Work in  Progress

The Impacts of Hospital Financial Incentives on Patient and Provider Responses and Outcomes (Job Market Paper) [Draft]

Policymakers often use financial incentives to influence healthcare providers' behavior. Evidence on provider responses to such incentives is mixed, and even less is known about their consequences for patients’ health. I use administrative data from Chile to study a government program intended to encourage preventive surgeries in public hospitals, through an incentive scheme that is non-linear in patient age. I exploit the age thresholds to provide evidence of public hospitals’ reallocation of surgeries toward healthier patients in the incentivized age range, away from sicker patients outside of it. Further, I show that high-income patients with access to both public and private hospitals respond by opting out of the public system when they are outside of the incentivized age range. Motivated by these facts, I develop and estimate a dynamic model of hospital and patient responses 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 10% 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 Changes in Public Health Administration on Mortality: Evidence from the Chilean Dictatorship (with Fernanda Rojas and Lelys Dinarte)

We study the effect of a change in the administration of health services in the public sector during the Chilean dictatorship on access to primary care and the subsequent impacts on mortality, fertility, and life expectancy. In 1980, a policy reform changed the administration of public services from a centralized system to a local system, putting local municipalities in charge of the administration of primary healthcare budgets, including creating new primary care centers. After this change in administration, public primary care services are now paid for by municipal budgets. This reform created significant variation in the quality of old and new primary care centers because the transition of local administration meant that primary care centers in poorer municipalities had smaller budgets. Thus, increased access to primary care due to new health services being constructed might have come at the expense of lower quality. We plan to leverage the fact that the implementation of the reform occurred in stages between 1981 and 1988. To do so, we have constructed a dataset from archival records on the date each primary care center is transferred to a local municipality, as well as built a panel dataset that comprises demographic variables for the universe of 346 municipalities in the country starting in 1960.

The Effects of a Preventive Health Care Model: The Case of the Public Primary Care System in Chile (with Fernanda Rojas and Lelys Dinarte)

We study a primary health care reform in 2005 that implied a slow conversion on the health care model used in primary health centers in the country. This conversion changed the type of care performed in primary care centers from reactive to preventive care, as coordination across multiple healthcare providers in these centers was increased. To do so, we are in the process of constructing a dataset with the dates of transitions using annual municipalities' reports. We plan to use time and geographical variation in exposure to these new primary care centers to investigate the effects of more preventive primary care on pregnancy and birth outcomes. Our preliminary findings are a decrease in the probability of miscarriage in the Chilean population, leading to a change in the composition of births in the country, with more premature and low-weight births arriving to term. There appears to be evidence that the healthcare model shifts also affect the probability of hospital admissions for high-risk pregnancy conditions due to its more preventive efforts.