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on Health Economics |
| By: | Jeffrey Clemens; Anwita Mahajan; Joseph J. Sabia |
| Abstract: | Adjustment frictions can cause the long-run effects of social insurance reforms to differ from their short-run effects. Using pre-committed extensions of event study specifications applied previously for short-run analyses, we test the hypothesis that the Affordable Care Act’s (ACA) impacts on insurance coverage and employment would increase following the substantial churn generated by the COVID-19 pandemic. Contrary to the hypothesis, the ACA’s impacts remained stable through the pandemic. Long-run effects on employment and employer coverage were modest and much smaller than initially projected. Our study illustrates how partially pre-committed designs can yield informative long-run estimates while limiting specification search. |
| JEL: | H51 H75 I13 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35190 |
| By: | D. Mark Anderson; Kerwin Kofi Charles; Daniel I. Rees |
| Abstract: | Whether medical innovation exacerbates or reduces racial health disparities remains an open question. We study surfactant replacement therapy (SRT), a life-saving intervention for premature infants with respiratory disorders. Before its approval by the FDA in 1989, premature Black infants were much less likely than their White counterparts to die from respiratory-related causes. Within a few years of FDA approval, the Black-White gap in respiratory-related neonatal mortality had essentially disappeared. Using 1980-2000 vital statistics data and non-respiratory-related mortality as a counterfactual outcome, we find that both Blacks and Whites benefited from the introduction of SRT, but White neonates experienced larger and more immediate reductions in mortality. We estimate that, by 1993, SRT had reduced respiratory-related mortality among White neonates by 46 percent, compared to 30 percent for Black neonates. These results are not explained by differences in health care access, as proxied by socioeconomic status or distance to the nearest neonatal intensive care unit. We conclude that racial differences in fetal pulmonary maturation, rather than barriers to access, likely drove the uneven impact of SRT on neonatal mortality. |
| JEL: | I14 I18 J13 J15 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35210 |
| By: | Biroli, Pietro (University of Bologna); Martin-Bassols, Nicolau (University of Bologna); Marees, Andries T. (Vrije Universiteit Amsterdam); van Kippersluis, Hans (Tinbergen Institute; Erasmus University Rotterdam); A. Rietveld, Cornelius (Tinbergen Institute; Erasmus University Rotterdam); Arce, Pia (University of Zurich); Thom, Kevin (University of Iowa); von Hinke, Stephanie (University of Bristol); Vollen, Jeremy (Northwestern University); Galama, Titus (Vrije Universiteit Amsterdam; Tinbergen Institute; University of Southern California) |
| Abstract: | The start of a human's life can be characterized by two lotteries: that of your genes (nature) and the family you were born into (nurture). These set in motion a trajectory, from birth onward, in health and human capital. Leveraging three longitudinal social-science data sets, we systematically analyze the relationship between an individual's genotype, the socioeconomic status (SES) of the families they grew up in, and their realized traits in adulthood. We proxy an individual's genetic predisposition by polygenic indexes (PGIs) and family SES by a latent factor of parental education and father's (former) occupational status. We then investigate how PGIs, parental SES, and their interaction contribute to later-life outcomes across a range of forty-five socioeconomic, anthropometric, health, behavioral, and personality traits. We find strong genetic and socioeconomic associations with these phenotypes, but no evidence of sizable gene-environment interactions. |
| Keywords: | gene-by-environment interplay, genoeconomics, polygenic indices, social science genetics, ESSGN |
| JEL: | I14 I24 J24 D31 C38 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18607 |
| By: | Ari Ercole |
| Abstract: | Health artificial intelligence (AI) adoption presents a paradox: point-solution tools diffuse readily through clinical populations, yet system-change AI, which carries the greatest potential for pathway-level transformation, consistently stalls at partial adoption. An evolutionary game theoretic model is developed to explain this pattern. Doctors choose among three strategies: genuine adoption, partial adoption, and rejection, where genuine adoption is required for systemic benefits to materialise above a population threshold. The system is shown to be generically bistable, with a stable partial adoption equilibrium coexisting alongside full genuine adoption. The basin of attraction of the partial adoption trap is enlarged by three compounding failure modes: a threshold coordination failure arising from the non-appropriable nature of systemic benefits; a trust failure arising from the organisation's inability to credibly commit to sharing productivity gains; and a cultural failure arising from negative coordination norms among doctors. These failure