Ph.D. Economist, Papers
Operating on commission: How physician financial incentives affect surgery rates (Job Market Paper, forthcoming in Health Economics)
- This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present.
Comparison of Pharmacists and Primary Care Providers as Immunizers with John Fontanesi, Jan D. Hirsch, Sarah M. Lorentz, and Debra Bowers. (forthcoming in The American Journal of Pharmacy Benefits)
- 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."
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 ones incentive to maintain their appearance and leads to an increase in body weight. We hypothesize that it is most difficult for individuals to exit a traditional marriage, and easiest for individuals to exit if the couple is cohabitating but not legally married. Using a 14-year panel data set, we test whether or not the ease of exiting a domestic relationship affects weight gain. For men, we find that the type of domestic relationship has little impact on weight gain. For women, however, marriage leads to a 2.4 kg weight gain compared to cohabitating.
Just-Not-in-Time Vaccines: Evaluating the Vaccine Management Business Improvement Project with John Fontanesi, (submitted to American Journal of Managed Care)
- 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.
- Prudence preferences have been shown to influence precautionary savings, asset allocation, and optimal prevention levels. In this paper, we will collect data from an experimental setting to measure prudence non-parametrically over both gains and losses. We find that 53.1% of individuals are prudent and 15.0% are imprudent. These preferences are constant regardless of the individuals level of risk aversion. Contrary to previous work in the literature, our results demonstrate that estimating prudence using parametric assumptions on the utility function often incorrectly categorizes risk lovers as imprudent. We also provide suggestive evidence that prudent individuals are more likely to choose lower levels of prevention.
Adam Smith meets Jonas Salk: Estimating the Social Cost of Third-Party Influenza Vaccination Restrictions with John Fontanesi.
- 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.
Last updated 27 May 2009