Geographic Variation in Mental Health Treatment Utilization: Evidence from Migration
American Economic Journal: Economic Policy · 2026 · [{"name": "Ding Hy", "affiliation": ["Shanghai University of Finance and Economics", "Fudan University"]}]
中文摘要
老年人口承受着沉重的精神疾病负担。尽管存在有效的治疗手段，包括服务（如心理治疗）和药物（如抗抑郁药、抗精神病药），本文记录了联邦医保（Medicare）参保人治疗利用率存在显著的地理差异。利用患者迁移，我发现服务利用率变异的45.8%可归因于地点特定因素，而药物利用率的这一比例仅为15.1%。进一步分析表明，医疗服务提供者可及性有助于解释服务使用与药物使用之间不同的地点效应。关于健康结果，我发现更高的治疗利用率与更低的自伤相关急诊科就诊风险相关。（JEL H75, I12, I13, I18）
Abstract
The older population bears a heavy burden of mental illness. Despite the availability of effective treatments, including services (e.g., psychotherapy) and drugs (e.g., antidepressants, antipsychotics), this paper documents substantial geographic variation in treatment utilization rates among Medicare enrollees. Exploiting patient migration, I show that 45.8 percent of service utilization variation is attributable to place-specific factors, compared to 15.1 percent for drug utilization. Further analyses suggest the role of provider accessibility in explaining the different place effects between service and drug use. Regarding health outcomes, I find that higher treatment utilization is associated with lower risks of self-harm-related emergency department visits. (JEL H75, I12, I13, I18)