modes are shown to be most severe precisely for the technologies with the greatest systemic value: the Value-Adoption Paradox. A cost ratchet dynamic implies that failed adoption attempts permanently lower barriers even when embedding fails, but this benefit is offset when trust erosion is rapid. Conditions are derived under which sustained but imperfect adoption pressure is welfare-improving, and the policy architecture required to escape the trap (targeting trust, sequencing, and team-level adoption) is characterised. Standard health system digital transformation policy, which typically addresses only the threshold failure through individual incentives, is predicted to systematically produce the partial adoption trap. |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2605.17388 |
| By: | Alexander Ahammer; Lea-Karla Matic |
| Abstract: | Medical spending is highly concentrated at the end of life and varies widely across patients, raising a first-order welfare question about whether marginal end-of-life spending reflects waste or generates meaningful benefits. Using Austrian administrative data, we document that end-of-life spending has grown markedly over time and remains highly dispersed even conditional on diagnosis, with predicted mortality explaining only a small share of the variation. We then study a largely underexplored margin: spillovers onto surviving spouses. Event study estimates show large and persistent changes in spouses’ employment and healthcare use around spousal death. However, these dynamics are essentially invariant to the decedent’s end-of-life spending intensity, a finding that is robust to different measures of spending intensity and to an instrumental variables design exploiting provider-level practice variation. Together, these results are consistent with an important role for inefficiencies in end-of-life care. |
| Keywords: | end-of-life, healthcare expenditure, efficiency, health shock, labor supply |
| JEL: | I10 I11 I12 I14 I18 J12 |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_12667 |
| By: | Molina, Teresa (University of Hawaii at Manoa); Siegal, Nicole (Indiana University); Choi, Jaehyun (Indiana University) |
| Abstract: | This paper examines whether and how migration decisions respond to state-level changes in abortion policy in the United States. Using information on gestational age limit abortion restrictions and interstate migration from 2006-2019, we estimate a gravity model of migration. We predict bilateral migration flows using gestational age restrictions in the origin and destination states, a variety of economic, demographic, and political control variables for both states, as well as state-pair and year fixed effects. While out-migration does not respond to gestational age restrictions, in-migration does: individuals are significantly less likely to move to states that implement a 20-week gestational age limit (the most restrictive policy in our study period). Heterogeneity analysis reveals similar effects for men and women, and large effects for women past reproductive age, suggesting these effects are driven at least in part by ideological preferences, not just the potential future need for an abortion. Results are robust to the use of an extended two-way fixed effects (ETWFE) estimator that accounts for heterogeneous treatment effects with staggered treatment adoption in non-linear models. |
| Keywords: | abortion restrictions, gestational age limits, interstate migration |
| JEL: | I18 R23 J13 |
| Date: | 2026–04 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18615 |
| By: | Madeline S. Helfer; Becky Staiger; Jessica Van Parys |
| Abstract: | This paper uses Medicaid claims data from 2017-2021 to measure racial/ethnic disparities in mid-life mortality among low-income adults with disabilities receiving Supplemental Security Income (SSI). We find that American Indian and Alaska Native and White SSI recipients have the highest age-adjusted mid-life mortality rates (2.9% and 2.6%, respectively), followed by Black and Hispanic recipients (2.3% and 1.9%), and then Asian recipients (1.6%). We also find differences in diagnosed chronic conditions, "despair-related" conditions, substance use disorders, and disabling conditions by race/ethnicity. Controlling for these differences attenuates the White-Hispanic, White-Asian, and AIAN-White mortality gaps; however, differences in clinical diagnoses by race do not affect the White-Black mortality gap. Our results show that within a socioeconomically vulnerable population, Black adults outlive Whites. |
| JEL: | I14 I38 J15 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35193 |
| By: | Sonkurt Sen |
| Abstract: | This paper examines the intergenerational effects of maternal exposure to terrorism on early childhood skill development. Using data from the 2018 Turkish Demographic and Health Survey linked to detailed records of terrorist incidents, I measure mothers’ exposure to conflict-related fatalities in their birth cities during early schooling years. I employ a two-stage difference-in-differences estimator that exploits spatial and cohort-level variation in exposure. The results show that maternal exposure to terrorism significantly reduces children’s socio-emotional and physical development, while having no detectable effects on literacy and numeracy. Further analysis suggests that these effects operate through reduced parental investments, lower maternal education andlowerwealth. Severalrobustnesschecks confirm the findings. |
