IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/28164.html
   My bibliography  Save this paper

Gender Identity, Race, and Ethnicity Discrimination in Access to Mental Health Care: Preliminary Evidence from a Multi-Wave Audit Field Experiment

Author

Listed:
  • Patrick Button
  • Eva Dils
  • Benjamin Harrell
  • Luca Fumarco
  • David Schwegman

Abstract

A broad body of interdisciplinary research establishes that transgender and non-binary individuals face discrimination across many contexts, including healthcare. Simultaneously, transgender individuals face various mental health disparities, including higher rates of depression and anxiety, suicidality, and PTSD. Therefore, understanding the role of discrimination in access to mental health care is essential. However, no previous research quantifies the extent to which transgender and non-binary people face discrimination in mental healthcare markets. We provide the first experimental evidence, using an audit study, of the extent to which cisgender women, transgender women, transgender men, non-binary people, and racial and ethnic minorities (African American and Hispanic individuals) face discrimination in access to mental health services. While data collection is ongoing, we find significant discrimination against transgender or non-binary African Americans and Hispanics in access to mental health care appointments.

Suggested Citation

  • Patrick Button & Eva Dils & Benjamin Harrell & Luca Fumarco & David Schwegman, 2020. "Gender Identity, Race, and Ethnicity Discrimination in Access to Mental Health Care: Preliminary Evidence from a Multi-Wave Audit Field Experiment," NBER Working Papers 28164, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:28164
    Note: HC HE
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w28164.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    2. Hanson, Andrew & Hawley, Zackary, 2011. "Do landlords discriminate in the rental housing market? Evidence from an internet field experiment in US cities," Journal of Urban Economics, Elsevier, vol. 70(2-3), pages 99-114, September.
    3. Stijn Baert & Bart Cockx & Niels Gheyle & Cora Vandamme, 2015. "Is There Less Discrimination in Occupations Where Recruitment Is Difficult?," ILR Review, Cornell University, ILR School, vol. 68(3), pages 467-500, May.
    4. Gaddis, S. Michael, 2015. "Discrimination in the Credential Society: An Audit Study of Race and College Selectivity in the Labor Market," SocArXiv 6qjue, Center for Open Science.
    5. Granberg, Mark & Andersson, Per A. & Ahmed, Ali, 2020. "Hiring Discrimination Against Transgender People: Evidence from a Field Experiment," Labour Economics, Elsevier, vol. 65(C).
    6. Francine D. Blau & Lawrence M. Kahn, 2017. "The Gender Wage Gap: Extent, Trends, and Explanations," Journal of Economic Literature, American Economic Association, vol. 55(3), pages 789-865, September.
    7. Sawyer, P.J. & Major, B. & Casad, B.J. & Townsend, S.S.M. & Mendes, W.B., 2012. "Discrimination and the stress response: Psychological and physiological consequences of anticipating prejudice in interethnic interactions," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 1020-1026.
    8. Peter Bergman & Isaac McFarlin Jr., 2018. "Education for All? A Nationwide Audit Study of School Choice," NBER Working Papers 25396, National Bureau of Economic Research, Inc.
    9. Stroumsa, D., 2014. "The state of transgender health care: Policy, law, and medical frameworks," American Journal of Public Health, American Public Health Association, vol. 104(3), pages 31-38.
    10. David Neumark & Ian Burn & Patrick Button, 2019. "Is It Harder for Older Workers to Find Jobs? New and Improved Evidence from a Field Experiment," Journal of Political Economy, University of Chicago Press, vol. 127(2), pages 922-970.
    11. Schulz, A.J. & Gravlee, C.C. & Williams, D.R. & Israel, B.A. & Mentz, G. & Rowe, Z., 2006. "Discrimination, symptoms of depression, and self-rated health among African American women in Detroit: Results from a longitudinal analysis," American Journal of Public Health, American Public Health Association, vol. 96(7), pages 1265-1270.
    12. Hannah Van Borm & Marlot Dhoop & Allien Van Acker & Stijn Baert, 2020. "What does someone's gender identity signal to employers?," International Journal of Manpower, Emerald Group Publishing Limited, vol. 41(6), pages 753-777, March.
    13. Magnus Carlsson & Luca Fumarco & Dan-Olof Rooth, 2018. "Ethnic discrimination in hiring, labour market tightness and the business cycle - evidence from field experiments," Applied Economics, Taylor & Francis Journals, vol. 50(24), pages 2652-2663, May.
    14. Silvia Angerer & Christian Waibel & Harald Stummer, 2019. "Discrimination in Health Care: A Field Experiment on the Impact of Patients’ Socioeconomic Status on Access to Care," American Journal of Health Economics, MIT Press, vol. 5(4), pages 407-427, Fall.
