Pandemic Depression: COVID-19 and the Mental Health of the Self-Employed

We investigate the effect of the COVID-19 pandemic on self-employed people’s mental health. Using representative longitudinal survey data from Germany, we reveal differential effects by gender: whereas self-employed women experienced a substantial deterioration in their mental health, self-employed men displayed no significant changes up to early 2021. Financial losses are important in explaining these differences. In addition, we find larger mental health responses among self-employed women who were directly affected by government-imposed restrictions and bore an increased childcare burden due to school and daycare closures. We also find that self-employed individuals who are more resilient coped better with the crisis.

An analysis of COVID-19 and WHO global research roadmap: knowledge mapping and future research agenda

In this study, we review the publications on the COVID-19 pandemic indexed in the Scopus database from 1st January to 15th October 2020, using bibliometric analysis. In essence, we evaluate the publications against the global research roadmap outlined by the World Health Organization (WHO). We find that academic publications are contributed by researchers worldwide, with the USA and China being the top contributors in several parameters. We show that most publications are clustered around the issues related to the outbreak, diagnosis, candidate medicine, and disease treatment by analyzing publication keywords. Besides, considerable importance is given to unravel the connection between the present viral disease with its previous strains and the anxiety and stress-related problems that arise from the COVID-19. We further visualize the knowledge structure of the publication with thematic mapping and illustrate that mental health-related research denotes a specialized research theme besides public health issues being the basic theme. Our findings aid to comprehend how the scholarly publications have developed to address the prioritized research agendas by the WHO. Thus, our study can guide researchers to explore the less studied areas. Consequently, it will assist policymakers and governments in developing integrated and effective policies to fight the pandemic.

A Macroeconomic Model of Healthcare Saturation, Inequality and the Output–Pandemia Trade-off

COVID-19 became a global health emergency because it threatened the collapse of health systems as demand for health goods and services and their relative prices surged. Governments responded with lockdowns and transfers. Empirical evidence shows that lockdowns and healthcare saturation contribute to explain the cross-country variation in GDP drops even after controlling for COVID-19 cases and mortality. We explain this output–pandemia trade-off as resulting from a shock to subsistence health demand that increases with capital utilization and economic activity in a model with entrepreneurs and workers. The health system saturates as the gap between supply and subsistence narrows, which worsens consumption and income inequality. An externality distorts utilization, because firms do not internalize that lower utilization reduces healthcare saturation. Lockdowns and transfers to workers are the optimal policy response. Quantitatively, strict lockdowns and large transfers yield sizable welfare gains because they neutralize the utilization externality and prevent a sharp rise in inequality. Welfare and output costs vary in response to small parameter changes or deviations from optimal policies. Weak lockdowns coupled with weak transfers programs are the worst alternative and yet are in line with what several emerging and least developed countries implemented.

A joint Bayesian spatiotemporal risk prediction model of COVID-19 incidence, IC admission, and death with application to Sweden

The three closely related COVID-19 outcomes of incidence, intensive care (IC) admission and death, are commonly modelled separately leading to biased estimation of the parameters and relatively poor forecasts. This paper presents a joint spatiotemporal model of the three outcomes based on weekly data that is used for risk prediction and identification of hotspots. The paper applies a pure spatiotemporal model consisting of structured and unstructured spatial and temporal effects and their interaction capturing the effects of the unobserved covariates. The pure spatiotemporal model limits the data requirements to the three outcomes and the population at risk per spatiotemporal unit. The empirical study for the 21 Swedish regions for the period 1 January 2020-4 May 2021 confirms that the joint model predictions outperform the separate model predictions. The fifteen-week-ahead spatiotemporal forecasts (5 May-11 August 2021) show a significant decline in the relative risk of COVID-19 incidence, IC admission, death and number of hotspots.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00168-022-01191-1.

The economic damage of COVID-19 on regional economies: an application of a spatial computable general equilibrium model to South Korea

We developed a spatial computable general equilibrium model of South Korea to assess the spatial spillover effects of the COVID-19 pandemic on South Korea's regional economic growth patterns. The model measures a wide range of economic losses, including human health costs at the city and county level, through an analysis of regional producers' profit maximization on the supply side and regional households' utility maximization on the demand side. The model's findings showed that if the level of spatial interaction decreases by 10% as a result of social distancing policies, the national gross domestic product drops by 0.815-0.864%. This loss in economic growth can be further decomposed into 0.729% loss in agglomeration effect, 0.080-0.130% loss in health effect associated with medical treatment and premature mortality, and 0.005% loss in labor effect. The results of the models and simulations shed light on not only the epidemiological effects of social distancing interventions, but also their resultant economic consequences. This ex-ante evaluation of social distancing measures' effects can serve as a guide for future policy decisions made at both the national and regional level, providing policymakers with the tools for tailored solutions that address both regional economic circumstances and the spatial distribution of COVID-19 cases.

