Thomas P. Hoe

I am an Assistant Professor at Cornell University in the Department for Policy Analysis and Management (PAM). I am also affiliated with the Institute for Fiscal Studies in London.

My research interests are in health care and public economics. In recent work I have evaluated how hospital incentives affect patients' health outcomes and waiting times. This has included studies of emergency department regulations and inpatient department crowding.

Prior to working in academia, I worked for the UK government and a private sector consultancy in London dealing with policy issues in antitrust, health care, and financial services.

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'Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers' with Jonathan Gruber (MIT) and George Stoye (UCL)

Abstract: The emergency department (ED) is a complex node of healthcare delivery that is facing market and regulatory pressure across developed economies to reduce wait times. In this paper we study how ED doctors respond to such incentives, by focussing on a landmark policy in England that imposed strong incentives to treat ED patients within four hours. Using bunching techniques, we estimate that the policy reduced affected patients' wait times by 19 minutes, yet distorted a number of medical decisions. In response to the policy, doctors increased the intensity of ED treatment and admitted more patients for costly inpatient care. We also find a striking 14% reduction in mortality. To determine the mechanism behind these health improvements, we exploit heterogeneity in patient severity and hospital crowding, and find strongly suggestive evidence that it is the reduced wait times, rather than the additional admits, that saves lives. Overall we conclude that, despite distorting medical decisions, constraining ED doctors can induce cost-effective reductions in mortality.

NBER Working Paper No. 24445

'Does Hospital Crowding Matter? Evidence from Trauma and Orthopedics in England'

Abstract: Hospital crowding is often associated with poor health outcomes. This paper estimates the impact of hospital crowding on patients and tests whether reductions in crowding would improve consumer welfare. Exploiting pseudo-random variation in emergency admits, I find that a one standard deviation admission shock increases the unplanned readmission rate by 4.1%. Further analysis suggests this is driven by emergency patients being discharged quicker and sicker. I then derive a sufficient statistic to test whether reducing crowding with a policy that rations non-emergency admissions would benefit consumers. I find that such policies can lead to widespread improvements in consumer welfare.

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Efficiency Gains or Quality Cuts? How Prospective Payment Can Reduce Health Care Quality