Exploring the impact of 'hostile environment' policies on psychological distress of ethnic groups in the UK: a differences-in-differences analysis.

PURPOSE: In 2012, the UK government announced legislation changes and heightened immigration controls designed to create a 'hostile environment for illegal migration.' We measured changes in psychological distress among people from minoritised ethnic groups compared to White British controls before and throughout the implementation of these policies. METHODS: We used the UK Household Longitudinal Survey to estimate difference-in-difference models for six ethnic groups (Bangladeshi, African, Caribbean, Indian, Pakistani, and White British) in three eras: pre-policy (2009-2012); (2) transition (2012-2016); and (3) ongoing policy (2016-2020). We calculated the adjusted marginal mean psychological distress score at each era using the 12-item General Health Questionnaire (GHQ). RESULTS: In the pre-policy era, we found higher psychological distress for the Pakistani, Bangladeshi, and Caribbean groups compared to the White British group. We observed patterns consistent with increasing psychological distress during the transition era for the Pakistani and Bangladeshi groups, with further increases in the ongoing era for the Bangladeshi group. Levels of psychological distress the Indian and African groups were similar to the White British group in the pre-policy era and decreased over successive eras. A small decrease was observed in the Caribbean group across policy eras, while levels remained stable in the White British group. CONCLUSION: We found evidence that psychological distress increased among Pakistani and Bangladeshi individuals following the introduction of hostile environment policies but did not detect increased distress in other ethnic groups. This finding underscores the importance of disaggregating analyses by ethnic group to capture the distinct experiences.

Explicit inference: A meta-replication of SEER cancer registry research evaluating the Affordable Care Act's Medicaid expansion.

OBJECTIVES: Among the provisions within the Affordable Care Act (ACA), expanding Medicaid was arguably the greatest contributor to increasing access to care. For over a decade, researchers have investigated how Medicaid expansion impacted cancer outcomes. Over this same decade, statistical theory illuminated how state-based policy research could be compromised by invalid inference. After reviewing the literature to identify the inference strategies of state-based cancer registry Medicaid expansion research, this study aimed to assess how inference decisions could change the interpretation of Medicaid expansion's impact on staging, treatment, and mortality in cancer patients. DATA SOURCES: Cancer case data (2000-2019) was obtained from the Surveillance, Epidemiology, End Results (SEER) programme. Cases included all cancer sites combined, top 10 cancer sites combined, and three screening amenable cancers (colorectal, female breast, female cervical). STUDY DESIGN: A Difference-in-Differences design estimated the association between Medicaid expansion and four binary outcomes: distant stage, initiating treatment >1 month after diagnosis, no surgery recommendation, and death. Three inference techniques were compared: (1) traditional, (2) cluster, and (3) Wild Cluster Bootstrap. DATA COLLECTION: Data was accessed via SEER*Stat. PRINCIPAL FINDINGS: Estimating standard errors via traditional inference would suggest that Medicaid expansion was associated with delayed treatment initiation and surgery recommendations. Traditional and clustered inference also suggested that Medicaid expansion reduced mortality. Inference using Wild Cluster Bootstrap techniques never rejected the null hypotheses. CONCLUSIONS: This study reiterates the importance of explicit inference. Future state-based, cancer policy research can be improved by incorporating emerging techniques. These findings warrant caution when interpreting prior SEER research reporting significant effects of Medicaid expansion on cancer outcomes, especially studies that did not explicitly define their inference strategy.

Health impact evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey.

