Research

Publications

Defying Distance? The Provision of Medical Services in the Digital Age

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]

Planning Ahead for Better Neighborhoods: Long Run Evidence from Tanzania

with Guy Michaels, Dzhamilya Nigmatulina, Ferdinand Rauch, Tanner Regan, and Neeraj Baruah.

Journal of Political Economy, 2021. [Working paper version] [Replication code]

Africa’s demand for urban housing is soaring, even as it faces a proliferation of slums. In this setting, can modest infrastructure investments in greenfield areas where people subsequently build their own houses facilitate long run neighborhood development? We study "Sites and Services" projects implemented in seven Tanzanian cities during the 1970s and 1980s, and we use a spatial regression discontinuity design to compare greenfield areas that were treated (“de novo”) to nearby greenfield areas that were not. We find that by the 2010s, de novo areas developed into neighborhoods with larger and more regularly laid out buildings and better quality housing.

Working Papers

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] [LSE Centre Piece] [LSE Business Review] [Dagens Nyheter]

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.

Coverage: [Youtube talk] [Faculti interview]

Work in Progress

Organizing Expertise with Externalities: Evidence from Primary Care
with Shan Huang, Nestor Le Nestour and Guy Michaels.

Many modern organizations use knowledge hierarchies, where frontline workers try to resolve tasks and pass those they cannot to experts. But the implications of this organization of expertise are not well understood, especially when firm revenues depend on who resolves each task or when the firm generates downstream externalities. We study a knowledge hierarchy (KH) using 500,000 patient cases from an online primary care firm, linked to outcomes and costs across Sweden’s healthcare system. We use variation in assignment arising from temporary doctor congestion, controlling for date-by-three-hour windows and flexible case characteristics. Within the KH, nurses resolve 70% of cases and pass the remainder to doctors. Relative to doctor-only care, the KH modestly affects lower-stakes outcomes (e.g., primary care follow-ups) but has no adverse effects on patient satisfaction, hospitalizations, earnings losses, or mortality. Although the mean effect of KH on systemwide (firm plus downstream) production costs is small, this masks substantial heterogeneity. Compared to using only doctors, the savings from the firm’s selective use of the KH equal 1.5% of online primary care costs. However, reassigning cases between the direct-to-doctor and KH routes within 15-minute windows to minimize systemwide production costs would save 6.6% of online primary care costs.

Remote Services for Remote Areas: Experimental Evidence on Digitization and Inclusive Development
with Erika Deserranno and Andrea Guariso.

Endline in India ongoing. [AEA RCT Registry]

Remote areas in low-income countries have poor access to quality healthcare. One challenge in developing state capacity in remote areas is the difficulty in attracting skilled workers (e.g., doctors and nurses), to which a common solution is to engage less skilled workers (e.g., community health workers). A new solution is to bring higher-skilled professionals to rural areas through digital technology. Telehealth, which connects patients to qualified healthcare professionals via phone, provides a new opportunity for governments to reach remote areas with high-quality healthcare services at relatively low costs. Although the popularity of telehealth has dramatically increased, there is to date no causal evidence of its impacts in low-income countries. This project aims to provide the first experimental evidence on the impact of telehealth on healthcare utilization and health outcomes in low-income countries.

Incentives and Culture: Evidence from a Multi-Country Experiment

with Oriana Bandiera and Greg Fischer.

Performance rewards are a cornerstone of management practices in Western countries but rarely used elsewhere. We test the hypothesis that the effect of rewards depends on whether a society values individual achievements. To do so, we set up identical data-entry firms in three countries and randomize the incentives offered to workers. We find that the effect of incentives on productivity aligns with the country’s rank on the individualism-collectivism scale, ranging from 0 in the least individualistic country to 20% in the most individualistic. We conclude that cultural norms must be embedded in the design of personnel policies in organizations.

Miscellaneous

Policy report in book format, with Mårten Blix.

Google Scholar