Research
Research
ECONOMICS
PUBLICATIONS
"How do mental health treatment delays impact long term mortality?"
American Economic Review 115 (5): 1672–1707
With a growing mental health crisis and a shortage of behavioral health specialists, those seeking mental health treatment often face long wait times to obtain care. I study how clinic congestion affects mortality for veterans experiencing mental health emergencies. I find that longer waiting times make it more likely that patients miss their follow up mental health visit, consequently increasing the probability that they permanently disengage from care. A one standard deviation increase in wait time between the ED visit and follow up appointment date (11.7 days) increases two-year mortality by about 1.5%.
[Published version] [Working paper version] [Supplementary appendix]
WORKING PAPERS
"Housing first or treatment first? Evidence from the VA's homelessness programs"
Debates in homelessness policy often pit “housing first” programs, in which subsidized housing is offered unconditionally and immediately, against “treatment first” interventions, which combine short-term housing with treatment for issues like substance use. Using a national sample of nearly 300,000 unhoused, mentally ill Veterans who are potentially eligible for the VA’s housing first program (known as HUD-VASH or VA Supportive Housing) or for a treatment first program (offered by a variety of local contractors), I examine mortality trends in the three years after initial program assignment. I find that “housing first” reduces three-year mortality by 4.6 percentage points relative to a counterfactual of neither program. In contrast, “treatment first” has no long-term effects on health relative to neither program.
"The effect of Red Scare propaganda on US public opinion: Evidence from the newspapers of William Randolph Hearst"
revise & resubmit, Journal of Economic History
Could anti-redistributive sentiment have long run roots in Red Scare-era propaganda? In the 1930s and 40s, the media mogul William Randolph Hearst espoused vehement anti-communist rhetoric in his newspapers. Fears of socialism went head to head with FDR’s New Deal, the first wide-scale federal spending program. Using variation in newspaper penetration across US counties, I show that an increase of 10 percentage points in Hearst circulation per capita decreased support for FDR by 2.1 percentage points. I also show evidence that these effects are long run, decreasing support for public healthcare and welfare programs through the late 20th century.
1. Chan D, Danesh K, Costantini S, Card D, Taylor L, Studdert D, “Mortality among Veterans following emergency visits to Veterans Affairs and other hospitals,” BMJ, February 2022
2. Kazemian P, Costantini S et al, “A novel method to estimate the indirect community benefit of HIV interventions using a microsimulation model of HIV disease,” Journal of Biomedical Informatics, July 2020
3. Reddy K, Horsburgh C, Wood R, Fields N, Girouard M, Costantini S et al, “Shortened tuberculosis treatment for people with HIV in South Africa: a model-based evaluation and cost-effectiveness analysis,” Annals of the American Thoracic Society, February 2020
4. Costantini S, Walensky R, “The cost of drugs in infectious diseases: branded, generics, and why we should care,” Journal of Infectious Diseases, March 2019
5. Reddy K, Gupta-Wright A, Fielding K, Costantini S et al, “Cost-effectiveness of urine-based tuberculosis screening in hospitalised patients with HIV in Africa: a microsimulation modeling study,” Lancet Global Health, January 2019
6. Kazemian P, Costantini S et al, “The cost effectiveness of pre-exposure prophylaxis and HIV testing in India,” Clinical Infectious Diseases, March 2019
7. Costantini S et al, “Staphylococcus aureus colonization in children undergoing heart surgery,” World Journal for Pediatric and Congenital Heart Surgery, July 2013