Increases in mental health diagnoses and suicidal behaviors in Emergency Departments are often cited as evidence of an accelerating child mental health crisis. We ask whether trends in ED visits provide an accurate picture of changes in U.S. child mental health. These measures have been profoundly affected by changing conventions about screening, defining, and coding of mental illness. We conclude that child mental health has been deteriorating, but not by the startling magnitudes suggested by jumps and trends in some measures such as suicidal ideation. Although reported suicidal behaviors rose 228% from 2006-2021, the true rise in mental health disorders is unlikely to exceed the 66% rise in youth suicide observed over the same period.

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.

I study how nursing homes responded to a large increase in Medicare reimbursement. The Balanced Budget Refinement Act of 1999 raised per-diem rates, with larger increases for clinically complex patients than for rehabilitation patients. Exploiting cross-facility variation in exposure, I find that higher reimbursement increased Medicare admissions by 18.7 percent but shifted admissions toward short-stay rehabilitation patients and away from clinically complex patients. Facilities expanded therapy services and contracted labor without adding beds or crowding out Medicaid residents. Thirty-day hospital transfers did not increase. These results reveal within-program patient selection as a key margin of provider response to administered prices.