| Keywords: | Skills Development, Terrorism, Human Capital, Early Childhood |
| JEL: | D74 H56 I25 J13 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2025_751 |
| By: | Henry Saffer |
| Abstract: | This paper is the first to examine the causal effects of school smartphone bans on the mental health of youth in the US. Time series data show that the mental health of youth has been declining for the past decade. Several researchers argue that easy access to social media and other internet sites provided by smartphones is to blame. To provide causal evidence of the effects of these bans, I rely on synthetic difference-in-difference models and the National Survey of Children’s Health (NSCH) from 2016 to 2024. Currently, there are data for only one state with two post-ban periods and two states with one post-ban period, which makes the results preliminary evidence only. The outcome variables are screentime and measures of psychological wellbeing. Overall, these early results provide no clear evidence that the school ban policy reduced screentime or improved psychological wellbeing. Future studies with additional years of data, when they are available, are needed to increase power and to estimate the longer-term effects of school bans on youth mental health. |
| JEL: | I18 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35181 |
| By: | Laaksonen, Jukka; Vaalavuo, Maria; Dobewall, Henrik |
| Abstract: | We study the causal effect of secondary school admission on adolescents’ mental health using extensive Finnish register data and a regression discontinuity design. Focusing on two separate margins among first-time applicants in 2008–2013—admission to vocational secondary education versus no admission, and admission to general versus vocational education —we examine short- and medium-term mental health impacts measured by health care utilization and psychotropic drug use. We find that admission to vocational education, relative to rejection by all applied secondary schools, reduces psychotropic drug use by 6.3 percentage points (-21%) within seven years of admission. While access to vocational education slightly increases health care visits in some areas, it substantially decreases visits for substance use. Moreover, we observe that admission to general rather than vocational education decreases specialized healthcare visits for mental health by 4.5 percentage points (-21%) within seven years of admission. The effects of admission to vocational education versus no admission emerge primarily after completing vocational education, possibly related to simultaneous labor market integration. Conversely, the effects of admission to general versus vocational education mostly appear already during the immediate years after admission, potentially driven by changes in peer characteristics and living arrangements. While causal mechanisms behind the mental health effects remain unclear, our results highlight important short and medium-term mental health benefits of secondary education. These findings point to the potential value of policies that ensure access to secondary education, such as extensions of compulsory education, and that support mental health during critical educational transitions. |
| Date: | 2026–05–11 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:b4a5r_v1 |
| By: | Sixian Shu; Midori Wakabayashi |
| Abstract: | This paper examines how spousal retirement affects psychological well-being in Chinese households using 2016–2020 China Family Panel Survey data. Exploiting statutory retirement ages as instruments in a two-stage least squares framework, we identify causal effects of retirement transitions. Results show clear gender asymmetries in these spillover effects. For men, a wife’s retirement increases life satisfaction regardless of the husband’s labor-force status, with further gains in depression and marital satisfaction once both partners retire. For women, a husband’s retirement raises depressive symptoms while the wife remains employed, but this effect disappears after her own retirement, when life satisfaction significantly improves. Mechanism analyses suggest these effects operate through gender-differentiated adjustments in household labor allocation and joint consumption patterns. These findings underscore that retirement in China is a collective family-level transition rather than an individual event, highlighting the role of institutional constraints and gender norms in shaping the welfare of aging couples. |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:toh:tupdaa:84 |
| By: | Robert Kaestner; Cuiping Schiman |
