2026
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Yvonne Krabbe-Alkemade, France Portrait, Maarten Lindeboom, Marjolein Broese van Groenou, Hendrika J Luijen, Dorly Deegdijk
2026-13
This study examines the causal effect of labor market restrictions faced by women in early adulthood on later-life cognitive functioning. To identify this effect, we exploit an exogenous policy change in the Netherlands that removed restrictions on married women's access to paid employment in 1957. Our study draws on data from the Longitudinal Aging Study Amsterdam, an ongoing cohort study of older individuals. We focus on individuals aged 75 and older born between 1928 and 1947. We first examine how work restrictions in early adulthood shape lifetime employment. Next, we assess how these work restrictions affect women’s later-life cognitive outcomes by exploiting an exogenous change in labor restriction laws and complement this with an instrumental variables approach. The estimation results indicate that restricted access to paid employment for women in early adulthood reduced labor force participation and occupational prestige over the life course. These reduced labor market opportunities, in turn, led to poorer cognitive functioning after age 75. We also find some suggestive evidence that these restrictions resulted in faster cognitive decline. Taken together, our findings indicate that restrictions on women’s access to paid employment adversely affect cognitive functioning, thereby contributing to cognitive disparities between men and women in later life. More broadly, they highlight the long-term cognitive benefits of sustained labor market engagement and cognitively stimulating work, with potential implications for dementia prevention.
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Chiara Campana, Pierre Koning, Maarten Lindeboom
2026-12
While evidence points at potentially strong effects of stricter screening and tightening eligibility criteria for Disability Insurance (DI), little is known about their targeting effects: are screened-out workers also those with better future health and more ability to work? To shed light on this, we employ Regression-Discontinuity-in-Time regressions that compare the long-term outcomes of DI application cohorts just before and after a reform in the Netherlands. The reform led to stricter screening in the sickness period before DI application and reduced the number of applicants by 33%. Up to 18 years after application, we find persistently lower survival rates and lower employment rates of post-reform cohorts. Using detailed information on the future chronic diseases of these cohorts and the application diagnoses, we next construct indices capturing long-term expected survival (a “Survival Health Index”, SHI) and long-term employment prospects (a “Work Ability Index”, WAI) for DI applicant cohorts in the years following application. These indices allow us to assess whether the reform primarily deterred applicants with health-related disabilities, work-related disabilities, or both. We find that the self-screening induced by the reform was stronger for applicants with work disabilities (low WAI scores compared to their SHI scores) than for health disabilities (low SHI scores compared to their WAI scores). This is largely due to a decline in applications of workers with mental and musculoskeletal health conditions that have high survival rates, but lower employment rates.
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Adam A. Dzulkipli, Nicole Black, David W. Johnston, Leonie Segal
2026-11
Debate over the optimal school starting age has focused largely on children’s educational and developmental outcomes, with little attention given to whether starting school earlier may protect vulnerable children from maltreatment. This paper examines that possibility by exploiting a date-of-birth cut-off for school entry in Australia. We find that earlier school entry reduces the probability of a maltreatment notification from a non-education reporter by 4.3 percentage points or 50% relative to the mean. The reduction is driven largely by fewer police notifications and notifications involving emotional abuse. In contrast, notifications from education-sector reporters are unaffected overall, reflecting offsetting changes in notifications from preschool and school-based educators. The protective effects are concentrated among children without younger siblings and extend to older siblings, with the pattern of results suggesting that relaxed childcare constraints and increased maternal employment may be important mechanisms.
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Lachlan Cameron, Nicole Black, David Johnston, Jane Pirkis, Jemimah Ride, Rita Santos
2026-10
Worldwide, gambling can cause economic and health-related harm to individuals and communities. Policy responses to reduce these harms require evidence on the effects of features of the gambling environment. This study explores whether geographical accessibility to gambling venues impacts suicides. We construct a longitudinal spatial data set with information on the number of gambling venues and suicides in Australian neighbourhoods from 2001 to 2018, and exploit changes in accessibility induced by venue openings and closures. The closure of a gambling venue is estimated to decrease the number of suicides per year in that area by 9.8%. Effects of gambling venues in neighbouring areas are small and statistically insignificant, indicating that the relationship between venue access and suicide is concentrated close to the venue location.
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Trong-Anh Trinh, David W. Johnston, Leonie Segal, Emmanuel Gnanamanickam and Nicole Black
2026-09
Cash transfers around birth may improve child health by reducing financial stress and helping families meet urgent household and infant needs. However, causal evidence remains limited on whether payment design affects health impacts, whether unconditional payments influence child safety, and whether benefits extend to older siblings. We examined the effects of an unconditional cash transfer at birth on child health and safety, and whether changing the transfer from a lump sum to instalments altered these effects.
