Research

We analyse the impact of the construction of medical schools and associated university hospitals in Japan during the 1970s, which was primarily driven by ‘One Prefecture, One Medical School Policy’ (OPOMS). We find that the number of physicians increased significantly in prefectures where a medical school was built, and this effect persisted for more than 20 years. Moreover, we uncover suggestive evidence that the establishment of university hospitals may lead to a reduction in the overall mortality rate, especially among the elderly. Our results also indicate that the improvement in health outcomes is likely attributed to access to high-quality care resulting from the opening of university hospitals, rather than an overall increase in the utilisation of healthcare services.

The paper investigates the heterogeneous effect of a policy-induced decline in people’s mobility on the Japanese labor market outcome during the early COVID-19 period. Regressing individual-level labor market outcomes on prefecture-level mobility changes using policy stringency index as an instrument, our two-stage least squares estimator presents the following findings. First, the number of people absent from work increased for all groups of individuals, but the magnitude was greater for workers with non-regular employment status, low-educated people, females especially with children, and those aged 31 to 45 years. Second, while work hours decreased for most groups, the magnitude was especially greater for business owners without employees and those aged 31 to 45. Third, the negative effect on unemployment was statistically significant for older males who worked as regular workers in the previous year. The impact was particularly considerable for those aged 60 and 65, thus suggesting that they lost their re-employment opportunity due to COVID-19. Fourth, all these adverse effects were greater for people working in service and sales occupations. Fifth, a counterfactual experiment of more stringent policies indicates that while an average worker would lose JPY 3857 in weekly earnings by shortening their work hours, the weekly loss for those aged 31 to 45 years and working in service and sales occupations would be about JPY 13,842.

This paper quantitatively analyzes the trade-off between job losses and the spread of COVID-19 in Japan. We derive an empirical specification from the social planner’s resource constraint under the susceptible, infected, recovered, and deaths (SIRD) model and estimate how job losses and the case growth rate are related to people’s mobility using the Japanese prefecture-level panel data on confirmed cases, involuntary job losses, people’s mobility, and teleworkability. Our findings are summarized as follows. First, we find that a decrease in mobility driven by containment policies is associated with an increase in involuntary job separations, but the high teleworkability mitigates the negative effect of decreased mobility on job losses. Second, estimating how the case growth is related to people’s mobility and past cases, we find that the case growth rate is positively related to an increase in people’s mobility but negatively associated with past confirmed cases. Third, using these estimates, we provide a quantitative analysis of the trade-off between job losses and the number of confirmed cases. Taking Tokyo in July 2020 as a benchmark, we find that the cost of saving 1 job per month is 2.3 more confirmed cases per month in the short run of 1 month. When we consider a trade-off for 3 months from July to September of 2020, protecting 1 job per month requires 6.6 more confirmed cases per month. Therefore, the trade-off becomes worse substantially in the longer run of 3 months, reflecting the exponential case growth when the people’s mobility is high.

We investigate the impact of virtual care adoption on primary care accessibility, utilisation, and patient welfare using administrative claims data from British Columbia (2018–2022). We document four main findings. First, virtual care is associated with increased visit frequency for established patients (intensive margin) but is uncorrelated with patient participation (extensive margin). Second, virtual visits occur at significantly greater distances than in-person interactions, exhibiting first-order stochastic dominance even within fixed patient-provider pairs. Third, we find that females, working-age adults, and residents of rural areas with strong metropolitan ties derive the largest relative increase in visits. Finally, estimating welfare implications via an opportunity cost framework, we show that welfare gains are spatially heterogeneous, favouring non-metropolitan residents. This suggests the technology primarily benefits those facing the highest physical access barriers.

We investigate the changes in dental care use patterns in Covid-19 and analyze the effectiveness of preventative care on cavities using foot traffic data from Safegraph and the public claims data in New Hampshire. We find the number of claims decreased by around 10% on average after the spread of Covid, but they went back to the level before Covid in 2021. We also find some comprehensive preventative care was replaced with the focused care during Covid. Finally, we find that a 1% decrease in the number of preventative care claims is related to a 21% increase in the number of cavity claims.