Ph.D. candidate, Papers
Operating on commission: How physician financial incentives affect surgery rates (Job Market Paper, Revise and Resubmit at Health Economics)
- Physicians act as agents for their patients and are responsible for selecting medical care levels in their patients’ best interest. Financial incentives, however, may influence the medical care physicians prescribe. This paper employs a nationally representative dataset to test how the physician compensation systems affect surgery rates. I find that when specialists are paid on a fee-for-service (FFS) basis rather than via capitation, surgery rates increase by 78%. Further, physicians are found to be more responsive to financial incentives when a patient requires elective outpatient surgery rather than non-elective inpatient surgery.
Why Does Getting Married Make You Fat? Incentives and Appearance Maintenance (with Uri Gneezy)
- Married individuals weigh more on average than non-married individuals. We suggest that exiting the dating market decreases one’s incentive to maintain their appearance and thus leads to an increase in body weight. The paper uses a 13 year panel data set and exploits variation in the type of domestic relationship in order to pinpoint how exiting the dating market affects body weight. We find a positive correlation between the strength of the domestic relationships in terms of probability of termination and weight gain.
Just-Not-in-Time Vaccines: Evaluating the Vaccine Management Business Improvement Project (with John Fontanesi, submitted to American Journal of Preventive Medicine)
- The Vaccines for Children (VFC) program provides free vaccines for eligible children and is a cornerstone of the American health care system. In hopes of improving the efficiency of this program, the Centers for Disease Control and Prevention (CDC) instituted a centralized vaccine distribution system in four pilot states in March 2007. This study collects data from two large Southern California providers in order to determine how centralizing vaccine distribution has influenced vaccine availability. After the VMBIP centralization was implemented, vaccine delivery times increased from 1.6 to 12 business days (p<0.001). Using a simulation methodology, this papers finds a large increase (p<0.01) in the number of days a provider will be left without any vaccine inventory for 7 of the 11 vaccines investigated. Further, we found a decrease in the up-to-date status for 12 month old children. During VMBIP’s initial implementation timeline, longer delivery times may have jeopardized vaccine availability for the nation’s youth.
Why Aristotle didn't get his flu shot: The impact of prudence on prevention (with Daniel Wiesen)
- Compliance with preventive care recommendations throughout the world is thought to be below optimal levels. Individual preferences rather than asymmetric information may explain this phenomenon. In fact, expected utility economic theory states that prudent individuals will select less preventive care than imprudent individuals. In this paper, we put the expected utility theory to an empirical test. We first collect data from an experimental setting to measure whether or not individuals are prudent. Then we test whether or not prudent individuals do indeed prefer lower levels of prevention.
Adam Smith meets Jonas Salk: Estimating the Social Cost of Third-Party Influenza Vaccination Restrictions (with John Fontanesi, submitted to Inquiry)
- Influenza is the 7th leading killer in the United States. In order to attenuate the threat of an influenza outbreak, the Centers for Disease Control and Prevention (CDC) have established guidelines recommending that all parents of children between 0 and 60 months old should be vaccinated. Insurance companies, however, will not reimburse pediatricians who administer influenza vaccinations to adults. This seemingly innocuous insurance company restriction, however, is creating significant costs for society. Using a new observational dataset we estimate the cost of this insurance restriction to be between $5.8 and $188.4 million. While narrowly the paper advocates allowing pediatricians to vaccinate adults, more generally it warns of the costs inherent when third party entities inhibit the scope of physician-patient interaction.
Comparison of Pharmacists and Primary Care Providers as Immunizers (with John Fontanesi, Jan D. Hirsch, Sarah M. Lorentz, and Debra Bowers; submitted to at Journal of the American Pharmacists Association)
- This study examines the potential role of “alternative community immunizers,” specifically pharmacists, in providing immunization services. A convenience sampling of almost 700 adults eligible for vaccinations was taken from 15 ambulatory care settings and 11 pharmacies in San Diego, California between 2006 and 2008. The results of the study found that patient characteristics and beliefs were similar between primary care and pharmacies, but pharmacies proved more consistent in following safety protocols; had lower unit costs; and were more efficient, with greater productivity. We conclude that pharmacies combine the best immunization practices of routine scheduled primary care visits and mass influenza vaccination clinics, but gaps still exist in pharmacies' ability to effectively transmit immunization records securely and provider willingness to embrace these "alternative immunizers."
Last updated 7 October 2008