Losing Insurance and Psychiatric Hospitalizations
We study the effect of losing insurance on psychiatric – mental health disorder (MHD) and substance use disorder (SUD) – hospital-based care. Psychiatric disorders cost the U.S. over $1T each year and hospitalizations provide important and valuable care for patients with these disorders. We use variation in public insurance coverage (Medicaid) eligibility offered by a large-scale and unexpected disenrollment in the state of Tennessee in 2005 that lead to 190,000 individuals losing their insurance. Medicaid enrollees are at elevated risk for psychiatric disorders. Following the disenrollment, hospitalizations for SUDs declined by 15.4%. Findings suggest that MHD hospitalizations declined by 4.2%, but the coefficient estimate is imprecise. The expected financing of hospital care received also changed, with the probability that Medicaid was listed as the expected payer for MHD and SUD hospitalizations declining by 27.5% and 30.8% respectively post-disenrollment. We provide suggestive evidence that psychiatric health declined post-disenrollment.
The analysis and conclusions set forth are those of the authors and do not indicate concurrence by other members of the research staff or the Board of Governors. All authors contributed equally to this study. HCUP data were obtained by Sebastian Tello-Trillo under the purview of the University of Virginia licenses. The remaining co-authors did not have any unauthorized access to these data while working on this paper. Authors are listed in alphabetical order. We thank Chandler McClellan, Brant Callaway, Ben Cook, Salma Freed, Andrew Goodman-Bacon, Samantha Harris, Steven Hill, Edward Miller, Ryan Mutter, Daniel Rees, and seminar participants at the University of Wisconsin, Southern Economics Association Conference, American Society of Health Economists Conference, and Association for Public Policy and Management for helpful comments, and the Tennessee Department of Health, Division of TennCare for excellent data assistance. Errors are our own. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
Johanna Catherine Maclean & Sebastian Tello-Trillo & Douglas Webber, 2023. "Losing insurance and psychiatric hospitalizations," Journal of Economic Behavior & Organization, vol 205, pages 508-527. citation courtesy of