Similarities and Differences in Health Technology Assessment Systems and Implications for Coverage Decisions: Evidence from 32 Countries

Health technology assessment (HTA) systems across countries vary in the way they are set up, according to their role and based on how funding decisions are reached. Our objective was to study the characteristics of these systems and their likely impact on the funding of technologies undergoing HTA. Based on a literature review, we created a conceptual framework that captures key operating features of HTA systems. We used this framework to map current HTA activities across 32 countries in the European Union, the UK, Canada and Australia. Evidence was collected through a systematic search of competent authority websites and grey literature sources. Primary data collection through expert consultation validated our findings and further complemented the analysis. Sixty-three HTA bodies were identified. Most have a national scope (76%), are independent (73%), have an advisory role (52%), evaluate pharmaceuticals predominantly or exclusively (76%), assess health technologies based on their clinical and cost-effectiveness (73%) and involve various stakeholders as members of the HTA committee (94%) and/or through external consultation (76%). The majority of HTA outcomes are not legally binding (81%). Although all study countries implement HTA, the way it fits into decision-making, negotiation processes, and coverage and funding decisions differs significantly across countries. HTA is a dynamic and transformative process and there is a need for transparency to investigate whether evidence-based information influences coverage decisions.

The Effects of School Closures on COVID-19: A Cross-Country Panel Analysis

BACKGROUND

There has been much debate about the effects and importance of closing, keeping closed, or not opening schools in order to prevent COVID-19 contagion. This policy has been questioned regarding both its efficacy and the social cost it entails, including the possible asymmetric impact it has on genders in many societies due to traditional childcare roles. To the best of our knowledge no existing contribution has attempted to gauge the effectiveness of such a policy over time, in a longitudinal cross-country perspective.

OBJECTIVES

This paper aimed to fill the gap in the literature by assessing, at a European level, the effect of school closures (or the lack of such measures) on the numbers of new COVID-19 infections, in the absence of vaccines. Given this policy's expected change in effectiveness over time, we also measured the effectiveness of having schools closed after a given number of days (from 7 to 100).

METHODS

We pursued our objectives by means of a quantitative panel analysis, building a longitudinal dataset with observations from countries in Europe, from 1 January to 30 September, and estimating the impact of school closure via feasible-generalised least-squares fixed effect and random effect estimators, and analysis of variance (ANOVA) mixed models.

RESULTS

Our results show that having schools closed is effective in reducing the number of new cases. Countries that implement closure have fewer new COVID-19 cases than those that do not. This becomes a reality around 20 days after the implementation of the policy. Its efficacy continues to be detectable up to 100 days after implementation. The result is robust to controls for other forms of social distancing.

CONCLUSION

Results suggest that school closure is effective in reducing the number of people who are infected with COVID-19. Unlike what has been suggested in previous analyses or with regard to other diseases, its efficacy continues to be detectable up to 100 days after the introduction of the policy.

[Vaccinated, Recovered and Tested in the Workplace: Situation in Firms in Lower Saxony at the End of 2021]

The amendment of the Infection Protection Act at the end of November 2021 made it possible to map vaccinated, recovered and tested employees at the firm-level for the first time after the start of vaccinations in Germany. The Employers' Associations of Lower Saxony (UVN), IHK Hannover, creditreform and the Institute for Economic Policy at Leibniz University Hanover conducted a short online survey on the vaccination and recovery status, the number of antigen rapid tests as well as the proportion of employees working from home. The results provide important indications about the general risk in everyday professional life, as well as the associated organisational effort in firms.

Will the economic growth benefit public health? Health vulnerability, urbanization and COVID-19 in the USA

Economic growth has a significant impact on health vulnerability primarily through the process of urbanization. This paper conducts a pioneer study by analyzing the impact of regional economic growth and urbanization on the public health vulnerability in the 51 states and territories of the USA from 2011 to 2018 with a fixed-effect panel data regression model. We construct an epidemiological vulnerability index (EVI) using regional smoking, diabetes, obesity, and hypertension, collect CDC social vulnerability index (SVI) as state-level public health vulnerability status, and use COVID-19 to test the actual effect of health vulnerability. The preliminary results show that higher regional economic growth is related to lower EVI and SVI, while urbanization is positively associated with regional health vulnerability and the severity of COVID-19 from case rate and death rate. Robustness check with unemployment shows the same result. We conclude that economic growth is related to lower public health vulnerability, and urbanization has negative public health benefits. Our finding indicates an urgent need to balance the externalities generated by economic development and urbanization trends on public health vulnerability by promoting reasonable medical resource distribution, health practices and safety, improving social and environmental justice, and other health management measures.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s00168-021-01103-9.

