【保险学术前沿】期刊JHE 2025年102卷目录及摘要

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：

医疗成本：

●政府网站逐步公开医疗项目价格，对于手术类项目和影像类检查项目，费用分别下降了5.1%和9.1%。价格下降主要得益于医疗机构与保险公司之间的协商议价，而非患者的低价搜索行为。

●当初级保健医生掌握专科医生费用信息并存在经济激励时，向低成本专科医生转诊显著提升。费用排名每降低一个等级，转诊份额增加4.6个百分点，短期内可降低45%转诊成本，但该行为调整具有时效约束性（四个月）。

●基于孟加拉国"女性中学助学金计划"，研究发现助学金计划显著改善了受益者子女的健康状况，5年资助使子女全程免疫接种率提升4.2个百分点，并降低儿童死亡率。

心理健康：

●尽管心理健康状况的下降很可能加剧了不利的死亡趋势，但其整体影响有限。心理健康恶化解释了近年来核心年龄段白人死亡率上升的9%至29%。

●高速互联网入户显著增加了医院中青少年心理健康诊断的数量，并导致青少年自杀率显著上升，尤其在女性群体中更为突出。

●利用2022年美国劳动年龄人口的数据发现，农村人群的抑郁发生率较高，约33%–39%的城乡差异可由收入、教育、年龄、性别和地理区域解释，其中收入为主要驱动因素。

医疗需求：

●非临床因素确实会影响患者所接受的医疗服务。独居患者由于缺乏家庭支持，在临床痊愈后仍延迟出院，这一效应在公立医院以及老年患者中更为明显，在城乡之间及不同社会经济地位群体中影响相似。

●基于奥地利登记数据，女性初级保健医生的诊所收入比男性医生低15%，接诊的患者数量也少7%。患者被分配到女性医生后，其更有可能离开那些由女性医生接手的初级保健诊所。这归因于女性初级保健医生工作时间较短，不是患者更偏向于男性医生。

●新生儿护理领域的进展极大地提高了高风险新生儿的存活率。针对出生体重接近正常值（2500g）的中度风险婴儿，发现入住低能力新生儿病房会通过成本密集型护理降低其出院后医疗服务需求，而入住最高能力病房无此效应。

※ 本期目录

●Price transparency in healthcare: Bargaining incentives and patient responses

●When women take over: Physician gender and health care provision

●The impact of neonatal care on moderate-risk infants: Evidence from healthcare use in the first two years of life

●Does knowing the costs of other physicians affect doctors’ referrals?

●Legal status and voluntary abortions by immigrants

●Mental health and mortality trends in the United States

●High speed internet and the widening gender gap in adolescent mental health: Evidence from Spanish hospital records

●Regression and decomposition with ordinal health outcomes

●Living alone and provider behaviour in public and private hospitals

●The impact of the Female Secondary School Stipend Program on child health

Price transparency in healthcare: Bargaining incentives and patient responses

医疗服务的价格透明度：议价激励与患者响应

作者

Yujie Feng（美国康奈尔大学经济系）

摘要：This paper studies the impact of price transparency on healthcare prices, using a natural experiment involving the gradual disclosure of medical procedure prices on a state-run website. The study finds that negotiated allowed amounts decreased by 5.1% for surgical procedures and 9.1% for radiology procedures, which have higher average allowed amounts and attracted more price requests on the website. In contrast, for lab procedures, the evidence is mixed and does not point to a clear effect. The observed reductions are primarily driven by provider–insurer negotiations rather than patient price shopping. Price reductions were consistent across all providers and insurers, regardless of whether their prices were listed on the transparency website, and extended to providers in neighboring states.

本文利用一项涉及政府网站逐步公开医疗项目价格的“自然实验”，研究了价格透明度对医疗服务价格的影响。研究发现，对于手术类项目（平均议定费用较高，且在网站上吸引了更多价格查询）和影像类检查项目，保险议定费用分别下降了5.1%和9.1%。相比之下，实验室检查项目的证据较为复杂，未显示出明确的影响。观测到的价格下降主要得益于医疗机构与保险公司之间的协商议价，而非患者的低价搜索行为。价格的下降对所有医疗机构和保险公司都普遍存在，无论其价格是否在该透明度网站上公布；并且，这种降价效应还波及其邻近州的医疗机构。

原文链接：

When women take over: Physician gender and health care provision

当女性接管时：医生性别与医疗服务提供

作者

Gerald J. Pruckner（奥地利林茨约翰内斯·开普勒大学经济系），Flora Stiftinger（奥地利林茨约翰内斯·开普勒大学经济系），Katrin Zocher（奥地利林茨约翰内斯·开普勒大学经济系）

