Publications

To What Extent are Trends in Teen Mental Health Driven by Changes in Reporting?The Example of Suicide-Related Hospital Visits
With Janet Currie
Journal of Human Resources 0423-12854R1, September 2023.
     PDF   

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.

Tackling the Substance Use Disorder Crisis: The Role of Access to Treatment Facilities
With Janet Currie
Journal of Health Economics 81: 102579, January 2022.
     PDF   

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.

A Path Out: Prescription Drug Abuse, Treatment, and Suicide
With Mark Borgschulte and Guillermo Marshall
Journal of Economic Behavior and Organization 149: 169-184, May 2018.
     PDF   

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.

Working Papers

Spillover Effects of Medicare Policy on Medicaid: Evidence From the Nursing Home Industry
Presented at NBER Summer Institute SI 2021 Aging

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.

Work in Progress

Drivers of Racial Differences in Unnecessary C-Sections (with Janet Currie and Molly Schnell).

Provider Responses to Medicaid Expansions.

Role of Provider and Practice Characteristics in Cancer Screening During COVID-19 (with Ann Nguyen, Jose Nova, Jennifer Tsui, and Yiming Ma).