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The poor diets of many consumers are often attributed to limited access to healthy foods. In this paper, we use detailed data describing the healthfulness of household food purchases and the retail landscapes in which these consumers are making these decisions to study the role of access in explaining why some people in the United States eat more nutritious foods than others. We first confirm that households with lower income and education purchase less healthful foods. We then measure the spatial variation in the average nutritional quality of available food products across local markets, revealing that healthy foods are less likely to be available in low-income neighborhoods. Though significant, spatial differences in access are small and explain only a fraction of the variation that we observe in the nutritional content of household purchases. Systematic socioeconomic disparities in household purchases persist after controlling for access: even in the same store, more educated households purchase more healthful foods. Consistent with this result, we further find that the nutritional quality of purchases made by households with low levels of income and education respond very little when new stores enter or when existing stores change their product offerings. Together, our results indicate that policies aimed at improving access to healthy foods in underserved areas will leave most of the socioeconomic disparities in nutritional consumption intact.

Zonder onderwerpscode: economie

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This paper uses quarterly county-level data to examine the relationship between opioid prescription rates and employment-to-population ratios from 2006-2014. We first estimate models of the effect of opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We also estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, but there is no relationship for men. These findings suggest that although they are addictive and dangerous, opioids may allow some women to work who would otherwise leave the labor force. When we examine the effect of employment-to-population ratios on opioid prescriptions, our results are more ambiguous. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely to curb the opioid epidemic.

Zonder onderwerpscode: economie

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We examine how supply-side health insurance generosity affects patient access, use, and health. Exploiting large, exogenous changes in Medicaid reimbursement rates for physicians, we find that increasing payments for new patient office visits reduces reports of providers turning away beneficiaries: closing the gap in payments between Medicaid and private insurers would reduce more than two-thirds of disparities in access among adults and would eliminate such disparities entirely among children. These improvements in access lead to more office visits, better self-reported health, and reduced school absenteeism. While attention is often focused on the role of demand-side insurance generosity, such as program eligibility and patient cost-sharing, our results demonstrate that financial incentives for physicians drive access to care and have important implications for patient health.

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This paper uses quarterly county-level data from 2006-2014 to examine the direction of causality in the relationship between per capita opioid prescription rates and employment-to-population ratios. We first estimate models of the effect of per capita opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, while there is no relationship for men. We then estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument, and find ambiguous results. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely on its own to curb the opioid epidemic.