Is There a Trade‐Off between COVID‐19 Control and Economic Activity? Implications from the Phillips Curve Debate

In this paper, we argue that the roles of public policies concerning COVID‐19 can be better understood in light of the past discussions on the Great Inflation of the 1970s and the 1980s. Like the Phillips Curve in macroeconomics, the pandemic presents a trade‐off between economic activities and something undesirable, which is, in this case, infection. Like the Phillips Curve, this apparent output‐infection trade‐off is an elusive one and it is lost in the long run. Containing infections calls for decisive policy action. This paper shows that we could design a reaction function, which sets the level of economic activity as a function of the state of infection, in such a way that the possibility of an infection explosion would be eliminated. Our empirical analysis suggests that Tokyo, New York, and London since September 2020 do not satisfy this desirable property.

Covid-19 and Capital Flows: The Responses of Investors to the Responses of Governments

This paper examines the effect of national government response measures to Covid-19 on German international capital flows. Analyzing highly disaggregated monthly data from the German balance of payments statistics over the period from January 2019 through January 2021, we find that bilateral financial interactions are negatively affected by stricter containment and closure policies as well as health system policies of a partner country, while German capital flows benefit from a partner’s economic support policies. Moreover, to the extent that public interventions to fight the pandemic affect financial interactions, the adjustment mainly takes place along the intensive margin.

A New Dataset for Local and National COVID-19-Related Restrictions in Italy

This paper presents a novel dataset of non-pharmaceutical interventions adopted by Italian authorities to tackle the COVID-19 pandemic at the national and local levels. The dataset follows the structure of the Oxford Coronavirus Government Response Tracker (OxCGRT; Hale et al. in Nat Human Behav 5:529–538, 10.1038/s41562-021-01079-8, 2021)). We include several novelties with respect to the original source. First, we tailor the classification of provisions to the measures adopted in Italy. Second, we collect detailed information on local restrictions in the country, including lockdowns and school closures. Third, we apply a bottom-up approach to construct population-weighted average stringency indexes (Italian Stringency Indexes, ItSIs) at the provincial, regional, and country-wide levels. While expanding the geographical coverage of the stringency indicators, we preserve the comparability of the ItSIs with the original stringency index published in the OxCGRT. As an application, we show that the correlations of our ItSI with community mobility indicators and various measures of economic activity are higher than those obtained with the OxCGRT indicator.

Italian Workers at Risk During the COVID-19 Epidemic

We analyze the task-content of occupations operating in about 600 sectors of the economy with a focus on the dimensions that expose workers to contagion risks during the COVID-19 epidemic. We do so in the Italian context, leveraging extremely detailed and granular information from ICP, the Italian equivalent of O*Net (the survey that describes the task content of US occupations). We find that several sectors need physical proximity to operate, mainly in services and retail trade. Workers at risk of complications from COVID-19 (mainly males above the age of 50) are concentrated in sectors characterized by little physical proximity or where working from home is feasible. We then study the sectoral lockdowns put in place by the Italian Government in March 2020. We find that governmental restrictions hit the sectors where the risk of contagion in the workplace was more widespread: the effect is stronger for proximity to the public than that with co-workers. The share of workers who have the possibility to work from home is higher in sectors that were not forced to close. The evidence we provide is useful to identify which activities pose larger risks for contagion among workers in the workplace and where to reinforce safety measures.

Stock Prices and Economic Activity in the Time of Coronavirus

Stock prices and workplace mobility trace out striking clockwise paths in daily data from mid-February to late May 2020. Global stock prices fell 30% from 17 February to 12 March, before mobility declined. Over the next 11 days, stocks fell another 10 percentage points as mobility dropped 40%. From 23 March to 9 April, stocks recovered half their losses and mobility fell further. From 9 April to late May, both stocks and mobility rose modestly. This dynamic plays out across the 35 countries in our sample, with notable departures in China, South Korea and Taiwan. The size of the global stock market crash in reaction to the pandemic is many times larger than a standard asset-pricing model implies. Looking more closely at the world’s two largest economies, the pandemic had greater effects on stock market levels and volatilities in the USA than in China even before it became evident that early US containment efforts would flounder. Newspaper-based narrative evidence confirms the dominant—and historically unprecedented—role of pandemic-related developments in the stock market behavior of both countries.

Responses to COVID‐19 in Southeast Asia: Diverse Paths and Ongoing Challenges

Due to geographical proximity and trade links with China, Southeast Asian countries were among the first to be exposed to and affected by COVID‐19. However, despite shared challenges including protecting population health and economic security, policy responses by national governments have been varied and remain so a year into the pandemic. This article critically reviews Southeast Asian countries' approaches to COVID‐19 with reference to individual country experiences and Association of Southeast Asian Nations. We discuss key policy responses: leadership, public risk communications, health system preparedness and resilience, economic support and social protection, aid and global health diplomacy, digital technologies, and the region's multilateral response.

Sustainable Health Financing for COVID‐19 Preparedness and Response in Asia and the Pacific

To make health systems more resilient to shocks and crises, it is critical for governments to invest in core health system functions such as financing, service delivery, and governance. Ensuring sufficient resources for health is necessary for basic infrastructure including vaccines; the overall level of health expenditure and the public sources of funding are important. Funding for public health services, including infection prevention and control, surveillance, and information systems, is fundamental to ensure health systems are prepared for and respond to health emergencies. Funding should be made available for a quick and effective response to emergencies, requiring a supportive flexible public financial management system. Moreover, it is essential to mitigate the potential risks of health system collapses through innovative ways, for example, telemedicine, and mobilizing private sector providers. Vulnerable groups who are even more impacted during crises need special attention. Multisectoral cooperation is paramount to health system resilience during pandemic response.

