Emilia Simeonova

Marriage, bereavement and mortality: The role of health care utilization

There is ample evidence that bereavement is associated with heightened mortality. Regardless of whether this strong association is truly causal, little is known about the factors contributing to it. This study begins to unpack the black box of the bereavement-mortality puzzle by investigating the extent to which heath behaviors and health care utilization patterns vary among chronically ill elderly males living with a spouse and those who are widowed, and by asking whether these differences contribute to the well-documented correlation between widowhood and health deterioration. In order to separate the effect of health care utilization from other potential channels it uses a unique dataset of doctor-patient encounters that allows in-depth analysis of the organization and effectiveness of medical care. Changes in health care utilization attributable to bereavement have a negative effect on survival but account for a small part of the overall negative effect of widowhood on longevity.

How Does Household Income Affect Child Personality Traits and Behaviors

We examine the effects of a quasi-experimental unconditional household income transfer on child emotional and behavioral health and personality traits. Using longitudinal data, we find that there are large beneficial effects on childrens emotional and behavioral health and personality traits during adolescence. We find evidence that these effects are most pronounced for children who start out with the lowest initial endowments. The income intervention also results in improvements in parental relationships which we interpret as a potential mechanism behind our findings.

Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

Objective The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. Study design A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. Results The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Conclusion Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women’s access to safe abortion.

Congestion Pricing, Air Pollution and Children's Health

This study examines the effects of a congestion tax in central Stockholm on ambient air pollution and the health of local children. We demonstrate that the tax reduced ambient air pollution by 5–15 percent and the rate of acute asthma attacks among young children. We do not see corresponding changes in accidents or hospitalizations for nonrespiratory conditions. As the change in health was more gradual than the change in pollution, it may take time for the full health effects of changes in pollution to materialize if the mechanism is pollution. Hence, short-run estimates of pollution reduction programs may understate long-run health benefits.

Can health IT adoption reduce health disparities

There are large and persistent racial differences in health-care utilization and outcomes for chronic conditions in the United States. The recent uptake in electronic health records in outpatient care settings could affect these disparities. This research shows that the adoption of electronic health records reduces the racial gap in outpatient care outcomes. We provide a basic conceptual framework that demonstrates some of the mechanisms that may drive these results.