“How Access to Addictive Drugs Affects Substance Abuse Treatment Capacity: Evidence from Medicare Part D” Revision Requested at Health Economics
This paper explores how a shock to the demand for substance abuse treatment (SAT) due to Medicare Part D caused an increase the supply of treatment capacity. Previous work has already documented that Part D exacerbated national upward trends in opioid-related treatment admissions and mortality by allowing for greater ease of access to prescription narcotics. However, there is still little research on how SAT providers respond to increases in demand for their services, especially regarding the expansion of overall capacity. I show that states which experienced greater demand for SAT due to Medicare Part D saw larger increases in the prevalence of residential and hospital SAT facilities and beds. Furthermore, these states also saw increases in providers offering medication-assisted treatment for opioid-use disorder.
“A Fine Predicament: Conditioning, Compliance and Consequences in a Labeled Cash Transfer Program” (with Carolyn J. Heinrich), World Development, 129, May 2020, 104876
The Kenya Cash Transfer Programme for Orphans and Vulnerable Children (CT-OVC) presents a valuable opportunity to examine the effects of imposing monetary penalties for noncompliance with conditions in cash transfer programs, in contrast to providing only guidance (or “labeling”) for cash transfer use. We take advantage of random assignment to a conditional arm within the CT-OVC treatment locations to understand the impact of imposing conditions with penalties on program beneficiaries, as well as how this effect varies by household wealth. Program beneficiaries (orphans and vulnerable children) were expected to visit health facilities for immunizations, growth monitoring and nutrition supplements and to enroll in and attend school. We find little difference in program outcomes between households in the conditional treatment arm compared to those in the treatment arm with labeling only (in which information was provided about these expectations but compliance was not monitored). However, among the poorest CT-OVC beneficiaries, assignment to the conditional arm was associated with penalty fines and a significant decrease in non-food consumption. This suggests that in comparison to labeled cash transfers, conditional cash transfers may produce unintended, regressive policy effects for the most vulnerable participants.
Works in Progress
“Social Security Eligibility and Health Care Utilization: Evidence from Administrative Data“
Intuitively, it is unclear whether retirement is a net positive or negative for health and how it might influence people’s propensity to seek care. The nature of this relationship has important consequences for when individuals choose to retire and for how providers choose to treat retirees. This study provides evidence on this question by examining how reaching the U.S. early eligibility age (62) for Social Security affects health care utilization patterns. I accomplish this using a regression discontinuity design combined with administrative data on hospital admissions from California and New York state.
“Pediatric Versus Adult Health Care for the Marginal Patient“
Medical practice has traditionally been divided into two major age-based categories: pediatric and adult medicine. Although the timing for the transition between the two is ideally individually-tailored to the patient, many hospitals employ arbitrary age cut-offs for new inpatients instead. Despite the role of these policies in determining the allocation of health care providers to patients, their full consequences for patient outcomes have yet to be studied. This paper uses a regression discontinuity design to exploit a common version of this policy whereby hospitals direct new inpatients below 18 years of age to pediatric services and new inpatient above 18 years of age to adult services. Using administrative data on the near-universe of inpatient, emergency department, and ambulatory surgery admissions from New York between 2002-2017 provided by HCUP, I obtain the following results. First, admission after 18 discontinuously decreases the likelihood of being billed for pediatric accommodations by 12.3 percentage points. Additionally, admission after 18 causes the hospital to assign an attending physician who treats patients that are 8.2 years older, on average, than the patients treated by physicians assigned to those admitted under 18. Admission after 18 also decreases the likelihood of being admitted via transfer by 30%, increases the number of cardiac and imaging tests received by 12.8%, increases the number of therapeutic services received by 5.7%, and increases the number of procedures received by 3.4%. Preliminary results also indicate that admission after 18 may discontinuously increase hospital revisit rates by approximately 5%. Robustness checks demonstrate that inpatient discharges evolve smoothly through the age 18 cut-off, including when separated by primary payer type, ruling out changes in sample composition as the primary driver of results. Lastly, results are generally stronger for emergency-type inpatient admissions, during which patients have less discretion over their treatment experience.