Carlos Dobkin’s research while affiliated with Massachusetts Institute of Technology and other places

Though there is compelling evidence that medical expenses do cause bankruptcies in the United States, they may cause far fewer than has been claimed. Overemphasizing such events may distract from an understanding of the true nature of health-related economic hardship.

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills, and bankruptcy, and reduce earnings, income, access to credit, and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger fewer than 5 percent of all bankruptcies in our sample.

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills, and bankruptcy, and reduce earnings, income, access to credit, and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger fewer than 5 percent of all bankruptcies in our sample.

Despite the fact that nonfatal injuries are much more common than fatal ones, most studies examining the health effects of tighter alcohol control have focused on fatalities. We provide the first comprehensive quasi-experimental evaluation of the effect of the minimum legal drinking age in the United States on injuries serious enough to require treatment in a hospital. Using a near census of emergency department (ED) and hospital discharge records from several large states we document that at age 21, ED visits and hospital admissions increase by 69.4 and 9.2 per 10,000 person-years respectively. These increases are due mainly to an increase in the rate at which young men experience accidental injuries, alcohol overdoses, and injuries inflicted by others – providing the literature's first direct evidence that easing access to alcohol increases the risk of violent victimization. Our results indicate that the literature's disproportionate focus on mortality leads to a significant underestimation the benefits of tighter alcohol control.. We thank Phil Cook and seminar participants at the 2010 American Society of Health Economists Conference for valuable comments. Some of the results in this paper are based on confidential data. Readers can contact the authors for information on obtaining access. We gratefully acknowledge grant support from NIH/NIAAA #RO1 AA017302-01. The usual caveats apply.

A substantial economics literature documents that tighter alcohol controls reduce alcohol-related harms, but far less is known about mechanisms. We use the universe of Canadian mortality records to document that Canada's Minimum Legal Drinking Age (MLDA) significantly reduces mortality rates of young men but has much smaller effects on women. Using drinking data that are far more detailed than in prior work, we document that the MLDA substantially reduces 'extreme' drinking among men but not women. Our results suggest that alcohol control efforts targeting young adults should focus on reducing extreme drinking behavior.

We use variation from the minimum legal drinking age to estimate the causal effect of access to alcohol on crime. Using a census of arrests in California and a regression discontinuity design, we find that individuals just over age 21 are 5.9% more likely to be arrested than individuals just under 21. This increase is mostly due to assaults, alcohol-related offenses, and nuisance crimes. These results suggest that policies that restrict access to alcohol have the potential to substantially reduce crime.

Health insurance affects the rate at which individuals visit hospitals and emergency departments (EDs). We identify the causal effect of losing health insurance using a regression discontinuity design. We compare individuals just before and after their twenty third birthday, which insurers have used as a cutoff after which students are no longer eligible for their parents' health insurance: 1.5% of young adults lose their health insurance upon turning 23, and this transition leads to a 1.6% decrease in ED visits and a 0.8% decrease in hospital stays. We discuss why these estimates are larger than those observed among teenage populations. © 2014 by the President and Fellows of Harvard College and the Massachusetts Institute of Technology.

In this paper we estimate the effect of class attendance on exam performance by implementing a policy in three large economics classes that required students scoring below the median on the midterm exam to attend class. This policy generated a large discontinuity in the rate of post-midterm attendance. We estimate that near the threshold, the post-midterm attendance rate was 36 percentage points higher for those students facing compulsory attendance. The discontinuous attendance policy is also associated with a significant difference in performance on the final exam. We estimate that a 10 percentage point increase in a student's overall attendance rate results in a 0.20 standard deviation increase in the final exam score. Given the large estimated effect of attendance on exam performance, we then consider what motivates student absenteeism by implementing two campus wide surveys of lecture attendance. First, we observe characteristics and attendance rates of 180 large lecture courses and find little relationship between attendance and factors within the instructor's control. Next, we conduct a web survey of undergraduates, where students primarily report missing class due to sleep, feeling that lecture was not worthwhile, or needing to prepare for another class.

The Amethyst Initiative, signed by more than 100 college presidents and other higher education officials calls for a reexamination of the minimum legal drinking age in the United States. A central argument of the initiative is that the U.S. minimum legal drinking age policy results in more dangerous drinking than would occur if the legal drinking age were lower. A companion organization called Choose Responsibility explicitly proposes "a series of changes that will allow 18-20 year-olds to purchase, possess and consume alcoholic beverages." Does the age-21 drinking limit in the United States reduce alcohol consumption by young adults and its harms, or as the signatories of the Amethyst Initiative contend, is it "not working"? In this paper, we summarize a large and compelling body of empirical evidence which shows that one of the central claims of the signatories of the Amethyst Initiative is incorrect: setting the minimum legal drinking age at 21 clearly reduces alcohol consumption and its major harms. We use a panel fixed effects approach and a regression discontinuity approach to estimate the effects of the minimum legal drinking age on mortality, and we also discuss what is known about the relationship between the minimum legal drinking age and other adverse outcomes such as nonfatal injury and crime. We document the effect of the minimum legal drinking age on alcohol consumption and estimate the costs of adverse alcohol-related events on a per-drink basis. Finally we consider implications for the correct choice of a minimum legal drinking age.