“How Access to Addictive Drugs Affects Substance Abuse Treatment Capacity: Evidence from Medicare Part D”
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.
“Coming of Age: The Impact of Being Medically Treated as an Adult“
It is well-documented that the United States has a severe shortage of mental health care capacity in terms of both doctors and facilities. Because of this, patients often experience prolonged stays in the ER while waiting to be admitted to a psychiatric inpatient unit. Children face an especially difficult time due to the relative scarcity of pediatric psych units and often need to be transferred to a distant hospital. However, once they turn 18, they become eligible for treatment in adult psych units, which are much more commonplace than pediatric units. This paper studies the degree to which this relaxed constraint on treatment availability affects mental health care utilization for young adults. Using a regression discontinuity design along with administrative inpatient and emergency room data from New York state, I find that turning 18 and qualifying for adult treatment increases inpatient hospitalizations for mental health issues by approximately 15%. I also find that interfacility transfers for mental health admissions decline by about 21% at age 18, but transfers between inpatient units in the sample hospital increase by about 18%. The latter two results provide evidence that individuals are being directed towards adult rather than pediatric care at this age, thereby increasing the likelihood that they are admitted at all.