摘要：The share of female physicians has risen in OECD countries in recent decades, but we know little about the effects of physician gender on patient health care use. We exploit quasi-random assignment of primary care providers (PCPs) to existing PCP practices and patients and estimate the causal effect of female PCPs on health care provision. Using Austrian register data and a difference-in-differences strategy, we find that female PCPs generate 15% less revenue and see 7% fewer patients than male PCPs. Shifting the focus to patient-level outcomes, we observe that health care utilization remains largely unchanged following assignment to a female physician. However, results show that patients are more likely to leave PCP practices with female successors. Our results do not support the idea that the decision to change PCP is driven by preferences against being treated by female physicians. Instead, our analysis suggests that the observed differences are partly explained by female PCPs working fewer hours, especially those facing working time restrictions. As the share of female physicians continues to rise, measures to increase work flexibility may be necessary to maintain broad access to outpatient health care.

近几十年来，经济合作与发展组织（OECD）国家中女性医生的比例持续上升，但我们对于医生性别如何影响患者医疗服务利用的认知却相当有限。本研究利用准随机分配的方式，将初级保健医生（PCPs）匹配到现有的初级保健诊所和患者群体中，从而估计了女性初级保健医生对医疗服务供给的因果效应。基于奥地利登记数据和双重差分策略，我们发现女性初级保健医生的诊所收入比男性医生低15%，接诊的患者数量也少7%。当我们将焦点转向患者层面的结果时，观察到患者被分配到女性医生后，其医疗服务利用率基本保持不变。然而，结果显示，患者更有可能离开那些由女性医生接手的初级保健诊所。我们的结果并不支持患者决定更换医生源于偏好男性医生或拒绝女性医生诊疗这一观点。相反，分析表明，观察到的差异部分可归因于女性初级保健医生工作时间较短，尤其是那些面临工作时间受限的女性医生。随着女性医生比例持续升高，可能需要采取提升工作灵活性的措施，以保障门诊医疗服务的广泛可及性。

原文链接：

The impact of neonatal care on moderate-risk infants: Evidence from healthcare use in the first two years of life

新生儿护理对中等风险婴儿的影响：基于生命最初两年医疗服务使用的证据

作者

Serena Yu（悉尼科技大学，健康学院，健康经济研究与评估中心），等

摘要：Advances in evidence-based neonatal care have led to large improvements in the survival rates of high-risk newborns. Yet studies have documented wide variation in the care of more prevalent moderate-risk infants, who comprise a much larger proportion of admissions to neonatal care. In this study, we build on a small literature which uses quasi-experimental design to understand the impact of neonatal care, and for the first time, examine this moderate-risk cohort of infants. We use individual-level data on the full population of births in the state of New South Wales, Australia to examine the impact of neonatal care on the healthcare use of moderate-risk infants in the first two years of life. We implement a regression discontinuity design exploiting admission protocols based on birthweight among neonatal units of three different and explicit levels of capability. Unlike previous studies, which examine differences in outcomes across the high-risk cut-off at 1500 g, our study examines differences for moderate-risk infants born near birthweight cut-offs closer to normal birth weight (2500 g). While admission to the neonatal unit jumps across the cut-off, we find modest impacts on downstream healthcare use, including both in-hospital and out-of-hospital care. However, we identify heterogeneous effects across varying capability levels. Moderate risk infants admitted to lower capability neonatal units received more cost-intensive care, resulting in reduced healthcare use following discharge from hospital, while the same was not observed for those admitted to the highest capability units. We suggest that this is due to more aggressive clinical management at lower capability units, and leave this as a priority for future research.

循证新生儿护理领域的进展极大地提高了高风险新生儿的存活率。然而，研究表明，在新生儿护理中更为普遍的中等风险婴儿的护理存在广泛的差异，而这些中等风险婴儿占据了新生儿护理入院人数的较大比例。本研究依托运用准实验设计探讨新生儿护理影响的文献，首次针对此类中度风险婴儿群体展开研究。我们采用澳大利亚新南威尔士州全域出生人口的个体层面数据，探究新生儿护理对中度风险婴儿生命前两年医疗服务使用的影响。通过断点回归设计，我们利用三家具有明确不同能力级别的新生儿病房基于出生体重的收治标准展开分析。与既往研究关注1500克高风险临界值两侧的结局差异不同，本研究聚焦于出生体重接近正常值（2500克）临界点的中度风险婴儿。研究发现：尽管跨越临界值会导致新生儿病房收治率突变，但对后续医疗服务包括院内及院外护理的影响较为有限。然而，我们识别出不同能力级别病房的异质性效应：入住低能力新生儿病房的中度风险婴儿接受了更多成本密集型护理，导致出院后医疗服务使用减少；而入住最高能力病房的婴儿则未显现此现象。我们推测这源于低能力病房更为激进的临床管理策略，该机制有待未来研究优先验证。

原文链接：

Does knowing the costs of other physicians affect doctors’ referrals?

