Causal Spousal Health Spillover Effects and Implications for Program Evaluation

Abstract

Current methods of cost effectiveness analysis implicitly assume zero spillovers among social ties. This can underestimate the benefits of health interventions and misallocate resources toward interventions with lower comprehensive effects. We discuss the implications of social spillovers for program evaluation and document the first evidence of causal spillovers of health behaviors between spouses by leveraging experimental data from the Lung Health Study (smoking) and COMBINE Study (drinking). We find large decreases in spousal substance use from treatments with a therapy component, which reduces the incremental cost effectiveness ratios of some treatments by 12 to 18 percent.

Liquid Assets? the Short-Run Liabilities of Binge Drinking

“…Besides the discussion below in this subsection, we formally account for the possibility that the exclusion restriction does not hold, employing the method described by Conley, Hansen, and Rossi (2012). In particular, we estimate β 1 under various priors for the influence that the a × w interaction effect might have on Y directly (see also Fletcher and Marksteiner [2017] and Satyanath, Voigtländer, and Voth [2017]). A natural prior is to assume that the age group-weekend night interaction effect is a fraction, δ, of the reduced form parameter π 1 .…”

“…As in Fletcher and Marksteiner (2017) among others, we contextualize the restrictions on δ by their percentage on the reduced form parameter π 1 and, in the table, present the results for the case in which δ = 0.50. In the Online Appendix we show the results found for other unions of CI with δ set at 0.20, 0.40, 0.60 and 0.80.…”

Impact of In‐Hospital Death on Spending for Bereaved Spouses

“…; Al‐Janabi and Van Exel ; Al‐Janabi et al. ; Fletcher and Marksteiner ), current health care cost estimates do not routinely consider potential downstream costs associated with the health care expenditures of family members who care for their seriously ill loved ones (Hurd et al. ).…”

“…Furthermore, these analyses suggest that assessment of EOL costs may need to account for the downstream costs of health care for spouses. Despite a growing literature demonstrating the evidence to support inclusion of family "health spillovers" in economic evaluation (Bobinac et al 2011;Brouwer et al 2013;Fletcher and Marksteiner 2017), current health care cost estimates do not routinely consider potential downstream costs associated with the health care expenditures of family members who care for their seriously ill loved ones (Hurd et al 2013). A more comprehensive (and less individualistic) perspective on health care and assessment of costs is justified as many caregivers are themselves older, in poor health, and also Medicare beneficiaries (National Academies of Sciences 2016).…”

Estimating the effects of friends on health behaviors of adolescents

“…See Fletcher and Marksteiner (2017) for an application of RCTs to examine health behavior spillovers between spouses. …”