The effect of urgent care centers on emergency department attendance and waiting times, with Peter Bristow and Luke Connelly (under review)
Available at: https://ssrn.com/abstract=5243075
The timeliness of hospital Emergency Department (ED) care continues to deteriorate in many countries around the world. Urgent care centers (UCCs) represent an alternative practice model that has recently been proposed and introduced in the state of Queensland, Australia, aimed at reducing non-urgent ED attendance. To examine the impact of this policy, we exploit the staggered opening of UCCs, studying their effects on ED attendance, waiting time to be seen, and nearby general practice attendance, using three modern difference-in-differences estimators and a generalized synthetic control method. We show that, while the number of ED presentations declined, they did so for only one treatment cohort, for which presentation numbers pre-treatment had seen a different trajectory compared to the controls, and thus we cannot conclude the decline was caused by the UCCs’ opening. We find that the UCCs did not improve the timeliness of care provided, nor reduce the rate of attendance at local general practices. However, we find a striking 32% increase in the total number of presentations across the ED and UCCs combined. Potential mechanisms may be the lower time-price for UCC care, exposing latent demand. These findings have policy implications: when healthcare providers consider opening a UCC, the result may be a satisfaction of latent demand, rather than a reduction in ED attendance or waiting times.
The Good Old Days? Mental Health Across Birth Cohorts, with Luke Connelly and Will Whittaker (under review)
Available at https://ssrn.com/abstract=5238437
The share of the population reporting to be in poor mental health has risen substantially in the last decade, particularly in younger age groups. These prevalence estimates are usually based on subjective responses to mental health screening questions, where reporting may differ between generations due to changes in social stigma and awareness. In this paper, we study reporting heterogeneity between birth cohorts in Australia. Based on the concept that true mental health is considered a latent variable, we compute a standardised mental health index employing a wide range of predictors, including socioeconomic factors, childhood conditions, physical health, life events, and financial information. Using data from the Household, Income and Labour Dynamics Survey in Australia between 2002 and 2021, we find that over- and under-reporting of poor mental health is decreasing among younger birth cohorts. Once we account for reporting bias the relationship between age and poor mental health returns back to the well-known hump shape with worse mental health in mid-life. While we continue to see a rise in poor mental health overall, the trend seems to be less sharp than is suggested by unadjusted prevalence rates.
The impact of informal care provision on loneliness & social isolation, with Isaac Koomson and Raymond Kofinti (submitted)
While informal care is regarded as an appealing alternative to formal care, it often comes at the expense of the caregiver. Existing studies have primarily focused on the financial implications of informal caregiving with limited attention to its hidden costs, including social aspects. This study contributes to the literature by examining the effects of informal caregiving on loneliness and social isolation using longitudinal data from a large nationally representative household survey in Australia. To study the relationship, we first employ a dynamic difference-in-differences (DID) method, exploiting the variation in the timing of caring across informal caregivers. Second, we complement our analysis with an instrumental variable (IV) method, using eligibility to government-funded Carer Payment as IV. Both strategies show that informal caregiving increases the probability of experiencing loneliness, particularly among female caregivers who provide care to their spouses. Our DID results do not show an effect on social isolation, whereas IV estimates suggest that informal caregiving increases social isolation among male compliers, but not females. Some of the effect of informal care on social health seems to be driven by changes to the relationship satisfaction between spouses when taking on a carer role.
Mass shootings and violent crime: The effect of subjective safety beliefs on health behavior, with Chris Rose and Brenda Gannon (draft available upon request)
Personal safety concerns consistently rank among the top issues in public opinion polls but are largely ignored in the economics literature on crime. This paper studies the impact of subjective beliefs around neighborhood safety on health behavior, namely physical activity, in the older adult population of the United States. We further provide new evidence of the reduced form impacts of mass shootings and crime on physical activity for this older group of people that have been overlooked in the literature so far, but who are disproportionately concerned about their safety. Using data from a large nationally representative survey of older adults between 2004 and 2020, we apply two complementary identification strategies. First, we exploit variation in timing and location of mass shootings and employ a staggered difference-in-differences estimator, showing that physical activity of respondents in the impacted counties declines in the years following the incident. Second, we implement an instrumental variables correlated random-coefficient estimator (IV-CRC), that allows for multi-valued treatments, catering for the categorical measurement of neighborhood safety beliefs. We use mass shootings and violent crime rates to construct instruments for safety beliefs and study their effect on physical activity. We find a significant deterrent effect of feeling unsafe on physical activity, which is stronger for females than males and more pronounced among people aged 75 and above.
The dynamic impact of parental separation on children's psychosocial development: Evidence from Australia, with Xiaoxue Dou, Bao Nguyen and Luke Connelly (work in progress)
Children’s mental health is a foundational determinant of their present well-being, but has also far-reaching implications for economic and social outcomes in adolescence and adulthood, including social capital accumulation, labor market success and future healthcare utilisation. Whilst existing research has explored various determinants of children's psychosocial development, the impact of parental separation remains ambiguous. This study contributes to the literature by investigating the relationship between parental separation and children’s psychosocial development outcomes using longitudinal data from the Longitudinal Study of Australian Children. Specifically, we employ a dynamic difference-in-differences framework to estimate the short- and medium-term effects of parental separation on children's psychosocial development. Our approach accounts for the non-absorbing nature of separations, treatment lags, and heterogeneous intensities of parental relationship transitions. Our findings suggest that parental separation has significant adverse effects on children's psychosocial development, particularly in terms of hyperactivity, peer problems, and prosocial behaviours. The adverse effects peak immediately after separation and gradually diminish over time, though some subgroups, such as children from lower socioeconomic backgrounds or those with less-educated parents, experience more persistent negative effects. Boys exhibit greater declines in prosocial behaviour and increased hyperactivity, whereas girls show heightened emotional distress and peer-related difficulties. Our results underscore the importance of targeted interventions to support children during and after parental separation, particularly for vulnerable subgroups.
Income support for informal caregivers and its effect on labor supply: Quasi-experimental evidence from Australia, with Bao Nguyen and Luke Connelly (work in progress)