Suchergebnisse

Nonmedical exemptions from school-entry vaccine mandates are receiving increased policy and public health scrutiny. This paper examines how expanding the availability of exemptions influences vaccination rates in early childhood and academic achievement in middle school. We leverage 2003 legislation that granted personal belief exemptions (PBE) in Texas and Arkansas, two states the previously allowed exemptions only for medical or religious regions. We find that PBE decreased vaccination coverage among black and low-income preschoolers by 16.1% and 8.3%, respectively. Furthermore, we find that those cohorts affected by the policy change in early childhood performed less well on standardized tests of academic achievement in middle school. Estimated effects on mathematics and English Language Arts test scores were largest for black students, especially those residing in economically disadvantaged counties.

Access to health care is an important determinant of health, but it remains unclear whether having more physicians reduces mortality. In this study, we used Taiwan's population-level National Death Certification Registry data to investigate whether a greater supply of physicians is associated with lower rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment. Our baseline regression analysis adjusting only for age and sex shows that an increase in the number of physicians per 1000 is associated with a reduction of 1.7 ( P < .01) and 0.97 ( P < .01) age-standardized deaths per 100 000 for men and women, respectively. However, in our full analyses that control for socioeconomic factors and Taiwan's health insurance expansion, we find that physician supply is no longer statistically associated with amenable mortality rates. Nevertheless, we found that greater physician supply levels are associated with a reduction in deaths from ischemic heart disease (−0.13 ( P < .05) for men, and −0.066 ( P < .05) for women). These findings suggest that overall, physician supply is not associated with amenable mortality rates after controlling for socioeconomic factors but may help reduce amenable mortality rates in specific causes of death.