| Abstract: | In this article, we exploit the recent, rapid diffusion of the use of GLP-1 drugs among individuals with diabetes to measure the effect of the use of these drugs on mental health, self-rated health, employment, and marriage. The documented large weight loss from GLP-1 use may plausibly affect these outcomes and evidence of these broader impacts of GLP-1 use is necessary to evaluate their full value. Estimates are obtained using a longitudinal (within-person) regression approach. Results indicate that GLP-1 use is not meaningfully associated with mental health, self-rated health, employment, and marriage. Overall, our analysis adds new evidence about how GLP-1 use is affecting the lives of individuals with diabetes. |
| JEL: | I11 I12 I31 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35198 |
| By: | Lu, Kelin; Wang, Chao |
| Abstract: | Fertility decisions are forward-looking and made within couples, yet little is known about how young couples perceive the consequences of childbearing. We survey 1, 800 respondents from paired Chinese one-child couples and elicit second-birth plans and expectations about life outcomes under alternative fertility choices, including consumption, wages, time burdens, and old-age support. We use these data to estimate a household bargaining model. Wives are more likely than husbands to oppose a second birth. The main driver of this disagreement is not wives' weak bargaining power, but gender differences in preferences over child quantity. Policy simulations show that public childcare, especially when it also reduces motherhood wage penalties, is more effective than cash transfers. The old-age value of children operates more through support in adverse health states than through financial transfers, but an additional child provides only limited extra insurance. These results show the value of measuring the beliefs and trade-offs that shape fertility decisions among current cohorts. |
| Keywords: | Subjective expectations, Fertility plans, Household bargaining, Pro-natalist policy |
| JEL: | D1 D7 J1 |
| Date: | 2026–04–26 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:128947 |
| By: | Croke, Kevin; Daniels, Benjamin; Lipinski, Robert; Rogger, Daniel |
| Abstract: | This paper examines the impacts of family doctors writing an explicit “care contract” with at-risk patients for increased holistic primary care. The intervention was designed to shift the care relationship between the two parties away from episodic curative care and towards a holistic plan for patient welfare. The experiment tracked healthcare utilization, diagnosis, prescription, hospitalization, and mortality outcomes through the universe of patient records. The program caused increased screening, diagnosis and treatment of chronic health issues among enrolled patients by about 10% across these categories, with suggestive evidence that hospitalization declined by 8%. Among ‘mild-risk’ patients, the treatment group experienced annual reductions in all-cause mortality of 20%, in an analysis pre-specified as exploratory. |
| Date: | 2026–05–19 |
| URL: | https://d.repec.org/n?u=RePEc:wbk:wbrwps:11388 |
| By: | Paul Bingley; Nabanita Datta Gupta; Malene Kallestrup-Lamb; Alexander O.K. Marin |
| Abstract: | Using Danish SHARE data from 2004–2022, we examine income gradients in health among retirees ages 60–79 across functional, diagnosed, comprehensive, mental, and cognitive domains. Higher-income retirees are healthier across all dimensions, but the evolution of inequality differs across measures. Functional and comprehensive health gaps narrow over time because lower-income retirees improve, whereas mental health gaps remain large and persistent. Diagnosed and cognitive health show smaller, less stable gradients. Overall, health inequality at older ages is substantial but not uniform: physical health disparities compress, while mental health disparities show no sign of convergence. |
| JEL: | I14 J14 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35165 |
| By: | Rivera, Nathaly M.; Ruiz-Tagle, J. Cristobal; Spiller, Elisheba |
| Abstract: | Renewable energy can yield social benefits through local air quality improvements and their subsequent effects on human health. We estimate some of these benefits using data gathered during the rapid adoption of large-scale solar power generation in Chile over the last decade. Relying on exogenous variation from solar irradiation and incremental solar generation capacity over time, we find that solar energy displaces coal generation and curtails hospital admissions due to respiratory diseases. These effects are largely manifested in cities downwind of and near coal plants that are displaced by the introduction of new solar. The reduction in exposure to air pollution from these displaced coal plants seems to be driving this relationship. Our results help quantify the health benefits that can be achieved through greater renewable energy investments. |
| Keywords: | coal displacement; coal power plants; developing countries; Latin America; morbidity; pollution; power plants; solar generation |
| JEL: | I18 L94 Q42 Q53 |
| Date: | 2024–07–01 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:123756 |
| By: | Omar Martin Fieles-Ahmad; Selina Schulze Spüntrup |
