【保险学术前沿】JHE 2025年101卷（第二部分）目录及摘要

声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。

期刊介绍：

《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风险健康行为）、疾病不良后果、需求者、供应者和其他卫生保健机构的行为模型、政策干预的评估以及卫生政策的效率和分配等方面。该刊每年发行6期，平均每期发表文章10篇左右，2024年影响因子为3.4。

本期看点：

●来自印度的数据显示：新冠病毒对婴儿死亡率的直接影响有限，更多的是带来了间接效应，例如：收入冲击、医疗服务获取受限，以及在此期间人们因疫情而回避孕产护理等行为变化。

●基于美国《国家健康访谈调查》数据研究发现：对于越战时期主动报名参军的志愿者来说，服役带来了显著的不良健康影响。

●医院与医生纵向整合，提升医疗协同指标。整合有助于缩小专科服务的适用范围，从而提高整体社会效率。但会导致：预防性医疗服务增加，女性住院率下降，和整体医疗支出上升。

●我国儿童系统管理（Systematic Management of Children，SMC）的实施促进了儿童身体和心理健康的改善，提升了教育成果，增强了认知能力，并使青少年持续接受常规健康体检，成年后收入可提高约5%。

●国际采购机构在药品供应中发挥着重要作用，集中采购能够降低药品价格，有助于减少交付延迟，但同时会导致预期采购周期延长

●健康冲击使得全职就业减少，但兼职就业无显著变化。在家庭层面，公共转移支付和“新增工作者效应”的共同作用有效弥补了收入损失。经历健康冲击的个体，尤其是女性，在家庭生产上投入更多时间。

●社会遗传保险（social genetic insurance scheme）通过对低风险个体征税、对高风险个体补贴，实现了减少个体因疾病带来的终生效用风险，以在对低风险个体征收极少税收的情况下，实现对高风险个体的大额转移，从而显著提升高风险个体的福利，而对低风险个体的影响极小。

※ 本期目录

●COVID-19 and mortality among infants: Evidence from India

●The effects of Vietnam-era military service on the long-term health of veterans: A bounds analysis

●Does physician-hospital vertical integration signal care-coordination? Evidence from mover-stayer analysis of commercially insured enrollees

●Long-term impacts of growth and development monitoring: Evidence from routine health examinations in early childhood

●Procurement institutions and essential drug supply in low and middle-income countries

●The impacts of health shocks on household labor supply and domestic production

●Social genetic insurance: A life-cycle perspective

COVID-19 and mortality among infants: Evidence from India

新冠疫情与婴儿死亡率：来自印度的证据

作者

Erdal Asker（西乔治亚大学经济学系）， Shatakshee Dhongde（西乔治亚大学经济学系），Abu S.Shonchoy（佛罗里达国际大学经济学系）

摘要：We present the first survey-based evidence on infant mortality in a developing country during the COVID-19 pandemic. Employing high-quality, nationally representative data from India, our analyses document a significant rise in mortality rates among infants during a six month period in 2020 covering the pandemic and the ensuing lockdown. The difference-in-differences estimates show that mortality among infants at ages 1, 3, and 6 months increased by about 9, 13, and 16 deaths per 1000 births, corresponding to an increase of 30, 42, and 44 percent, respectively. Since COVID-19 had minimal direct impact on infant mortality, our estimates likely capture some of the indirect effects on infant mortality through income shocks, reduced healthcare access, and behavioral changes such as avoidance of hospitals for maternal care during this period.

我们首次提供了关于发展中国家在新冠疫情期间婴儿死亡率的基于调查的证据。利用来自印度的高质量、具有全国代表性的数据，我们的分析显示，在2020年涵盖疫情暴发及其后封锁的六个月期间，婴儿死亡率显著上升。利用双重差分法估计，出生后1个月、3个月和6个月的婴儿死亡率每千出生分别增加约9人、13人和16人，分别对应约30%、42%和44%的增长幅度。鉴于新冠病毒对婴儿死亡率的直接影响有限，我们的估计结果更可能反映了间接效应，例如：收入冲击、医疗服务获取受限，以及在此期间人们因疫情而回避孕产护理等行为变化。

原文链接：

The effects of Vietnam-era military service on the long-term health of veterans: A bounds analysis

越战时期服役对退伍军人长期健康的影响：一种区间估计分析

作者

Xintong Wang（宾夕法尼亚州斯利珀里罗克大学 财务、会计、市场与经济系），Carlos A.Flores（加州理工州立大学圣路易斯-奥比斯波分校经济学系），Alfonso Flores-Lagunes（W.E.阿普约翰就业研究所；IZA劳动经济研究所；全球劳动组织GLO）

摘要：We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans’ health outcomes using a restricted version of the National Health Interview Survey 1974–2013 and employing the draft lotteries as an instrumental variable. We conduct inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the “compliers”), as well as for those who volunteer for enlistment (the “always takers”). The causal analysis for volunteers, who represent over 70% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ sharp nonparametric bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 38 years after the end of the Vietnam War. We do not find consistent statistical evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear around 10 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service.

