We study altruism of health care providers—the extent to which they consider the welfare of others when making treatment decisions—in a setting where choice of treatment quantity affects provider profit and public spending, but not patient health. In our setting, providers choose dosages of anticancer drugs around vial-size cutoffs. These drugs are dosed variably and packaged in large and expensive single-use vials ($1,180 for the average vial in our sample). A typical infusion uses a small number of vials and the excess in the last vial is thrown away. Because Medicare pays for the infused and discarded portion of the vial, costs increase substantially at vial-size cutoffs. Using bunching methods in Medicare claims data, we find that 9% of the 3.8 million claims in our sample have doses manipulated down across these cutoffs. Our results strongly suggest that providers sacrifice profit in order to lower costs for patients and/or Medicare. Treatment guidelines recommend this dose manipulation and state that small dose reductions (e.g., less than 10%) are unlikely to affect health outcomes. 46% of claims in these narrow windows have their doses reduced. Using Medicare reimbursement rates, we can quantify that a provider who manipulates down foregoes $0.056 in profit for every $1 of reduced patient and Medicare expenses. This provides a novel revealed preference quantification of provider altruism.
This paper evaluates policies rolled out during the COVID-19 pandemic aimed at stabilizing the economy and their effects on health outcomes. Using difference-in-difference models, we estimate the effects of three stimulus payments and reopening of the economy on mortality, emergency department visits, and inpatient stays of Medicaid and Medicare beneficiaries. The results imply that the effects of stimulus payments on mortality and utilization exhibit considerable heterogeneity across different rounds and public health insurance programs. We find that the effects of stimulus payments were less pronounced for individuals with previous diagnosis of opioid use disorder suggesting that a positive income shock has no impact on drug consumption of the at risk population. The opening of the economy only positively affects the utilization of emergency department services.
This paper exploits variation resulting from a series of federal and state Medicaid expansions between 1977 and 2017 to estimate the effects of children’s access to public health insurance on the labor market outcomes of their mothers. The results imply that the extended Medicaid eligibility of children leads to positive labor supply responses at the extensive and intensive margins of single mothers and to negative labor supply responses at the extensive margin of married mothers. The analysis of mechanisms suggests that extended children’s Medicaid eligibility positively affects take-up of Medicaid and health of children.
This paper provides direct evidence that members of a disfavored group adjust their economic behavior in response to prejudice. We exploit plausibly exogenous, localized increases in anti-Arab and anti-Muslim sentiment generated by combat fatalities of U.S. service members from a given state during the wars in Iraq and Afghanistan between 2001 and 2014. Linking detailed records on military fatalities with survey data, we estimate the causal effect of these shocks on the labor supply of Arab and Muslim men residing in the affected states. Following a home-state fatality, Arab and Muslim men reduce their weekly hours of work by approximately one percent relative to the baseline sample mean. The reduction is twice as large among the self-employed and concentrated in occupations requiring frequent customer or co-worker interaction. These patterns are consistent with avoidance-based sorting predicted by prejudice-based models of discrimination. The timing of the response coincides with short-lived increases in anti-Muslim hate crimes, confirming that the estimated effects reflect shifts in prejudice rather than broader economic conditions. Our findings provide direct evidence that prejudice can distort market outcomes by inducing targeted individuals to withdraw from interactions with prejudiced market participants.
Racial harassment is highly prevalent in the workplace. Extensive medical literature suggests that this type of harassment has considerable impacts on cognitive abilities and risk preferences of subjects. Yet, virtually no work has evaluated the impact of racial harassment on the task-specific productivity of racial minorities outside of controlled experiments. To evaluate this relationship we make use of a natural experiment that decreased racial harassment in football stadiums and a novel dataset with more than 40 different measures of task-specific productivity of football players. Our results show that in the absence of discrimination African players do not experience any increase in productivity measures associated with efficiency relative to other players. We also rule out any differences in the risk profile of plays between both groups. However, we observe significant increases in measures associated with in-game participation, implying that the overall increase in performance of African players in this context is linked to increases in participation. Put together, our results have broad implications for minorities on labor markets, suggesting that a decrease in racial hostilities in work environments can lead to gains in participation of racial minorities.
MEDICAL AND HEALTH POLICY
Quality of Beneficiary Identifiers in Medicaid Enrollment Files (under review)
with Meredith Adams, Daniel Guth, Alina Denham and Elaine Hill
draft available upon request
Trends in Medicare healthcare utilization before and during the COVID-19 Pandemic: Is there a “new normal”? (under review)
with Grace Sventek, Alina Denham, Daniel Guth, Robert Hurley, Meredith Adams, and Elaine Hill
draft available upon request
Disparities in Use of Benzodiazepine and Medications for Opioid Use Disorder between Urban and Rural Residents with Opioid use Disorder since COVID-19 Pandemic (under review)
with Hugh Crean, Suiyue Cui, Daniel Guth, Elaine Hill, Daniel Maeng, Patrick Walsh
draft available upon request
Quality of National Death Index Segment from Centers for Medicare and Medicaid Services
with Meredith Adams, Daniel Guth, Robert Hurley, Grace Sventek, and Elaine Hill
draft available upon request
Continuous Medicaid Coverage Protects Access to Medications for Opioid Use Disorder
with Alina Denham, Aniket Patil, Daniel Guth, Grace Sventek, Tanzy Love, Robert Hurley, Meredith Adams, Elaine Hill
draft available upon request
Quantifying Opioid Use Disorder Prevalence and Medication Treatment in Public Insurance from 1999-2022
with Daniel Guth, Robert Hurley, Meredith Adams, Grace Sventek, and Elaine Hill
draft available upon request
Work in Progress
Risky Behavior and Mental Health of Children during the Pandemic: Evidence from Schooling Mode (with Meredith Adams, Daniel Guth, and Elaine Hill)
Health Effects of Very High Out-of-Pocket Medical Expenses: Body-Size Based Dosing and Discarded Chemotherapy Drugs (with Geoffrey Schnorr)
Impeachment of Government Officials and Public Health Provision (with Thiago de Lucena Coelho, Socorro Martinez, Bruno Martins Pessoa.)
Political Alignment and Provision of Means-Tested Programs
Sibling Spillovers of Public Health Insurance: Evidence from Medicaid Expansions
Rural versus Urban Disparities in Mortality and Medical Outcomes of Opioid Exposure since COVID-19 Pandemic: Findings from the Poison Control Center Data (with Hugh Crean, Suiyue Cui, Daniel Guth, Elaine Hill, Daniel Maeng, Patrick Walsh)
Opioid Use Disorder Diagnoses, Treatment, and Adverse Outcomes Among Pregnant and Postpartum Women During the COVID-19 Pandemic (with Grace Sventek, Daniel Guth, Meredith Adams, Elaine Hill)
X-Waiver Repeal Act on Buprenorphine: Effect on Prescribers and Prescribing (with Aniket Patil, Daniel Guth, Deniz Naghibi, Grace Sventek, Robert Hurley, Meredith Adams, Elaine Hill)
Analyzing COVID-19 Era Policies to Expand Access to Medication for Opioid Use Disorder (with Daniel Guth, Robert Hurley, Meredith Adams, Grace Sventek, Elaine Hill)