“Macroeconomic Conditions and Opioid Abuse.” Journal of Health Economics. Volume 56, December 2017, Pages 222-233. DOI: 10.1016/j.jhealeco.2017.07.009. (Earlier version released as NBER Working Paper No. 23192)
with Christopher J. Ruhm and Kosali Simon
Media: Vox, Scientific American, CNBC, The Atlantic, The Washington Post, Axios,
U.S. News, Marginal Revolution, Breitbart, Bloomberg, National Affairs
“Opposition to Obamacare: A Closer Look.” Academic Medicine. Volume 92, Issue 9, September 2017, Pages 1241-1247. DOI: 10.1097/ACM.0000000000001725.
with Paul R. Gordon, Laurel Gray, Eve C. Shapiro, and James E. Dalen
Media: The Herald Times, The Indiana Daily Student, The Los Angeles Times
“Understanding Excess Emissions from Industrial Facilities: Evidence from Texas.” Environmental Science & Technology. January 2018. DOI: 10.1021/acs.est.7b04887
with Nikos Zirogiannis and David Konisky
"External Impacts of Local Energy Policy: The Case of Renewable Portfolio Standards." Accepted at the Journal of the Association of Environmental and Resource Economists
with Ivan Rudik
Over 20% of Americans do not have adequate access to primary care services due to a lack of available physicians (HRSA, 2014). In response many have called for an increased role of the Nurse Practitioner. The retail health clinic, a recent innovation, is well suited to serve as a conduit for this expanded role. In this paper, I examine retail health clinics by estimating the determinants of clinic location choice and by evaluating their impact on unnecessary visits to nearby emergency departments (EDs). First, I construct a structural discrete choice model of clinic location that accounts for both demand and competition effects. This model incorporates a rich error structure that allows for spatial correlation and market level unobservable heterogeneity. I find that clinics are more likely to locate in areas that are populous, wealthy, educated, and white, and that they are less likely to locate in traditionally under-served communities. Second, I combine the results of my predictive model with data on ED visits to determine if clinics help direct patients away from receiving treatment at expensive emergency rooms. I find that access to retail clinics causes a substantial decrease in the number of ED visits for bronchitis and upper respiratory infections. The savings associated with retail clinic induced ED diversion is conservatively estimated to be at least $88 million in 2012 alone. In California, counterfactual analysis suggests that relaxing the barriers to clinic entry would result in $10.5 million in annual health care savings.
Once thought to be a disease of the past, tuberculosis is making a worldwide resurgence due to the advent of drug resistant strains of the disease. As our pharmacological weapons become less effective, some are calling for a return of sanitaria, institutions from the time before antibiotics that have been credited for causing a pre-antibiotic decline in tuberculosis mortality. However, no quantitative studies have been conducted to validate this claim and there has been no research that has identified the primary mechanism through which sanitaria could have made such an impact. Using data from North Carolina, this paper measures the impact of sanitaria on the decline in tuberculosis mortality. Results from an instrumental variables approach indicate that access to an additional sanitaria bed reduced the death rate from tuberculosis for white residents by nearly .695 per 100,000 and had no impact for black residents. Interpreting these results through the lens of an epidemiological model it is inferred that this benefit was provided through both quarantine and through reducing the likelihood of disease transmission by educating the public in hygienic practice.