Research

Eliminating prices for socially valuable goods can improve access but also distort demand and raise fiscal cost. We study this trade-off in the context of a policy adopted by many governments to expand pharmaceutical access: full elimination of copayments at the point of purchase. We ask what are the market and health consequences of full drug subsidies. We exploit Poland’s Drugs 75+ reform, which made hundreds of prescription drugs free of charge for seniors above an age threshold. Using administrative reimbursement data over 2014–2024, we leverage the age-eligibility cutoff and the staggered adoption of drugs into the free list in a robust event-study framework. Consumption rises by about 11% on impact and grows to 14% by twelve months, increasing monotonically in the pre-policy copay. Within chemically equivalent substitutes, patients shift toward higher-priced variants. Together, the additional coverage, quantity, and substitution responses roughly double per-drug government spending. Comparing cohorts reaching the eligibility age just before and just after the reform, we find a significant increase in primary care visits but do not detect effects on specialist visits, hospitalizations, or urgent care over 18 months. Using a structural model of the antihypertensive market, we investigate an alternative design that makes only the cheapest product in each substitute group free: it would deliver 62% of the fiscal savings of repealing the policy while reducing eligible-senior consumption by only 6%.

While economic and health dynamics across generations have been well studied, the role of environmental factors in driving intergenerational persistence remains underexplored. This paper examines the first- and second-generation effects of leadborne pollution on health and fertility outcomes. We exploit the phase-out of leaded gasoline in Mexico in the 1990s, which led to a sharp decline in air lead pollution. Using a shift-share design to identify variation in prenatal lead exposure, we find that a full reduction in lead exposure results in a 1.97 per thousand reduction in fetal deaths, a 0.53 per thousand increase in birth rates, and a 3.33 per thousand decrease in infant mortality. Female children exposed to higher in-utero lead levels are more likely to give birth earlier and less likely to migrate. In the second generation, the effects of in utero exposure vary by local socioeconomic conditions: in better-off municipalities, long-term effects are null, whereas in marginalized municipalities, children of exposed mothers experience significantly lower birth weights and elevated rates of preterm birth. These findings highlight how structural disadvantage mediates the intergenerational transmission of environmental shocks.

This paper provides causal evidence that the sex composition of dating markets affects maternal and neonatal health. Using a novel instrument that leverages randomness in sex at birth to vary the availability of male partners, I find that a more favorable dating market for women decreases non-marital but increases marital fertility, lowers rates of chlamydia and hypertension among mothers, and decreases the incidence of low APGAR scores and a composite index of adverse birth outcomes. These effects appear to operate primarily through changes in relationship dynamics and selection into motherhood. Connecting this to inequalities, racial disparities in partner availability can explain 5–10 of the Black–White pregnancy health gap.

We provide causal evidence on the financial consequences and moral hazard effects of a universal prescription drug subsidy for seniors—a policy widely implemented in many countries. Our analysis leverages Poland’s introduction of such a subsidy, which fully eliminated out-of-pocket costs for selected medications at age 75. Exploiting the sharp age eligibility threshold and policy timing, we apply a difference-in-discontinuities design to detailed household expenditure data. We find substantial reductions in medication spending and a 62% decrease in catastrophic drug expenditures, indicative of a strong insurance effect. However, these financial gains disproportionately accrued to wealthier households, raising distributional concerns. We also document increased household spending on alcohol and cigarettes, consistent with ex ante moral hazard. These findings demonstrate that while universal drug subsidies effectively reduce financial risk among older adults, they may also induce unintended behavioral responses and amplify existing inequities.

This study examines the impact of temporary school closures on influenza transmission and respiratory mortality, leveraging a natural experiment from winter break timings in Polish schools. Analyzing 12 years of ILI (Influenza-Like Illness) data and two decades of respiratory death records, findings indicate significant reductions in ILI incidence post-closures: 75% among school-aged children, 55% in adults, 52% in pre-school children, and 41% in the elderly. Notably, a 7% decrease in respiratory mortality was observed among the elderly, highlighting school closures as an effective public health intervention for reducing influenza spread and mortality among high-risk groups.

This paper investigates how reopening hotels and ski facilities in Poland impacted tourism spending, mobility, and COVID-19 outcomes. We used administrative data from a government program that subsidizes travel to show that the policy increased the consumption of tourism services in ski resorts. By leveraging geolocation data from Facebook, we showed that ski resorts experienced a significant influx of tourists, increasing the number of local users by up to 50%. Furthermore, we confirmed an increase in the probability of meetings between pairs of users from distanced locations and users from tourist and non-tourist areas. As the policy impacted travel and gatherings, we then analyzed its effect on the diffusion of COVID-19. We found that counties with ski facilities experienced more infections after the reopening. Moreover, counties strongly connected to the ski resorts during the reopening had more subsequent cases than weakly connected counties. Cost-benefit analysis shows that costs stemming from additional hospitalizations and deaths vastly outweighed the economic benefits of reopening, even in the ski resorts.