| Abstract: | We study how the diffusion of illicit synthetic opioids affected the supply of deceased organ donors in the United States after 2012. As fentanyl spread rapidly from east to west, it produced sharp, uneven increases in overdose mortality across states. We first study the arrival of fentanyl as a dichotomous shock in a difference-in-differences framework at the organ procurement organization (OPO) level, contrasting regions east and west of the Mississippi River due to drug-market segmentation. We then turn to the intensive margin using a state-level IV approach that leverages the westward diffusion of fentanyl over time, with exposure measured using fentanyl mortality. Both approaches show that fentanyl exposure caused large increases in overdose-driven donor supply and transplanted organs, revealing how a lethal epidemic reshaped the availability of transplantable organs. |
| Date: | 2026 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ifowps:_426 |
| By: | Akio Kawasaki (Faculty of Economics, Oita University); Noriaki Matsushima (Osaka School of International Public Policy, the University of Osaka) |
| Abstract: | Digital entrants in health care and health insurance often compete against public or mission-oriented organizations rather than only against private rivals. We develop a Hotelling model of mixed competition in which a private data-rich firm chooses the scope of consumer-data collection and then uses the acquired information to personalize offers. The rival supplies a standard service and is either a welfare-maximizing public firm or a profit-maximizing private firm. We characterize equilibrium data collection, prices, consumer surplus, profits, and social welfare. The private digital firm chooses a wider data-harvesting range when its rival is private than when its rival is public, because a public rival uses welfare-oriented pricing to discipline the induced market allocation rather than to maximize its own profit. The welfare ranking is non-monotonic in the value created by personalization. When the benefit from personalization is either small or large, competition against a public rival yields higher welfare; when the benefit is intermediate, competition against a private rival can dominate because it induces a broader rollout of personalized service. These results highlight that the welfare effects of digital entry depend jointly on data-driven personalization and the ownership objective of incumbent health-sector organizations. |
| Keywords: | digital services, personalized pricing, public entities, health services |
| JEL: | I13 L13 D43 |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:osp:wpaper:26e005 |
| By: | Daniel Herrera-Araujo; Henrik Andersson; Damien Dussaux; Maria Kostopoulou; Olof Bystrom |
| Abstract: | Cancer can result from exposure to various environmental contaminants and chemicals, including heavy metals, pesticides and pathogens. In addition to the risk of mortality, cancer can also lead to non-fatal health effects that degrade patients' quality of life. However, no comprehensive study to-date has assessed the morbidity burden of cancer, making it difficult to quantify its true economic impact. This paper seeks to fill that gap. It presents findings from a new stated preference study examining individuals’ willingness-to-pay to avoid the physical, emotional and economic burdens of surviving cancer across 10 countries (Canada, Denmark, Estonia, Japan, Mexico, Norway, Slovenia, Spain, the United Kingdom and the United States). It serves as a component of a broader project on Surveys on Willingness-to-Pay to Avoid Negative Chemicals-Related Health Effects (SWACHE) seeking to establish internationally comparable values for the willingness-to-pay to avoid negative health effects due to chemicals exposure. The findings presented herein can be used in cost-benefit analyses of policies that affect exposure to known or suspected carcinogens, contributing to more effective and equitable public health protection. |
| Keywords: | cancer, chemicals regulation, economic valuation, health risk, health valuation, monetised benefits, morbidity valuation, non-fatal cancer, non-market valuation, stated preferences, surveys, value of a statistical case, willingness-to-pay |
| JEL: | D61 I18 J17 K32 Q51 Q53 Q58 |
| Date: | 2026–05–20 |
| URL: | https://d.repec.org/n?u=RePEc:oec:envaaa:274-en |
| By: | Integlia, Davide; Marra, Alessandro |
| Abstract: | Stakeholder-based health need elicitation is a critical component of health needs assessment, yet commonly relies on direct questioning methods (interviews, focus groups, and surveys) that yield heterogeneous and experience-driven responses, limiting comparability and decision relevance. This paper reviews the existing literature on stakeholder elicitation methods in health need research, identifies their principal methodological limitations, and proposes a vignette-based approach designed to standardize the elicitation context and reduce bias associated with individually salient experiences. By presenting stakeholders with realistic, contextually grounded scenarios, the method facilitates the emergence of both explicit and implicit needs while improving the comparability of responses across participants. The approach is adaptable to different stakeholder groups through tailored vignette structures and questioning strategies, ranging from open-ended exploration to structured decision-making prompts. The integration of voice response collection further enables the analysis of paralinguistic cues (tone, hesitation, and affective markers), enhancing the interpretive depth of the analysis and facilitating the identification of high priority but under-reported needs. |
