Designing Dynamic Reassignment Mechanisms: Evidence from GP Allocation with Victoria Marone and Dan Waldinger.
[NBER Working Paper No. 32458] Revision requested at American Economic Review.
Abstract: Many centralized assignment systems seek to not only provide good matches for participants’ current needs, but also to accommodate changing preferences and circumstances. We study the problem of designing such a mechanism in the context of Norway’s system for dynamically allocating patients to general practitioners (GPs). We provide direct evidence of misallocation under the current system––patients sitting on waitlists for each others’ GPs, but who cannot trade––and propose an alternative mechanism that adapts the Top-Trading Cycles (TTC) algorithm to a dynamic environyment. In contrast to the static case, dynamic TTC may leave some agents worse off relative to a status quo where trades are not permitted, introducing a new set of concerns about fairness. We then estimate a structural model of switching behavior and GP choice and empirically evaluate how this mechanism would perform relative to the status quo. While introducing TTC would on average reduce waiting times and increase patient welfare––with especially large benefits for female patients and recent movers––patients endowed with undesirable GPs would be harmed. Adjustments to the priority system can avoid harming this group while preserving most of the gains from TTC.
Reconciling Estimates of the Long-Term Earnings Effect of Fertility with Simon Bensnes and Edwin Leuven
Abstract: This paper provides methodological and empirical contributions to the child-penalty literature. We propose a new estimator that combines elements from standard event study and instrumental variable estimators, and show how these are related. We find that while all three approaches lead to similar conclusions about the impact of children on earnings differences between mothers and their partners – around 20 percent – they may lead to very different conclusions as to whether it is mothers or partners that drive this difference, the key policy issue. Where in the event study the complete impact comes from mothers, our findings suggest that only about one fourth of the impact is driven by maternal responses. The paper also has potential implications for event-study designs more generally. In particular, we validate event-study estimates using external information, and characterize bias. This provides new insights in the nature of selection into fertility, which shows that common intuitions regarding parallel trend assumptions may be misleading and that pre-trends may be uninformative about the sign of the selection bias in the treatment period.
The Distributional Effects of Cost-Sharing in a Universal Healthcare System with Simon Bensnes and Victoria Marone (draft coming soon!)
Abstract: Patient cost-sharing is used as a tool to limit over-utilization of insured healthcare services in almost all high-income countries. We study its (marginal) distributional consequences in the context of a publicly-funded universal health insurance system, where consumers (as tax-payers) are residual claimants on insurer spending. We highlight the critical distinction between consumers' level of demand versus their elasticity of demand for healthcare services, and estimate the relationship of each of these objects with socio-economic characteristics. Using detailed administrative data on the Norwegian national health insurance scheme, we study a 2010 policy change that raised the age threshold for copayment waivers, thereby increasing patient cost-sharing substantially for adolescents. We find that lower-income individuals have both higher average healthcare utilization as well as higher responsiveness to cost-sharing. Cost-sharing therefore places a larger burden on this group both in terms of the financial cost of out-of-pocket spending and in terms of reduced quantities of healthcare that these individuals choose to utilize.
Optimal Insurance for Healthcare Amenities with Victoria Marone
Abstract: We consider a model of a health insurance market in which sick consumers face a choice of healthcare amenity level. A minimum amenity level is available at no out-of-pocket cost (under some universal, base level of insurance coverage), but consumer heterogeneity drives demand for higher amenity levels. We study two central policy questions related to the design of "top-up'' insurance markets: (i) at what level to set the universally-available minimum amenity level, and (ii) whether consumers should retain the monetary value of this benefit if they choose a higher amenity level. We estimate the model in the context of the Norwegian market for Assisted Reproductive Technology (ART).
Gender Gaps in Promotion (with Sebastian Shaqiri Johansson, Andreas Kostøl, Jan Nimczik and Andrea Weber)
Breastfeeding, Health Outcomes and Maternal Labor Supply (with Nina Drange and Monique De Haan)
What is the case for universal breast cancer screening?
Deniz Dutz, Santiago Lacouture, Magne Mogstad, Alex Torgovitsky, and Winnie van Dijk. Selection in Surveys: Using Randomized Incentives to Detect and Account for Nonresponse Bias. Accepted for publication by the Review of Economic Studies.
Godøy, A., Huitfeldt, I., Haaland VF., and Votruba, M. (2024). Hospital Queues, Patient Health and Labor Supply. American Economic Journal: Economic Policy.
Huitfeldt, I., Kostøl, A. R., Nimczik, J., & Weber, A. (2022). Internal labor markets: A worker flow approach. Journal of Econometrics.
Huitfeldt, I. (2021). Hospital Reimbursement and Capacity Constraints: Evidence from Orthopedic Surgeries. Health Policy.
Bensen, S. & Huitfeldt, I. (2020) Rumor has it: How do patients respond to patient-generated physician ratings? Journal of Health Economics.
Godøy, A. & Huitfeldt, I. (2020). Regional Variation in Health Care Utilization and Mortality. Journal of Health Economics.
S.A.C. Kittelsen et al. (2015). Costs and quality at the hospital level in the Nordic countries. Health Economics.