    15. Marianne Bertrand & Sendhil Mullainathan, 2004. "Are Emily and Greg More Employable Than Lakisha and Jamal? A Field Experiment on Labor Market Discrimination," American Economic Review, American Economic Association, vol. 94(4), pages 991-1013, September.
    16. Rajiv Sharma & Sarah Tinkler & Arnab Mitra & Sudeshna Pal & Raven Susu‐Mago & Miron Stano, 2018. "State Medicaid fees and access to primary care physicians," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 629-636, March.
    17. Jennifer L. Doleac & Luke C.D. Stein, 2013. "The Visible Hand: Race and Online Market Outcomes," Economic Journal, Royal Economic Society, vol. 123(11), pages 469-492, November.
    18. Kory Kroft & Fabian Lange & Matthew J. Notowidigdo, 2013. "Duration Dependence and Labor Market Conditions: Evidence from a Field Experiment," The Quarterly Journal of Economics, Oxford University Press, vol. 128(3), pages 1123-1167.
    19. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
    20. Mustanski, B.S. & Garofalo, R. & Emerson, E.M., 2010. "Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths," American Journal of Public Health, American Public Health Association, vol. 100(12), pages 2426-2432.
    21. Becker, Gary S., 1971. "The Economics of Discrimination," University of Chicago Press Economics Books, University of Chicago Press, edition 2, number 9780226041162.
    22. Lutfey, Karen E. & Campbell, Stephen M. & Renfrew, Megan R. & Marceau, Lisa D. & Roland, Martin & McKinlay, John B., 2008. "How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment," Social Science & Medicine, Elsevier, vol. 67(9), pages 1391-1399, November.
    23. Clements-Nolle, K. & Marx, R. & Guzman, R. & Katz, M., 2001. "HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention," American Journal of Public Health, American Public Health Association, vol. 91(6), pages 915-921.
    24. Joanna N. Lahey & Douglas R. Oxley, 2018. "Discrimination at the Intersection of Age, Race, and Gender: Evidence from a Lab-in-the-field Experiment," NBER Working Papers 25357, National Bureau of Economic Research, Inc.
    25. Corrado Giulietti & Mirco Tonin & Michael Vlassopoulos, 2019. "Racial Discrimination in Local Public Services: A Field Experiment in the United States," Journal of the European Economic Association, European Economic Association, vol. 17(1), pages 165-204.
    26. Sharma, Rajiv & Mitra, Arnab & Stano, Miron, 2015. "Insurance, race/ethnicity, and sex in the search for a new physician," Economics Letters, Elsevier, vol. 137(C), pages 150-153.
    27. Ian Burn & Patrick Button & Theodore F. Figinski & Joanne Song McLaughlin, 2020. "Why Retirement, Social Security, and Age Discrimination Policies Need to Consider the Intersectional Experiences of Older Women," NBER Working Papers 27450, National Bureau of Economic Research, Inc.
    28. Gordon B. Dahl & Matthew M. Knepper, 2020. "Age Discrimination across the Business Cycle," NBER Working Papers 27581, National Bureau of Economic Research, Inc.
    29. Johannes Hemker & Anselm Rink, 2017. "Multiple Dimensions of Bureaucratic Discrimination: Evidence from German Welfare Offices," American Journal of Political Science, John Wiley & Sons, vol. 61(4), pages 786-803, October.
    30. Phelps, Edmund S, 1972. "The Statistical Theory of Racism and Sexism," American Economic Review, American Economic Association, vol. 62(4), pages 659-661, September.
    31. Meyer, I.H. & Brown, T.N.T. & Herman, J.L. & Reisner, S.L. & Bockting, W.O., 2017. "Demographic characteristics and health status of transgender adults in select US regions: Behavioral risk factor surveillance system, 2014," American Journal of Public Health, American Public Health Association, vol. 107(4), pages 582-589.
    32. Hanson, Andrew & Hawley, Zackary & Martin, Hal & Liu, Bo, 2016. "Discrimination in mortgage lending: Evidence from a correspondence experiment," Journal of Urban Economics, Elsevier, vol. 92(C), pages 48-65.
    33. Arber, Sara & McKinlay, John & Adams, Ann & Marceau, Lisa & Link, Carol & O'Donnell, Amy, 2006. "Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment," Social Science & Medicine, Elsevier, vol. 62(1), pages 103-115, January.
    34. Murchie, Judson & Pang, Jindong, 2018. "Rental housing discrimination across protected classes: Evidence from a randomized experiment," Regional Science and Urban Economics, Elsevier, vol. 73(C), pages 170-179.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Button, Patrick & Walker, Brigham, 2020. "Employment discrimination against Indigenous Peoples in the United States: Evidence from a field experiment," Labour Economics, Elsevier, vol. 65(C).
    2. Luca Fumarco & S. Michael Gaddis & Iain Snoddy, 2021. "Winmail3: An automated email package with an application to correspondence audit tests," Working Papers 2110, Tulane University, Department of Economics.
