Serious mental illness (SMI) is a disabling condition that develops early in life and imposes substantial economic burden. There is a growing belief that early intervention for SMI has lifelong benefits for patients. However, assessing the cost-effectiveness of early intervention efforts is hampered by a lack of evidence on the long-term benefits. We address this by estimating the lifetime burden of SMI for those diagnosed by age 25 using a dynamic microsimulation model. We estimate that the per-patient lifetime burden of SMI is $1.85 million dollars. We also find that a policy intervention focused on improving the educational attainment of SMI patients reduces the average per-person burden of SMI by $73,600 (4.0%), driven primarily by higher lifetime earnings, totaling over $8.9 billion in reduced burden per cohort of SMI patients. These findings provide a benchmark for the potential value of improving educational attainment for SMI patients.

We study the impact of a medical breakthrough (HAART) on domestic violence and illicit drug use among low-income women infected with HIV. To identify causal effects, we assume that variation in women's immune system health when HAART was introduced affected how strongly their experience of domestic violence or drug use responded to the breakthrough. Immune system health is objectively measured using white blood cell (CD4) counts. Because the women in our sample were informed of their CD4 count, it is reasonable to assume they react to it. Using this identification strategy, we find that HAART introduction reduced domestic violence and illicit drug use. To explain our estimates, we treat health as a form of human capital and argue that women with more human capital face stronger incentives to make costly investments with future payoffs, such as avoiding abusive partners or reducing illicit drug use.

No abstract

Over the past decade, the number of studies examining the effects of health insurance has grown rapidly, along with the breadth of outcomes considered. In light of growing research in this area and the intense policy focus on coverage expansions in the United States, there is need for an up-to-date and comprehensive literature review and synthesis of lessons learned. We reviewed 112 experimental or quasi-experimental studies on the effects of health insurance prior to people becoming eligible for Medicare on a broad set of outcomes. Over the past decade, evidence related to the effect of increased access to health insurance has strengthened, illuminating that children and vulnerable adults are most likely to see health and economic benefits. We identified promising areas for future study in this active and burgeoning research area, noting benefit design of health insurance and outcomes such as government program participation and self-reported health status as targets.