Economic Impacts of SARS/MERS/COVID‐19 in Asian Countries

This paper surveys the recent literature on the economic impacts of SARS, MERS, and COVID‐19, which Asian countries have experienced in the past two decades. In particular, we provide a detailed summary of how each of the past infectious diseases has impacted on the Asian economies and the extent of that impact. This paper also documents how the governments of Asian countries have responded to the COVID‐19 shocks with their economic policies, and discusses the effectiveness of these economic policies to mitigate the COVID‐19 shocks on their economies.

[Digitalisation in Companies: The COVID-19 Pandemic as a Push Factor]

This article shows the extent to which companies' investments in digital technologies have increased during the COVID-19 pandemic. Based on a large German company survey conducted by the Institute for Employment Research, the authors examine whether and which companies have invested in different types of digital technologies, how these investments are connected to working from home, and how investments are influenced by the economic situation of companies during the pandemic. The authors also discuss further training activities provided and planned by employers and how those are related to their investments in digital technologies.

[Pandemics - What Can be Done Better (Economically) in the Future?]

The COVID-19 pandemic has highlighted the fragility of the health system, society and economy when global crises occur. In order to be better prepared for the next crisis, health policy, economic, legal, ethical and political questions must be answered. The Berlin-Brandenburg Academy of Sciences and Humanities (BBAW) organised a symposium on this topic on 29 June 2021. Are there better strategies for more resilience, effectiveness and justice? What can be left to the market, and what is a matter for the state? How should funding, responsibilities and decisionmaking rights be sorted within a country and across (European) national borders? Selected contributions to the symposium are summarised in this Wirtschaftsdienst-Zeitgespräch.

COVID‐19's Lockdown and Crime Victimization: The State of Emergency under the Abe Administration

COVID‐19 has led many governments to impose lockdowns in efforts to reduce the spread of the virus. One of the many consequences of the lockdown is a reduction in crime. We apply a difference‐in‐differences approach to the 2018–2020 Crime Statistics to investigate the effect of the 2020 lockdown on crime victimization in Japan. We find that the 2020 lockdown leads to 12.7% and 20.9% declines in violent and property crime victimization rates per 100,000 people, respectively. Moreover, we observe that premeditated crimes, such as breaking‐and‐entering and sexual assault, decline more than non‐premeditated crimes, such as homicide. We also explore the heterogeneous effects of the lockdown by age groups. We observe that there is a significant decline in sexual assault victimization for those between the ages of 0 and 29, and there are significant declines in overall violent and property crime victimizations and their subtypes for those between ages of 30 and 59. Finally, we show that there is an improvement in suicide rates, which suggests that better mental health is the mechanism partially mediating the relationship between lockdown and crime victimization.

The Impact of the Coronavirus Lockdown on Domestic Violence

We use 911 call records and mobile device location data to study the impact of the coronavirus lockdown on domestic violence. The percent of people at home sharply increased at all hours, and nearly doubled during regular working hours, from 45% to 85%. Domestic violence increased 12% on average and 20% during working hours. Using neighborhood-level identifiers, we show that the rate of first-time abuse likely increased even more: 16% on average and 23% during working hours. Our results contribute to an urgent need to quantify the physical and psychological burdens of prolonged lockdown policies.

[Digitalisation for Health - Some Economic Aspects]

When it comes to digitalising healthcare, Germany lags way behind other countries. In its 2021 report, the Health System Advisory Council discusses a strategy to overcome this shortcoming, i. e. the digitalisation of the German healthcare system. The idea is to shape digitalisation in a way that healthcare provision is improved with patients' well-being in mind. Therefore, market failures in digital health markets have to be addressed as well as the chances and challenges that come with the usage of large amounts of data. Furthermore, this article highlights the potential of the electronic health record (EHR) and of the digital health app market and discusses requirements for reaching environmental and social sustainability within the context of the digitalisation of health.

[Opportunities and Risks of Vaccination Progress]

The success of the vaccination campaign in Germany depends decisively on the availability of vaccines, vaccination capacities and the willingness to vaccinate. On the basis of model calculations, this article presents the possible scenarios of the vaccination progress and discusses requirements for the organisation of the vaccination campaign. It also addresses the long-term perspectives and challenges, e. g. with regard to the vaccination of children and adolescents or the global vaccination progress.

[Is Mandatory Vaccination Against the Coronavirus Necessary?]