    3. Catherine Balfe & Patrick Button & Mary Penn & David Schwegman, 2021. "Infrequent Identity Signals and Detection Risks in Audit Correspondence Studies," NBER Working Papers 28718, National Bureau of Economic Research, Inc.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Button, Patrick & Walker, Brigham, 2020. "Employment discrimination against Indigenous Peoples in the United States: Evidence from a field experiment," Labour Economics, Elsevier, vol. 65(C).
    2. Gaddis, S. Michael, 2018. "An Introduction to Audit Studies in the Social Sciences," SocArXiv e5hfc, Center for Open Science.
    3. Halla, Martin & Kah, Christopher & Sausgruber, Rupert, 2021. "Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany," Department of Economics Working Paper Series 319, WU Vienna University of Economics and Business.
    4. Mattie Mackenzie-Liu & David J. Schwegman & Leonard M. Lopoo, 2020. "Do Foster Care Agencies Discriminate Against Gay Couples? Evidence from a Correspondence Study," Center for Policy Research Working Papers 224, Center for Policy Research, Maxwell School, Syracuse University.
    5. Mattie Mackenzie‐Liu & David J. Schwegman & Leonard M. Lopoo, 2021. "Do Foster Care Agencies Discriminate Against Gay Couples? Evidence from a Correspondence Study," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(4), pages 1140-1170, September.
    6. Baert, Stijn, 2017. "Hiring Discrimination: An Overview of (Almost) All Correspondence Experiments Since 2005," GLO Discussion Paper Series 61, Global Labor Organization (GLO).
    7. Cahuc, Pierre & Carcillo, Stéphane & Minea, Andreea & Valfort, Marie-Anne, 2019. "When Correspondence Studies Fail to Detect Hiring Discrimination," IZA Discussion Papers 12653, Institute of Labor Economics (IZA).
    8. Chowdhury, Shyamal & Ooi, Evarn & Slonim, Robert, 2020. "Racial Discrimination and White First Name Adoption: Evidence from a Correspondence Study in the Australian Labour Market," IZA Discussion Papers 13208, Institute of Labor Economics (IZA).
    9. David Neumark, 2018. "Experimental Research on Labor Market Discrimination," Journal of Economic Literature, American Economic Association, vol. 56(3), pages 799-866, September.
    10. Anthony Edo & Nicolas Jacquemet & Constantine Yannelis, 2019. "Language skills and homophilous hiring discrimination: Evidence from gender and racially differentiated applications," Review of Economics of the Household, Springer, vol. 17(1), pages 349-376, March.
    11. Jacquemet, Nicolas & Yannelis, Constantine, 2012. "Indiscriminate discrimination: A correspondence test for ethnic homophily in the Chicago labor market," Labour Economics, Elsevier, vol. 19(6), pages 824-832.
    12. Gordon B. Dahl & Matthew M. Knepper, 2020. "Age Discrimination across the Business Cycle," NBER Working Papers 27581, National Bureau of Economic Research, Inc.
    13. Stijn Baert & Sunčica Vujić, 2018. "Does it pay to care? Volunteering and employment opportunities," Journal of Population Economics, Springer;European Society for Population Economics, vol. 31(3), pages 819-836, July.
    14. Bertrand, Marianne & Duflo, Esther, 2016. "Field Experiments on Discrimination," CEPR Discussion Papers 11123, C.E.P.R. Discussion Papers.
    15. Nunley, John M. & Owens, Mark F. & Howard, R. Stephen, 2011. "The effects of information and competition on racial discrimination: Evidence from a field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 80(3), pages 670-679.
    16. Tjaden, Jasper Dag & Schwemmer, Carsten & Khadjavi, Menusch, 2018. "Ride with Me - Ethnic Discrimination, Social Markets and the Sharing Economy," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, pages 418-432.
    17. Laouénan, Morgane & Rathelot, Roland, 2017. "Ethnic Discrimination on an Online Marketplace of Vacation Rental," CAGE Online Working Paper Series 318, Competitive Advantage in the Global Economy (CAGE).
    18. Valfort, Marie-Anne, 2020. "Anti-Muslim discrimination in France: Evidence from a field experiment," World Development, Elsevier, vol. 135(C).
    19. Baert, Stijn & Norga, Jennifer & Thuy, Yannick & Van Hecke, Marieke, 2016. "Getting grey hairs in the labour market. An alternative experiment on age discrimination," Journal of Economic Psychology, Elsevier, vol. 57(C), pages 86-101.
    20. Hanson, Andrew & Hawley, Zackary & Martin, Hal & Liu, Bo, 2016. "Discrimination in mortgage lending: Evidence from a correspondence experiment," Journal of Urban Economics, Elsevier, vol. 92(C), pages 48-65.

    More about this item

    JEL classification:

    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination
    • J16 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Gender; Non-labor Discrimination

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:28164. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.