Vortragssitzung
Synthetic Control: Exploring organ donation & sugar taxes
Vorträge
Does implementing opt-out solve the organ shortage problem? Evidence from a synthetic control approach
Selina Schulze Spüntrup, ifo Institute, Dresden
Einleitung / Introduction
From the beginning of organ transplantation, countries have sought to increase the number of life-saving organs donated. In particular, some countries have changed their organ donation legislation to make every deceased a potential organ donor unless the person has objected. Using the variation in the two cases of Argentina and Wales, I examine whether these countries could effectively achieve higher organ donation rates by switching to an opt-out system.
Methode / Method
Using a panel dataset covering a 21-year period, I apply a synthetic control approach to focus on countries that changed their prevailing organ donation legislation from opt-in to opt-out. I compare them to a synthetic counterfactual from countries that have kept their legislation the same since 1999.
Ergebnisse / Results
The estimates for implementing an opt-out policy in Argentina and Wales show similar patterns. In both cases the trend for the treated unit outperforms the synthetic control after the law has changed. I find that adopting an opt-out system raised organ donation rates in Argentina by 40%. In Wales, the introduction of opt-out led to a 34% increase in organ donation rates.
Zusammenfassung / Conclusion
Synthetic control estimates show that Argentina and Wales achieved substantially higher organ donation rates with the shift from an opt-in to an opt-out system than without the reform taking place. While sizeable, the impact of opt-out does not suffice to solve the organ shortage problem completely but may mitigate it.
AutorInnen
Selina Schulze Spüntrup, ifo Institute, Dresden
Who has the final say? Effect of family veto removal on organ donation rates: Evidence from Sweden
Paul Gerhard Peters, ZEW
Einleitung / Introduction
In recent years, the demand for organ transplants has steadily increased. However, changes in organ donation rates failed to meet the rising demand, leading to longer waiting lists for patients in need of organs. This scarcity has prompted researchers and governments to study determinants of organ donation rates across countries with a focus on consent systems, mainly presumed consent (opt-out) and explicit consent (opt-in). Despite many countries, switching from opt-in to opt-out systems in the last years with the goal of increasing donation rates, these efforts were unsuccessful. However, in 2022, Sweden took a further step, removing the possibility of veto for next of kin in the cadaveric donation decision process (hard opt-out). In this paper, we study how this novel reform has impacted organ donation rates.
Methode / Method
We use quarterly level data from Scandinavian countries on number of deceased and utilized donors and number of living and deceased donated organs by type of organ. Our data ranges from 2017 until September 2023. We supplement our data with country-level controls potentially linked to the number of organ donations, such as mortality rate. In addition to a difference-in-differences (DiD) model, we implement a Synthetic Control and Synthetic DiD approach.
Ergebnisse / Results
The preliminary results show no impact of the reform on actual deceased donors (brain death and cardiovascular death) per million population. Regarding donations by type of organ, we only find a small but significant impact of the reform on deceased kidney donation. We do not find significant effects on living donation.
Zusammenfassung / Conclusion
We are the first to study a reform on transition from soft to hard opt-out and one of the few using quantitative methods to study effects of legislative changes on organ donation numbers. In contrast to existing studies, we are only able to find evidence for beneficial effects of the family veto removal on organ donations among kidney donations. Besides this, we are unable to confirm family veto to be a decisive factor to explain differences in organ donation rates. With our analysis, we contribute to the ongoing debate on the link between legislative defaults and organ donation rates and highlight the distinction between soft and hard opt-out systems.
AutorInnen
Paul Gerhard Peters, ZEW
Jan Köhler, ZEW
Impact of the Mexican tax on unhealthy beverages and foods on undernourishment: a synthetic control approach
Sandra Tappendorf
Einleitung / Introduction
Mexico is facing a double burden of malnutrition with a high portion of its population being overweight or obese, and a growing prevalence of undernourishment. In line with the idea of a holistic approach to combat malnutrition, we examine the impact of the 2014 introduction of a tax on unhealthy beverages and foods that was aimed at addressing obesity. Due to the growing prevalence of undernourishment, we intend to shed light on the question whether this tax had an impact on undernourishment indicators. The broader theory on the double burden of malnutrition suggests that a reduced consumption of highly-processed foods will also benefit people that suffer from stunting and undernourishment. Contrarily, some studies in sub-Saharan African countries find evidence that rates of children under five years stunting are decreasing due to an increased availability of processed foods through extended supermarket infrastructure. Bansal and Zilberman (2021) argue that calorie taxes can increase nutritional status and life expectancy in some countries, but may reduce them in others. Therefore, different countries need different strategies, and within countries individuals need adjusted strategies to account for their differences. Studies on the impact of the Mexican tax find a reduction of purchased products, many of them find the purchases of taxed products to decrease more in households with low socioeconomic status compared to households with high socioeconomic status. From this finding, two competing narratives arise, one claiming the tax to be regressive and burdening the poor disproportionately, the other deriving the tax to be progressive due to lowered consumption of unhealthy products leading to health care savings and productivity gains in these households. So far, the studies do not explicitly address the tax’s potential impact on undernourishment indicators.
Methode / Method
We apply the synthetic control method, a quasi-experimental approach developed by Abadie et al. (2003; 2010; 2021) comparing the development in Mexico after the introduction of the tax with a synthetic Mexico that had a similar development before. We use (a) the FAO data set on prevalence of undernourishment and (b) the Joint Malnutrition Estimates of UNICEF, WHO, and World Bank Group on the percentage of children under five years that are stunting.
Ergebnisse / Results
We find that the Mexican tax did not significantly impact the proportion of children under five years stunting or the prevalence of undernourishment in Mexico.
Zusammenfassung / Conclusion
The finding contradicts the argument by food industry-funded research that the poor are negatively affected by the tax, from a nutritional perspective. More independent research is necessary to better understand the effects of the tax and similar policies on the poor in general and people of different nutritional status.