Working Papers

Patient vs. Provider Incentives in Long Term Care (with Martin B. Hackmann), NBER Working Paper 25178, reject & resubmit, American Economic Review

Abstract: How do patient and provider incentives affect mode and cost of long-term care? Our analysis of 1 million nursing home stays yields three main insights. First, Medicaid-covered residents prolong their stays instead of transitioning to community-based care due to limited cost-sharing. Second, nursing homes shorten Medicaid stays when capacity binds to admit more profitable out-of-pocket payers. Third, providers react more elastically to financial incentives than patients, so moving to episode-based provider reimbursement is more effective in shortening Medicaid stays than increasing resident cost-sharing. Moreover, we do not find evidence for health improvements due to longer stays for marginal Medicaid beneficiaries.

Media coverage: BloombergSkilled Nursing News

Multiple Testing and the Distributional Effects of Accountability Incentives in Education (with Steven F. Lehrer and Kyungchul Song) [Online Appendix]

Abstract: Economic theory that underlies many empirical microeconomic applications predicts that treatment responses depend on individuals’ characteristics and location on the outcome distribution. Using data from a large-scale Pakistani school report card experiment, we consider tests for treatment effect heterogeneity that make corrections for multiple testing to avoid an overestimation of positive treatment effects. These tests uncover evidence of policy-relevant heterogeneous effects from information provision on child test scores. Further, our analysis reinforces the importance of preventing the inflation of false positive conclusions since over 65% of statistically significant quantile treatment effects become insignificant once corrections for multiple testing are applied.

Medical Innovation, Education, and Labor Market Outcomes of Cancer Patients (with Sung-Hee Jeon) [Online Appendix], revise & resubmit, Journal of Health Economics

Abstract: Innovations in cancer treatment have lowered mortality, but little is know about their economic benefits. We assess the effect of two decades of improvement in cancer treatment options on the labor market outcomes of breast and prostate cancer patients. In addition, we compare this effect across cancer patients with different levels of educational attainment. We estimate the effect of medical innovation on cancer patients’ labor market outcomes employing tax return and cancer registry data from Canada and measuring medical innovation by using the number of approved drugs and a quality-adjusted patent index. While cancer patients are less likely to work after their diagnosis, we find that the innovations in cancer treatment during the 1990s and 2000s reduced the negative employment effects of cancer by 63% to 70%. These benefits of medical innovation are limited to cancer patients with postsecondary education, raising concerns about unequal access to improved treatment options.

The Effect of Medical Cannabis Dispensaries on Opioid and Heroin Overdose Mortality (with Julio Garin and Rhet A. Smith)

Abstract: Opioid overdose is the most common cause of accidental death in the United States and no policy response has been able to contain this epidemic to date. We examine whether local access to medical cannabis can reduce opioid-related mortality. Using a unique data set of medical cannabis dispensaries combined with county-level mortality data, we estimate the effect of dispensaries operating in a county on the number of overdose deaths. We find that counties with dispensaries experience 6% to 8% fewer opioid-related deaths among non-Hispanic white men. Mortality involving heroin declines by approximately 10% following the opening of a dispensary.

Media coverage: Boston GlobeAdam Smith Institute, Civilized, Marijuana Moment, Weed News, NORML

Health Shocks, Human Capital, and Labor Market Outcomes (with Francisco Parro)

Abstract: Health, human capital, and labor market outcomes are linked through complex connections that are not fully understood. We explore these links by estimating a flexible yet tractable dynamic model of human capital accumulation in the presence of health shocks using administrative data from Chile. We find that (i) human capital mitigates the negative labor market effects of health events, (ii) these alleviating effects operate through channels involving occupational choice, the frequency of exposure to health events, and access to health care, and (iii) the effect of health shocks on labor market outcomes is heterogeneous across industries and types of diagnoses.

Media coverage: Upjohn Institute

Minimum Wages and Healthy Diet (with Kathryn L. Clark and Ryan C. Thomas), submitted

Abstract: A healthy diet is often unaffordable for low-income individuals, so income-lifting policies may play an important role in not only alleviating poverty but also in improving nutrition. We investigate if higher minimum wages can contribute to an improved diet by increasing consumption of fruits and vegetables. Exploiting recent minimum wage increases in the U.S. and using individual-level data from the Behavioral Risk Factor Surveillance System we identify the causal effect of minimum wage changes on fruit and vegetable intake among low-wage individuals in a triple-differences framework. Our results indicate that higher minimum wages contribute positively but moderately to improved nutrition.

Time Trends Matter: The Case of Medical Cannabis Laws and Opioid Overdose Mortality [email me for draft]

Abstract: Mortality due to opioid overdoses has been growing rapidly in the U.S., with some states experiencing much steeper increases than others. Legalizing medical cannabis could reduce opioid-related mortality if potential opioid users substitute towards cannabis as a safer alternative. I show, however, that a substantial reduction in opioid-related mortality associated with the implementation of medical cannabis laws can be explained by selection bias. States that legalized medical cannabis exhibit lower pre-existing mortality trends. Accordingly, the mitigating effect of medical cannabis laws on opioid-related mortality vanishes when I include state-specific time trends in state-year-level difference-in-differences regressions.

Wage Premiums, Shirking Deterrence, Gift Exchange and Employee Quality: Firm Evidence (with Constanca Esteves-Sorenson and Ernesto Freitas) [email me for draft]

Abstract: Why may firms pay efficiency wages: above-market clearing wages which are not contingent on output? We explore the contribution to productivity of three main mechanisms underpinning efficiency wages (shirking, gift-exchange, and selection) by exploring a novel personnel data set from two Portuguese hotel chains as well as particular features of the Portuguese labor market. We find evidence of the three mechanisms. In the first firm, higher wage premiums at the time of hiring decrease shirking, consistent with selection. Higher yearly wage premiums also reduce shirking, consistent with the shirking and gift-exchange models. However, tenure induces an increase in shirking which is consistent with the shirking model.