Promoting Health Care Efficiencies
Lightning Round SessionSaturday, Jan. 3, 2026 8:00 AM - 10:00 AM (EST)
- Chair: Adam Biener, Lafayette College
Health Impacts of Federal Pandemic Aid to State and Local Governments
Abstract
The COVID-19 pandemic led to unprecedented levels of federal transfers to state and local governments. Did this funding impact population health? To answer this question, we leverage the fact that U.S. states that enjoy excess representation in Congress received substantially more fiscal assistance than did relatively underrepresented states. We find that the aid driven by excess representation had substantial impacts on population health. For each $1,000 increase in federal fiscal aid per state resident, we estimate that states experienced 38 fewer deaths from all causes per 100,000 residents from 2020 through 2022, of which 2/3 came from reductions in COVID-19 mortality. We estimate that the last $331 billion in federal pandemic aid, which corresponds with our in-sample variation, generated $591 billion in value through life years saved. Additional aid also reduced rates of COVID-19 related hospitalizations and emergency room visits, though not in the total number of positive cases detected. Plausible mechanisms for these improved outcomes include higher rates of COVID-19 vaccination, which plausibly account for nearly half of the mortality reductions we observe, and higher rates of COVID-19 testing. Medicaid enrollments and hospital capacity do not appear to play substantial mediating roles. Our robustness analyses provide evidence that the effects we estimate cannot be explained by pre-existing mortality trends, by the pandemic’s differential impacts on relatively dense vs. rural areas, or by the pandemic’s differential impacts on populations with more elderly individuals or with higher prevalence of chronic conditions. The mortality impacts we estimate were substantially greater for non-Hispanic Black Americans than for non-Hispanic White Americans, such that federal funds are associated with a reduction in population-wide health disparities over the course of the pandemic.Knowledge Spillovers and R&D Investment: Evidence from Drug Development Decisions
Abstract
This paper studies how pharmaceutical firms make investment decisions in drug development, focusing on how they account for knowledge spillovers and economies of scope when investing across drug types and multiple indications. We highlight that firms make decisions at the portfolio level, considering interdependencies both within and across drugs. Understanding how firms internalize these dynamics is key to evaluating incentives for developing small-market drugs and the role of strategic collaborations, which generate value beyond individual projects by strengthening a firm’s broader pipeline.To support our analysis, we develop a structural model that incorporates the interdependencies between drug projects and firms’ investment strategies. Our empirical findings show that firms frequently add new indications during clinical development to expand market potential and reduce the risk of failure. This is especially common among mixed orphan drugs—those developed for both rare and larger-market indications. Most orphan drugs in our dataset originate from projects initially tested for more common diseases, which then benefit from orphan designation and show higher success rates. We also find that firms benefit from collaboration deals to expand their pipelines into new disease areas, particularly where in-house development capabilities are limited. Finally, we conduct counterfactual simulations to assess the effects of regulatory incentives, such as orphan drug designation or policies that promote public-private collaboration, on drug development outcomes. Overall, this project provides new insights into the strategic behavior of pharmaceutical firms and aims to inform policy efforts that promote socially valuable drug innovation.
Gender Combination and Team Performance: Evidence from Heart Procedures
Abstract
Despite growing interest in how gender composition shapes team performance, littleis known about its impact in high-stakes healthcare settings. In this paper, I use inpatient
discharge records for two common heart procedures - percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) - to investigate how
the gender combinations between the attending physicians (who manage inpatient care
during hospitalization) and proceduralists (who perform the procedures) affect patient
health outcomes. Exploiting the quasi-random pairings of physicians and proceduralists,
I find that mixed-gender teams reduce in-hospital mortality by approximately 12
percent. Further decomposition analysis suggests that female physicians outperforming
their male counterparts when paired with male proceduralists, whereas no significant
difference is observed when partner with female proceduralists.
Additional tests show that the observed benefits are not driven by increased utilization
of medical resources. Instead, the results appear consistent with communication
or social norms mechanisms: the mortality gap narrows with higher patient severity
and greater familiarity between physicians and proceduralists, as measured by prior
collaboration and the share of male proceduralists among a physician’s colleagues.
