WORKING PAPERS

Diagnostic errors in child mental health: Assessing treatment selection and its long-term consequences [Job Market Paper] Download

Poor mental health has long-term effects on individual quality of life and socioeconomic inequality. Yet, the subjective nature of mental health may result in missed disorders in some children and over-utilization of care for others. In this paper, I study mental health care utilization in childhood and the long-term implications of any misallocation by exploiting discontinuous treatment uptake by a child's school starting age and a Canadian pharmaceutical insurance policy expansion. I combine these treatment changes with an estimate of mental health risk to elucidate under or over-utilization of medical care and long-run, risk-conditional mental health treatment effects on education and labour market outcomes. I find that treated young-for-grade children tend to have lower mental illness risk, suggesting over-utilization. At the same time, removing out-of-pocket costs increases treatment rates specifically for high-risk children. Long-term adverse effects of mental health treatment on education, social assistance receipt and income are concentrated in low-risk individuals. High-risk children with missed or delayed diagnoses see diminished health trajectories from not receiving care, but only very high-risk kids see human capital benefits. As missed or delayed diagnoses represent a larger misallocation of scarce support resources, I find that targeted screening before age 11 and reductions in out-of-pocket costs would reduce inequities in mental health care access and improve downstream socioeconomic inequality.

  • Presented at 2020 American Society for Health Economics Child Health Emerging Scholars Session View - at 26m30s

  • Upcoming presentations: iHEA 2021 Mental Health Session


The Long Arm of the Clean Air Act: Pollution Abatement and COVID-19 Racial Disparities (with Boriana Miloucheva) Download [Update coming soon]

This paper investigates the role of exposure to fine particulate pollution (PM2.5) on racial disparities in COVID-19 cases and deaths. Accounting for many potential confounding variables, we find a 1-unit increase in exposure to PM2.5 increased COVID-19 deaths by 28 percent. Nearly all of this PM2.5 effect is born by counties with a higher than median proportion of Black residents. As pollution may be confounded with other unobserved factors impacting COVID-19 spread and exacerbation, we leverage pollution spillovers from neighbouring counties and policy variation due to the Clean Air Act-set maximums on acceptable pollution levels to test these results. We find our results remain robust to this instrumental variable approach. Symmetrically, we also find that counties just above CAA pollution thresholds, which had significant pollution reductions over time, saw a full standard deviation reduction in COVID-19 deaths per 100,000. Counties with higher representation of minority or Black residents saw reductions in deaths by 1.50 and 1.15 standard deviations, respectively. Nevertheless, these protective effects insufficiently compensate for the still higher levels of pollution exposure in counties with more Black or minority residents and the more consequential impact of pollution for these communities, as accounting for PM2.5 and other potential drivers explain only half of the racial gap in COVID-19 outcomes.


ADHD Misidentification in School: Causes and Mitigators (with Elizabeth Dhuey and Audrey Laporte) Download

We estimate over- or under-identification of ADHD occurring in school-based behavioural assessments based on school starting age. To isolate teacher ADHD assessment error direction, we use teacher-parent assessment residuals in a fuzzy regression discontinuity. We show that being young-for-grade or male generates some over-assessment. However, the under-assessment of the oldest students in a grade, especially the oldest females, drives the school starting age gap in ADHD identification. We link this gender breakdown, along with higher rates of assessment error in lower-income schools, to growing education attainment gaps. Importantly, we demonstrate that teacher special education training mitigates these relative age-based assessment errors.

  • First Prize, 2020 International Health Economics Association Student Paper Award

  • Upcoming presentations: iHEA 2021 Awardee Session, WEAI 2021 Age of School Entry Session


PUBLICATIONS

Furzer, J., Gupta, S., Nathan, P.C., Pole, J., Schechter, T. Kruegar, J. & Pechlivanoglou, P. (2020). Cost-effectiveness of Tisagenlecleucel vs Standard Care in High-risk Relapsed Pediatric Acute Lymphoblastic Leukemia in Canada. JAMA: Oncology. 6(3):393-401.

Furzer, J., Tessier, L., Hodgson, D., Nathan, P.C., Gupta, S., Cotton, C. & Pechlivanoglou, P. (2020). Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin Lymphoma. Journal of the National Cancer Institute. 112(1): 63-70.

Alfada, S. & Furzer, J. (2017). Cost Analysis of a Long-term Randomized Clinical Trial of Patients Treated with Immediately Loaded Implant-Supported Fixed Prosthesis. Clinical Implant Dentistry and Related Research, 19(6):1-6.


WORK IN PROGRESS

Recessions and Child Mental Health: Do Universal Child Benefits have Protective Effects?

The More You Know: Can Information Nudges Improve Online Learning Engagement?