“Picking Your Patients: Selective Admissions in the Nursing Home Industry” (Job Market Paper)
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Abstract: Do healthcare providers pick their patients? This paper uses patient-level administrative data on skilled nursing facilities in California to estimate a structural model of selective admission practices in the nursing home industry. I exploit within-facility covariation between occupancy and admitted patient characteristics to distinguish admission patterns attributable to selective admission practices from those attributable to heterogeneous patient preferences. In spite of anti-discrimination laws, I find strong evidence of selective admission practices that disproportionately harm Medicaid-eligible patients with lengthy anticipated stays. Counterfactual simulations show that enforcing a prohibition on selective admissions would increase access for these residents at the cost of crowding out short-stay non-Medicaid patients from their preferred facilities. I simulate two additional policies intended to mitigate selective admissions: raising the Medicaid reimbursement rate and expanding capacity. I find the latter to be less costly and more effective than the former.
“Bargaining and International Reference Pricing in the Pharmaceutical Industry” (with Pierre Dubois and Shoshana Vasserman)
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Abstract: The United States spends twice as much per person on pharmaceuticals as European countries, in large part because prices are higher in the US. This has led policymakers in the US to consider legislation for price controls. This paper assesses the effects of a hypothetical US reference pricing policy that would cap prices in US markets by those offered in Canada. We estimate a structural model of demand and supply for pharmaceuticals in the US and Canada, in which Canadian prices are set through a negotiation process between pharmaceutical companies and the Canadian government. We then simulate the impacts of the counterfactual international reference pricing rule, allowing firms to internalize the cross-country impacts of their prices both when setting prices in the US and when negotiating prices in Canada. We find that such a policy results in a slight decrease in US prices and a substantial increase in Canadian prices. The magnitude of these effects depends on the particular structure of the policy. Overall, we find modest consumer welfare gains in the US, but substantial consumer welfare losses in Canada. Moreover, we find that pharmaceutical profits increase in net, suggesting that reference pricing of this form would constitute a net transfer from consumers to firms.
Research In Progress:
“Competition and Internal Capital Markets in the Nursing Home Industry” (with YoungJun Song and Prabhava Upadrashta)
“Mergers and Acquisitions in the Nursing Home Industry” (with YoungJun Song and Prabhava Upadrashta)
“New Data on Private Rates in the Nursing Home Industry” (with Fangli Geng and David Grabowski)
“Vacancy Chains and Real Estate Passthrough” (with Nathan Hipsman and Prabhava Upadrashta)
“Preferences for Suspense and Surprise in a Massive Online Computer Game” (with Paola Giuliano, Quinn Keefer, Michaela Pagel, and Joshua Tasoff)