Research

Working Papers

Geographic Variation in Mental Health Treatment Utilization: Evidence from Migration

Revise and Resubmit at the American Economic Journal: Economic Policy

Mental illnesses, including depression and anxiety, are widespread among elderly adults in the U.S. Despite the availability of effective treatments, including services (e.g., psychotherapy) and drugs (e.g., antidepressants, antipsychotics), this paper documents substantial geographic variation in treatment utilization rates among Medicare enrollees. Exploiting patient migration, I show that 45.8% of service utilization variation is attributable to place-specific factors, compared to 15.1% for drug utilization. Further analyses suggest the role of provider accessibility in explaining the different place effects between service and drug use. Regarding health outcomes, I find that higher treatment utilization is associated with lower risks of suicide and self-harm-related Emergency Department visits.

Germs in the Family: The Long-Term Consequences of Intra-Household Endemic Respiratory Disease Spread

Joint with N. Meltem Daysal, Maya Rossin-Slater, and Hannes Schwandt

While the COVID-19 pandemic has laid bare the large costs of infectious diseases, less attention has been paid to the impacts of more common, endemic respiratory viruses that frequently circulate in the population, especially when it comes to their potential long-term consequences for population health, human capital, and economic outcomes. This paper uses Danish population-level administrative data on 35 birth cohorts of children to provide a comprehensive analysis of both the mechanisms through which infants become infected by respiratory illnesses, as well as the consequences of early-life respiratory disease exposure for their later outcomes. First, we document a striking difference in the likelihood of severe respiratory illness by birth order: younger siblings have two to three times higher rates of hospitalization for respiratory conditions before age one than older siblings at the same age. We argue that the family unit is central in virus transmission, with older children “bringing home” the virus to their younger siblings. We then combine the birth order variation with within-municipality variation in respiratory disease prevalence among preschool-aged children to identify differential long-term impacts of early-life respiratory illness between younger and older siblings. We find that moving from the 25th to the 75th percentile in the local disease prevalence distribution (“disease index”) is associated with a 30.9 percent differential increase in the number of respiratory illness hospitalizations in the first year of life for younger compared to older siblings. In the long term, for younger relative to older siblings, we find a 0.5 percent differential reduction in the likelihood of high school graduation, and a 1.3 percent additional reduction in age-30 earnings.

Publications in Economics

Getting the Price Right? The Impact of Competitive Bidding in the Medicare Program

Joint with Mark Duggan and Amanda Starc
Forthcoming at the Review of Economics and Statistics

We study Medicare’s competitive bidding program (CBP) for durable medical equipment (DME). We use Medicare claims data to examine the effect on prices and utilization, focusing on continuous positive airway pressure (CPAP) devices for sleep apnea. We find that spending falls by 47.2% percent after a highly imperfect bidding mechanism is introduced. This is almost entirely driven by a 44.8% price reduction, though quantities also fall by 4.3%. To disentangle supply and demand, we leverage differential cost sharing across Medicare recipients. We measure a demand elasticity of -0.272 and find that quantity reductions are concentrated among less clinically appropriate groups.

The Effects of Chronic Disease Management in Primary Health Care: Evidence from Rural China

Joint with Yiwei Chen, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen, Chunmei Wang, Kaixu Xie, and Karen Eggleston Journal of Health Economics (2021)

Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.

Publications in Public Health and Health Policy

Influence of Patient and Hospital Characteristics on Inpatient Satisfaction in China’s Tertiary Hospitals: A Cross-Sectional Study

Joint with Linlin Hu, Shiyang Liu, Zijuan Wang, Guangyu Hu, and Yuanli Liu
Health Expectations (2020)

How Perceived Quality of Care Affects Outpatient Satisfaction in China: A Cross-Sectional Study of 136 Tertiary Hospitals

Joint with Linlin Hu, Guangyu Hu, Zijuan Wang, Shiyang Liu, and Yuanli Liu
Inquiry: A Journal of Medical Care Organization, Provision and Financing (2019)