Job Market Candidate
Department of Economics
579 Jane Stanford Way
Stanford, CA 94305
I am on the job market in the 2021-2022 academic year and am available for virtual interviews.
Job Market Paper|
Geographic Variation in Mental Health Care: Evidence from Migration (draft coming soon)
Mental illnesses such as depression and anxiety are common among elderly adults in the U.S. Although treatments have been shown to be effective for many mental health conditions, care utilization rates vary substantially across geographic areas. Using administrative data on Medicare insurance claims, I study changes in mental health care utilization for patients who move across areas with differing rates of average utilization. This design allows me to identify the relative importance of patient versus place-specific factors in driving the geographic variation in mental health care use. I find that 60% of the geographic differences can be attributed to place-specific factors. Within the place component, the number of mental health care professionals positively affects mental health care use, but only explains up to 20% of the place effect. Public attitudes towards mental illnesses are also important place-specific factors that affect patients' care use. This is shown in asymmetric responses between moving to higher versus lower care utilization areas, especially among people never diagnosed with mental illnesses before moving. Finally, I document a strong negative correlation between area-level mental health care utilization rates and the suicide rates, and suggestive evidence that moving to high utilization areas reduces individuals' likelihood of self-harm emergency department visits. These findings suggest that promoting mental health care use would benefit the elderly population in Medicare.
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, Karen Eggleston
Accepted at the Journal of Health Economics
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.
Getting the Price Right? The Impact of Competitive Bidding in the Medicare Program
Joint with Mark Duggan, and Amanda Starc
Revise and Resubmit at the The Review of Economics and Statistics
We study Medicare's competitive bidding program (CBP) for durable medical equipment (DME). We exploit Medicare claims data to examine both prices and utilization, focusing on continuous positive airway pressure (CPAP) devices to treat sleep apnea. We find that spending falls by 47.2% percent after a highly imperfect bidding mechanism is introduced. The effect 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.
Germs in the Family: The Long-Term Consequences of Intra-Household 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 development and adult 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 relative to older siblings. In the long term, for younger relative to older siblings, we find an additional 0.016 and 0.012 of a standard deviation penalty in Danish and mathematics test scores, respectfully, a 0.4 percentage point differential decline in the likelihood of high school graduation, and a 1.3 percent additional reduction in earnings at age 30.
Gender Difference in Mental Health Diagnosis and Services
Elderly men are less likely to be diagnosed with mental health problems but have 5-15 times higher suicide rate than elderly women. Such potential under-diagnosis and under-treatment could be caused by low awareness and high stigma towards mental health problems among elderly men. Using 20% Medicare claims data, I investigate gender differences in mental illness diagnosis rate, place of first diagnosis, follow-up treatment after being diagnosed in inpatient/ER settings. Preliminary results show that, conditional on getting diagnosed, males are less likely to be diagnosed from PCPs but more from inpatient care. They are also less likely to get follow-up treatment 2-11 months after being diagnosed in inpatient/ER settings. Instrumented by the gender ratio of local PCPs, male PCPs further decrease male patients' mental health diagnosis rate.
Linlin Hu, Hui Ding, Shiyang Liu, Zijuan Wang, Guangyu Hu, and Yuanli Liu. (2020).
"Influence of Patient and Hospital Characteristics on Inpatient Satisfaction in China's Tertiary Hospitals: A Cross-sectional Study"
, 23(1), 115-124.
Linlin Hu, Hui Ding, Guangyu Hu, Zijuan Wang, Shiyang Liu, and Yuanli Liu. (2019).
"How Perceived Quality of Care Affects Outpatient Satisfaction in China: A Cross-Sectional Study of 136 Tertiary Hospitals."
Inquiry: A Journal of Medical Care Organization, Provision and Financing.