Description: Department of Economics

Description: Johannes Spinnewijn

| CV |

| Working Papers|

| In Progress|

| Published Papers |

| Other Publications |

| Teaching|

| Miscellaneous|

| LSE Economics |

| Public Econ at LSE |

Johannes Spinnewijn

Position: Professor of Economics

Research Interests: Public Economics, Social Insurance, Behavioral Economics, Health Economics

Other Positions and Affiliations:

Contact details:


Job Opportunity: Pre-doctoral Research Assistants

  • The Public Finance Group of the Economics Dept at the LSE is hiring full-time pre-doctoral research assistants. Applicants should be completing (or have completed) a Bachelor's or Masters degree and have strong quantitative and programming skills. This position is suitable for people looking to obtain experience in economic research for 1 to 2 years before applying to graduate school in economics. If you would like more information, please visit our website here or see the advert here.

Working Papers

  • The Chronic Disease Index: Analyzing Health Inequalities Over the Lifecycle (with Kaveh Danesh, Jon Kolstad and Will Parker) - VoxEU, Leuvense Economisch Standpunten; NBER Bulletin, ESB, De Standaard; Radio 1, Financieel Dagblad, Knack - October 2025

    • Abstract: The rich live longer than the poor, but how and when health differences arise over the course of life remains less understood. Leveraging rich administrative data from the Netherlands, we link chronic disease profiles to mortality risk at old-age to construct a health index that is comprehensive, measured repeatedly and at scale. Our index allows us to study the dynamics of health inequality, which translate into mortality differences later in life. We find that about 50% of the health gap between income groups at age 70 has already materialized at age 40. Approximately 60% of the gap is due to low-income individuals developing chronic illness at a faster rate, rather than chronically ill individuals sorting into lower-income groups. We also examine the contributions of a wide range of mediators to the onset of chronic diseases and find that socioeconomic factors play a predominant role.

  • The Impact and Incidence of Supplemental Health Insurance: Evidence from Sweden (with Marten Palme, David Seim and Jens Wikstrom)

    • Abstract: This paper studies the role of private supplemental health insurance (SHI) in universal healthcare systems. Linking novel microdata on SHI contracts to rich administrative data from Sweden, we document a steep income gradient in take-up: higher-income individuals are substantially more likely to enroll in SHI despite a greater healthcare need among lower-income individuals. Exploiting variation in the timing of employer-sponsored SHI, we find large and persistent increases in healthcare utilization (23 percent). The effects are even larger for low-income individuals and extend beyond specialist consultations to high-value treatments, consistent with binding rationing in public care. Focusing on cancer as a high-stakes condition, we find that SHI increases screening and diagnoses and reduces mortality. Although SHI is privately contracted, its effects materialize largely within the public healthcare system: coverage increases publicly financed utilization and reduces waiting times, generating negative fiscal and congestion externalities.

  • Explaining the Atomistic versus Ecological Fallacies in SES-Health Gradients (with Will Parker) - forthcoming in AEA Papers & Proceedings

    • Abstract: A long literature in economics and public health has examined the relationship between socioeconomic status (SES) and health, often relying on area-based measures when individual-level data are unavailable. Using comprehensive Dutch administrative data, we build on work estimating income-health gradients (e.g., Chetty et al. (2016)) and study how the level of aggregation systematically shapes estimates by inducing so-called ecological or atomistic biases. Individual and area income proxy for different channels (e.g., personal resources vs. local surroundings), but are obviously correlated. Aggregating to the area level reduces meaningful variation and attenuates non-linearities. We find that area-level estimates exaggerate the income gradient relative to individual-level estimates and are less robust to including individual and area-level controls respectively. Moreover, interaction analyses reveal that area exposure is highly unequal: the health of low-income households are far more sensitive to neighbourhood conditions than high-income households. Together, these findings shed light on the sources of SES–health gradients and show how data aggregation affects both interpretation and empirical estimates.

  • At-Risk or Responsive? Targeting in Unemployment Policy (with Sebastian Ernst, Andreas Mueller and Joost Bollens) - Coming Soon

    • Abstract: This paper evaluates the use of algorithmic risk profiling to direct job search support toward individuals most at risk of long-term unemployment. Using three regression discontinuity designs and rich administrative data from the Flemish Public Employment Service (VDAB) in Belgium, we address two key dimensions: who and when to target. First, job search counseling raises employment on average, but treatment effects decline sharply with predicted risk. This reveals a fundamental trade-off between targeting those most at risk and those most responsive to intervention. Second, we find no evidence of depreciation in treatment effects at the individual level, but strong dynamic selection: as spells lengthen, surviving job seekers have both higher baseline risk and lower treatment responsiveness, generating a trade-off between the timing of treatment and the composition of the remaining pool. We develop and calibrate a conceptual framework for optimal targeting whose key sufficient statistic is the ratio of predicted treatment effects to predicted job-finding probabilities. Targeting rules combining both objects substantially outperform the status quo, yielding welfare gains nearly three times larger than random assignment, while targeting on risk scores alone performs worse than random targeting.