The end of the pandemic requires that SARS-CoV-2 vaccines be used. However, vaccination itself can lead to temporary adverse health effects and/or long-term damage. Vaccination initially represents a private good demanded by an individual cost-benefit calculus; however, it also creates positive externalities and thus too few individual incentives to vaccinate. Getting vaccinated is not a dominant rational strategy, neither in the overall population, nor among the old and the young, nor when the long-term costs of the pandemic are taken into account. It is all the more important to "price in" the long-term consequences of a lasting pandemic.

Testing as an approach to control the Corona epidemic dynamics and avoid lockdowns

Vaccinations, lockdowns and testing strategies are three potential elements of an effective anti-coronavirus, and in particular Covid-19, health policy. The following analysis considers - within a simple model - the potentially crucial role of a Corona testing approach in combination with a quarantine approach which is shown herein to be a substitute for broad lockdown measures. The cost of lockdowns/shutdowns are rather high so that – beyond progress in terms of a broad vaccination program – a rational testing strategy should also be carefully considered. Testing has to be organized on the basis of an adequate testing infrastructure which could largely be implemented in firms, schools, universities and public administration settings. As regards the cost of a systematic broad Covid-19 testing strategy, these could come close to 0.5% of national income if there are no vaccinations. The Testing & Quarantine approach suggested here – with tests for symptomatic as well as asymptomatic people - is based on a random sampling and would require rather broad and frequent testing; possibly one test per person every 7–10 days. At the same time, one should consider that the cost of further lockdowns/shutdowns of a duration of 1 month could be very high, such that a standard cost benefit analysis supports the testing approach suggested herein. Also, an optimal policy mix could be designed where both vaccinations and testing play a crucial role. As of late January 2021, no further lockdowns in Germany and other OECD countries would be necessary if a broad testing infrastructure can be established rather quickly. This in turn will reinforce economic optimism and help to jumpstart economic growth in Europe, the US and Asia in a solid way. The basic logic of the testing approach pointed out here for industrialized countries could also be applied in developing countries. The approach presented is complementary to the IMF analysis of Cherif/Hasanov.

An absorptive capacity-based systems view of Covid-19 in the small business economy

According to Johns Hopkins University, by December 2020, more than 78 million SARS-COV-2 (Covid-19) cases have been reported with more than 1.7 million deaths, out of which more than 300 thousand were in the U.S. alone. No country on earth has been untouched by the preemptive creation of a global recession to combat a global disease. Covid-19 has disrupted supply chains, consumption patterns, and business models in a multitude of industries which include a large share of small and medium enterprises (SMEs). SMEs account for the largest share of employment in market-based economies so any discussion of the economic impact of Covid-19 is incomplete without the SME sector. The purpose of this paper is to explore a systems perspective of the Covid-19 pandemic using the absorptive capacity construct.

Covid-19 vaccines: A model of acceptance behavior in the healthcare sector

The emergence of Covid-19 has affected all aspects of human life across the globe. Lockdowns everywhere are having dramatic social and economic consequences. No therapy has yet been approved, and vaccines are a priority potential tool to control the pandemic and its impacts. Multiple vaccines are in the last stage of the development process, but part of the population is not willing to get vaccinated for Covid-19. Several studies have examined the percentage of the population willing to get vaccinated, but few have analyzed the reasons for their decision. In this context, researching the factors influencing individuals’ intention to use a potential Covid-19 vaccine will be important to public health strategies. This paper analyzes these factors with an adapted Cognitive-Affective-Normative (CAN) model. Perceived vaccine efficacy is used as a cognitive variable, fear of the vaccine and fear of Covid-19 are used as affective variables, and social influence is used as the normative variable. The proposed model strongly explains the intention to use the Covid-19 vaccine (R2 = 0.81). The results show that vaccine efficacy will be the most important determinant of Covid-19 vaccine acceptance, followed by social influence. The findings can be very helpful for public health policies aimed at achieving widespread vaccination, a must for vaccine success.

The COVID-19 crisis in the EU: the resilience of healthcare systems, government responses and their socio-economic effects

The global outbreak of COVID-19 forced EU governments to implement drastic confinement measures to contain the spread of the Coronavirus. These measures, however, come at a high economic cost. In this work, we analyze the resilience/preparedness of public health systems, the confinement measures introduced by governments, and their socio-economic effects. We also investigate the relationships between these elements by focusing on the EU Member States. We conduct an after-action review (AAR) study based on three indices. The first index indicates the preparedness of the countries’ health systems to deal with a potential health shock resulting from the COVID-19 outbreak. The second index shows the strictness of confinement measures taken per Member State in spring 2020. Finally, the third index captures the expected socio-economic effects of such measures on each country for the year 2020. Our findings show that on average, countries with less prepared health systems implemented stricter confinement measures and that higher levels of stringency in the confinement measures are associated with stronger, negative, socio-economic impacts. However, the results differ across countries in the case of each index. Overall, the results call for health systems to be better prepared to handle public health crises and for a more coordinated EU approach to overcome divergences across countries.

