Research
Research
Job Market Paper
"Spillover Effects of Nursing Home Closures on Resident Health in Neighboring Facilities: Evidence from Different Market Structures" [Paper] [Poster]
Abstract: I study how nursing home closures affect the health of residents who remain in surviving facilities. Using resident-level Minimum Data Set (MDS 3.0) assessments linked to facility and county characteristics from 2011--2017, I employ a staggered difference-in-differences design with propensity-score matching to estimate the causal impact of nearby closures. The results show substantial heterogeneity across market structures. In concentrated markets, closures increase occupancy, reduce registered-nurse staffing, and raise the prevalence of chronic and neurodegenerative conditions such as heart failure, Alzheimer's disease, and chronic respiratory illness. In contrast, in competitive markets, closures are mostly absorbed without noticeable decline and often lead to slight improvements in health outcomes. The heterogeneity also extends across facility types. For example, nonprofit, chain-affiliated, and low-Medicaid share facilities are more resilient to closures than for-profit, independent, and high-Medicaid share nursing homes. These findings demonstrate that the effects of provider exit depend critically on local capacity, competition, and institutional characteristics. The underlying mechanism is consistent with these patterns: closures raise occupancy and reduce staffing per resident, particularly in concentrated markets, where surviving facilities face tighter capacity and labor constraints. In conclusion, the evidence indicates that competition enhances allocative efficiency when capacity is elastic, whereas closures in concentrated markets tighten resource constraints and diminish the quality of care. Policy responses should therefore be market-sensitive--raising Medicaid reimbursement in low-margin areas and relaxing certificate-of-need (CON) restrictions--to preserve access and quality in vulnerable regions.
Poster presented at Association for Public Policy Analysis and Management (APPAM) Annual Meeting (Seattle, WA), 2025
Paper accepted at American Society of Health Economists (ASHEcon) Annual Conference (Nashville, TN), 2025
Poster presented at Allied Social Science Associations (ASSA) Annual Meeting, AEA Poster Session (San Francisco, CA), 2025
Paper presented at Association for Public Policy Analysis and Management (APPAM) Annual Meeting (National Harbor, MD), 2024
Paper presented at American Society of Health Economists (ASHEcon) Annual Conference (San Diego, CA), 2024
Working Papers
"Economic Consequences of Nursing Home Closures" (with Pinka Chatterji and Chun-Yu Ho). [Draft available]
Abstract: We use a difference-in-difference design to test whether nursing home closures affect local labor market and socioeconomic conditions in rural and urban areas. Using county-level data from 2009 to 2019, we find that nursing home closures are associated with 1-3 percent reductions in total, health sector, and non-health sector employment in both urban and rural areas. In rural areas only, nursing home closures led to broader effects on the economy, and are associated with increased unemployment, uninsurance, and poverty; reduced labor force participation and income; and reduced population inflow. Our findings suggest that nursing home closures may exacerbate rural-urban economic disparities, highlighting the need for policies that support nursing homes to promote economic resilience in rural communities.
Paper presented at Association for Public Policy Analysis and Management (APPAM) Annual Meeting (National Harbor, MD), 2024
Paper presented at American Society of Health Economists (ASHEcon) Annual Conference (San Diego, CA), 2024
Paper presented at Eastern Economic Association (EEA) Annual Meeting (Boston, MA), 2024
Paper presented at Southern Economic Association (SEA) Annual Meeting (New Orleans, LA), 2023
"Racial/Ethnic and Geographic Disparities in Access to Nursing Homes" (with Pinka Chatterji and Chun-Yu Ho). [Draft available]
Abstract: This study examines racial/ethnic and geographic disparities in access to nursing home beds, high-quality nursing home beds, and Alzheimer’s care beds from 2009 to 2020. Using county-year data compiled from multiple federal sources, we compare access across majority racial/ethnic groups in rural and urban areas. The results show clear and widening gaps, particularly in rural communities: Rural Black and Hispanic counties have substantially fewer high-quality nursing home beds, and rural Hispanic counties have fewer Alzheimer’s care beds compared with rural White counties. Overall, disparities in access to high-quality and specialized long-term care have increased among Black, Hispanic, and White populations, with the largest disadvantages concentrated in rural areas.
Research in Progress
"Green Technology and Labor Demand: Evidence from Matched U.S. Employer-Employee and Patent Data" (with Erling Barth and Gerald R. Marschke)
Paper presented at Federal Statistical Research Data Center (FSRDC) Annual Research Conference (Ithaca, NY), 2025
"Shocks to the Mind: Mental Health and Behavioral Responses to Natural Disasters" (with Hyoshin Ki)
Paper presented at Association for Public Policy Analysis and Management (APPAM) Annual Meeting (Seattle, WA), 2025
"The Impact of Paid Family Leave on Mothers’ Postpartum Employment Continuity and Income" (with Kyung Min Lee, Chanup Jeung, Sita N. Slavov, and Mee Jung Kim)
"Evaluating Post-Acute Care Discharges: Nursing Homes vs. Home Care for Elderly Patients with Hip Fracture and Stroke" (with Pinka Chatterji, Chun-Yu Ho, and Jun Li)