Working Papers
Defying Distance? The Provision of Medical Services in the Digital Age
Revised & Resubmitted for the American Economic Review
Winner of Sir John Hicks Prize for Outstanding Doctoral Thesis
Winner of European Economic Association and UniCredit Foundation Best Job Market Paper
Digital platforms reduce geographic frictions, enabling better matching between service providers and users. I quantify reallocation gains in Swedish online healthcare, using nationwide time-conditional random assignment between patients and physicians. Matching high-risk patients with doctors effective at reducing Emergency Room visits lowers such visits by 4.4% (s.e. 1.3); reallocations also reduce counter-guideline antibiotics by 3.1% (1.3). I find limited trade-offs in matching: horizontal differentiation among doctors and varied patient needs allow improvement in multiple outcomes simultaneously. Efficiency-enhancing reallocations also affect equity. The findings highlight the potential for care reorganization aligning provider heterogeneity with patient needs when geographic constraints are lifted.
Coverage: [Discussed by Sweden's Minister for Health Care] [Dagens Medicin] [Faculti interview] [The Visible Hand Podcast] [Swedish Agency on eHealth Strategy]
Online versus In-Person Services: Effects on Patients and Costs
with Nestor Le Nestour and Guy Michaels.
Online delivery of one-to-one services promises convenience and potential cost savings, but its broader implications for consumer outcomes and total provision costs remain unclear. We study online primary care consultations using novel Swedish data and quasi-random assignment of patients to nurses with varying propensities to direct to online versus in-person doctors. We find that online consultations occur sooner, are shorter, and yield comparable diagnoses, prescriptions, referrals, and patient satisfaction. We also find no adverse medium- or long-term effects on health or employment. However, short-term increases in follow-up consultations and emergency department visits offset online’s mean cost savings. Nevertheless, for less vulnerable patients, who are unlikely to follow up, online does offer significant cost savings. These findings highlight the importance of adequately assigning cases across modes in realizing online’s efficiency gains.
Coverage: [VoxEU]
CEO-Firm Matches and Productivity in 42 Countries
with Oriana Bandiera, David Laszlo, Andrea Prat, Raffaella Sadun and Helena Schweiger.
Firms are key to economic development, and CEOs are key to firm productivity. Are firms in countries at varying stages of development led by the right CEOs, and if not, why? We develop a parsimonious measure of CEO time use that allows us to differentiate CEOs into “leaders” and “managers” in a survey of 4,800 manufacturing firms across 42 countries, with income per capita ranging from USD 4,000 to 45,000. We find that poorer countries have fewer leaders and relate this to training opportunities. Even when suitable leaders are available, they often do not lead the firms that would benefit the most, resulting in mismatches that can cause up to a 20% loss in productivity for the mismatched firms. The findings imply that policies that address the causes of mismatch could significantly enhance growth without additional resources.