The Aspirational District Program (ADP) is a unique initiative of Government of India launched in 2018 that aims to reduce inter-district multidimensional inequality. ADP aims to bring the least developed districts to catch up with the rest of the other districts in the country. The program is comprehensive in its scope as it targets improvement of several key development indicators spanning health and nutrition, education, agriculture and water resources, financial inclusion and skill development and basic infrastructure indicators. Aspirational districts (ADs) are eligible for enhanced funding and priority allocation of various initiatives undertaken by the central and the state governments. Our research estimates the causal impact of ADP on the targeted health and nutrition indicators using a combination of propensity score matching and difference-in-differences (PSM-DID). We use the fourth and fifth rounds of National Family Health Survey (NFHS) data collected in 2015-16 and 2019-21 respectively which serve as the pre and post-treatment data for our analysis. Moreover, we take advantage of the transparent mechanism outlined for the identification of ADs under ADP, which we use for propensity score matching for our PSM-DID. While we observe negative impact of ADP on early initiation of breastfeeding, we believe that the impact is confounded with the effects of Covid-19 since part of NFHS-5 data was collected during the pandemic. However, the negative impact of ADP on early initiation of breastfeeding disappears when we only use pre-covid data (i.e. data for districts from states surveyed before the pandemic). Additionally, using pre-covid data we find a reduction in the prevalence of underweight children younger than 5 years to an extent of 2 to 4 percentage points in ADs as an impact of ADP, which is robust across multiple specification. We do not find evidence of a positive or a negative impact of ADP on any other health and nutrition indicators. Future research efforts should be made towards impact evaluation of all the targeted indicators in order to get a comprehensive unbiased evaluation of ADP.

Assessing long-term effects of gaseous air pollution exposure on mortality in the United States using a variant of difference-in-differences analysis.

Long-term mortality effects of particulate air pollution have been investigated in a causal analytic frame, while causal evidence for associations with gaseous air pollutants remains extensively lacking, especially for carbon monoxide (CO) and sulfur dioxide (SO2). In this study, we estimated the causal relationship of long-term exposure to nitrogen dioxide (NO2), CO, SO2, and ozone (O3) with mortality. Utilizing the data from National Morbidity, Mortality, and Air Pollution Study, we applied a variant of difference-in-differences (DID) method with conditional Poisson regression and generalized weighted quantile sum regression (gWQS) to investigate the independent and joint effects. Independent exposures to NO2, CO, and SO2 were causally associated with increased risks of total, nonaccidental, and cardiovascular mortality, while no evident associations with O3 were identified in the entire population. In gWQS analyses, an interquartile range-equivalent increase in mixture exposure was associated with a relative risk of 1.067 (95% confidence interval: 1.010-1.126) for total mortality, 1.067 (1.009-1.128) for nonaccidental mortality, and 1.125 (1.060-1.193) for cardiovascular mortality, where NO2 was identified as the most significant contributor to the overall effect. This nationwide DID analysis provided causal evidence for independent and combined effects of NO2, CO, SO2, and O3 on increased mortality risks among the US general population.

The social effects of energy regulation: Energy-consuming rights trading system and corporate labor demand.

Although it is a key measure to control energy consumption and promote the improvement of industrial structure, energy market allocation reform has rarely been concerned with its impact on employment, an important livelihood issue. To fill this gap, this paper takes the Energy-Consumption Rights Trading System (ECRTS) enacted by China in 2016 as a research background and adopts the difference-in-difference approach to explore the effects and mechanisms of the ECRTS on enterprise labor demand. The results show that the ECRTS significantly reduces firms' labor demand, particularly for low-skilled workers, through both production scale effects and technological upgrading effects. Specifically, the ECRTS has led to a decrease in sales revenues and an increase in labor productivity, thereby reducing firms' labor demand. Heterogeneity tests indicate that the ECRTS has a greater impact on employment in firms with lower energy-consumption intensity, domestic capital injections, weaker innovation capacity, and lower market power. The paper also explores the welfare consequences of the policy, finding that while the ECRTS does not improve the environmental performance of firms it does not pass on the compliance costs of regulations to incumbent workers. The overall impact is neutral. This paper extends the study of the economic consequences of the ECRTS and has implications for other developing countries in reconciling energy regulation and employment.

The Impact of Air Pollution Controls on Health and Health Inequity Among Middle-Aged and Older Chinese: Evidence From Panel Data.

