Research
Publications
"Parental Skills, Assortative Mating, and the Incidence and Autism Spectrum Disorder " with Meltem Daysal (University of Copenhagen) Todd Elder (Michigan State University) Judy Hellerstein (University of Maryland at College Park) and Scott Imberman (Michigan State University) download nber wp w28652 download IZA DP No. 14227 forthcoming, American Journal of Health Economics
We use rich administrative data from Denmark to assess medical theories that autism spectrum disorder (ASD) is a heritable condition transmitted through underlying parental skills. Positing that occupational choices reflect skills, we create two separate occupation-based skill measures and find that these measures are associated with ASD incidence among children, especially through the father’s side. We also assess the empirical relevance of assortative mating based on skill, concluding that intertemporal changes in assortative mating explain little of the increase in ASD diagnoses in recent decades.
Chiara Orsini "The Mortality Effects of Changing Public Funding for Home Health Care: An Empirical Analysis of Medicare Home Health Care in the United States" Health Economics, 2019, Volume 28(7) pages 921-936 download (journal website) download (accepted version, working paper format)
(previous title: Can changes in in-Kind Transfers to the Elderly Kill? Quasi-Experimental Evidence")
Soohyung Lee and Chiara Orsini, "Girls and Boys: Economic Crisis, Fertility, and Birth Outcomes" Journal of Applied Econometrics, 2018, Volume 33(7) pages 1044-1063, download (journal website) download (accepted version, working paper format)
We investigate the impact of an economic shock on fertility and birth outcomes, paying special attention to possible heterogeneous effects based on the gender of the child. We focus on South Korea, a country that is known for its son preference and that was unexpectedly hit by a financial crisis in 1997. To identify the causal impact of the crisis on fertility and birth outcomes, we examine women who were already pregnant when the crisis began and exploit regional- and time- variation in economic hardship. We find that the economic crisis had a greater negative impact on girls than boys in terms of both natality and birth weight, different from the prediction based on biological mechanisms, including the Trivers-Willard Hypothesis. This relative disadvantage of girls is worse among newborns who have at least one older sibling. Our results suggest that, in response to adverse economic conditions, parents may make choices that are less favorable to the unborn if they are girls and have older siblings.
Soohyung Lee and Chiara Orsini, "Did the Geat Recession Affect Sex Ratios at Birth For Groups With a Son Preference?" Economics Letters May 2017, download (journal website) download (accepted version, working paper format)
This paper examines the extent to which the Great Recession affected gender composition at birth. We focus on ethnic minorities in the US known for a son preference – Chinese, Indians, and Koreans. Using the DID method, we find that in response to the Great Recession, the fraction of newborn boys increased among Chinese Americans. Our results suggest that a cultural norm, namely son preference, may be directly affected by economic conditions.
Chiara Orsini and Mauricio Avendano, "Macro-Economic Conditions and Infant Health: A Changing Relationship Between Black and White Infants in the United States", PLOS ONE, 2015 download Supplementary Information download link to e-version link
We study whether the relationship between the state unemployment rate at the time of conception and infant health, infant mortality and maternal characteristics in the United States has changed over the years 1980-2004. We use microdata on births and deaths for years 1980-2004 and find that the relationship between the state unemployment rate at the time of conception and infant mortality and birthweight changes over time and is stronger for blacks than whites. For years 1980-1989 increases in the state unemployment rate are associated with a decline in infant mortality among blacks, an effect driven by mortality from gestational development and birth weight, and complications of placenta while in utero. In contrast, state economic conditions are unrelated to black infant mortality in years 1990-2004 and white infant mortality in any period, although effects vary by cause of death. We explore potential mechanisms for our findings and, including mothers younger than 18 in the analysis, uncover evidence of age-related maternal selection in response to the business cycle. In particular, in years 1980-1989 an increase in the unemployment rate at the time of conception is associated with fewer babies born to young mothers. The magnitude and direction of the relationship between business cycles and infant mortality differs by race and period. Age-related selection into motherhood in response to the business cycle is a possible explanation for this changing relationship.
Chiara Orsini, "Ownership and Exit Behavior : evidence from the home health care market" (2016) The BE Journal of Economic Analysis and Policy 2016 , download (journal website) download (accepted version, working paper format)
In the US health care system a high fraction of suppliers are not-for-profit companies. Some argue that non-profits are “for-profits in disguise” and I test this proposition in a quasi-experimental way by examining the exit behavior of home health care firms after a legislative change reduced considerably reimbursed visits per patient. The change allows me to construct a cross provider measure of restriction in reimbursement and use this measure and time series variation due to the passage of the law in my estimates. To identify the impact of limits in reimbursement on exit I use a grouped hazard framework, combine a stock and a flow sample of home health care agencies, and correct for length biased sampling. The hazard rates of exits among for-profit firms are higher than those of not-profit firms rejecting the null that these sectors responded to the legislation in similar ways. In addition, my results expand the view that “not-for-profit” firms are a form of “trapped capital”. There is little capital investment in the home health care market so the slower exit rate for-profit firms after the law change indicates the possible role of labor inputs in generating differences in exit behavior across sectors.
