Research

Job Market Paper:

Mechanisms of Hospital Quality Improvement: The Role of Patient Allocation, Updated draft coming soon

Abstract: This paper asks how hospitals improved the quality of care in response to a Medicare program that penalized excess readmissions of elderly heart attack patients. I document two main findings. First, hospitals reallocated heart attack patients toward cardiologists and toward doctors who, before the program, had larger heart attack caseloads, higher treatment intensity, and lower readmission and higher survival rates adjusted for patient health. Heart attack care also became more specialized, and these same doctors were increasingly assigned patients appropriate for intensive treatment, indicating better doctor-patient matches. Second, the response depended on hospitals’ affiliation with physicians, many of whom are not hospital employees. Both the quality improvements and the reallocation were larger in hospitals that employed or contracted with physicians than in hospitals with neither arrangement, suggesting that affiliation helps hospitals pass quality incentives on to physicians and control patient assignments.

Publications:

Do urgent care centers reduce Medicare spending?, with Janet Currie and Dan Zeltzer
Journal of Health Economics, May 2023, Volume 89
The NIHCM Foundation 2024 Health Care Research Award Finalist
Media coverage: NBER Bulletin on Health, Brookings Institute Hutchins Roundup, Tradeoffs

Working Papers:

Illegal Drug Use and Government Policy: Evidence from a Darknet Marketplace,
with Priyanka Goonetilleke, Artem Kuriksha, and Peter Meylakhs 

Abstract: This paper develops a structural model of demand for illegal drugs to study how consumers substitute between drugs in response to government policies. We construct a unique dataset by scraping a darknet marketplace that dominated the retail illegal drug trade in Russia. We exploit novel micro-level moment conditions and estimate a median demand elasticity of -1.9. Using the estimated model, we show that after cannabis legalization, for every four additional doses of cannabis, one fewer dose of another drug is consumed. We also find that new synthetic drugs sharply increased total drug demand and that enforcement can raise drug-market revenue.

Work in Progress:

Healthcare Providers Responses to Shocks: Evidence from Snowstorms, with Ashvin Gandhi and David Molitor.
Presented at ASHEcon 2026. Slides

Abstract: Research on healthcare provider quality focuses on average outcomes, but how providers perform when operations are suddenly disrupted is far less understood. We study how hospitals and nursing homes respond to one such disruption: major snowstorms. Using Medicare data, we compare the same facilities on the same calendar dates in snowstorm and non-snowstorm years. On the day of a snowstorm, nursing home staffing declines, and admissions and discharges fall sharply in both settings. In nursing homes, this transient shock delays discharges for weeks, extending stays with potential health and financial implications for residents. Delays are largest for short-stay residents, for whom reimbursement is typically highest. Hospitals, by contrast, accelerate some discharges before the storm and resolve delays within days. This pattern is consistent with differences in payment incentives: nursing homes are reimbursed per diem, whereas hospitals receive a fixed payment per admission and bear the cost of extra days.

The Effects of Snowfall on Mortality and Hospital Use, with David Molitor. Slides

Abstract: Snow routinely disrupts daily life, yet its effects on health and healthcare use have not been studied comprehensively. We link spatially granular daily snowfall data to decades of Medicare mortality and hospital records. Snow increases mortality on the day of a snowfall and for several days after. It also sharply reduces hospital visits on that day and the preceding day, consistent with anticipatory behavior. Although visits rebound afterward, the net effect is negative, suggesting that some care is forgone, with potentially adverse health consequences. In contrast, visits for fractures, cold-related conditions, and heart attacks increase, indicating direct negative health effects. The decline in hospital visits is larger in counties with less historical snowfall, consistent with adaptation, and smaller for patients living in the same zip code as a hospital, consistent with travel barriers. Finally, snow accounts for a substantial share of the well-established cold-mortality relationship and of cold's negative effect on hospital visits.

Hospital Quality and Patient Choice: Evidence from “Hospital Compare” reports

Abstract: High variation in hospital quality translates into substantial differences in survival and other health outcomes between patients admitted to high and low-quality hospitals. This paper examines whether the ``Hospital Compare'' public reports on hospital quality induced reallocation of patients toward hospitals with high reported quality in terms of mortality and unplanned readmissions. In the sample of elderly Medicare patients, the reports publication led to reallocation of non-ambulance admissions with no effect on patients arriving via ambulance, as they have limited choice of hospital. There are several key findings. First, information is more useful when patients have the time and opportunity to make a choice.  The effect is the largest for transfer and referral admissions compared to patients coming to the emergency room.  Second, the fact that doctors typically guide patient choices in transfer and referral admissions implies that doctors and patient surrogates are more responsive to information about hospital quality than the patients themselves. This is further implied by  the greater effect for patients with dementia, who often rely on others for decision-making, compared to other elderly patients. Finally, quality reports are most valuable when patients have more options  of nearby hospitals: the effect of quality reports is concentrated in the most urbanized markets.