Emma Kalish, PhD Candidate in Economics

Title: Medical Innovation and Health Disparities
Abstract: We examine whether medical innovation can reinforce existing health disparities by disproportionately benefiting socioeconomically advantaged patients. The reason is that less advantaged patients often do not use new medications. This may be due to high costs of new drugs, but could also reflect differences in how side effects of new treatments interact with labor supply. To investigate, we develop a dynamic lifecycle model in which the effect of medical treatment on labor supply varies across sociodemographic groups. We estimate the model using rich data on treatment choices and employment decisions of men infected with HIV. In the model, treatments can improve long-run health, but can also cause immediate side effects that interact with the utility cost of work. Estimates indicate that HIV-infected men often forego medication to avoid side effects, in part to remain employed. This effect is stronger for people with fewer years of education, leading to lower use of treatment and worse health outcomes. As a result, while a breakthrough HIV treatment---known as HAART---improved lifetime utility for all patients, it disproportionately benefitted those with higher levels of completed education, thereby reinforcing existing inequality. A counterfactual subsidy that increases non-labor income reduces employment for all education groups, but only increases adoption of HAART and improves health among lower-education individuals, who face a starker health-work tradeoff.

Matt Eisenberg, PhD, Assistant Professor

Title: Studying how state and local health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: A mixed-methods study protocol of COVID-19

Abstract: Background: Disasters pose a major threat to the delivery of addiction treatment and drug overdose prevention services.   Such disruptions can be life-threatening in that even short service interruptions can lead to relapse or overdose. Relative to other types of healthcare and public health services, addiction and overdose services are particularly vulnerable to disaster-related disruptions for a variety of reasons including fragmentation from the general medical system and addiction stigma, which may de-prioritize addiction services during disasters. Most disaster policymaking occurs at the state level and is implemented at the local level by healthcare systems and public health authorities. There is limited rigorous evidence surrounding the implementation and outcomes of policies intended to mitigate the adverse effects of public health disasters on healthcare delivery generally and addiction and overdose prevention services specifically. This protocol describes a mixed-methods study designed to address this gap in the literature. A key contribution of this study is its characterization of local-level implementation of state policies. Methods: The overall study uses a concurrent-embedded design. Aims 1-2 use difference-in-difference analyses of large-scale observational databases to examine the effects of health services delivery policies designed to mitigate the effects of the COVID-19 pandemic on healthcare delivery overall or addiction services specifically on treatment and overdose.  Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize implementation of the policies of interest in counties embedded within states. A unique aspect of the study is incorporation of area-level measures of mobility drawn from cell-phone data. These measures capture the volume of travel in an area during the COVID-19 pandemic relative to pre-pandemic travel. As limited mobility is a signal of likely disruptions to healthcare services, these measures are an important tool for disentangling the effects of the health service delivery policies from general COVID-19 related disruptions to in-person service delivery. Discussion: Results of this mixed-methods study will inform the enactment and implementation of policies to mitigate addiction service disruptions in future public health disasters.