with M. Schaelling
One goal of standardized tests is to measure aptitude across heterogeneous students with minimal bias. However, students differ in their experiential knowledge, familiarity, or interest in topics that appear in written content. Could this contribute to bias and widen observed racial test gaps? We study this question empirically using item-level data from high-stakes reading comprehension exams in Texas. We use detailed time-use data and natural language processing techniques to define and build a race/ethnicity-specific measure of a student's "relatability" to passage content in the exams. Relying on quasi-random variation in topics across passages, we find that a one standard deviation increase in the presence of relatable text in a passage predicts a 1.7pp increase in performance on the passage. Extended to the test-level, a one standard deviation increase in test-level relatability leads to a 0.05 standard deviation change in student performance. Our results suggest that equalizing the relatability of passages in these standardized tests could reduce the Black-white and Hispanic-white test score gaps by 4% (0.5pp and 0.4pp, respectively). We then counterfactually estimate over 11,000 Black students and 15,000 Hispanic students during our sample period were designated to be at a lower reading comprehension level due to relatability.
Paper presented at: Society of Labor Economists (SOLE), Society for Research on Educational Effectiveness (SREE), Population Association of America (PAA), and Association for Public Policy Analysis and Management (APPAM)
with D. Cutler, L. Dafny, D. Grabowski, and C. Ody • August 2025
We examine whether vertical integration of hospitals and skilled nursing facilities (SNFs) could lessen competition by foreclosing rival SNFs’ access to lucrative referrals. We find that it could: among integrated providers, a one percent increase in SNF reimbursement for a given patient discharged from the upstream hospital increases the self-referral rate to the hospital’s downstream SNF(s) by 1.8 percent. We find no evidence of offsetting benefits for patients and payers: these increased self-referrals have an imprecisely estimated zero effect on patient outcomes and Medicare spending.
Paper presented at: American Economic Association (AEA), Federal Trade Commission (FTC): Microeconomics
Improving the take-up of preventive care is an important public health policy goal. I study the drivers of flu vaccination in the United States, where immunization is close to universally encouraged, but take-up is relatively low. I generate a plausibly random measure of vaccine effectiveness by combining cross-state and cross-season variation in the vaccine's antigenic match to circulating strains. Preliminary results among Medicare beneficiaries from 2013-2019 suggest that more effective vaccines are likely to reduce subsequent year take-up. I find evidence of persistence and stronger effects for currently vaccinated individuals. These results could indicate that salience about the condition may be a more important driver of flu vaccination decisions than the effectiveness of the vaccine.
Paper presented at: Population Association of America (PAA)
Note: I acknowledge that this project is a result of initial work done in collaboration with Aaron Berman.
with L. Dafny • April 2020
As the number of COVID-19 cases nationwide continues to grow, a number of hospitals will need to convert acute care beds into intensive care beds, and discharge stable patients to post-acute care settings such as nursing homes. In addition, nursing homes unable to care for COVID patients requiring intensive support services - or unable to isolate their COVID-positive residents - will require safe and high-quality options. We recommend designating specific nursing homes (also known as "skilled nursing facilities") to serve as "COVID-19 Skilled Care Centers" (CSSCs). Officials should identify these nursing facilities immediately, so the facilities can decline new uninfected patients and isolate/transfer uninfected longer-term residents. (see COVID-19 Skilled Care Center Scorecard)
with L. Dafny • April 2020
(see Designating Certain Post-Acute Care Facilities as COVID-19 Skilled Care Centers Can Increase Hospital Capacity and Keep Nursing Home Patients Safer)