Health Disparities Caused by Weather, Homelessness, Education, Transportation, and Patient Initiatives
Paper Session
Friday, Jan. 5, 2024 10:15 AM - 12:15 PM (CST)
- Chair: Christopher (Kitt) Carpenter, Vanderbilt University
Can Patients Improve Equitable Health Care Access?: Alternate Patient Scripts and Primary Care Appointment Availability
Abstract
We conducted a field experiment that measured primary care appointment access in association with simulated patient signals of gender and race (Black or White) or ethnicity (Hispanic). Simulated patients were randomly assigned to three strategies (scripts) in seeking an appointment: (1) a “control” script, (2) an additional prompt to seek an alternate provider (i.e., “alternate provider” script), and (3) an additional prompt complimenting the practice for its reputation (i.e., “reputation” script). Simulated patients were randomly assigned to primary care physicians drawn from a nationally representative sample. The alternate provider script was associated with a 20-percentage point increase [95% CI: 0.11, 0.28; p<0.01] in appointment offers from alternate providers. However, these gains were unequally distributed with potential equity-decreasing effects.The Causal Effects of Education on Family Health: Evidence from Expanding Access to Higher Education
Abstract
Exploiting the geographical expansion of the Finnish university system, we study the causal effects of education on family health. We find that education has positive impacts not only on individuals’ health but also on their parents’ health later in life. An additional year of education decreases the probability of mental health-related hospitalizations and drug use by 3–4 percentage points while having less significant impacts on early mortality. As for the spillover effects, it increases a mother’s probability of old age survival by 2–3 percentage points, whereas the estimated effects on parents’ mental health and a father’s survival are less significant.The Mortality of the U.S. Homeless Population
Abstract
This paper provides the first national calculation of mortality, the most severe indicator of health and well-being, for the U.S. homeless population. We use a sample of 140,000 people who were sheltered or unsheltered homeless during the 2010 Census, by far the largest and closest to representative sample ever used to study the homeless population. These individuals, along with housed and housed poor comparison groups, are linked to Social Security Administration data on all-cause mortality from 2010-2022 to estimate the magnitude of health disparities associated with homelessness. We find that non-elderly people experiencing homelessness have 3.5 times higher mortality than those who are housed, accounting for differences in demographic characteristics and geography. A 40-year-old homeless person faces a similar mortality risk to a housed person nearly twenty years older and a poor housed person nearly ten years older. The mortality rate of the homeless population relative to the housed is highest when individuals are in their 30s and 40s but falls in relative terms starting around age 50. Within the homeless population, people who are Black, female, and Hispanic have lower relative mortality risk than their white, male, and non-Hispanic counterparts. Employment, higher income, and observed family connections are also associated with lower mortality, but mortality risk is similar for people who were observed as sheltered and unsheltered homeless in 2010. Homeless individuals’ mortality rose by 33 percent during the COVID-19 pandemic, an increase that, while similar in proportional terms to the increase for the housed population, affected a much larger share of the homeless population due to their substantially elevated baseline mortality rate. These findings elucidate the persistent hardships associated with homelessness while also identifying more vulnerable segments of an already exceptionally deprived population.JEL Classifications
- I1 - Health