Working Paper: NBER ID: w25936
Authors: Johanna Catherine Maclean; Sebastian Tellotrillo; Douglas Webber
Abstract: We study the effect of losing insurance on psychiatric – mental health disorder (MHD) and substance use disorder (SUD) – hospital-based care. Psychiatric disorders cost the U.S. over $1T each year and hospitalizations provide important and valuable care for patients with these disorders. We use variation in public insurance coverage (Medicaid) eligibility offered by a large-scale and unexpected disenrollment in the state of Tennessee in 2005 that lead to 190,000 individuals losing their insurance. Medicaid enrollees are at elevated risk for psychiatric disorders. Following the disenrollment, hospitalizations for SUDs declined by 15.4%. Findings suggest that MHD hospitalizations declined by 4.2%, but the coefficient estimate is imprecise. The expected financing of hospital care received also changed, with the probability that Medicaid was listed as the expected payer for MHD and SUD hospitalizations declining by 27.5% and 30.8% respectively post-disenrollment. We provide suggestive evidence that psychiatric health declined post-disenrollment.
Keywords: Insurance; Psychiatric Hospitalizations; Medicaid; Mental Health Disorders; Substance Use Disorders
JEL Codes: I1; I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Losing Medicaid insurance due to disenrollment in Tennessee (I18) | Decline in hospitalizations for substance use disorders (SUD) (I12) |
| Losing Medicaid insurance due to disenrollment in Tennessee (I18) | Decline in hospitalizations for mental health disorders (MHD) (I19) |
| Losing Medicaid insurance due to disenrollment in Tennessee (I18) | Change in expected financing of hospital care for SUD (G52) |
| Losing Medicaid insurance due to disenrollment in Tennessee (I18) | Change in expected financing of hospital care for MHD (I13) |
| Losing Medicaid insurance due to disenrollment in Tennessee (I18) | Worsening psychiatric health (I19) |