Job Market Paper

Higher Education and Adult Health: Evidence from China’s College Entrance Exam Suspension

Abstract: While the correlation between education and health is well-established, causal evidence on the role of higher education in producing health in developing countries remains scarce. This study exploits a natural experiment in China, where high school seniors between 1966 and 1969 were denied timely access to higher education due to the suspension of the national college entrance examination (NCEE), to study the causal effects of college completion on health. Employing a fuzzy regression discontinuity design, I find that the NCEE suspension resulted in a 29.3% reduction in college completion for the disrupted cohorts by age 50 compared to unaffected cohorts. This lost educational opportunity led to significant and lasting adverse health consequences. Estimates imply that a one percentage-point decrease in the cumulative college completion rate increases the likelihood of smoking and drinking in later life by 1.1 and 2.2 percentage points, respectively. Further analyses suggest that these effects are partly driven by lost labor market returns, are concentrated in provinces where college disruption was most acute, and are absent for later cohorts who faced milder restrictions on access to higher education. Together, the results point to higher education as a critical determinant of population health, with implications for both education policy and health equity in resource-constrained settings.

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

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.

Retirement and Health Inequality: Evidence from Gender and Occupational Gaps in Hospital Readmission. with Lele Zhao and Lu Yao.

Abstract: Understanding the health effects of retirement is critical for aging societies, yet evidence remains mixed. This study leverages China’s rigid, gender- and occupation-specific statutory retirement ages as a natural experiment to identify causal effects. We utilize a novel, high-frequency administrative dataset comprising universal inpatient discharge records from a leading tertiary hospital, providing granular details on diagnoses, costs, and healthcare quality that are rarely available in survey data. Employing a regression discontinuity design, we document a striking pattern of heterogeneity: retirement causes a substantial, immediate increase in hospital readmissions, specifically among white-collar females (cadres), whereas no similar health shocks are found for males or blue-collar females. Mechanism analyses explicitly disentangle the drivers of this “cadre penalty.” We rule out income effects and insurance coverage as primary explanations. Instead, results point to two non-monetary factors unique to female cadres: the abrupt depreciation of work-related social capital combined with the intensification of grandchild care responsibilities. These twin pressures crowd out recovery time, highlighting how statutory retirement can act as a structural health risk for high-status women.

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.

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.

• 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.

• 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.