了解其他医生的费用是否会影响医生的转诊行为

作者

Scott Barkowski（纽约州立大学布法罗分校经济学系）

摘要：Patient referrals from primary care physicians (PCPs) to specialists are common in the American health care industry, but are typically made without any knowledge of relative specialist costs. In this study, I estimate the effect of providing such information to PCPs on referral patterns. Implementing a field experiment with an Independent Practice Association (IPA), I sent a list of average costs for new ophthalmology referrals to randomly chosen primary care medical practices. Using administrative referral data, I find that PCPs increased referral share to less costly ophthalmology practices during the first two months after treatment by 4.6 percentage points for each reduction in costliness rank (e.g., each rank closer to the least expensive). Effects were only found for patients for whom the PCPs had cost reduction incentives, and dissipated over the following four months. For the patients whose referrals were affected, I estimate that the expected cost to the IPA of a referral to ophthalmology fell during the first two months by about $80 (45% of pre-intervention referral cost).

在美国医疗行业中，初级保健医生（PCPs）向专科医生转诊患者的行为十分普遍，但此类转诊通常在不了解专科医生相对成本的情况下进行。本研究通过实地实验评估了向初级保健医生提供此类信息对其转诊模式的影响。笔者与一家独立执业协会（IPA）合作开展实验，随机选取部分初级保健医疗机构，向其定向发送眼科新转诊患者的平均费用清单。基于行政转诊数据分析发现：在干预后的前两个月内，初级保健医生向成本较低的眼科诊所的转诊份额显著提升——费用排名每降低一个等级（例如更接近最便宜诊所的排名），转诊份额即增加4.6个百分点。此效应仅存在于初级保健医生具有成本节约激励机制的患者群体中，并在后续四个月内逐渐消退。对于转诊行为受干预影响的患者，据估算其眼科转诊的预期成本在前两个月内平均降低约80美元（相当于干预前转诊成本的45%）。

原文链接：

Legal status and voluntary abortions by immigrants

移民的合法身份与自愿流产行为

作者

Luca Pieroni（意大利佩鲁贾大学政治科学系）， 等

摘要：We estimate the effect of granting legal status to immigrant women on voluntary abortions. We exploit the 2007 EU enlargement as an exogenous shock to legal status for Romanian and Bulgarian women, considering Italy as a destination country. Using a standard Difference-in-Differences model, we estimate a decline between 60% and 70% in voluntary pregnancy termination (VPT) rates for the new EU citizens from the two Eastern countries. We also introduce a novel framework to separate the total effect of the enlargement into a “citizenship” effect due to (legal or illegal) migrants already present in Italy and a “selection” effect due to new flows of immigrants. We show that the findings are robust to several alternative explanations. The drop in abortions points to legal status as a way to empower immigrant women.

我们评估了赋予移民女性合法身份对自愿流产行为的影响。本文利用2007年欧盟扩大给罗马尼亚和保加利亚女性带来合法身份的外生性冲击，并以意大利作为移民目标国。运用标准的双重差分法（Difference-in-Differences），我们估算这两个东欧国家的新欧盟公民在意大利的自愿终止妊娠（VPT）率下降了60%至70%。此外，本文引入一个新的分析框架，将欧盟扩大的总体效应分解为两部分：一是“公民身份效应”，即针对已经在意大利的（合法或非法）移民的影响；二是“选择效应”，即由于新一轮移民流入带来的影响。我们进一步展示，这一发现在多种替代性解释下都具有稳健性。自愿流产率的下降表明，合法身份可能是一种赋予移民女性更多自主权的手段。