Work in Progress

  • Sources of Socioeconomic Inequality in Cancer Mortality (with Kaveh Danesh, Jon Kolstad, Will Parker and Mieke Aarts)

  • The Social Determinants of Mental Health (with Canishk Naik and Will Parker)

  • The Impact and Incidence of Choice Environment: Evidence from Health Insurance in the Netherlands (with Chloé de Meulenaer, Ben Handel and Jon Kolstad)

Published Papers

Other Publications

Current Courses Taught

  • Public Economics (PhD, LSE course, ec534)
  • Public Economics (MSc, LSE course, ec426)
  • Public Economics (MPA, LSE course, ec410)

Press Coverage/Other Writings

  • "We kennen te veel gewicht toe aan roken en drinken" Interview in Financieel Dagblad (December 15, 2024) (link)
  • "Arme mensen verouderen sneller door hun omgeving" Economische en Statistische Berichten (November 20, 2024) (link)
  • "Gezondheidskloof in Nederland: mensen met lager inkomen gaan eerder dood" Interview on NPO Radio 1 (November 19, 2024) (link)
  • "Waarom we blindvaren in de strijd tegen gezondheidsongelijkheid" Op-ed in De Standaard (October 30, 2024) (link)
  • "Waarom sterven mensen met een lager inkomen vroeger?" Interview in Knack (October 29, 2024) (link)
  • "Closing the health gap: How chronic illness drives health inequality early on" VoxEU (September 24, 2024) (link)
  • "Met enkele lukrake financiele prikkels redden we het niet" Op-ed in De Standaard / Le Soir (July 9, 2022) (link DS, link LS)
  • "The hidden costs of incentivising later retirement" VoxEU (March 22, 2022) (link)
  • "Covid has been a catastrophe. Can it also be an opportunity?" featured in Financial Times (April 2, 2021) (link)
  • "Slechte eigenrisicokeuzes maken de zorgverzekering duurder voor laagopgeleiden" Economische en Statistische Berichten (February 20, 2021) (link)
  • "Heb je je slecht geïnformeerd over je zorgpolis? Dan ben je vaak duurder uit" Interview in NRC (March 25, 2021) (link)
  • "Onderzoekers: eigen risico in de zorg vergroot ongelijkheid" Interview in Financieel Dagblad (February 9, 2021) (link)
  • "Job seekers' beliefs and the causes of long-term unemployment" VoxEU (January 29, 2021) (link)
  • "Inequality in choice quality: Evidence from health insurance choices in the Netherlands" VoxEU (November 21, 2020) (link)
  • "Waarom we liever de cijfers dan het buikgevoel laten spreken" Op-ed in De Standaard (August 27, 2019) (link)
  • "Moeten de werkloosheidsuitkeringen toe- of afnemen in de tijd?" Interview in Knack (August 14, 2019) (link)
  • "Uitkeringen zijn geen spelletje hoger/lager" Op-ed in De Standaard (September 24, 2018) (link)
  • "Une baisse plus rapide des allocations est-elle a recommander?" Op-ed in Le Soir (September 24, 2018) (link)
  • "Consumption Data: New Frontiers" VoxEU (April 4, 2018) (link)
  • "Unemployment Insurance and Adverse Selection" VoxEU (February 3, 2018) (link)
  • "Designing Tax Policy in High-Evasion Economies" VoxEU (January 5, 2016) (link), Microeconomic Insights (April 27, 2016) (link)
  • "De mythe van de hangmat" Op-ed in De Standaard (May 15, 2014) (link)
  • "De ivoren toren van economen is een mythe" Op-ed in De Standaard (August 3, 2013) (link)
  • "En als we langdurig werklozen meer zouden betalen?" Op-ed in De Morgen (February 12, 2012) (link)
  • "The Role of Commitment" comment on "On the interaction between subsidiarity and interpersonal solidarity" by Jacques Dreze (link)
  • "Hard cash or a secure job - which is better?" featured in Financial Times (February 7, 2009) (link)

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