Carlos Dobkin

The Clean Air Act of 1970 and Adult Mortality

Previous research has established an association between air pollution and adult mortality. However, studies utilizing short-term fluctuations in pollution may detect mortality changes among the already ill or dying, while prospective cohort studies, which utilize geographic differences in long-run pollution levels, may suffer from severe omitted variables bias. This study utilizes the long-run reduction in total suspended particulates (TSPs) pollution induced by the Clean Air Act of 1970, which mandated aggressive regulation of local polluters in heavily polluted counties. We find that regulatory status is associated with large reductions in TSPs pollution but has little association with reductions in either adult or elderly mortality. These findings are interpreted with caution due to several caveats.

The Health Effects of Military Service: Evidence from the Vietnam Draft

There is a strong cross-sectional association between military service and adverse health. However, veterans differ very significantly in their observable characteristics from nonveterans, suggesting that some of the association between military service and adverse health may be due to omitted variables bias. To address this problem, we use draft eligibility as an instrument for military service. Despite a very strong first-stage relationship between draft eligibility and military service, the two-stage least squares estimates of the difference in health between veterans and nonveterans are statistically insignificant and too imprecise to preclude the differences in health found in the cross-sectional regressions.

Do School Entry Laws Affect Educational Attainment and Labor Market Outcomes

Age based school entry laws force parents and educators to consider an important tradeoff: Though students who are the youngest in their school cohort typically have poorer academic performance, on average, they have slightly higher educational attainment. In this paper we document that for a large cohort of California and Texas natives the school entry laws increased educational attainment of students who enter school early, but also lowered their academic performance while in school. However, we find no evidence that the age at which children enter school effects job market outcomes, such as wages or the probability of employment. This suggests that the net effect on adult labor market outcomes of the increased educational attainment and poorer academic performance is close to zero.

The minimum legal drinking age and crime

We use variation from the minimum legal drinking age to estimate the causal effect of access to alcohol on crime. Using a census of arrests in California and a regression discontinuity design, we find that individuals just over age 21 are 5.9% more likely to be arrested than individuals just under 21. This increase is mostly due to assaults, alcohol-related offenses, and nuisance crimes. These results suggest that policies that restrict access to alcohol have the potential to substantially reduce crime.

The Economic Consequences of Hospital Admissions

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills and bankruptcy, and reduce earnings, income, access to credit and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger less than 5 percent of all bankruptcies.

The Mechanisms of Alcohol Control.

A substantial economics literature documents that tighter alcohol controls reduce alcohol-related harms but far less is known about mechanisms. We use the universe of Canadian mortality records to document that Canada’s Minimum Legal Drinking Age (MLDA) significantly reduces mortality rates of young men but has much smaller effects on women. Using drinking data that are far more detailed than in prior work, we document that the MLDA substantially reduces “extreme” drinking among men but not women. Our results suggest that alcohol control efforts targeting young adults should focus on reducing extreme drinking behavior.

The Impact of Health Insurance Status on Treatment Intensity and Health Outcomes

This paper uses the abrupt changes in health insurance coverage at age 65 arising from the Medicare program eligibility rules to evaluate the impact of insurance status on treatment intensity and health outcomes. Drawing from several million hospital discharge records for the State of California, the authors begin by identifying a subset of patients who are admitted through the emergency room for non-deferrable conditions-diagnoses with the same daily admission rates on weekends and weekdays. Among this subset of patients there is no discernable rise in the number of admissions at age 65, suggesting that the severity of illness is similar for patients who are just under 65 and those who are just over 65. The fraction of patients in this group who lack health insurance, however, falls sharply at age 65, while the proportion with Medicare as their primary insurer rises. Tracking health-related outcomes of the group, they find significant increases in treatment intensity at the age 65 barrier, including increases in the number of procedures performed, and total list charges. They also find a rise in the probability that patients are transferred to other units within the same hospital, coupled with a reduction in the probability of discharge to home. Finally, they estimate a drop in the rate of re-admission within one month of the initial discharge.

Myth and Measurement — The Case of Medical Bankruptcies

Myth and Measurement Though there is compelling evidence that medical expenses do cause bankruptcies in the United States, they may cause far fewer than has been claimed. Overemphasizing such event...

The Minimum Legal Drinking Age and Morbidity in the United States

We provide the first evaluation of the effect of the U.S. minimum legal drinking age (MLDA) on nonfatal injuries. Using administrative records from several states and a regression discontinuity approach, we document that inpatient hospital admissions and emergency department (ED) visits increase by 8.4 and 71.3 per 10,000 person-years, respectively, at age 21. These effects are due mainly to an increase in the rate at which young men experience accidental injuries, alcohol overdoses, and injuries inflicted by others. Our results suggest that the literature’s disproportionate focus on mortality leads to a significant underestimation of the benefits of tighter alcohol control.

Welfare Leavers' Use of Medicaid Transitional Medical Assistance in California, 1993–1997

Using administrative and survey data, we estimate participation rates in Transitional Medical Assistance (TMA) for the period 1993–97 by California welfare leavers during their first six months post-welfare. We find that although many welfare leavers were eligible for TMA (35% to 47% of exiters), only 26% of eligible people were enrolled in the TMA program. Another 14% were covered by non-TMA Medicaid for the entire six months. Most TMA-eligible exiters had Medicaid coverage (all of it non-TMA) for less than six months (49%) or no Medicaid coverage at all (11%). Supplementary analyses using data from the National Survey of Americas Families indicate that if fully implemented, TMA could have substantially reduced uninsurance among welfare leavers.