Institutional Trust and Compliance with Measures to Fight COVID-19

The paper investigates the causal relationship between the trust in institutions and compliance with measures introduced to slow down the spread of the novel coronavirus COVID-19 in Slovakia. In addition, the impact of socio-economic characteristics on compliance with introduced measures was analysed. Data were obtained from a survey carried out by the Slovak Academy of Sciences on a representative sample of the Slovak population of 1,000 respondents. To derive the causal relationship between institutional trust and compliance behaviour, a probit regression model was used. Findings suggest that trust in public institutions helps to increase compliance with social distancing. In addition, some socio-economic characteristics such as employment status, age or whether individuals felt endangered by COVID-19 had a positive and statistically significant effect on compliance with measures used to slow the spread of the COVID-19 virus. Institutional trust did not have a statistically significant effect on compliance with face-covering measures.

[Trumps Economic Policy and the Corona Shock - Perspectives for the USA]

The United States is characterised by a structural populism problem that persists even without Trump as president. Its economic policy is fundamentally contradictory. The US fiscal and deficit policy under Trump was considered risky even before the corona shock, while the aggressive US trade policy is a self-inflicted wound. If we look at effective lifetime income, Germany, France and the United States are on an equal footing. This is due in part to the lag in life expectancy in the US and the much higher health care costs - relative to GDP - in the American system. A transatlantic dialogue on reform would be worthwhile after the corona shock of 2020.

[Spatial Interregional Spread of COVID-19 Through Commuter Interdependence]

The coronavirus has plunged the global economy into crisis. Since the beginning of March, contact and exit restrictions and bans on business activities have been imposed in Germany, schools have been closed, child care has been suspended, and strict hygiene regulations have been issued. In the meantime, the number of reported new infections has been significantly reduced and the German healthcare system does not appear to be overburdened to date. This is one of the reasons why there is now an intensive debate about easing the regulations, which would allow additional economic activity. The article also examines commuter links and the role they have played in the spread of COVID-19 in Germany as well as bad weather conditions and a high population density.

Macroeconomic and health care aspects of the coronavirus epidemic: EU, US and global perspectives

The novel coronavirus (COVID-19) epidemic represents a major challenge for the world economy. While a detailed longer-term diffusion path of the new virus cannot be anticipated for individual countries, one may anticipate international supply shocks and declining GDP growth in many OECD countries and China in 2020; and one should expect falling asset prices in Asia, the United States and the European Union plus the United Kingdom – except for the price of risk-free government bonds. In the course of 2020/21 the US, the EU and the UK, as well as other countries, will face both an increasing number of infected patients as well as a higher case fatality ratio. Health care expenditures in the US could increase more than in the Eurozone and the EU in the medium term, a development that undermines the international competitiveness of the United States. The analysis suggests that per capita income is a positive function of the effective trade openness and of the new Global Health Security Index indicator from the NTI/Johns Hopkins University. A rising health care-GDP ratio in the US is equivalent to a rising US export tariff. As regards the coronavirus challenge, the ratio of acute care beds to the elderly in OECD countries shows considerable variation. Due to international tourism contraction alone, output growth in the Eurozone, the US and China can be expected to fall by about 1.6% in 2020. The COVID-19 challenge for the US Trump Administration is a serious one, since the lack of experts in the Administration will become more apparent in such a systemic stress situation – and this might well affect the November 2020 US presidential election which, in turn, would itself have considerable impacts on the UK and the EU27 as well as EU-UK trade negotiations. Integrating the health care sector into macroeconomics, which should include growth analysis, is an important task. The role of health quality - and health insurance coverage - for endogenous time horizons and economic welfare, respectively, is emphasized.

[COVID-19, Influenza and Economic Activity - An Impact Analysis Perspective]

The German debate about the policy implications of the coronavirus becomes increasingly heated given different views on the mortality rate from SARS CoV-2, as well as the epidemiological and economic impact of lockdown measures imposed by the government. Impact analysis applying features of randomised control trials would provide clear evidence. However, this is currently unavailable due to a lack of an appropriate control group of countries without measures. Thus, polarisation is likely to rise if observed mortality rates remain low.

The Benefits and Costs of Using Social Distancing to Flatten the Curve for COVID-19

We examine the net benefits of social distancing to slow the spread of COVID-19 in USA. Social distancing saves lives but imposes large costs on society due to reduced economic activity. We use epidemiological and economic forecasting to perform a rapid benefit–cost analysis of controlling the COVID-19 outbreak. Assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of about $5.2 trillion in our benchmark case. We examine the magnitude of the critical parameters that might imply negative net benefits, including the value of statistical life and the discount rate. A key unknown factor is the speed of economic recovery with and without social distancing measures in place. A series of robustness checks also highlight the key role of the value of mortality risk reductions and discounting in the analysis and point to a need for effective economic stimulus when the outbreak has passed.