原文链接：

Mental health and mortality trends in the United States

美国的心理健康与死亡率趋势

作者

Christopher J. Ruhm（弗吉尼亚大学弗兰克·巴顿领导与公共政策学院；美国国家经济研究局（NBER））

摘要：This study investigates whether worsening mental health has played a significant role in the rising mortality rates experienced by some population groups in the early 21st century, a question that has gained prominence with increased attention to so-called “deaths of despair.” The main takeaway is that although declining psychological health has likely contributed to adverse mortality trends—especially among prime-age non-Hispanic Whites—its overall impact is limited and not well captured by standard definitions of “deaths of despair.” Five key findings support this conclusion. First, mental health deteriorated between 1993 and 2019 for all population groups examined. Second, these declines are associated with higher predicted death rates and help explain worsening mortality trends for prime-age non-Hispanic Whites and, to a lesser extent, non-Hispanic Blacks between 1999 and 2019. Third, while these correlations lend some support to the broader idea of “deaths of despair,” the specific causes comprising them appear to be both more expansive and different from those previously emphasized. Fourth, heterogeneity in how worsening mental distress affects mortality—rather than in mental health trends themselves—is more important in explaining Black-White disparities in its overall impact. Finally, in the primary specifications, deteriorating mental health accounts for an estimated 9 % to 29 % of the rise in mortality rates among prime-age Whites in recent years.

本研究探讨了心理健康恶化是否在21世纪初某些人口群体死亡率上升中发挥了重要作用。随着对所谓“绝望死亡”（deaths of despair）问题关注的加剧，这一问题变得尤为重要。研究的主要结论是：尽管心理健康状况的下降很可能加剧了不利的死亡趋势——特别是在核心年龄段的非西班牙裔白人中——但其整体影响有限，且标准“绝望死亡”的定义并不能很好地捕捉这一现象。五项主要发现支持这一结论：

第一，在1993年至2019年间，所有研究人口群体的心理健康都有所恶化；第二，这种恶化与更高的预测死亡率相关，这解释了1999至2019年间核心年龄段非西裔白人（以及在较小程度上的非西裔黑人）死亡率的恶化趋势；第三，尽管这些相关性在一定程度上支持了“绝望死亡”的广义概念，但其中所涵盖的具体死因比以往强调的更为广泛且不同；第四，对死亡率影响的族群差异主要源于心理困扰对死亡率的不同影响，而非心理健康趋势本身的差异，这在解释黑人与白人之间的影响差距方面尤为重要；最后，在主要的模型设定下，心理健康恶化解释了近年来核心年龄段白人死亡率上升的9%至29%。

原文链接：

High speed internet and the widening gender gap in adolescent mental health: Evidence from Spanish hospital records

高速互联网与青少年心理健康性别差距的扩大：来自西班牙医院记录的证据

作者

Esther Arenas-Arroyo（奥地利维也纳经济与工商大学经济学系），Daniel Fernandez-Kranz（西班牙IE大学经济学系），Natalia Nollenberger（西班牙IE大学经济学系）

摘要：We exploit variations in fiber optic (FTTH) deployment to assess the impact of high-speed internet access on adolescent mental health. Our findings reveal that FTTH access increases addictive Internet usage and reduces time allocated to sleep, homework, as well as social interactions with family and friends. Access to FTTH increases mental health diagnoses in hospitals and contributes to a notable rise in adolescent suicide rates, particularly among girls. As new platforms and apps gain traction among adolescents, understanding the impact of connectivity improvement becomes important. This is especially relevant given the current FTTH growth replacing older broadband technologies.

我们利用光纤入户（FTTH）铺设进程中的地区差异，评估高速互联网接入对青少年心理健康的影响。研究发现，FTTH接入会导致青少年上网成瘾行为增加，减少睡眠时间、完成作业的时间，以及与家人朋友的社交互动时间。FTTH接入还显著增加了医院中青少年心理健康诊断的数量，并导致青少年自杀率显著上升，尤其在女性群体中更为突出。随着新平台和应用程序在青少年中日益普及，了解网络连接改善的影响显得尤为重要，尤其是在FTTH正逐步取代传统宽带技术的背景下。

原文链接：

Regression and decomposition with ordinal health outcomes

序数型健康结果的回归与分解

作者

Qian Wu（西南财经大学统计学院；西南财经大学金融安全与行为大数据实验室（教育部哲学社会科学实验室）），David M. Kaplan（美国密苏里大学经济学系）

摘要：Although ordinal health outcome values are categories like “poor” health or “moderate” depression, they are often assigned values 1,2,3... for convenience. We provide results on interpretation of subsequent analysis based on ordinary least squares (OLS) regression. For description, unlike for prediction, the OLS estimand’s interpretation does not require that the 1,2,3... are cardinal values: it is always the “best linear approximation” of a summary of the conditional survival functions. Further, for Blinder–Oaxaca-type decomposition, the OLS-based estimator is numerically equivalent to a certain counterfactual-based decomposition of the survival function, again regardless of any cardinal values. Empirically, with 2022 U.S. data for working-age adults, we estimate a higher incidence of depression in the rural population, and we decompose the rural–urban difference. Including a nonparametric estimator that we describe, estimators agree that 33%–39% of the rural–urban difference is statistically explained by income, education, age, sex, and geographic region. The OLS-based detailed decomposition shows this is mostly from income.