Meltem Daysal and Chiara Orsini, "Spillover Effects of Drug Safety Warnings on Preventive Health Care Use" B.E. Journal of Economic Analysis and Policy, 2015, vol.1, download (journal website) download (accepted version, working paper format)
We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women's Health Initiative Study (WHIS) -- the largest randomized controlled trial of women's health -- which demonstrated in 2002 the health risks associated with the long-term use of Hormone Replacement Therapy (HRT). We first show that, after the release of the WHIS findings, HRT use dropped sharply among post-menopausal women. We then estimate the spillover effects of the WHIS findings on preventive care by means of a difference-in-differences methodology comparing changes in preventive care use among 60 to 69 year-old women (who have high rates of HRT use) with the change among women aged 75 and above (who have much lower rates of HRT use). Using data from the Behavioral Risk Factor Surveillance System for the period 1998--2007, we find that women aged 60--69 had statistically and economically significant declines in their annual mammography checks, checkups, cholesterol checks and blood stool tests, when compared to older women.
Chiara Orsini "Changing the way the Eldelry Live: Evidence From the Home Health Care Market in the United States", Journal of Public Economics, 94 (2010), download (journal website) download (accepted version, working paper format)
I examine how decreases in government coverage of home health care visits to the elderly in the United States have affected their living arrangements. Specifically, I exploit geographic variation in the Medicare Home Health Care reimbursement rate that arose as a result of legislation passed in 1997 and I identify its impact on the living arrangements of older Medicare beneficiaries. I find that less generous reimbursement policies lead to a greater fraction of elderly giving up independent living. Baseline model estimates suggest that a decline in reimbursement of one visit per user leads to a 0.98% increase in the fraction of elderly Medicare beneficiaries living in shared living arrangements, that is, living with somebody else, rather than alone or with only the spouse. This estimate implies that a decline in reimbursement of 5.1 visits per Medicare beneficiary increases the fraction of elderly that live in shared living arrangements by 1.12 percentage points. Such an increase is consistent with the time series increase in the fraction of elderly that live in shared living arrangements between 1997 and 2000.
Working Papers
Meltem Daysal and Chiara Orsini, "The Miracle Drugs: Hormone Replacement Therapy and Labor Market Behavior of Middle-Aged Women", Iza Working Paper No. 7993 download
In an aging society, determining which factors contribute to the employment of older individuals is increasingly important. We examine the impact of medical innovations on the employment of middle-aged women focusing on the specific case of Hormone Replacement Therapy (HRT), a common treatment for the alleviation of negative menopausal symptoms. HRT medications were among the most popular prescriptions in the United States until 2002 when the Women's Health Initiative Study - the largest randomized control trial on women ever undertaken- documented the health risks associated with their long term use. We exploit the release of these findings within a Fixed Effect Instrumental Variable framework to address the endogeneity in HRT use. Our results indicate substantial benefits of HRT use to short-term employment of middle-aged women.
Chiara Orsini "The Long Arm of Long Term Care Policies: Effects of Cuts in Publicly Funded Home Health Care for the Elderly on Self-Reported Health of Middle-Aged Women and Men" draft available upon request
I use the large cuts in Medicare Home Health Care brought about by the Interim Payment System (IPS) in 1997 as a quasi-experiment to estimate the impact of the imposition of limits in reimbursement for home health care on self-reported health of “potential caregivers,” the group of people who, due to their demographics, is very likely to include adult children of the elderly who are most impacted by the policy. I find that the IPS caused an increase in the fraction of poorly educated, married, middle-aged women who report being in fair or poor health and an increase in the number of days in the previous month in which physical health was not good for this group of women. Differently, the IPS caused a decline in the number of days in which mental health was not good for unmarried, low-educated middle-aged men. My results suggest that a trigger of differences in well-being between low-educated middle-aged men and women is represented by changes in public provision of home health care. Also, because self-reported measures of health of the elderly Medicare beneficiaries were not affected by the IPS, my findings stress the importance of looking beyond individuals directly receiving home health care services to evaluate the health effects of sudden cuts in the public provision of home health care.
Chiara Orsini "Work-Conditional Income Support Programs and Gender at Birth: Quasi-Experimental Evidence" draft available upon request