Objectives: We evaluated the long-term effects of air pollution controls on health and health inequity among Chinese >45 years of age. Methods: Data were derived from the China Health Aging and Retirement Longitudinal Survey and the China National Environmental Monitoring Centre. Decreases in PM2.5 and PM10 were scaled to measure air quality controls. We used a quasi-experimental design to estimate the impact of air quality controls on self-reported health and health inequity. Health disparities were estimated using the concentration index and the horizontal index. Results: Air pollution controls significantly improved self-reported health by 20% (OR 1.20, 95% CI, 1.02-1.42). The poorest group had a 40% (OR 1.41, 95% CI, 0.96-2.08) higher probability of having excellent self-reported health after air pollution controls. A pro-rich health inequity was observed, and the horizontal index decreased after air pollution controls. Conclusion: Air pollution controls have a long-term positive effect on health and health equity. The poorest population are the main beneficiaries of air pollution controls, which suggests policymakers should make efforts to reduce health inequity in air pollution controls.

Effects of a cafeteria-based sustainable diet intervention on the adherence to the EAT-Lancet planetary health diet and greenhouse gas emissions of consumers: a quasi-experimental study at a large German hospital.

BACKGROUND: Sustainable diets contribute to improving human health and reducing food-related greenhouse gas emissions (GHGE). Here, we established the effects of a facility-based sustainable diet intervention on the adherence to the EAT-Lancet Planetary Health Diet and GHGE of consumers. METHODS: In this quasi-experiment, vegan menus and educational material on sustainable diets were provided in the largest cafeteria of a German hospital for 3 months. Regular customers (> 1/week) in this cafeteria (intervention group) and in all other hospital cafeterias (control group) completed a questionnaire about their sociodemographic and dietary characteristics before and after the intervention period. We calculated difference-in-differences (DID), their 95% confidence intervals (CIs), and p-values for the adherence to the EAT-Lancet Planetary Health Diet Index (PHDI; 0-42 score points) and food-related GHGE. The protocol was registered at the German Clinical Trial Register (reference: DRKS00032620). FINDINGS: In this study population (N = 190; age range: 18-79 years; women: 67%; highest level of formal education: 63%), the mean baseline PHDI (25·1 ± 4·8 vs. 24·7 ± 5·8 points) and the mean baseline GHGE (3·3 ± 0·8 vs. 3·3 ± 0·7 kg CO2-eq./d) were similar between the intervention (n = 92) and the control group (n = 98). The PHDI increase was 0·6 points (95% CI: -0·4, + 1·6) higher in the intervention group than in the control group. This trend was stronger among frequent consumers of the vegan menu than among rare and never consumers. No between-group difference was seen for GHGE changes (DID: 0·0; 95% CI: -0·2, + 0·1 kg CO2-eq./d). INTERPRETATION: Pending verification in a longer-term project and a larger sample, this quasi-experiment in a big hospital in Germany suggests that offering vegan menus and information material in the cafeteria enhances the adherence to healthy and environmentally friendly diets among regular customers. These findings argue for making sustainable food choices the default option and for improving nutrition literacy. FUNDING: Federal Ministry of Economic Affairs and Climate Action (BMWK), Else-Kröner-Fresenius Foundation (EKFS), Robert-Bosch Foundation (RBS).

How do physicians respond to new medical research?

What happens when the findings of a prominent medical study are overturned? Using a medical trial on breech births, we estimate the effect of the reversal of such a medical study on physician choices and infant health outcomes. Using the United States Birth Certificate Records from 1995 to 2010, we employ a difference-in-differences estimator for C-sections, low Apgar, and low birth weight measures. We find that the reversal of a multi-site, high profile, randomized control trial on the appropriate delivery of term breech births, the Term Breech Trial, led to a 15%-23% decline in C-sections for such births at a time when the overall trend in C-sections was rising. We find our largest estimated effects amongst traditionally disadvantaged groups (i.e., non-white, and minimal education). However, we do not find that such a change in practice had significant impacts on infant health. Contrary to prior studies, we find that physicians updated their beliefs quickly, and do indeed adjust to new medical research, particularly young physicians, prior to mandatory policy or professional guidelines.

