Jonathan A. Seward

We investigate the causal impact of jail mental health needs scores, assigned by clinicians, on youth and adult outcomes. Utilizing an instrumental variable (IV) approach leveraging quasi-random assignment of intake clinicians, we find that worse scores increase incarceration duration and suicide attempts in both groups and recidivism in adults. For the marginal person, worse scores may lead to consequences like prolonged jail stays, which counteract potential benefits. We discuss possible mechanisms, including the existence of a mental health docket for misdemeanors, and effects of scores on bond posting, mental health care, type of housing within the jail, and length of stay.

Hospital ownership of physician practices has grown across the US, and these strategic decisions drive higher prices and spending. We show that following hospital acquisition of physician practices, physicians shift approximately 10% of their Medicare and commercially insured cases from ambulatory surgery centers (ASCs) to hospital outpatient departments. Physicians became up to 18% less likely to utilize ASCs after integration. Altering physician choices over treatment setting can be in conflict with patient and payer cost, convenience, and quality preferences.

We examine changes in hospital outpatient surgery trends and case mix for Medicare and privately insured patients needing total knee arthroplasty (TKA) after Medicare removed TKA from its Inpatient Only list on January 1, 2018. Using all Florida hospital discharge records from 2012 through 2018, we find an immediate shift of roughly 15% of Medicare TKA cases to the outpatient setting, with evidence of selection against the potentially riskiest Medicare TKA patients for outpatient delivery. Vertically integrated orthopedic physicians maintained both payer groups' cases in higher-cost inpatient settings.