Becky Staiger, Esther E. Velasquez, Mathew V. Kiang, and Michael L. Barnett. "The Detailing Margin: Opioid Marketing, Prescribing, and Patient Outcomes."
Abstract: Direct-to-physician marketing ("detailing") features prominently in pharmaceutical sales strategies, yet studies leveraging geographic variation or payment disclosures provide an incomplete picture of how marketing intensity shapes individual provider behavior and patient outcomes. We link newly available Purdue Pharma detailing records to Medicare claims for Massachusetts physicians (2006--2018). Comparing physicians with varying detailing intensity, we find high exposure increases Purdue opioid prescriptions by 11% and patient-level opioid use by 4%. Prescribing responses plateau beyond moderate exposure, while downstream harms--a 22% increase in falls and fractures--concentrate at intermediate levels and among populations plausibly closest to the margin of opioid indication.
Alex Schulte, Becky Staiger, Amanda Brewster, Lori Freedman, and Hector Rodriguez. "Downstream Effects of Restricted Access to Contraception: Evidence from Hospitals with Religious Directives."
Abstract: As demand for postpartum contraception increases, a growing number of hospitals are adopting religious restrictions known as the Ethical and Religious Directives (ERDs) that explicitly prohibit contraception provision. Yet, despite ongoing state and federal policy debates, causal evidence on the longer term health consequences of institutional religious restrictions remains scarce. We use quasi-random variation in geographic proximity to hospitals with and without ERDs to evaluate the effect of giving birth at an ERD-adherent hospital on postpartum contraception and downstream reproductive health outcomes. Our instrumental variable approach uses data on over 9 million birth hospitalizations from 2010--2023 across eleven states. We find giving birth at an ERD-adherent hospital reduces permanent contraception by 3.82 percentage points (pp, 63% relative to the mean) and non-permanent contraception by 1.39 pp (36% relative decrease). Effects are substantially larger for rural patients, for whom ERD-adherent hospitalization reduces permanent and non-permanent contraception by 70% and 71%, respectively. Among rural patients, we subsequently document a 33% increase in short-interval pregnancies, which carry serious maternal and infant health risks. Urban patients show no significant effects on non-permanent contraception or short-interval pregnancy, consistent with greater access to non-hospital contraception options. These findings provide the first causal evidence linking hospital religious restrictions to adverse downstream health outcomes, informing policy debates on hospital transparency, merger oversight, and institutional conscience protections.
Ajin Lee, Maya Rossin-Slater, Becky Staiger, and Amanda Su. "Managed Care in Medicaid's Long-Term Services and Supports."
Other versions: NBER Working Paper No. 35055
Abstract: An aging US population has raised important questions regarding the organization, delivery, and funding of long-term services and supports (LTSS), prompting many state Medicaid programs to shift from fee-for-service to managed care models for LTSS delivery. We analyze the effects of transitioning to managed LTSS (MLTSS) on health outcomes among dual-eligible Medicare-Medicaid beneficiaries aged 65 and older in Florida and New York. Using Medicare claims data and a differences-in-differences design leveraging county-by-county MLTSS rollouts, we find that MLTSS leads to a 4.2 percent increase in hospitalizations in Florida, but no significant change in New York. Analysis of preventive care suggests that declining flu vaccination rates in Florida may have contributed to increased hospitalizations from respiratory causes. These findings highlight important differences in MLTSS effects across states and underscore the value of Medicare data for measuring health effects in the dual-eligible population.
Becky Staiger, Laurence Baker, and Tina Hernandez-Boussard. "Provider Opioid Prescribing Behaviors and Opioid Use in Medicaid."
Abstract: Liberal prescription of opioids is widely believed to have contributed to the ongoing epidemic of opioid misuse and related harms within the United States and elsewhere. Policies aimed at curbing the epidemic have focused on encouraging providers to adopt stricter opioid prescribing behaviors. However, the extent to which the association between providers' opioid prescribing behaviors and their patients' opioid use reflects a causal influence of behavior versus patient-provider sorting is unclear. Using Medicaid claims data for three states from 2016-2021, we use provider exits from Medicaid to evaluate how enrollees with chronic pain are affected by a switch to a lower- or higher-prescribing provider. We find that among patients with prior opioid use, switching to lower intensity physicians leads to as much as a 75% decrease in opioid use, with evidence of increased hospitalizations. While we observe a 15% increase in opioid use among opioid-naive enrollees who switch to more intensely prescribing providers, the health effects are less clear. Our findings are similar when using an instrumental variables approach to correct for the potential endogeneity of the destination provider's prescribing intensity.
Madeline Helfer, Becky Staiger, and Jessica Van Parys. "Mortality Rates by Race and Ethnicity Among People with Disabilities."
Draft coming soon.
Katja Hofmann, Caitlin Myers, Maya Rossin-Slater, and Becky Staiger. "Access to Abortion Care and Low-Income Women's Health: Evidence from Medicaid Beneficiaries."
Draft coming soon.
Physician Practice Acquisitions and Medicaid Enrollee Outcomes
(with Ambar La Forgia and Bohan Li)
Joseph Doyle and Becky Staiger. "Physician Group Influences on Treatment Intensity and Health: Evidence from Physician Switchers." AEJ: Economic Policy. 2025.
Other versions: NBER Working Paper No. 29613
Becky Staiger, Madeline Helfer, and Jessica Van Parys. "The Effect of Medicaid Expansion on the Take-up of Disability Benefits by Race and Ethnicity." Health Economics. 2023.
Other versions: NBER Working Paper No. 31557.
Becky Staiger. "Disruptions to the Patient-Provider Relationship and Patient Utilization and Outcomes: Evidence from Medicaid Managed Care." Journal of Health Economics. 2022.
Stacy Chen and Becky Staiger. "Medicaid Expansion Increased Income Among Newly-Eligible Adults." Health Affairs Scholar. 2025.
Becky Staiger*, Valentin Bolotnyy*, Sonya Borrero, Maya Rossin-Slater, Jessica Van Parys, Caitlin Myers. "Obstetrician and Gynecologist Physicians' Practice Locations Before and After the Dobbs Decision." JAMA Network Open. 2025.
Media coverage: CNN, The Hill (Op-Ed)
Becky Staiger*, Anran Li*, Diane Alexander, and Molly Schnell. "Enrollment Brokers Did Not Increase Medicaid Enrollment, 2008-18." Health Affairs. 2022.
*Indicates shared first authorship