The impact of patient registration on utilisation and quality of care: a propensity score matching and staggered difference-in-differences analysis of a cohort of 16,775 people with type 2 diabetes.

BACKGROUND: In 2012, Luxembourg introduced a Referring Doctor (RD) policy, whereby patients voluntarily register with a primary care practitioner, who coordinates patients' health care and ensures optimal follow-up. We contribute to the limited evidence base on patient registration by evaluating the effects of the RD policy. METHODS: We used data on 16,775 people with type 2 diabetes on oral medication (PWT2D), enrolled with the Luxembourg National Fund from 2010 to 2018. We examined the utilisation of primary and specialist outpatient care, quality of care process indicators, and reimbursed prescribed medicines over the short- (until 2015) and medium-term (until 2018). We used propensity score matching to identify comparable groups of patients with and without an RD. We applied difference-in-differences methods that accounted for patients' registration with an RD in different years. RESULTS: There was low enrolment of PWT2D in the RD programme. The differences-in-differences parallel trends assumption was not met for: general practitioner (GP) consultations, GP home visits (medium-term), HbA1c test (short-term), complete cholesterol test (short-term), kidney function (urine) test (short-term), and the number of repeat prescribed cardiovascular system medicines (short-term). There was a statistically significant increase in the number of: HbA1c tests (medium-term: 0.09 (95% CI: 0.01 to 0.18)); kidney function (blood) tests in the short- (0.10 (95% CI: 0.01 to 0.19)) and medium-term (0.11 (95% CI: 0.03 to 0.20)); kidney function (urine) tests (medium-term: 0.06 (95% CI: 0.02 to 0.10)); repeat prescribed medicines in the short- (0.19 (95% CI: 0.03 to 0.36)) and medium-term (0.18 (95% CI: 0.02 to 0.34)); and repeat prescribed cardiovascular system medicines (medium-term: 0.08 (95% CI: 0.01 to 0.15)). Sensitivity analyses also revealed increases in kidney function (urine) tests (short-term: 0.07 (95% CI: 0.03 to 0.11)) and dental consultations (short-term: 0.06, 95% CI: 0.00 to 0.11), and decreases in specialist consultations (short-term: -0.28, 95% CI: -0.51 to -0.04; medium-term: -0.26, 95% CI: -0.49 to -0.03). CONCLUSIONS: The RD programme had a limited effect on care quality indicators and reimbursed prescribed medicines for PWT2D. Future research should extend the analysis beyond this cohort and explore data linkage to include clinical outcomes and socio-economic characteristics.

Green investor behavior and corporate green innovation: Evidence from Chinese listed companies.

Businesses embracing green innovation can encourage high-quality green economic development in addition to reducing emissions. In this paper, we use the Difference-in-Differences (DID) to investigate the influence of green investor behavior on the green innovation of companies, using the first-ever green investor investment in a company as a quasi-natural experiment. According to research, green investors have the power to accelerate corporate green innovation greatly. Three key strategies that green investors can use to do this include raising institutional investment levels, enhancing the green perception of executives, and bringing in top talent. Heterogeneity analysis shows that non-high-polluting, big, and state-owned enterprises (SOEs) are more likely to benefit from green investors' green innovation effects. Further analysis reveals that (ⅰ) green investors' influence on an enterprise's level of green innovation can help it improve its ESG ratings; (ii) green investors can encourage green innovation in source control but have little effect on green innovation in end-of-pipe treatment; (ⅲ) green investors can support both non-green and green innovation in enterprises, but have a greater influence on green innovation. This study strengthens the micro relationship between green investors and corporate green innovation. It also supports the theoretical underpinnings of corporate green innovation, which is significant for advancing green innovation, environmental protection, and high-quality economic development in emerging economies.

Has China's hierarchical medical system improved doctor-patient relationships?

BACKGROUND AND OBJECTIVE: Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform. METHODS: With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy. RESULTS: Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger. CONCLUSION: While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.

Green credit policy and residents' health: quasi-natural experimental evidence from China.