Methods. We used linked administrative data for all births in South Australia to evaluate two reforms to Australia’s Baby Bonus program: the 2004 introduction of a lump-sum payment of A$3000 and the 2009 change from a lump-sum payment of A$5000 to 13 fortnightly instalments. We estimated difference-in-discontinuities models comparing outcome discontinuities at each reform date with discontinuities at the same date one year earlier. Primary outcomes were any hospital presentation or admission and any Child Protection Services notification for the focal infant in the first six months after birth. We also examined older sibling outcomes, later follow-up windows, diagnosis-specific hospital outcomes, and maltreatment subtypes.
Findings. The 2004 lump-sum payment reduced infant hospital presentations and admissions by 9·8 percentage points (95% CI 7·3 to 12·2), from a pre-reform rate of 22·1%. Reductions were concentrated in respiratory and digestive conditions. Older siblings also had fewer hospital presentations and admissions. The 2009 change to instalments increased infant hospital presentations and admissions by 2·8 percentage points (95% CI 0·1 to 5·5), from a pre-reform rate of 18·4%. Neither reform was associated with detectable changes in Child Protection Services notifications. Interpretation. At-birth cash transfers can improve infant and sibling health without increasing maltreatment risk, but payment design shapes effectiveness: a lump sum produced larger health benefits than the same amount delivered as instalments.
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Kai Shen Lim, Bijetri Bose, Terence C. Cheng
2026-08
Word-of-mouth (WOM) recommendations from family and friends can substitute for absent quality certification and weak regulatory oversight. Whether such informal information improves or distorts patient decisions remains unclear. We study this question using original linked household and facility survey data from Odisha, India, covering 3,090 patient visits across 373 villages. Patients who choose providers based on recommendations spend more out-of-pocket on drugs and transportation. Yet, this additional spending does not translate into better outcomes: WOM is not associated with higher perceived care quality, and WOM users are significantly less likely to return to the same provider. To understand these patterns, we estimate an attentive logit model that separately identifies consideration and preference stages of provider choice. We find that WOM narrows attention to a smaller set of providers that are not higher-quality. Counterfactual simulations show that removing WOM-induced attention distortions does not significantly improve the quality of providers patients choose, while raising awareness towards other providers yields modest gains. These findings suggest that informal networks cannot reliably substitute for formal quality information systems in fragmented healthcare markets.
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Carol Propper
2026-07
In the last two decades European policy makers have sought to increase the use of market mechanisms in the delivery of healthcare. These reforms introduce competition and choice into previously heavily constrained environments. This leads to a set of interesting economic issues that have been addressed in a range of papers, both theoretical and empirical. This paper examines whether this popular reform model has resulted in improvements in outcomes for patients and/or taxpayers. It synthesises the existing economic analyses, highlights what is known and what is not, and signals potential next steps for economic research.
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Nicole Black, Lachlan Deer, Johannes S. Kunz, David W. Johnston
2026-06
National public health awareness campaigns that emphasize peer-to-peer support are increasingly adopted, but evidence on the effects of peer-based programs at scale remains limited. Using quasi-experimental methods, we examine whether the prominent nationwide “R U OK? Day” campaign affects short-term mental health outcomes in Australia. Leveraging survey and administrative data, we find R U OK? Day leads to a 4% of a standard deviation increase in self-reported mental wellbeing, with the effect particularly pronounced among middle-aged males who experience a 9% of a standard deviation increase. We find no detectable effects on mental health care utilization, and we detect no statistically significant changes in suicide-related deaths in the short run, though the mortality outcomes are rare and power is limited. Our results underscore that peer-based campaigns can improve mental wellbeing, especially for high-risk groups, and point to a distinction between short-run psychological responses and outcomes that require behavioural follow-through.
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David W. Johnston, Sundar Ponnusamy
2026-05
How do households finance a costly, sudden shock? We study this question using natural disasters as a source of exogenous variation. Exploiting 15 waves of Australian longitudinal data and individual fixed-effects models, we estimate the effects of direct disaster exposure on household expenditure, income, assets, liabilities, and financial hardship, including coping margins that are typically unobserved in administrative data. Disaster exposure increases expenditure, driven by repair-related spending, while income and assets remain largely unchanged. The main adjustment occurs through significant increases in personal debt and informal financing. For many households, these responses are insufficient to avoid material deprivation, with increases in the likelihood of going without meals, missing utility payments, and being unable to heat the home. These effects are larger among households without insurance coverage and are concentrated in the year of the shock.
