The Impacts of Hospital Financial Incentives on Patient and Provider Responses and Outcomes (Job Market Paper) [Draft]
I study a government program designed to encourage preventive surgeries in public hospitals through an age-based, non-linear incentive scheme, using administrative data from Chile. By exploiting age thresholds, I provide evidence that public hospitals reallocate surgeries toward healthier patients in the incentivized age range, at the expense of sicker patients outside of it. Additionally, I show that high-income patients with access to both public and private hospitals respond by opting out of the public system when they fall outside of the incentivized age range. Motivated by these facts, I develop and estimate a dynamic model of hospital and patient responses to financial incentives that allows me to quantify the effects of alternative policies and explore how they differ by patient income. My estimates suggest that eliminating the non-linearity in incentives reduces the long-run incidence of patient health complications by as much as 13.8\% among low-income patients. Among high-income patients, the impacts on downstream health are much smaller, as they maintain access to care regardless of the incentive scheme by being able to access both public and private providers. These results suggest that provider financial incentives may have significant consequences for health disparities.
Research in Progress
The Effect of Decentralization on Child Mortality: Evidence from a Public Health Reform (with Fernanda Rojas-Ampuero) [Draft]
In the 1980s in Chile, a policy reform shifted the administration of public services from a centralized to a local system, placing local municipalities in charge of administering primary care establishments. We exploit the reform's staggered implementation and past utilization rates of establishments to study how differential exposure to this reform affects child mortality and birth outcomes. We combine birth records with archival data on the dates when each primary care establishment was transferred to a local municipality. Our results indicate that greater exposure to the reform leads to higher neonatal and infant mortality during the implementation period, with the effects disappearing afterward. The rise in child mortality is driven by perinatal conditions, consistent with worse birth outcomes such as low birth weight. Rural municipalities and those with a higher administrative burden experienced greater increases in child mortality.
More Than Just Mom: Cascading Effects of the Child Penalty (with Kurt Lavetti, Yolunda Nabors, and Maya Rossin-Slater)