Background: Residents' health plays an important role in economic prosperity and national development. Methods: The research analyzes data from 262 prefecture-level cities in China spanning the period from 2010 to 2021. Utilizing the implementation of green credit policy in China as a quasi-natural experiment, the paper employs the time-varying Differences-in- Differences (DID) model to evaluate the influence of green credit policy on residents' health. Results: The paper results show that: (1) the green credit policy significantly improves residents' health, and this conclusion still holds after a series of robustness tests. (2) Mechanism analysis reveals that the green credit policy affects residents' health through the improvements of the environment and the elevation of public services standards in demonstration cities. (3) Heterogeneity analysis shows that the impact of green credit policy on residents' health is more significant in the western cities and resource-based cities than in the central-eastern cities and non-resource-based cities. This paper explains the specific path and realization of green credit policy to enhance residents' health, which provides a reference for further designing and improving effective green credit policy. Discussion: The deficiencies within the green credit policy has resulted in limited improvements. It is recommended that China should broaden the ambit of the green credit policy and refine the criteria for its execution.

The "Belt and Road" Initiative and China's sporting goods exports: Basic characteristics and policy evaluation.

The paper analyzes the basic characteristics of China's sporting goods exports using data from the CEPII BACI database from 2007 to 2019, combined with the social network analysis method, and evaluates the policy effect of the "Belt and Road" initiative implementation on the impact of China's sporting goods exports using the difference-in-differences method. The research findings are as follows: 1) The overall scale of China's sporting goods exports has consistently expanded, marked by a rapid increase in the total export volume. The exported goods exhibit a comprehensive range of product categories, indicating an ongoing evolution in the structural composition of products. Geographically, the export destinations are widespread, covering a diverse range of countries. However, there is a noticeable concentration trend in sporting goods exports, with gymnastics and track and field equipment being the primary export commodities. These sporting goods predominantly penetrate markets in Southeast Asia, West Asia, and Eastern Europe. In the sporting goods trade network associated with the "Belt and Road" initiative, China holds a central role, with Thailand, Turkey, and Poland progressively advancing toward central positions. 2) The implementation of the "Belt and Road" initiative has had a positive impact on China's sporting goods exports, and the policy's influence is particularly significant on the countries and regions along the "Belt and Road". The implementation of the policy does not favor the breathing growth of sporting goods exports, but it does promote the deepening of the export product. Based on these perspectives, it is imperative for China to establish a robust and sustainable trade network, proactively foster sporting diplomacy, maintain strategic focus, and enhance product quality to effectively propel the development of a sporting powerhouse.

Effects of essential caregiver policies on COVID-19 and non-COVID-19 deaths in nursing homes.

Federal authorities banned nursing home visitation in the early days of the coronavirus disease 2019 (COVID-19) pandemic. However, there was growing concern that physical isolation may have unintended harms on nursing home residents. Thus, nursing homes and policymakers faced a tradeoff between minimizing COVID-19 outbreaks and limiting the unintended harms. Between June 2020 and January 2021, 17 states implemented Essential Caregiver policies (ECPs) allowing nursing home visitation by designated family members or friends under controlled circumstances. Using the Nursing Home COVID-19 Public File and other relevant data, we analyze the effects of ECPs on deaths among nursing home residents. We exploit variation in the existence of ECPs across states and over time, finding that these policies effectively reduce both non-COVID-19 and COVID-19 deaths, resulting in a decrease in total deaths. These effects are larger for states that implemented policies mandatorily or without restrictions, indicating a dose-response relationship. These policies reduce non-COVID-19 deaths in facilities with higher quality or staffing levels, while reducing COVID-19 deaths in facilities with lower quality or staffing levels. Our findings support the use and expansion of ECPs to balance resident safety and the need for social interaction and informal care during future pandemics.

Assessment of a Community-Based Nutrition Program for Women and Children in Nepal Using Demographic and Health Survey.