| Date: | 2026–05–11 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:cvfqt_v1 |
| By: | Alison Andrew (University of Oxford & Institute for Fiscal Studies); Sonya Krutikova (University of Manchester & Institute for Fiscal Studies); Gabriela Smarrelli (Center for Global Development); Hemlata Verma (International Centre for Research on Women) |
| Abstract: | The social environment is key to sustaining gender inequalities but many policies and programs target only women and do not involve the wider community. Can such approaches work or, by pushing women to break accepted norms, do they expose women to stress and backlash? What are the impacts of engaging the wider community? We use a 3-armed RCT covering 5000 adolescent girls across 125 communities in rural Rajasthan to explore these questions. We assess the impacts of weekly Girl Groups that worked only with adolescent girls and the impacts of additionally engaging the wider community. Both models led to a reduction in school dropout and early marriage. However, targeting adolescent girls without involving the broader community led to an increase in girls adopting a ruminative thinking style and no improvements in depression and anxiety. By contrast, when the wider community was engaged, girls’ symptoms of depression and anxiety fell by 0.16 SD and 0.17 SD, respectively, and there were no negative impacts on rumination. We show evidence that such improvements in mental health may have resulted from the community engagement changing prevailing attitudes and internalized norms. |
| Date: | 2026–05–11 |
| URL: | https://d.repec.org/n?u=RePEc:cgd:wpaper:745 |
| By: | Nemschoff, Danielle |
| Abstract: | Police officers in the United States are often the first responders to mental health crises, despite growing concerns about whether traditional policing is well-suited to these encounters. One response has been crisis-intervention team (CIT) training for police. Unlike alternatives such as unarmed responders or co-responder models, CIT seeks to improve outcomes by training officers to de-escalate mental health crises themselves. This paper provides causal evidence on whether CIT training reduces police use of force and arrests during mental health incidents. I construct a comprehensive administrative dataset linking calls for service, police reports, use-of-force records, officer demographics, and detailed training records from the New Orleans Police Department from 2017 through 2023. To estimate the causal effect of CIT training, I use a difference-in-differences framework that exploits variation in the timing of training across officers. Specifically, I compare changes in propensity to use force and make an arrest for officers before and after they receive training to those of officers who are not-yet-trained but will be trained in the future. I find no evidence that CIT training reduces officers’ use of force or likelihood of making an arrest in mental health incidents. I also find no spillover effects on officer behavior in other types of calls. Importantly, officers who select into training are officers who are already less likely to use force even prior to training, indicating strong positive selection. Taken together, these results suggest that voluntary training programs, as currently implemented, may not meaningfully change officer behavior and instead primarily attract officers who are already less prone to use force. |
| Keywords: | policing; crisis-intervention; mental health; police; use of force; arrest; crisis response; CIT |
| JEL: | J0 K0 |
| Date: | 2026–05–11 |
| URL: | https://d.repec.org/n?u=RePEc:pra:mprapa:129062 |
| By: | Hayato Tagawa |
| Abstract: | This paper develops a difference-in-differences framework for staggered policy adoption when units can be affected by other units' adoption. For each treated cohort and event time, the framework separates the effect of own adoption, the spillover effect generated by other adopters, and the total effect under the realized rollout. Identification uses a prespecified summary of spillover exposure and parallel trends comparisons among units with the same exposure at the baseline and target dates. Spillover effects are learned from never-treated units and evaluated for treated cohorts under the exposure distribution they face. We construct estimators for these effects and an inference procedure that allows for spatial dependence. Monte Carlo simulations illustrate that standard DID estimators that ignore spillovers can miss the total effect, whereas the proposed estimators have small bias for these effects and the associated confidence intervals have coverage close to the nominal level. In an empirical study of the Community Health Centers rollout, estimated spillovers account for a substantial share of the effect on older-adult mortality. |
| Date: | 2026–05 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2605.15119 |