COVID-19 infections and fatalities developments: empirical evidence for OECD countries and newly industrialized economies

This paper presents empirical results on coronavirus infection and fatality rates from cross-country regressions for OECD economies and a sample of middle- and high-income countries. We include environmental, economic, medical, and policy variables in our analysis to explain the number of corona cases and deaths per million. We find a significant positive impact of local air pollution on infection rates in the whole sample and on fatality rates for OECD countries. Obesity rates have a positive effect on cases and deaths across the different estimation equations. The strategy of aiming to achieve herd immunity has a significant positive effect on infections as well as on death rates. The first affected countries have significantly higher mortality rates, revealing the lack of experience and medical capacity to deal with the pandemic in an initial phase. Postponing – and fighting - the pandemic could save lives in many countries and generate considerable economic benefits. Other medical and policy variables discussed in the public sphere do not show a significant impact in the regression analysis. Our results suggest that improving air quality and fighting obesity helps reduce the negative effects of a coronavirus pandemic significantly. Policy options for fighting a second epidemic wave should take into account the results from this study in order to optimize global epidemic policy.

Forming COVID-19 Policy Under Uncertainty

This paper presents my thinking and concerns about formation of COVID-19 policy. Policy formation must cope with substantial uncertainties about the nature of the disease, the dynamics of transmission, and behavioral responses. Data uncertainties limit our knowledge of the past trajectory and current state of the pandemic. Data and modeling uncertainties limit our ability to predict the impacts of alternative policies. I explain why current epidemiological and macroeconomic modeling cannot deliver realistically optimal policy. I describe my recent work quantifying basic data uncertainties that make policy analysis difficult. I discuss approaches for policy choice under uncertainty and suggest adaptive policy diversification.

Rural-urban disparities in the utilization of mental health inpatient services in China: the role of health insurance

Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China's on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. This retrospective study used 10 years (2005-2014) of hospital electronic health records from the Shandong Center for Mental Health and the DaiZhuang Psychiatric Hospital, two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Consistent with the existing literature, our study suggests that increasing insurance schemes' reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.

Do Larger Health Insurance Subsidies Benefit Patients or Producers? Evidence from Medicare Advantage

A central question in the debate over privatized Medicare is whether increased government payments to private Medicare Advantage (MA) plans generate lower premiums for consumers or higher profits for producers. Using difference‑in‑differences variation brought about by a sharp legislative change, we find that MA insurers pass through 45 percent of increased payments in lower premiums and an additional 9 percent in more generous benefits. We show that advantageous selection into MA cannot explain this incomplete pass‑through. Instead, our evidence suggests that market power is important, with premium pass‑through rates of 13 percent in the least competitive markets and 74 percent in the most competitive.

Socioeconomic inequality of diabetes patients' health care utilization in Denmark

Understanding socioeconomic inequalities in health care is critical for achieving health equity. The aim of this paper is threefold: 1) to quantify inequality in diabetes health care service utilization; 2) to understand determinants of these inequalities in relation to socio-demographic and clinical morbidity factors; and 3) to compare the empirical outcome of using income level and educational level as proxies for Socio Economic Status (SES).Data on the entire Danish population of diabetes patients in 2011 (N = 318,729) were applied. Patients' unique personal identification number enabled individual patient data from several national registers to be linked. A concentration index approach with decomposition into contributing factors was applied. Differences in diabetes patients' health care utilization patterns suggest that use of services differ among patients of lower and higher SES, despite the Danish universal health care system. Especially, out-patient services, rehabilitation and specialists in primary care show different utilization patterns according to SES. Comparison of the empirical outcome from using educational level and income level as proxy for patients' SES indicate important differences in inequality estimates. While income, alike other measures of labor market attachment, to a certain extent is explained by morbidity and thus endogenous, education is more decisive for patients' ability to take advantage of the more specialized services provided in a universal health care system.

Quantifying the broader economic consequences of quadrivalent human papillomavirus (HPV) vaccination in Germany applying a government perspective framework

HPV infections can cause substantial burden in females and males as it is associated with several genital cancers, in addition to genital warts. Traditional economic evaluations often focus on quantifying cost-effectiveness, however, it is increasingly recognized that vaccinations may generate broader benefits not captured in cost-effectiveness analysis. Τhe aim of this study was to evaluate the broader economic consequences associated with HPV vaccination in males and females and to conduct a lifetime cost-benefit analysis of investing in universal vaccination in Germany from the perspective of government. Methodologies from generational accounting, human capital and health economics were combined to estimate the broader economic consequences of HPV vaccination including the fiscal impact for the government. A cohort model was developed simulating the medical costs and average lifetime fiscal transfers between the government and 12-year-old immunized and non-immunized males and females. To estimate tax revenue attributed to vaccination-related changes in morbidity and mortality, direct and indirect tax rates were linked to differences in age- and gender-specific earnings. Based on HPV vaccination costs, the base case cost-benefit analysis demonstrated that investing <euro>1 in universal HPV vaccination could yield <euro>1.7 in gross tax revenue over the lifetime of the cohorts. After taking into consideration the governmental transfers, universal HPV vaccination in Germany could result in incremental positive net discounted taxes (i.e. tax revenue-transfers) from <euro>62 million for the German government. The vaccination of males and females with the quadrivalent HPV vaccine is likely to have positive effects on public finances.