尽管序数型健康结果通常是诸如“差”健康状态或“中度”抑郁等分类值，但在实证分析中，往往会为方便将其赋值为1、2、3……。本文提供了基于普通最小二乘（OLS）回归进行后续分析的解释框架。对于描述性分析而言（不同于预测性分析），OLS估计量的解释并不依赖于1、2、3等值为定量值：它始终可以被理解为条件生存函数摘要的“最佳线性近似”。进一步地，对于Blinder–Oaxaca类型的分解，OLS估计量在数值上等价于一种基于反事实生存函数的分解形式，同样不依赖于这些数值是否具有定量意义。在实证方面，本文利用2022年美国劳动年龄人口的数据发现：农村人群的抑郁发生率较高，并对城乡差异进行了分解。结合我们提出的非参数估计量，估计结果一致认为约33%–39% 的城乡差异可由收入、教育、年龄、性别和地理区域解释。OLS细致分解显示，这一差异主要由收入因素驱动。

原文链接：

Living alone and provider behaviour in public and private hospitals

独居与公立、私立医院中的医疗服务提供行为

作者

Luigi Siciliani（英国约克大学经济与相关研究系；健康与社会关怀经济研究单位（ESHCRU））， Jinglin Wen（英国约克大学健康经济学中心）， James Gaughan（英国约克大学健康经济学中心）

摘要：Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.

新冠疫情之后，许多经合组织（OECD）国家的医院面临巨大压力，需要应对因医疗服务暂停而积压的大量患者。缩短住院天数是释放医疗容量、提升效率的一个手段。患者的个人情况（如是否独居）可能影响其住院时长。本研究检验了此类非临床因素是否会影响患者所接受的护理。当前多个国家中，独居老年人口数量正在上升。独居患者由于缺乏家庭支持，可能在临床痊愈后仍延迟出院。我们考察了在英格兰，接受髋关节置换术（这是一种常见的计划性手术）的公费患者中，独居是否会影响其在公立与私立医院中的住院时长。由于私立医疗机构有更强的成本控制激励，独居这一非临床因素在出院决策中可能被更少地考虑。我们使用管理数据，控制了一系列详细的患者特征、医院因素及地区医疗资源供应，发现独居确实会显著延长患者的住院时长。这一效应在公立医院以及老年患者中更为明显；在城乡之间及不同社会经济地位群体中影响相似。更广泛地说，本研究表明，非临床因素确实会影响患者所接受的医疗服务。

原文链接：

The impact of the Female Secondary School Stipend Program on child health

女性中学助学金计划对儿童健康的影响

作者

Md Shahjahan（南佛罗里达大学经济学系）, Giulia La Mattina（南佛罗里达大学经济学系）, Padmaja Ayyagari（南佛罗里达大学经济学系）

摘要：In this study, we examine the inter-generational effects of the 1994 Female Secondary School Stipend Program (FSSSP) on child health inputs and child health outcomes in Bangladesh. Prior studies have shown that the FSSSP significantly increased secondary schooling among rural girls. Applying a difference-in-differences model based on differential exposure to FSSSP by birth cohort and rural residence, we find that full immunization rates increased by 4.2 percentage points among children of mothers eligible for a stipend for 5 years relative to children of mothers who were not eligible, but there were no significant effects for children of mothers eligible for a stipend for only 2 years. We also find improvements in other health inputs (e.g., antenatal care) and in child health outcomes (e.g., mortality). We also explore changes in marriage, fertility, autonomy, labor supply, and media exposure, which may contribute to the observed improvements in child health.

本研究评估了孟加拉国1994年“女子中学助学金计划”（FSSSP）对儿童健康投入和健康结果的代际影响。先前的研究表明，FSSSP显著提高了农村女孩的中学入学率。我们运用双重差分法，依据出生世代和农村居住状况对FSSSP的不同接触程度进行分析。结果发现：与未享受助学金资格的母亲所生子女相比，那些母亲连续5年享受助学金资格的子女，其全程免疫接种率提高了4.2个百分点；而只有2年资格的母亲所生子女并未显示出显著差异。我们还发现，在其他健康投入（如产前护理）以及儿童健康结果（如死亡率）方面也有改善。此外，我们还考察了婚姻年龄、生育行为、自主权、劳动参与和媒体接触等方面的变化，这些可能是促成儿童健康改善的中介因素。

原文链接：

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