Working Papers
Working Papers
Deaths of Despair and the Decline of American Religion (with Daniel Hungerman and Tyler Giles), NBER Working Paper #30840, revise and resubmitted, Journal of the European Economic Association
Abstract: In recent decades, death rates from poisonings, suicides, and alcoholic liver disease have dramatically increased in the United States. We show that these “deaths of despair” began to increase relative to trend in the early 1990s, that this increase was preceded by a decline in religious participation, and that both trends were driven by middle-aged white Americans. Using repeals of blue laws as an exogenous shock to religiosity, we confirm that religious practice has significant effects on these mortality rates. Our findings show that social factors such as organized religion can play an important role in understanding deaths of despair.
Press: The Economist, Brookings, The Atlantic, Market Watch, Washington Examiner, Daily Mail, Star Tribune
Representation in Product Development: Evidence from Insurance and Clinical Trials (with Jennifer Kao), submitted
We investigate the causes and consequences of demographic disparities in product development. In 2000, Medicare expanded coverage of clinical trial costs, reducing participation costs for elderly enrollees. This policy increased trials for diseases common among the elderly by 24 percent, led trial sponsors to broaden enrollment criteria, and may have increased elderly enrollment. This policy was associated with increased prescription utilization among elderly individuals. To explore potential mechanisms, we examine clinical outcomes and adverse events. Our findings highlight how financial incentives can shape research priorities and improve representation in research.
Press: UCLA Anderson Review
Medicaid Rates and Mental Health Treatment (with Alexei Alexandrov, Christophe Combemale, and Lindsey Lacey), submitted
We examine how Medicaid reimbursement rates affect mental health access and use. Allegheny County delivers behavioral health services to Medicaid recipients through a managed care organization that frequently changes provider and service-specific rates. We find that increasing Medicaid payments for mental health services leads to increased service provision, with an elasticity of approximately 0.16. The average 20% rate increase would result in a 3.2% increase in supply. Payments primarily increase services for existing patients, with a small increase in new patients. We find the largest increases in supply occur when Medicaid rates approach or exceed Medicare reimbursement rates.
The Earnings Incidence of Employer-Provided Health Insurance (with Jonathan Holmes and Kurt Lavetti)
Clinical Trials and Real World Effects of Medical Treatments (with David Chan and Matthew Grennan)
Impact of False Positive Tests on Medical Trust and Preventive Care Utilization (with Alex Hoagland and Emily Lawler)
Funding of Clinical Trials and Reported Drug Efficacy, Journal of Political Economy, 132(10), October 2024: 3298-3333.
Abstract: This paper estimates the effect of financial sponsorship of clinical trials on reported drug efficacy, leveraging the insight that the exact same sets of drugs are often compared in different trials conducted by parties with different financial interests. I assemble new psychiatric trial data to estimate that a drug appears substantially more effective when the trial is sponsored by that drug's manufacturer, compared with the same drug in a trial with the same combination of drugs but without sponsorship. This difference is not explained by observable characteristics, but publication bias is important. Pre-registration may be effective in overcoming this bias.
Press: Ohio State News, Drug Discovery News
Ungated links: Paper, Appendix
Screening and Selection: The Case of Mammograms (with Liran Einav, Amy Finkelstein, Abigail Ostriker, and Heidi Williams), American Economic Review, 110(12), December 2020: 3836-3870.
Abstract: We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting the recommendation from age 40 to 45 results in three times as many deaths if compliers were randomly selected than under the estimated patterns of selection. The results highlight the importance of considering characteristics of compliers when making and designing recommendations.
Press: Science, Marginal Revolution
Ungated links: Paper, Appendix
Outpatient Wait Times and Quality of Care for Medicaid Patients (with Amy Finkelstein and Liran Einav), Health Affairs, 36(5), May 2017: 826-832.
Abstract: The time patients spend in a doctor’s waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care.