我们利用1974–2013年间受限版本的美国《国家健康访谈调查》（National Health Interview Survey）数据，并以征兵抽签作为工具变量，分析了越战时期美国军人服役对退伍军人健康状况的短期和长期影响。本研究对两类人群的健康影响进行了推断：一类是服从抽签分配的入伍者，另一类是主动报名参军的志愿者。本研究对志愿参军者的因果分析具有创新性，因为现有文献大多仅关注“服从者”，而志愿者在退伍军人中占比超过70%。由于志愿者群体的因果效应无法被点估计，我们采用了一种基于弱均值单调性假设下的严格非参数区间估计方法进行分析。我们考察了大量健康结果和行为指标，包括越战结束后长达38年的死亡率等长期健康数据。对于“服从者”群体，我们未发现一致的统计学证据表明其健康受到显著负面影响，这与既有文献结果相符。然而，对于“志愿者”群体，我们的区间估计显示出统计显著的负面健康效应，这些影响大约在冲突结束后10年开始显现。总体而言，作为一个整体群体，退伍军人经历了服役带来的统计学上显著的不良健康影响。这些发现对退伍军人退役后的补偿与医疗政策具有重要启示意义。

原文链接：

Does physician-hospital vertical integration signal care-coordination? Evidence from mover-stayer analysis of commercially insured enrollees

医师与医院的纵向整合是否意味着医疗协同？——基于商业保险参保人迁移-滞留分析的证据

作者

William Encinosa（乔治城大学），Avi Dor（乔治·华盛顿大学；美国国家经济研究局（NBER））

摘要：The sharp growth in physician groups being purchased by hospitals has sparked extensive policy debate, with little evidence on the merits of such integration. We fill the gap by examining care-coordination under integration. We exploit the fact that integration varies across MSAs and focus on PPO patients with employment-based moves between MSAs. We develop a mover-stayer model with heterogenous effects to examine whether vertically integrated practices treat patients differently, or whether they just treat different patients. Moving to a more integrated market causes an increase in care coordination indices. Specifically, moving to an area with more specialty care integration causes an increase in team referrals between primary and specialty care, less lab and imaging use, less out-of-network care, and reductions in spending. That is, systems are able to narrow the scope of specialty services overall, hence creating greater social efficiencies. Moving to a market with more integrated primary care causes an increase in preventive care, decreased inpatient use by women, but an increase in spending.

近年来，医院收购医生集团的现象急剧增长，引发了广泛的政策讨论，但关于此类整合效益的实证证据仍较为有限。本文通过考察整合下的医疗协同来填补这一研究空白。我们利用不同大都市统计区（MSAs）之间整合程度的差异，并聚焦于因工作变动在MSA间迁移的优选医疗网络（PPO）保险参保人。我们构建了一个具有异质效应的“迁移-滞留”模型，以识别：纵向整合的医疗机构是改变了治疗方式，还是仅仅服务了不同类型的患者。研究发现：迁入整合程度更高的市场会提升医疗协同指标。具体来说，迁入专科整合程度更高的地区会带来：初级与专科之间的转诊协作增加，实验室与影像检查使用减少，

网络外就医减少，以及医疗支出降低。也就是说，整合有助于缩小专科服务的适用范围，从而提高整体社会效率。另一方面，迁入初级保健整合程度更高的市场则会导致：预防性医疗服务增加，女性住院率下降，但整体医疗支出上升。

原文链接：

Long-term impacts of growth and development monitoring: Evidence from routine health examinations in early childhood

生长发育监测的长期影响：来自儿童早期常规健康检查的证据

作者

Yinhe Liang（中央财经大学经济学院），Xiaobo Peng（中央财经大学经济学院），Meiping Aggie Sun（福坦莫大学经济学系）

摘要：This paper examines the long-term impacts of growth and development monitoring in early childhood. For this purpose, we evaluate a public health program, the Systematic Management of Children (SMC), which offers growth and development monitoring through routine health checkups for all young children (0–6 years) in China. Using data on the program’s county-by-county rollout, we find that full exposure to the SMC from birth increases adult income by 5%. We further provide evidence that the introduction to the SMC leads to improved physical and mental health, better educational outcomes, increased cognitive skills, and sustained use of routine health checkups among adolescents.

