The policy takeaway? Beyond raising public insurance reimbursement, we need geographically-sensitive interventions that account for the way places shape the balance between economic pressures and social responsibility. Read here: academic.oup.com/sf/advance-a... or DM if blocked by paywall

In the end, the same psychiatrist will likely make different choices on public insurance participation or opt-out depending on the social environment where they are embedded. These local structures modulate individual decision-making above and beyond individual values 👇

In places with multiple psychiatrists (i.e., not monopolies), they tend to coordinate rather than compete. This type of market segmentation means that every location studied had at least some public insurance access, making coverage wide (if very thin) 👇

Psychiatrists respond to patient needs—but more strongly when the economic incentives align. In areas with more Medicaid pts., psychiatrists are likelier to accept Medicaid. This is not true for Medicare, where pts. (older, but many not necessarily poor) can more often afford to pay for care 👇

I analyzed data about all Georgia psychiatrists & ran a "secret shopper" audit to see how social geography shapes tensions between markets and morals. In rural areas, the same conditions that concentrate responsibility also create market monopolies—pulling psychiatrists in polar directions 👇