Rising reports of suicidal behaviors in children and adolescents have led to the recognition of a youth mental health crisis. However, reported rates can be influenced by access to screening and changes in reporting conventions, as well as by changes in social stigma. Using data on all hospital visits in New Jersey from 2008-2019, we investigate two inflection points in adolescent suicide-related visits and show that a rise in 2012 followed changes in screening recommendations, while a sharp rise in 2016-2017 followed changes in the coding of suicidal ideation. Rates of other suicidal behaviors including self-harm, attempted suicides, and completed suicides were essentially flat over this period. These results suggest that underlying suicide-related behaviors among children, while alarmingly high, may not have risen as sharply as reported rates suggest. Hence, researchers should approach reported trends cautiously.

The continuing drug overdose crisis in the U.S. has highlighted the urgent need for greater access to treatment. This paper examines the impact of openings and closings of substance use disorder treatment facilities in New Jersey on emergency room visits for substance use disorder issues among nearby residents. We find that drug-related ER visits increase by 7.4% after a facility closure and decrease by 6.5% after an opening. The effects are smaller for the middle aged than for either younger or older people, and are also somewhat larger for Black residents, and for those on Medicaid. The results suggest that expanding access to treatment results in significant reductions in morbidity related to drugs.

In this paper we investigate the dual role of supply restrictions and drug treatment in combating the concurrent rise of opioid abuse and suicide in the United States over the last two decades. We find that supply-side interventions decrease suicides in places with strong addiction-help networks, implying that prescription drug abuse is associated with an inherent risk of suicide. Our findings support an important role for access to treatment services in policies designed to combat the opioid epidemic.

Black mothers with unscheduled deliveries are 25 percent more likely to deliver by C-section than non-Hispanic white mothers. The gap is highest for mothers with the lowest risk and is reduced by only four percentage points when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and doctor or medical practice group. Remarkably, the gap disappears when the costs of ordering an unscheduled C-section are higher due to the unscheduled delivery occurring at the same time as a scheduled C-section. This finding is consistent with provider discretion—rather than differences in unobserved medical risk—accounting for persistent racial disparities in delivery method. The additional C-sections that take place for low-risk women when hospitals are unconstrained negatively impact maternal and infant health.

Despite rapid growth in the U.S. elderly population, the utilization of nursing facilities in the country has decreased substantially since the 2000s. Previous literature has attributed the decline to the surge in alternative services such as in-home care. This paper explores a different explanation for this phenomenon. Using administrative data and a quasi-random variation in Medicare reimbursement policy, I find that a one percent increase in Medicare fees reduces Medicaid admissions to nursing facilities operating near capacity by two percent. I do not find evidence of increased access for new Medicare residents, but I estimate a one percent increase in Medicare readmissions. Because a significant fraction of long-term residents are enrolled in both Medicaid and Medicare, there is an incentive for facilities to strategically adjust their readmissions to induce a Medicare payment. These findings show how changes in Medicare policy have fueled the shift in focusing on long-term care covered by Medicaid to short-term care covered by Medicare. It also illustrates how the existence of separate payment systems for Medicare and Medicaid have unintended negative consequences by reducing Medicaid beneficiaries’ access to long-term care.