定。在健康狀況可觀測(cè)的理想情境下，最優(yōu)保險(xiǎn)提供與醫(yī)療支出無(wú)關(guān)的一次性賠付。但當(dāng)疾病嚴(yán)重程度不可觀測(cè)時(shí)（引發(fā)事后道德風(fēng)險(xiǎn)），該方案缺乏激勵(lì)相容性。此時(shí)最優(yōu)保險(xiǎn)設(shè)計(jì)需使賠付金額隨預(yù)防性和治療性支出同步遞增，因?yàn)楦咧С黾饶軠p少信息租金，又能實(shí)現(xiàn)激勵(lì)相容。盡管預(yù)防性服務(wù)在患病前選擇，但其通過雙重機(jī)制影響激勵(lì)約束：（1）對(duì)重癥患者更具成效；（2）重癥患者收入邊際效用較低，預(yù)防性支出對(duì)其影響較小。這兩種效應(yīng)共同塑造了最優(yōu)報(bào)銷結(jié)構(gòu)。此外，當(dāng)個(gè)體低估預(yù)防性服務(wù)收益時(shí)，主要結(jié)論依然成立，但報(bào)銷公式中需加入矯正性項(xiàng)以修正認(rèn)知偏差。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000840

Longevity, Education, and Income: How large is the triangle?

長(zhǎng)壽、教育與收入：這個(gè)三角關(guān)系有多宏大

作者

Hoyt Bleakle（密歇根大學(xué)）

摘要：While health affects economic development and wellbeing through a variety of pathways, one commonly suggested channel is a “horizon” mechanism in which increased longevity induces additional education. A recent literature devotes much attention to how much education responds to increasing longevity, while this study asks instead what impact this specific channel has on wellbeing (welfare). I note that death is like a tax on human-capital investments, which suggests using a standard tool of introductory economics: triangles. I estimate the (triangular) gain from reoptimization when education adjusts to lower adult mortality. Even for implausibly large responses of education to survival differences, almost all of today’s low-human-development countries, if switched instantaneously to Japan’s survival curve, would place a value on this channel of less than 3% of income. (This contrasts with a 40% ‘rectangle’ that they would gain even if education were held fixed.) Calibrating the model instead with well identified studies, I find that the horizon triangle for the typical low-income country is less than a percent of lifetime income.

盡管健康通過多種途徑影響經(jīng)濟(jì)發(fā)展與福祉，一個(gè)常被提及的作用渠道是"期限"機(jī)制——即壽命延長(zhǎng)會(huì)促使人們?cè)黾咏逃度搿，F(xiàn)有文獻(xiàn)多聚焦于教育對(duì)壽命延長(zhǎng)的反應(yīng)程度，而本研究則探討這一特定渠道對(duì)福祉（福利）的實(shí)際影響。筆者認(rèn)為死亡如同對(duì)人力資本投資征稅，這啟示我們可以運(yùn)用基礎(chǔ)經(jīng)濟(jì)學(xué)中的標(biāo)準(zhǔn)分析工具：三角形。通過估算當(dāng)教育因成人死亡率下降而重新優(yōu)化時(shí)產(chǎn)生的（三角形）收益，研究發(fā)現(xiàn)：即便教育對(duì)生存率差異的反應(yīng)程度達(dá)到極高水平，幾乎所有當(dāng)今低人力資本發(fā)展國(guó)家若立即切換至日本的生存曲線，由此渠道產(chǎn)生的價(jià)值評(píng)估仍低于其收入的3%（這與教育保持不變時(shí)仍能獲得40%的"矩形"收益形成鮮明對(duì)比）。進(jìn)一步采用經(jīng)嚴(yán)謹(jǐn)論證的研究數(shù)據(jù)對(duì)模型進(jìn)行校準(zhǔn)后，發(fā)現(xiàn)典型低收入國(guó)家的"期限三角形"收益實(shí)際上不足終身收入的百分之一。

原文鏈接：https://www.sciencedirect.com/science/article/pii/S0167629625000876

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