本文探讨了儿童早期生长发育监测的长期影响。为此，我们评估了一项公共卫生项目——儿童系统管理（Systematic Management of Children，SMC），该项目通过常规健康体检为中国所有0至6岁的儿童提供生长发育监测。基于该项目在各县逐步推广的数据，我们发现，从出生起全面接受SMC干预，成年后收入可提高约5%。此外，我们还提供证据表明，SMC的实施促进了身体和心理健康的改善，提升了教育成果，增强了认知能力，并使青少年持续接受常规健康体检。

原文链接：

Procurement institutions and essential drug supply in low and middle-income countries

低中收入国家的采购制度与基本药物供应

作者

Lucy Xiaolu Wang（马萨诸塞大学阿默斯特分校 资源经济学系；德国马克斯·普朗克创新与竞争研究所；加拿大健康经济学中心），Nahim Bin Zahur（皇后大学经济学系）

摘要：International procurement institutions play an important role in drug supply. We study price, delivery, and procurement lead time of drug products for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007–2017 across procurement institution types. We find that pooled procurement lowers prices: pooling internationally is most effective for small buyers and concentrated markets, while pooling within-country is most effective for large buyers and unconcentrated markets. Pooling can reduce delays, but at the cost of longer anticipated procurement lead times. Finally, pooled procurement is more effective for older drugs, compared to patent pooling institutions that target newer drugs. Our findings are robust to alternative fixed effects specifications, instrumental variable estimation,

国际采购机构在药品供应中发挥着重要作用。我们研究了2007年至2017年间，106个发展中国家针对主要传染病药品（抗逆转录病毒药物、抗疟疾药物、抗结核药物和抗生素）在不同采购机构类型下的价格、交付情况及采购周期。研究发现，集中采购能够降低药品价格：国际集中采购对于规模较小的买家和市场集中度高的情况最为有效，而国内集中采购则对规模较大买家和市场分散的情况效果最佳。集中采购有助于减少交付延迟，但同时会导致预期采购周期延长。最后，相较于针对新药的专利集中采购机构，集中采购对较老药品的效果更为显著。我们的结论在采用不同固定效应模型、工具变量估计、对不可观测选择性的检验以及考虑买家需求弹性异质性和与主要全球卫生计划的交互影响的额外分析中均保持稳健。

原文链接：

The impacts of health shocks on household labor supply and domestic production

健康冲击对家庭劳动力供给及家庭生产的影响

作者

Giovanni Di Meo（苏黎世联邦理工学院经济研究中心），Onur Eryilmaz（苏黎世联邦理工学院经济研究中心）

摘要：This paper investigates the impact of severe health shocks on labor supply decisions and domestic production within German households. We draw from the German Socio-Economic Panel (SOEP), focusing on individuals aged 25 to 55 at the time of their first observed health shock. After the health shock, we find that affected individuals suffer a persistent loss in annual gross labor income of around 4,000 euros. This effect results mostly from adjustments at the extensive margin, with labor market participation declining by about 16%. We observe a reduction in full-time employment, but no significant effect on part-time employment. At the household level, a combination of public transfers and added worker effect effectively compensates for the income loss. Finally, individuals experiencing a health shock, particularly women, spend more time on domestic production.

本文研究了严重健康冲击对德国家庭劳动力供给决策及家庭生产的影响。我们利用德国社会经济面板数据（SOEP），聚焦于首次观察到健康冲击时年龄在25至55岁的个体。健康冲击发生后，受影响个体的年毛劳动收入持续减少约4000欧元。该影响主要来自劳动参与率的调整，劳动力市场参与率下降约16%。我们观察到全职就业减少，但兼职就业无显著变化。在家庭层面，公共转移支付和“新增工作者效应”的共同作用有效弥补了收入损失。最后，经历健康冲击的个体，尤其是女性，在家庭生产上投入更多时间。

原文链接：

Social genetic insurance:A life-cycle perspective

社会遗传保险：生命周期视角

作者

Hélène Schernberg（日内瓦协会）

摘要：Temporal risk aversion can justify a social genetic insurance scheme, even in the absence of reclassification risk. I model individuals who take a genetic test in period 0 and may become ill in period 2. I show that redistributing from low-risk to high-risk individuals in period 1 can increase social welfare, even when the high-risk are not financially penalized. Temporally risk-averse individuals value reductions in the risk to their lifetime utility brought by illness, such as increased morbidity and mortality. A social insurance can achieve this by taxing the low-risk and subsidizing the high-risk. I calibrate a multi-period life-cycle model for breast cancer and Huntington’s disease and quantify the optimal redistribution. For these two conditions, which are rare, substantial transfers to the high-risk can be achieved with minimal taxation on the low-risk. Thus, the welfare of the high-risk is substantially improved with little impact on the low-risk.

即使不存在重新分类风险的情况下，时间性风险厌恶可以为社会遗传保险计划提供合理依据。本文建立了一个模型，假设个体在第0期接受基因检测，并可能在第2期发病。研究表明，即使高风险个体未受到经济惩罚，在第1期从低风险个体向高风险个体的财富再分配仍能提高社会福利。具有时间性风险厌恶的个体高度重视减少因疾病带来的终生效用风险，如发病率和死亡率的增加。社会保险通过对低风险个体征税、对高风险个体补贴，实现这一目标。本文针对乳腺癌和亨廷顿病这两种罕见疾病，校准了一个多期生命周期模型，量化了最优的财富再分配方案。结果显示，可以在对低风险个体征收极少税收的情况下，实现对高风险个体的大额转移，从而显著提升高风险个体的福利，而对低风险个体的影响极小。

原文链接：

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