Undernutrition is a particularly acute problem in middle- and low-income countries. The "Suaahara" program is a 5-year community-focused program in Nepal, aimed at improving the health and nutrition of pregnant and lactating women and their children under the age of 2 years. This research contributes to evidence on the impact of the "Suaahara" program in 41 treated districts compared to 34 control districts. Using the difference-in-differences method, we found that the weight-for-height z-score and body mass index z-score of children under the age of 2 in the treated districts significantly increased by 0.223 standard deviations (SDs) and 0.236 SDs, respectively, compared with the control districts 5 years before and after the program. The number of antenatal care visits (at least four visits) and safe deliveries significantly increased for pregnant women by 10.4% and 9.1%, respectively, in the treated districts compared with the control districts. The prevalence of fever in children under 2 years of age was significantly reduced by 6.2% in the treated districts. The results show the significance of a policy evaluation with transparent indicators on public health, which is necessary for policymakers so that they can propose evidence-based policy.

Can major public health emergencies increase the participation of commercial insurance? Evidence from China.

Background: Public health emergencies have a lasting impact on a country's economic and social development. However, commercial insurance can disperse these negative consequences and reduce risk losses. Method: Based on the Chinese Household Tracking Survey and Peking University Digital Inclusive Finance Index, this study employed a difference-in-differences model to test the impact of the COVID-19 outbreak on commercial insurance participation and the impact mechanism. Results: The analysis showed that the outbreak of COVID-19 improved residents' risk perception, risk preference and digital finance and promoted their participation in commercial insurance, commercial endowment insurance, and commercial medical insurance. Conclusion: Major public health emergencies can increase commercial insurance participation, but the promotional effect of commercial insurance on rural and low-income individuals is relatively limited. To tap into potential customers, financial institutions should focus on vulnerable societal groups. This study supplements the relevant literature on the impact of major public health emergencies on commercial insurance participation.

Improving access to primary health care through financial innovation in rural China: a quasi-experimental synthetic difference-in-differences approach.

BACKGROUND: Inadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund. METHODS: We employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform's impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure. RESULTS: The reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59-23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China. CONCLUSIONS: This research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.

Medication use evaluation of tocilizumab implementation in COVID-19 treatment guidelines: A causal inference approach.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Introduction of new medications to health-system formularies is often not accompanied by assessments of their clinical impact on the local patient population. The growing availability of electronic health record (EHR) data and advancements in pharmacoepidemiology methods offer institutions the opportunity to monitor the medication implementation process and assess clinical effectiveness in the local clinical context. In this study, we applied novel causal inference methods to evaluate the effects of a formulary policy introducing tocilizumab therapy for critically ill patients with coronavirus disease 2019 (COVID-19). METHODS: We conducted a medication use evaluation utilizing EHR data from patients admitted to a large medical center during the 6 months before and after implementation of a formulary policy endorsing the use of tocilizumab for treatment of COVID-19. The impact of tocilizumab on 28-day all-cause mortality was assessed using a difference-in-differences analysis, with ineligible patients serving as a nonequivalent control group, and a matched analysis guided by a target trial emulation framework. Safety endpoints assessed included the incidence of secondary infections and liver enzyme elevations. Our findings were benchmarked against clinical trials, an observational study, and a meta-analysis. RESULTS: Following guideline modification, tocilizumab was administered to 69% of eligible patients. This implementation was associated with a 3.1% absolute risk reduction in 28-day mortality (odds ratio, 0.86; number needed to treat to prevent one death, 32) attributable to the inclusion of tocilizumab in the guidelines and an additional 8.6% absolute risk reduction (odds ratio, 0.65; number needed to treat to prevent one death, 12) linked to its administration. These findings were consistent with estimates from published literature, although the effect estimates from the difference-in-differences analysis exhibited imprecision. CONCLUSION: Evaluating formulary management decisions through novel causal inference approaches offers valuable estimates of clinical effectiveness and the potential to optimize the impact of new medications on population outcomes.

The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador.

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea.

BACKGROUND: South Korea's National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of "Moon Care" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system's universality. METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy's effect. RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy's effect, but only for non-payments. CONCLUSIONS: We observed the policy's intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.