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1.
Health Aff (Millwood) ; 41(12):1812-1820, 2022.
Article in English | PubMed | ID: covidwho-2154308

ABSTRACT

The COVID-19 pandemic has led to substantial increases in the use of telehealth and virtual care in the US. Differential patient and provider access to technology and resources has raised concerns that existing health disparities may be extenuated by shifts to virtual care. We used data from one of the largest providers of employer-sponsored insurance, the California Public Employees' Retirement System, to examine potential disparities in the use of telehealth. We found that lower-income, non-White, and non-English-speaking people were more likely to use telehealth during the period we studied. These differences were driven by enrollment in a clinically and financially integrated care delivery system, Kaiser Permanente. Kaiser's use of telehealth was higher before and during the pandemic than that of other delivery models. Access to integrated care may be more important to the adoption of health technology than patient-level differences.

2.
Working Paper Series National Bureau of Economic Research ; 51, 2022.
Article in English | GIM | ID: covidwho-2080107

ABSTRACT

Safe and effective vaccines have vastly reduced the lethality of the COVID-19 pandemic worldwide, but disparities exist in vaccine take-up. Although the out-of-pocket price is set to zero in the U.S., time (information gathering, signing up, transportation and waiting) and misinformation costs still apply. To understand the extent to which geographic access impacts COVID-19 vaccination take-up rates and COVID-19 health outcomes, we leverage exogenous, pre-existing variation in locations of retail pharmacies participating the U.S. federal government's vaccine distribution program through which over 40% of US vaccine doses were administered. We use unique data on nearly all COVID-19 vaccine administrations in 2021. We find that the presence of a participating retail pharmacy vaccination site in a county leads to an approximately 26% increase in the per-capita number of doses administered, possibly indicating that proximity and familiarity play a substantial role in vaccine take-up decisions. Increases in county-level per capita participating retail pharmacies lead to an increase in COVID-19 vaccination rates and a decline in the number of new COVID-19 cases, hospitalizations, and deaths, with substantial heterogeneity based on county rurality, political leanings, income, and race composition. The relationship we estimate suggests that averting one COVID-19 case, hospitalization, and death requires approximately 25, 200, and 1,500 county-level vaccine total doses, respectively. These results imply a 9,500% to 22,500% economic return on the full costs of COVID-19 vaccination. Overall, our findings add to understanding vaccine take-up decisions for the design of COVID era and other public health interventions.

3.
Working Paper Series National Bureau of Economic Research ; 2021.
Article in English | GIM | ID: covidwho-1760230

ABSTRACT

The COVID-19 pandemic has led to a "second pandemic" of anxiety and depression. While vaccines are primarily aimed at reducing COVID-19 transmission and mortality risks, they may have important secondary benefits. We use data from U.S. Census Bureau's Household Pulse Survey merged to state-level COVID-19 vaccination eligibility data to estimate the secondary benefits of COVID-19 vaccination on mental health outcomes. To address endogenous COVID-19 vaccination, we leverage state-level variation in the timing of when age groups are eligible for vaccination. We estimate that COVID-19 vaccination reduces anxiety and depression symptoms by nearly 30%. Nearly all the benefits are private benefits, and we find little evidence of spillover effects, that is, increases in community vaccination rates are not associated with improved anxiety or depression symptoms among the unvaccinated. We find that COVID-19 vaccination is associated with larger reductions in anxiety or depression symptoms among individuals with lower education levels, who rent their housing, who are not able to telework, and who have children in their household. The economic benefit of reductions in anxiety and depression are approximately $350 billion. Our results highlight an important, but understudied, secondary benefit of COVID-19 vaccinations.

4.
Working Paper Series - National Bureau of Economic Research (Massachusetts)|2021. (w28930):unpaginated. 47 ref. ; 2021.
Article in English | CAB Abstracts | ID: covidwho-1760218

ABSTRACT

As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous as they might have unintended adverse effects on health. The effect of SIP policies on COVID-19 transmission and physical mobility is mixed. To understand the net effects of SIP policies, we measure the change in excess deaths following the implementation of SIP policies in 43 countries and all U.S. states. We use an event study framework to quantify changes in the number of excess deaths after the implementation of a SIP policy. We find that following the implementation of SIP policies, excess mortality increases. The increase in excess mortality is statistically significant in the immediate weeks following SIP implementation for the international comparison only and occurs despite the fact that there was a decline in the number of excess deaths prior to the implementation of the policy. At the U.S. state-level, excess mortality increases in the immediate weeks following SIP introduction and then trends below zero following 20 weeks of SIP implementation. We failed to find that countries or U.S. states that implemented SIP policies earlier, and in which SIP policies had longer to operate, had lower excess deaths than countries/U.S. states that were slower to implement SIP policies. We also failed to observe differences in excess death trends before and after the implementation of SIP policies based on pre-SIP COVID-19 death rates.

5.
Working Paper Series National Bureau of Economic Research ; 63, 2021.
Article in English | GIM | ID: covidwho-1760212

ABSTRACT

Schools across the United States and the world have been closed in an effort to mitigate the spread of COVID-19. However, the effect of school closure on COVID-19 transmission remains unclear. We estimate the causal effect of changes in the number of weekly visits to schools on COVID-19 transmission using a triple difference approach. In particular, we measure the effect of changes in county-level visits to schools on changes in COVID-19 diagnoses for households with school-age children relative to changes in COVID-19 diagnoses for households without schoolage children. We use a data set from the first 46 weeks of 2020 with 130 million household-week level observations that includes COVID-19 diagnoses merged to school visit tracking data from millions of mobile phones. We find that increases in county-level in-person visits to schools lead to an increase in COVID-19 diagnoses among households with children relative to households without school-age children. However, the effects are small in magnitude. A move from the 25th to the 75th percentile of county-level school visits translates to a 0.3 per 10,000 household increase in COVID-19 diagnoses. This change translates to a 3.2 percent relative increase. We find larger differences in low-income counties, in counties with higher COVID-19 prevalence, and at later stages of the COVID-19 pandemic.

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