Recommendation of rotavirus vaccination and herd effect: a budget impact analysis based on German health insurance data

The objective of this study was to assess the budget impact and health effects of introducing rotavirus (RV) vaccination in Saxony, Germany, from a health insurance perspective. Special emphasis is given to the herd effect. We analyzed direct medical and non-medical costs of RV infection for Social Health Insurance between 2007 and 2010 based on 360,000 routine data observations from the AOK PLUS for children below 5 years of age. We compared the actual annual number of RV cases (vaccination scenario) with the number derived from 2005 (no vaccination, base case scenario). The vaccination coverage rate has increased from 5% to 61% between 2007 and 2010. The number of RV cases decreased by 21% from 32,274 in 2007 to 25,614 in 2010. Based on vaccination coverage, the total cost savings per 1,000 children due to RV vaccination was estimated to be 39,686 Euros. The overall share of outpatient costs was 60%. Mean gross cost savings were expected to be 304 Euros per avoided case. The net cost savings were expected to be 19 Euros per avoided case. About 59% of total savings was due to herd protection resulting from increasing vaccine rates. The herd effect per avoided case increased with increasing vaccine coverage. Incidence of RV cases, vaccination costs and days absent from work were sensitive parameters. This retrospective analysis showed that the increase in RV vaccination coverage in Saxony has been budget neutral if not cost saving for sick funds.

Productivity or discrimination? An economic analysis of excess-weight penalty in the Swedish labor market

This article investigates the excess-weight penalty in income for men and women in the Swedish labor market, using longitudinal data. It compares two identification strategies, OLS and individual fixed effects, and distinguishes between two main sources of excess-weight penalties, lower productivity because of bad health and discrimination. For men, the analysis finds a significant obesity penalty related to discrimination when applying individual fixed effects. We do not find any significant excess-weight penalty for women.

Public health impact and cost-effectiveness of intranasal live attenuated influenza vaccination of children in Germany

In 2011, intranasally administered live attenuated influenza vaccine (LAIV) was approved in the EU for prophylaxis of seasonal influenza in 2-17-year-old children. Our objective was to estimate the potential epidemiological impact and cost-effectiveness of an LAIV-based extension of the influenza vaccination programme to healthy children in Germany. An age-structured dynamic model of influenza transmission was developed and combined with a decision-tree to evaluate different vaccination strategies in the German health care system. Model inputs were based on published literature or were derived by expert consulting using the Delphi technique. Unit costs were drawn from German sources. Under base-case assumptions, annual routine vaccination of children aged 2-17 years with LAIV assuming an uptake of 50% would prevent, across all ages, 16 million cases of symptomatic influenza, over 600,000 cases of acute otitis media, nearly 130,000 cases of community-acquired pneumonia, nearly 1.7 million prescriptions of antibiotics and over 165,000 hospitalisations over 10 years. The discounted incremental cost-effectiveness ratio was <euro> 1,228 per quality-adjusted life year gained from a broad third-party payer perspective (including reimbursed direct costs and specific transfer payments), when compared with the current strategy of vaccinating primarily risk groups with the conventional trivalent inactivated vaccine. Inclusion of patient co-payments and indirect costs in terms of productivity losses resulted in discounted 10-year cost savings of <euro> 3.4 billion. In conclusion, adopting universal influenza immunisation of healthy children and adolescents would lead to a substantial reduction in influenza-associated disease at a reasonable cost to the German statutory health insurance system. On the basis of the epidemiological and health economic simulation results, a recommendation of introducing annual routine influenza vaccination of children 2-17 years of age might be taken into consideration.

Examining variations in hospital productivity in the English NHS

OBJECTIVES

Numerous papers have measured hospital efficiency, mainly using a technique known as data envelopment analysis (DEA). A shortcoming of this technique is that the number of outputs for each hospital generally outstrips the number of hospitals. In this paper, we propose an alternative approach, involving the use of explicit weights to combine diverse outputs into a single index, thereby avoiding the need for DEA.

METHODS

Hospital productivity is measured as the ratio of outputs to inputs. Outputs capture quantity and quality of care for hospital patients; inputs include staff, equipment, and capital resources applied to patient care. Ordinary least squares regression is used to analyse why output and productivity varies between hospitals. We assess whether results are sensitive to consideration of quality.

RESULTS

Hospital productivity varies substantially across hospitals but is highly correlated year on year. Allowing for quality has little impact on relative productivity. We find that productivity is lower in hospitals with greater financial autonomy, and where a large proportion of income derives from education, research and development, and training activities. Hospitals treating greater proportions of children or elderly patients also tend to be less productive.

CONCLUSIONS

We have set out a means of assessing hospital productivity that captures their multiple outputs and inputs. We find substantial variation in productivity among English hospitals, suggesting scope for productivity improvement.