Mental health parity legislation, cost-sharing and substance-abuse treatment admissions.

Treatment is highly cost-effective in reducing an individual's substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992 to 2007. Only 10% of individuals with clinical SA disorders receive treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

Mitigation strategies and compliance in the COVID-19 fight; how much compliance is enough?

The U.S. with only 4% of the world's population, bears a disproportionate share of infections in the COVID-19 pandemic. To understand this puzzle, we investigate how mitigation strategies and compliance can work together (or in opposition) to reduce (or increase) the spread of COVID-19 infection. Building on the Oxford index, we create state-specific stringency indices tailored to U.S. conditions, to measure the degree of strictness of public mitigation measures. A modified time-varying SEIRD model, incorporating this Stringency Index as well as a Compliance Indicator is then estimated with daily data for a sample of 6 U.S. states: New York, New Hampshire, New Mexico, Colorado, Texas, and Arizona. We provide a simple visual policy tool to evaluate the various combinations of mitigation policies and compliance that can reduce the basic reproduction number to less than one, the acknowledged threshold in the epidemiological literature to control the pandemic. Understanding of this relationship by both the public and policy makers is key to controlling the pandemic. This tool has the potential to be used in a real-time, dynamic fashion for flexible policy options. Our methodology can be applied to other countries and has the potential to be extended to other epidemiological models as well. With this first step in attempting to quantify the factors that go into the "black box" of the transmission factor ß, we hope that our work will stimulate further research in the dual role of mitigation policies and compliance.

Religiosity and Health Through the Decades: Is There a Gender Difference?

PURPOSE: An empirical examination of the long-term association, disaggregated by gender, between religiosity and self-rated health with reference to demographic shifts in labor force participation, education, and income. DESIGN: General Social Survey data. SETTING: United States, 1974 to 2012. PARTICIPANTS: A total of 23 353 respondents. MEASURES: Self-assessed health; 2 key religiosity variables: attendance and intensity of belief; income, labor market variables, education, standard demographic variables, household size, region, and time dummies. ANALYSIS: Probit estimation conducted for the aggregate sample by gender as well as by decades to examine possible gender differential changes over time. RESULTS: Attendance has declined overall with a much greater decline for women. The overall positive association between religiosity and health masks considerable heterogeneity across gender and time; higher and stable for males, there is no longer a significant association for females. Increased education, income, and labor force participation can explain only part of this association. Education is the strongest mediator. CONCLUSION: The way women and men benefit from religious attendance has changed, suggesting that some pathways may be working differently for women now, especially those with less education. Moving away from church networks could be due to a perceived lack of support or substitution by other social networks. Ceteris paribus, since religious participation has been shown to weaken preference for risky consumption, declining participation, especially for women, may show up as an increase in risky behavior.

An empirical analysis of the association between social interaction and self-rated health.

PURPOSE: To empirically investigate the relationship of social interactions with self-rated health status. DESIGN: Cross-sectional study. SETTING: The United States, 1972-2008. SUBJECTS: 53,043 respondents interviewed. MEASURES: In-person interviews were conducted by the National Opinion Research Center. Health is measured via self-assessment, and a binary indicator defines whether the respondent reports excellent or good health. Impersonal social interaction is binary, reflecting membership in at least one organization; personal interaction is binary, reflecting whether the respondent visits relatives, neighbors, friends, or bars at least once a month. Demographic, region, and time variables are standard controls. ANALYSIS: Probit models were estimated at aggregated and disaggregated (race, gender, age, and education) levels. RESULTS: Impersonal interaction fell 5% between 1974 and 1994, with deeper declines (12%) in personal interaction. Neighbor visits fell most (24%), but friends gained (5%). Marginal estimates indicate both personal and impersonal interactions are associated with better health. However, friends show the strongest effect. A 1-SD increase in the probability of meeting friends versus joining a club or association is associated with a higher (.019 vs. .014) probability of being in very good or excellent health. CONCLUSION: Social interaction, impersonal or personal, is significantly associated with health. Public policy facilitating greater interactions of the type that benefits different demographic groups may be health promoting. Results are suggestive of potential network effects at the individual and community levels, which have implications for designing and targeting more effective health interventions.