Swati Mukerjee

Mental Health Parity Legislation, Cost-Sharing and Substance Abuse Treatment Admissions

Treatment is highly cost-effective in reducing an individuals substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992 to 2007. Only 10% of individuals with clinical SA disorders receive treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

Provision of Child Care: Cost Functions for Profit-Making and Not-for-Profit Day Care Centers

In this paper, we explore and compare the operation of profit making (PMOs) and not-for-profit (NPOs) day care centers using data from a random sample of Massachusetts day care centers. We find many differences in the characteristics of PMOs and NPOs. Most interestingly, NPOs pay significantly higher wages than PMOs although the staff of NPOs has aproximately the same education and less experience than the staff of PMOs. NPOs also have significantly more staff per child than PMOs. We estimate separate cost functions for PMOs and NPOs and find the parameters of these functions to be insignificant different imiplying that the higher observed costs for NPOs result from different input (e.g., paying higher wages) and output (e.g., more interaction and larger size) choices and not from differences in methods of operation. Finally, we find that current monetary and inkind subsidies have no significant effect on the costs of day care centers.

An Empirical Analysis of the Association between Social Interaction and Self-Rated Health

Purpose. To empirically investigate the relationship of social interactions with self-rated health status. Design. Cross-sectional study. Setting. The United States, 1972–2008. Subjects. 53,043 respondents interviewed. Measures. In-person interviews were conducted by the National Opinion Research Center. Health is measured via self-assessment, and a binary indicator defines whether the respondent reports excellent or good health. Impersonal social interaction is binary, reflecting membership in at least one organization; personal interaction is binary, reflecting whether the respondent visits relatives, neighbors, friends, or bars at least once a month. Demographic, region, and time variables are standard controls. Analysis. Probit models were estimated at aggregated and disaggregated (race, gender, age, and education) levels. Results. Impersonal interaction fell 5% between 1974 and 1994, with deeper declines (12%) in personal interaction. Neighbor visits fell most (24%), but friends gained (5%). Marginal estimates indicate both personal and impersonal interactions are associated with better health. However, friends show the strongest effect. A 1-SD increase in the probability of meeting friends versus joining a club or association is associated with a higher (.019 vs. .014) probability of being in very good or excellent health. Conclusion. Social interaction, impersonal or personal, is significantly associated with health. Public policy facilitating greater interactions of the type that benefits different demographic groups may be health promoting. Results are suggestive of potential network effects at the individual and community levels, which have implications for designing and targeting more effective health interventions.

The economic measurement and determinants of diversity

This paper has a 2-fold objective: (1) To introduce a measure that would be of general applicability in measuring diversity in different institutions. (2) To identify the determinants of diversity in child-care centers and, in particular, to examine whether the for-profit sector is less diverse than the not-for-profit sector in the child-care industry as the statistics suggest. Using our measure, we isolate factors that significantly influence diversity by using an economic model that makes diversity a decision variable of a firm. Two measures of diversity are suggested: absolute diversity and relative diversity (diversity relative to the surrounding community). To select a suitable index, the Herfindahl measure of concentration is considered relative to several suitable ecological indices measuring species diversity, and found to be virtually identical to such indices. Thus theH-index is used in both absolute and relative measures. Empirical estimation of both absolute and relative diversity equations use probability models and isolate factors that significantly influence both absolute diversity of child-care centers as well as their diversity relative to their respective counties. The data used is the recently released Profile of Child-Care Settings collected by the Mathematica Policy Research.

Job Satisfaction in the United States: Are Blacks Still More Satisfied?

Despite the substantial literature on the paradox of the happy female worker, research has been sparse in investigating race differences in job satisfaction. The last national level study on racial differences in job satisfaction was done in 1981 when, using national level U.S. data from the National Longitudinal Surveys of Mature Men for 1966, 1969 and 1971, Bartel showed that blacks had significantly more job satisfaction and further, that this racial gap had widened during this time. Though the reasons for this gap and its widening were not investigated, it was suggested, in a close parallel to the reason for the contented female worker, that lower expectations, in this case due to discrimination in the labor market, could be a reasonable explanation. Surprisingly, since then, there have been only a handful of studies focused on smaller, specific groups. This paper exploits two U.S. national level data sets, the GSS and the NLSY 1997, to examine the racial gap in job satisfaction. Simple means show that blacks are much less satisfied than whites and moreover, this difference has persisted not only across genders but also across almost four decades. To isolate the pure race effect, a sequential process is adopted by first examining the simple difference in the means of job satisfaction, then, through probit estimation, seeing the impact of individual attributes, finally progressing to incorporation of job attributes. Probit estimates give robust results. Blacks are significantly less satisfied than whites even when income, benefits and occupations are controlled. However, this racial gap is greater in the case of women and younger black men. An exploratory analysis shows that when discrimination is accounted for, the satisfaction gap is further reduced and the race coefficients are rendered insignificant. Estimates with comparison income show that the satisfaction gap is driven by perceived discrimination and not necessarily discrimination as captured by comparison income. This highlights the importance of policy measures to reduce perceptual discrimination.

Black teen childbearing: Reexamining the segmented labor market hypothesis

The objective of this paper is to examine whether the racial difference in the proportion of women who become teenage mothers is related to differences in their labor market options and choices. Specifically, we test the hypothesis described by McCrate (1990) who argues that the rationing of black women into the secondary labor market encourages their early childbearing since the secondary labor market does not reward additional schooling with higher wages. The fact that black and white women exhibit different patterns of fertility timing in the United States is well known. For instance, a study of women born from 1920-1939 shows that 24 percent of white women and 49 percent of black women gave birth by the age of 20 (Rindfuss, et al, 1988). By age 30, the two groups of women look much more similar with 86 percent of white women and 87 percent of black women having had a child. Thus, it is the timing of first birth rather than the percentage of women who remain childless that varies most between black and white women. Teen births are also important because they have been associated with negative outcomes later in life: fewer years of education, lower income, and increased poverty, for example (Lehrer 1985, Hofferth, 1987, Lundberg and Plotnick 1990). Although the literature on teenage childbearing is substantial, most analyses focus on non-economic models of behavior. Duncan and Hoffman

Religiosity and Health Through the Decades: Is There a Gender Difference?

Purpose: An empirical examination of the long-term association, disaggregated by gender, between religiosity and self-rated health with reference to demographic shifts in labor force participation, education, and income. Design: General Social Survey data. Setting: United States, 1974 to 2012. Participants: A total of 23 353 respondents. Measures: Self-assessed health; 2 key religiosity variables: attendance and intensity of belief; income, labor market variables, education, standard demographic variables, household size, region, and time dummies. Analysis: Probit estimation conducted for the aggregate sample by gender as well as by decades to examine possible gender differential changes over time. Results: Attendance has declined overall with a much greater decline for women. The overall positive association between religiosity and health masks considerable heterogeneity across gender and time; higher and stable for males, there is no longer a significant association for females. Increased education, income, and labor force participation can explain only part of this association. Education is the strongest mediator. Conclusion: The way women and men benefit from religious attendance has changed, suggesting that some pathways may be working differently for women now, especially those with less education. Moving away from church networks could be due to a perceived lack of support or substitution by other social networks. Ceteris paribus, since religious participation has been shown to weaken preference for risky consumption, declining participation, especially for women, may show up as an increase in risky behavior.