Job Market Paper
Abstract: This paper analyzes how market forces in the retail market for pharmaceuticals affect utilization of health care. Specifically, I study the impact of Walmart’s $4 Prescription Drug Program on utilization of blood pressure medication and hospitalizations for conditions amenable to drug therapy for the state of Florida. The empirical strategy relies on the change in the availability of cheap generic drugs introduced by the launch of Walmart’s program in 2006, exploiting differences in the distance to the nearest Walmart store across ZIP codes in a difference-in differences framework. I find that living close to a source of cheap generic drugs increases adherence to antihypertensive medications by 16 percent and decreases the probability of an avoidable hospitalization by 6.5 percent, saving over $50.5 million annually in inpatient costs. These findings shed some light on the potential of market forces to have a significant impact on utilization and overall costs in the health care system.
Abstract: This paper analyzes the effect of the recent U.S.financial crisis on community college enrollment among recent high school graduates. I find that community college enrollment rates increased by about six percentage points during 2008, after controlling for individual and family background characteristics. Consistent with the hypothesis that this increase was driven by macroeconomic factors, I find that states that were more severely affected by the crisis experienced larger increases in enrollment rates. I also find that enrollment rates in four-year colleges did not increase during 2008 and actually decreased in states where the economic downturn was more severe.
Work in Progress
The Impact of Rising Inequality on Health at Birth, joint with Anna Aizer and Hernan Winkler
Abstract: The income distribution has widened significantly over the past 40 years, primarily due to skill biased technological change which has disproportionately raised the income of the most highly skilled. There are a number of reason why, in theory, we might expect that increase in inequality to result in worse health outcomes. These include increases in psychosocial stress associated with low relative position and “pecuniary externalities” which refers to the fact that the price of medical goods and services might rise in an area with high average income, leaving the relatively poor worse off. We estimate the impact of rising inequality over the period 1970-2010 on health at birth. We define inequality two ways: as a group-level measure (the Gini coefficient for each county) and as an individual-level measure of relative deprivation which is the distance between an individual woman’s own income and the average income of her reference group (all other women in her county). Unlike most previous empirical work, we use individual level data and instrument for inequality, exploiting skill biased technological change over this period which resulted in large increases in inequality in areas with a wide distribution of skill, but much smaller increases in inequality in areas with a much more narrow skill distribution.
Household Schooling Decisions During Argentina’s Financial Crisis, joint with Sriniketh Nagavarapu