Research
This page collects current working papers and projects in progress.
Working Papers
The Health Costs of Firms
Abstract - How much do firms contribute to disparities in workers’ healthcare expenditure? Using linked Dutch employer–employee administrative data, I exploit worker moves across firms to separate persistent worker differences from persistent firm differences. Moving the same worker to a firm one standard deviation higher in the firm-effect distribution raises expected annual healthcare expenditure by 17.8%. The implied top–bottom quintile gap is comparable to expenditure gradients by income, wealth, and education, and more than half of the dispersion remains within narrowly defined industrial codes. Supporting a health-risk interpretation, workers who move to higher-expenditure firms increase use of pain, anti-inflammatory, and muscle relaxant medications and face higher disability entry and long-run mortality. Because Dutch health insurance is largely financed outside the employment relationship, the results point to a fiscal externality: firms generate healthcare expenditure that they do not fully bear.
Mental Health Literacy, Beliefs and Demand for Support among University Students
Abstract - This paper assesses the impact of a mental health literacy intervention on the demand for mental health support among university students. We run a field experiment with 2,978 students at a large Dutch university. The intervention raises willingness to pay and demand for a mental-health app among male respondents, and shifts information demand from psychological counselling toward coaching, driven by students with moderate distress. Increased perceived effectiveness of low-intensity therapy appears to be the mechanism. A three-week follow-up suggests a moderate improvement in mental-health scores for treated female students, consistent with higher care-seeking.
Combining Boundary and Interior Information in Ordered Multi-Threshold Regression Discontinuity Designs
Abstract - Ordered multi-threshold regression discontinuity designs often require aggregating local discontinuities across several known cutoffs. This paper shows that such aggregate parameters can be decomposed into boundary terms and smooth contrasts between adjacent thresholds. Interior observations do not identify a single RD jump, but they are informative about these smooth segment contrasts. We develop an integrated-derivative estimator for segment contrasts by numerically integrating nonparametric estimates of the derivative of the conditional mean between adjacent thresholds. We derive its asymptotic distribution, including the leading bias and a feasible variance formula. The main result shows that the integrated-derivative estimator is asymptotically independent of the corresponding boundary-level estimator for the same smooth contrast. This independence yields a transparent inverse-variance combination of boundary and interior signals. The combined estimator is an augmentation of boundary-level estimation and is most useful when boundary information is sparse or noisy. Simulations confirm the distributional approximation and show modest gains under regular designs and larger gains in sparse-boundary designs.
Childhood Mental Health Effects of Early-Life Exposure to a Parental Job Loss
Abstract - We study the mental health effects of early life exposure to paternal job loss. Using nationwide individual-level administrative register records, we focus on firm-closure-induced job losses for fathers with children below age five in the Netherlands. These children are more likely to take mental health-related medicines in their later childhood, and this increase is mainly driven by psychostimulant drugs. The increased uptake of psychostimulants ranges from 15 percent of mean uptake in the control group at age five to around 9 percent at age twelve. The effects are significantly larger for families with mothers being the main breadwinner, suggesting that the drop in paternal income resulting from displacement is not the main driver of psychostimulant uptake. We further find that the father is more likely to take mental health medication around the time of job loss, and that the children exposed to paternal job loss are more likely to live in dissolved families. We find no evidence of exposed children living in neighborhoods with different rates of psychostimulant consumption compared to control children, while parents of treated children do report more impulsive behavior and inattention symptoms.