Working Paper

Does Medicare Part D Reduce Disparities in Health? with Pinka Chatterji and Tu Nguyen [PDF available upon request]

Over the past three decades, new prescription drugs have transformed the treatment of chronic disease in the US, but we know little about the role that access to these drugs may play in remediating health disparities. In this paper, we test whether Medicare Part D - a publicly-funded prescription drug benefit program - is associated with education-related disparities in drug insurance coverage, medical utilization, and mortality. We find that Part D is associated with increased drug insurance rates, greater utilization of prescription drugs, and decreased out-of-pocket spending on drugs, and these improvements are magnified among low-educated individuals. We also find that Part D is associated with reductions in all-cause and cardiovascular mortality, and reductions in hospitalizations for cardiovascular disease that are processed through the emergency department. While there are larger reductions in all-cause and cardiovascular death counts among individuals with lower education than those with higher education, it does not lead to a larger decline in the mortality rate in percentage terms due to the former’s much higher baseline rate. 

Mental Health Agencies’ Adoption of Telehealth and Disparities in Care among Medicaid-enrolled Youth with David Mandell and Molly Candon, under review [PDF available upon request]

In response to the COVID-19 pandemic, many mental health care agencies switched from in-person care to telehealth. Agencies likely varied, however, in the extent to which they could switch quickly to remote care. Given the resources required to provide care remotely and the fact that minoritized individuals often receive care from agencies with fewer resources, the switch to telehealth may have exacerbated disparities in access to care—especially for youth who received mental health care in schools, which were closed during the pandemic. We investigated the relationship between agencies’ adoption of telehealth and patient-level disparities in access to outpatient mental health care among Medicaid-enrolled youth in Philadelphia during the pandemic. First, we examined the association between agencies’ telehealth adoption and patients’ outpatient mental health care use. We compared patients’ demographic characteristics and diagnoses by agencies’ level of telehealth adoption. Finally, we estimated racial and ethnic disparities in the use of outpatient mental health care and tested whether observed disparities change after controlling for agencies’ level of telehealth adoption. We found that agencies serving non-Hispanic Black youth were less likely to adopt telehealth. These youth in turn used substantially less outpatient mental health care than did non-Hispanic White youth, even after controlling for sex, age, and diagnoses. This gap in service use persisted throughout the pandemic. There are two sets of implications related to our findings. First, structural inequities among agencies may lead to substantial disparities in access to care, especially in times of crisis, suggesting the need to support agencies with fewer resources. Second, the effects of slower telehealth adoption, particularly among agencies who were more likely to treat Black youth, may lead to lasting problems that will require additional resources to address. 

Inter-generational Changes in the Educational Outcomes of Americans with Disabilities [PDF available upon request]

In this paper, we examine changes in educational and labor market outcomes of Americans with disabilities between the late 1970s and the late 1990s by comparing the two cohorts of the NLSY. Our preliminary findings show that the gap in educational attainment between the disabled and non-disabled increases over time. For men, the increase in the educational attainment difference mainly comes from an increase in the difference in college graduation rates. For women, increases in gaps appear in high school graduation, college attendance, and college graduation rates. Further, we develop a theory of education investment for disabled students. The model suggests two motivating factors for education investment decisions: 1) the cost of obtaining education, 2) the incentive to signal their productivity through education in order to overcome employers’ uncertainty about disabled workers. That is, if obtaining education is too burdensome for the disabled, they will lose incentive to obtain education. But, if the effect of the uncertainty is strong, then the incentive to signal will be preserved well or even increase. Consequently, the educational attainment gap can be affected by the two conflicting forces.

Work in Progress

Determinants of Effective Transitions from Acute Care to Outpatient Treatment for Opioid Use Disorder with Margaret Lowenstein, Ashish Thakrar, and David Mandell 

The Risk of Suicide Attempts and Suicide Deaths Following Incarceration in Philadelphia with Shari Jager-hyman, Suet Lim, Molly Candon et al.

Disproportionate Effects of the COVID Pandemic on People Scarred by the Great Recession