Research

Publications:

with Carlo del Ninno and Bradford Mills. (2015). Climatic Shocks and Poverty Dynamics in Mozambique. In Carlo del Ninno and Bradford Mills (Ed.) Safety Nets in Africa: Effective Mechanisms to Reach the Poor and Most Vulnerable (pp. 159 - 177): Agence Française de Développement and the World Bank.

Working Papers:

1. The Effect of Occupational Licensing for Nurse Practitioners on Prescription Use and Quality (JMP) [pdf]

In the United States, healthcare provider shortages prevent patients from accessing high-quality primary care services, a challenge exacerbated by increasing demand for medical services. With the aim of improving access to care, states have passed laws allowing nurse practitioners to perform services that were previously restricted or required physician oversight, such as writing prescriptions. There is little evidence on how these "scope of practice" (SOP) laws impact healthcare utilization and quality. Using a difference-in-differences design that exploits temporal and across-state variation in SOP laws and individual-level data from the 2002 to 2015 Medical Expenditure Panel Survey, I study the effects of these laws on detailed measures of prescription use and quality. I find that expanded prescription authority for nurse practitioners reduces the number of prescriptions filled per year by 8% and the number of unique medications received by 9%. The declines in use are particularly large among patients with coronary heart disease, resulting from providers consolidating patients' prescriptions. Importantly, clinically-accepted measures of medication quality are either unaffected or improve. These results indicate that expanding prescription authority for non-physician providers may reduce prescription use without jeopardizing medication quality.

[Online appendix]. Note, the online appendix is being continually updated. Please check back for the latest additions.

2. The Relationship Between Local Economic Conditions and Quality of Care [pdf]

Quality of care is linked to improved health outcomes, cost efficiency, and high-value health-care delivery. Recent policies, such as Medicare’s value-based purchasing programs, seek to improve quality of care by tying provider reimbursements to the quality of services provided. However, the impact of factors external to the healthcare system, such as fluctuations in economic conditions, on healthcare quality has been largely unexplored. This paper uses individual-level data from the Medical Expenditure Panel Survey to document the relationship between local economic conditions and patient perceptions of quality during the Great Recession. I estimate a positive relationship between county unemployment rates and measures of patient experience for those with chronic conditions, such as coronary heart disease. The results suggest that changes in quality generated by economic fluctuations most strongly affect high-users of care. These results also imply that value-based purchasing programs may need to account not only for patient characteristics, but also local economic and industry conditions that impact providers’ ability to provide high-quality services when adjusting quality targets that determine incentive payments.

Works in Progress:

1. Weeding out Workplace Accidents? The Effect of Medical Marijuana Dispensaries on Workplace Safety with Rhet Smith