Job Market Paper

Higher Education and Long-Term Health: Evidence from China’s College Entrance Exam Suspension

Abstract: This paper examines the long-term health investments and outcomes of cohorts whose access to higher education was disrupted by the suspension of China’s college entrance examination during 1966-1969. Using a fuzzy regression discontinuity design, I find that college completion yields large health-behavioral returns at older ages. However, these gains do not translate into disease-free aging. College completion increases the burden of diagnosed chronic diseases, while physical, mental, and cognitive health outcomes are not significantly affected. Mechanism analyses show that higher education increases preventive screening and strengthens formal-sector institutional anchors, including employee-based insurance and higher net wealth. These results suggest that higher education promotes managed morbidity: it increases health-system contact, disease detection, and chronic disease management rather than uniformly improving late-life health stocks.

Publication

• Facility Acquisition and Care Quality in the United States Dialysis Industry. with Ilana Segal, Truc Bui, and Kevin Callison. Journal for Healthcare Quality | [Link]

Working Papers

Retirement, Grandchild Care, and Inpatient Recovery: Evidence from China’s Gender-and Occupation-Specific Retirement Ages. with Lele Zhao, Lu Yao, and Guisong Wang.

[Submitted]

Abstract: Retirement is often viewed as a transition from work to leisure, but in aging societies with strong family-care norms, it may also reallocate individuals from paid work to unpaid care work, particularly grandchild care. This paper examines how retirement reshapes inpatient recovery in China, where statutory retirement ages differ by gender and occupation and place white-collar females’ retirement transitions near a period of rising grandchild-care responsibilities. Using administrative inpatient discharge records from a leading hospital, we implement a fuzzy regression discontinuity design around the retirement thresholds for men, blue collar females, and white-collar females. Retirement changes inpatient recovery only among white-collar females. At their statutory retirement threshold, hospital readmissions increase and length of stay declines, while inpatient spending shows no corresponding discontinuity. We find null effects for men and blue-collar females. This heterogeneity is difficult to reconcile with conventional financial or insurance channels. Instead, evidence from nationally representative survey data suggests that white-collar females encounter a caregiving squeeze at retirement, as grandchild care responsibilities rise sharply around the same age. Psychosocial stress from the disruption of work-related identity appears to play a complementary role. These findings suggest that the health consequences of retirement depend on what replaces paid work. The results caution that retirement policy should account for changes in family-care demands across the life cycle.

Police-Involved Killings and Public Finance: Evidence from Municipal Bond Markets. with Feng Chen, Stephanie F. Cheng, and Wei Long.

[Draft Upon Request]

Abstract: This paper studies how shocks to government stewardship are reflected in capital markets, using police-involved killings as salient public events. Using bond-level data from the U.S. municipal primary market from 2000 to 2019, we show that police-involved killings increase municipal bond offering spreads. Instrumental variable estimates imply that one additional fatal encounter in the prior 12 months raises spreads by about 6 basis points, with larger effects for incidents receiving greater media coverage. These responses reflect heightened fiscal risk, weakened confidence in local stewardship, and social disruption amplified by local investor exposure, extending the economic consequences beyond litigation and settlement costs.

Gender Identity, Race, Ethnicity, and Health Insurance Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment.with Patrick Button, Barbara Lundebjerg, Luca Fumarco, and Benjamin Harrell.

Abstract: We use a correspondence experiment to test if mental health providers (MHPs) (those who do talk therapy, such as therapists and psychologists) discriminate against prospective clients based on gender identity, gender, race, ethnicity, and health insurance or payment type. We send emails requesting appointments to MHPs in the United States. The emails come from fictitious prospective clients who have on-average identical emails, but signal a different gender identity, gender, race, ethnicity, and health insurance status or payment method. We test for differential treatment by MHPs by comparing response quality and response rates. We will then test for statistical discrimination and other explanatory factors by determining how discrimination varies by factors such as local demographics and social attitudes, pro- or anti-trans laws, and MHP characteristics.

The Effect of State Mental Health Parity Laws on Physician Behavior

Abstract: Numerous studies have evaluated the effectiveness of state mental health parity laws in increasing access to mental health services. However, few have examined the role of mental health physicians in facilitating this access to treatment, despite the critical role of physician behavior in understanding the mechanisms behind. This paper employs a restricted data set to provide causal evidence from various perspectives, highlighting multiple supply-side responses induced by state mental health parity laws. First, utilizing a mixed-economy model, I predict that mental health physicians in states with parity laws will increase the quantity of mental health services and their participation in private health insurance market. Second, employing difference-in-differences strategies, results show that the average visit duration decreases about 17% to accommodate increased quantities while physicians do not increase their total labor supply time too much. Third, the observed null effects on payer mix suggest that increased quantities may come mainly from increasing demand of existing patients. Fourth, parity laws do not appear to influence psychiatrists’ location decisions but they do affect psychiatric or mental health service provisions at the facility level. The facility responses have important policy implications in addressing geographical disparities in mental health service across states. The results also shed lights on the evaluation of subsequent mental health insurance expansions, such as Medicaid expansion in behavioral health services.

Work in Progress

• The Impact of Telemedicine on Physicians’ Offline Behavior and Patient Health Outcomes: Evidence from China. with Lele Zhao and Lu Yao.

  Abstract: China’s telemedicine industry was already approaching maturity before the COVID-19 pandemic, with over 466 million users of online medical services. The pandemic further accelerated its expansion and strengthened the integration of online and offline healthcare, a trend that is expected to continue in the post-pandemic period. Yet, the causal impact of physicians’ participation in telemedicine on their offline practice and patients’ health outcomes remains unclear. This study links comprehensive online consultation data from Haodf.com, a leading online healthcare platform, with inpatient claims data from a large public hospital (2019–2022). Using a stacked difference-in-differences design, we investigate how physicians’ telemedicine registration affects their offline practice and patient outcomes, with a specific focus on physicians who do not alter their patient mix after registration. The adoption of telemedicine increases both offline patient volume and volume share within a specialty, suggesting complementarity rather than substitution between online and in-person care. Despite the higher offline labor supply, we find no significant effects on length of stay, expenditure, readmission, or mortality, indicating that telemedicine does not compromise the quality of care. These results underscore the importance of designing telemedicine policies that not only expand access but also enhance the efficiency and equity of healthcare delivery.

• Medicare Spending, Mobility and Health Outcomes. with Kevin Callison.

  Abstract: A long-term decline in mobility among people in the U.S. is well documented. However, few studies have explained the causes of this phenomenon. This study aims to determine whether Medicare spending is associated with declining mobility for seniors and to examine whether declining mobility impacts health outcomes. The idea is based on the stylized fact that there are geographic variations in Medicare spending, and that these variations may be related to changes in seniors’ mobility over time. First, we aim to provide evidence that people living in high-spending areas are less likely to move to low-spending areas as the spending differences between the two types of areas decrease. Second, we will identify a control group of non-migrants to examine the impact of mobility on health outcomes. Our identification strategy employs a difference-in-differences (DiD) approach. Specifically, we will compare seniors who live in high-spending areas and do not move to low-spending regions with those who move to other high-spending areas. The latter group serves as a counterfactual for the former, as they share similar characteristics but make different migration decisions. Our findings will relate to both the efficiency evaluation of Medicare reimbursement and the assessment of successful aging in place.

• The Effect of Health Insurance on the Health of Near-elderly in the U.S.. with Kevin Callison and Robert Kaestner.