Causal Mediation in Natural Experiments

Natural experiments are a cornerstone of applied economics, providing settings for estimating causal effects with a compelling argument for treatment randomisation, but give little indication of the mechanisms behind causal effects. Causal Mediation (CM) is a framework for sufficiently identifying a mechanism behind the treatment effect, decomposing it into an indirect effect channel through a mediator mechanism and a remaining direct effect. By contrast, a suggestive analysis of mechanisms gives necessary but not sufficient evidence. Conventional CM methods require that the relevant mediator mechanism is as-good-as-randomly assigned; when people choose the mediator based on costs and benefits (whether to visit a doctor, to attend university, etc.), this assumption fails and conventional CM analyses are at risk of bias. I propose an alternative strategy that delivers unbiased estimates of CM effects despite unobserved selection, using instrumental variation in mediator take-up costs. The method identifies CM effects via the marginal effect of the mediator, with parametric or semi-parametric estimation that is simple to implement in two stages. Applying these methods to the Oregon Health Insurance Experiment reveals a substantial portion of the Medicaid lottery's effect on subjective health and well-being flows through increased healthcare usage -- an effect that a conventional CM analysis would mistake. This approach gives applied researchers an alternative method to estimate CM effects when an initial treatment is quasi-randomly assigned, but a mediator mechanism is not, as is common in natural experiments.