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Causal Spousal Health Spillover Effects and Implications for Program Evaluation.

Jason Fletcher, Ryne Marksteiner

    American Economic Journal. Economic Policy
    |July 31, 2018
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    Summary

    Social spillovers significantly impact health intervention cost-effectiveness. Accounting for these effects between spouses reduces cost-effectiveness ratios, improving resource allocation for public health programs.

    Keywords:
    H51 Government Expenditures and HealthI12 Health BehaviorI18 Government Policy • Regulation • Public Health

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    Area of Science:

    • Health Economics
    • Behavioral Economics
    • Public Health

    Background:

    • Cost-effectiveness analysis (CEA) often overlooks social spillovers, potentially leading to biased evaluations of health interventions.
    • Underestimating the comprehensive effects of interventions due to ignored spillovers can result in suboptimal resource allocation.
    • Social ties, particularly within marriage, can influence individual health behaviors, a factor rarely incorporated into standard CEA.

    Purpose of the Study:

    • To discuss the implications of social spillovers for program evaluation in health economics.
    • To provide the first empirical evidence of causal spillovers in health behaviors between spouses.
    • To re-evaluate the cost-effectiveness of interventions considering these spillovers.

    Main Methods:

    • Leveraging experimental data from the Lung Health Study (smoking cessation) and the COMBINE Study (alcohol reduction).
    • Employing methods to identify and quantify causal spillovers of health behaviors between married participants.
    • Recalculating incremental cost-effectiveness ratios (ICERs) incorporating observed spillovers.

    Main Results:

    • Significant reductions in spousal substance use (smoking and drinking) were observed when one partner received treatment, particularly those involving a therapy component.
    • These spillovers demonstrate a measurable impact of an individual's health intervention on their spouse's behavior.
    • The inclusion of social spillovers reduced the incremental cost-effectiveness ratios of certain interventions by 12 to 18 percent.

    Conclusions:

    • Social spillovers between spouses are a significant factor in health behavior change.
    • Current cost-effectiveness analyses may underestimate the true benefits of health interventions by not accounting for these spillovers.
    • Incorporating social spillovers into CEA can lead to more accurate resource allocation and improved public health program efficiency.