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Duncan Mortimer, Rohan Sweeney, Amelia Turagabeci, Sepesa Rasili
2026-04
Climate change is forcing difficult choices between in-place adaptation and relocation for Pacific Island communities, yet policy responses often rely on participatory planning frameworks that privilege louder voices or implicitly assume a consensus of preferences. We surveyed 476 adults across 25 at-risk Fijian villages using a discrete choice experiment to understand how individuals evaluate trade-offs between alternative future living arrangements, including location, services, housing, income opportunities, climate risk, and cultural connection. Our analysis identifies three distinct preference types — movers, stayers, and adapters — with sometimes conflicting priorities. While movers and adapters are generally willing to relocate to climate-resilient locations, stayers prefer to remain in their existing villages even in the absence of significant adaptation investment. These divergent preferences reveal relocation and in-place adaptation as spatially constrained and contested choices. Uncoordinated household-level decisions by movers and adapters risk redistributing rural populations across to urban centres and fragmenting communities. Preservation of connection to community and place may therefore require deliberate coordination and compromise at the community level, including the design of new climate-resilient settlements that accommodate the preferences of stayers. Recognising heterogeneous preferences and the limits of consensus-based participation is essential for designing community adaptation pathways that are socially, culturally, and spatially just and acceptable.
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Lihini de Silva, David Johnston, and Sundar Ponnusamy
2026-03
Government funding for environmental disasters and climate adaptation can strongly influence community recovery and resilience-building. Yet given funding is often distributed via competitive schemes, inequities may arise if allocation is determined by factors such as cost effectiveness rather than need. Consequently, disadvantaged communities may receive inadequate support and be highly vulnerable to future disasters. We examine whether federal government community grants following the Australian 2019/20 Black Summer Bushfires were distributed equitably. Using detailed grant-level data including where the grant activity took place, the recipient organisation, and the amount awarded, we find that even after controlling for physical exposure to the fires, communities that are more vulnerable by demographics (e.g., more children, elderly people, non-working individuals, and First Nations people) receive less. Communities with larger ethnic minority populations also get less though this result is not as robust. Conversely, communities with greater built environment vulnerability (i.e., more remote) receive more. We demonstrate that lower funding for demographics and minority vulnerable communities manifest mostly via grants targeting economic and social outcomes whilst higher funding for built environment vulnerable communities is largely driven by infrastructure grants. Furthermore, inequities persist across organisation types including government institutions, which are expected to more carefully consider equity compared to non-government organisations. Finally, the observed inequities hold even across grants received by the same organisation. Altogether, our findings suggest a tension in competitive grant schemes between targeting need and funding projects that are more likely to be successful and cost effective, resulting in socially vulnerable communities receiving less.
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Rohan Sweeney, Farzana Hossain, Jumriani Ansar, Indra Dwinata, Sitti Andriani Anwar, Arlyani Risal, Gang Chen, Michaela F. Prescott, S Fiona Barker, Karin Leder, Ansariadi Ansariadi, and David W. Johnston
2026-02
This study employs two discrete choice experiments (DCEs) conducted with two sample groups in Indonesia to investigate the informal settlement upgrading priorities of residents (sample 1) and explore how they align with public taxpayers’ preferences (sample 2). The first
DCE explores the relative importance placed upon common planning and public health priorities, such as water security, drainage, and diarrhoea in children, alongside local economic development priorities. The second DCE investigates the relative importance placed upon project implementation design considerations, including project completion time and community consultation. Our findings reveal that residents particularly prioritise improvements in water quality and economic development. While informal settlement upgrading interventions often prioritise improving water, sanitation and hygiene (WaSH) to reduce diarrhoea and other water-borne disease, our study highlights that residents also highly value economic empowerment, underscoring the need for integrated upgrading approaches that address both health and livelihood concerns. Taxpayer perspectives were well-aligned on upgrading outcome priorities, but diverged slightly on project implementation. Whereas residents prioritised minimising project duration and were less concerned with significant community consultation, taxpayers emphasised generating employment opportunities for residents within project designs. Both groups expressed an aversion to residents bearing full responsibility for resourcing ongoing operations and maintenance, preferring government or shared responsibility, highlighting the need for sustainable funding models. The study highlights the value of DCEs as a tool to support locally-led development, informing upgrading strategies that are more likely to be both politically feasible and successfully appropriated into urban livelihood practices of residents. -
Nicole Black, Anthony Harris, David W. Johnston, and Trong-Anh Trinh
2026-01
This paper examines how the composition of financial resources relates to financial hardship and financial satisfaction among retired households. Using 23 waves of a nationally representative Australian panel, we distinguish between government pensions, private income, liquid financial assets, housing wealth, and debt. In fixed-effects models that exploit within-individual changes over time, liquid financial assets are strongly associated with lower financial hardship and higher financial satisfaction, while other forms of wealth show little independent association. We additionally examine responses to health shocks and find that liquid assets significantly attenuate their adverse financial effects, providing direct evidence of a buffering role. These results indicate that retirees with similar total wealth may experience different financial outcomes depending on portfolio composition, and suggest that adequacy assessments based on aggregate wealth or income replacement rates alone may overlook an important source of financial vulnerability.