Job Market Paper

Quality Disclosure and Patient Switching: Evidence from the Dialysis Industry
In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the End Stage Renal Disease Quality Incentive Program (QIP) to improve information transparency between dialysis patients and their treatment center by publishing novel quality scores. How dialysis patients respond to these new scores is unclear. This paper explores the extent to which the publication of quality scores influences patients' likelihood of switching dialysis centers, and whether the salience of these scores induces a behavioral change in patients. My findings show that patients at centers with lower quality scores are significantly more likely to switch than those at high quality centers. Specifically, patients at centers with a published score in the 10th percentile are nearly 19% (1.11 percentage points) more likely to switch than patients at centers with a published score in the 90th percentile. Furthermore, patients who learn they are at a low-quality center when scores are published increase their likelihood of switching by over 1.18 percentage points, suggesting that patients respond to the salience of quality scores. These results suggest that increasing transparency around treatment quality can affect patient decision-making and improve provider-patient matching, with implications for patient welfare and resource allocation.

Working Papers

The Effect of Restricted Abortion Access on IUDs, Contraceptive Implants, and Vasectomies: Evidence from Texas
with Graham Gardner and Cara Haughey
Revise and Resubmit: Journal of Health Economics

US state legislation requiring parental involvement in the abortion decision of a minor has grown in prevalence since its origin in the 1970s. Today, 36 states impose a parental involvement requirement on their residents below the age of 18. These laws come in two primary categories: parental notification and parental consent. Though much research estimates the effects of these policies, limited evidence exists regarding any differential impact between parental notification and parental consent. This paper uses the synthetic control method to determine if the increased marginal cost of an abortion imposed by a parental consent statute affects the abortion rate and birth rate for minors relative to parental notification. Results indicate no evidence of a marginal effect of parental consent laws on the abortion/birth rate of minors overall, suggesting that the additional cost of a parental consent law may be small

Patient Preference or Provider Influence: Variation in Healthcare Spending Among Dialysis Patients

Dialysis patients spend a substantial amount of time interacting with the staff and peers at their dialysis center. In this paper, I use patient switching to disentangle the demand- and supply-side factors that influence health care spending. I use an event study to track non-dialysis health care spending before and after a change in dialysis provider, and relate this change to the peer utilization environment experienced by a switcher. The event-study estimation shows that switchers experience a sustained increase in utilization after a switch in dialysis provider, which does not dissipate over time. Point estimates suggest that dialysis centers account for about 37.6% of the variation in total spending after controlling for whether a patient is hospitalized. The results are consistent with dialysis centers having more of an influence for spending categories with the most patient discretion, such as non-dialysis outpatient services.

Value-Based Purchasing and Payment Reductions: Dialysis Center Response to the End Stage Renal Disease Quality Incentive Program

The Centers for Medicare and Medicaid Services introduced the End Stage Renal Disease Quality Incentive Program in 2012 to improve the quality of dialysis services and reduce costs. The Quality Incentive Program implemented value-based purchasing, where CMS withholds a percentage of reimbursement for dialysis centers scoring below a predetermined threshold. In this paper, I explore how dialysis centers respond to this component of the program. I begin by outlining differences between penalized and non-penalized dialysis center. I compare estimates from the canonical 2x2 difference-in-differences specification, a dynamic event study specification, and the methods derived in Callaway Sant'Anna (2021)  to tease out the effects of payment penalties on several outcome variables. I find that dialysis centers do respond to payment penalty by improving several outcomes, and the results that are robust to treatment timing heterogeneity.