However, physicians’ own experience and patient demographics do not explain the observed
gains. Moreover, pairing female physicians with male proceduralists lowers the
likelihood of experiencing repeat surgery, which may explain part of the mortality reduction.
These findings emphasize the importance of gender composition in healthcare
teams and suggest potential improvement in patient outcomes with careful team assignment
policies.
The Deadly Consequences of Labor Scarcity: Evidence from Hospitals
Abstract
Healthcare systems worldwide face increasing nursing shortages, but the consequences remain poorly understood. This paper examines how labor scarcity in hospitals affects healthcare provision and patient health, leveraging the 2011 Swiss franc stabilization. Due to regulations in the German healthcare sector, cross-border commuting became more attractive for German registered nurses, causing German hospitals to lose staff based on their proximity to the border. Using rich patient- and hospital-level administrative data in a matched difference-in-differences approach, I find that German border hospitals lost, on average, 12.5% of their nursing staff. In response, hospitals reduced care intensity, leading to a decline in surgeries. While hospitals attempted to prioritize care reductions (triage), even patients with urgent medical needs experienced cutbacks, resulting in a sharp rise in mortality rates and a stagnation in life expectancy. These findings highlight the fragility of healthcare systems to labor market regulations and labor scarcity.Optimal Entry of Hospital Obstetric Units
Abstract
Hospitals decide whether to enter the market for obstetric (OB) care by choosing to operate OB units. Relative to socially optimal entry, unregulated entry may be too high due to business stealing or too low due to patient surplus externalities. These effects are augmented by uninsured and Medicaid-insured patients who pay fixed below-cost prices. Beyond welfare, access to OB care is crucial for maternal and infant health. This study evaluates entry, welfare, and health in the market for OB care under unregulated entry, socially optimal entry, and two policies: certificate-of-need laws that restrict entry and conditional subsidies that promote entry. This study’s setting is Arkansas, and the primary dataset used is the Arkansas All-Payer Claims Database. First, I find that a private hospital is more likely to operate an OB unit if its county has more commercially-insured adult women and less likely if its county has more uninsured or Medicaid-insured adult women. For public hospitals, these correlations are reversed. This is consistent with public hospitals internalizing the social benefits of OB unit entry while private hospitals do not. Second, I use an instrumental variable approach to estimate the health effects of OB unit entry. The presence of an additional OB hospital improves maternal and infant health outcomes by reducing the distance that mothers must travel to deliver. Finally, I develop a static entry model in which multi-hospital systems make OB unit entry decisions. Medicaid prices are fixed while commercial prices are determined in equilibrium. Patient preferences depend on price, travel distance, and hospital characteristics. Marginal costs are identified from commercial price variation, and fixed costs are identified from OB unit entry decisions. I conduct counterfactual simulations to predict entry patterns and assess welfare and health. My findings suggest that unregulated entry is too low, imposing both welfare and health costs.The Effects of Internet Usage on Health Outcomes in Africa: A Short-Run and Long-Run Analysis
Abstract
This paper examines the effects of internet usage, GDP growth, and mobile subscriptions on health outcomesin 47 African countries from 2000 to 2022, employing both panel vector error correction and panel vector autoregression models. The findings indicate that both Internet usage and mobile subscriptions substantially enhance life expectancy, whereas the influence of GDP growth is comparatively minimal. Granger causality analysis supports the hypothesis that access to internet serves as a predictor for health outcomes. These results highlight the essential role of digital infrastructure in public health initiatives and advocate for increased investments in digital access to improve health outcomes globally.
Soft Drink Taxes and Health in the Long Run
Abstract
Childhood obesity is associated with chronic diseases in adulthood. Given that added sugar is a key risk factor for weight gain and that soft drinks serve as the largest source of added sugar for children, soda taxes during childhood can reduce health risks later in life. This paper examines the impacts of soda taxes experienced during early adolescence on long-term consumption patterns and adult mortality, leveraging variation in the timing and magnitude of state-level soda taxes. Using cohort-level panel data constructed from U.S. death certificates and Census data, I find that a one percentage point increase in soda taxes experienced at ages 9–11 is associated with a 1.1% reduction in mortality rates from age 20 onward. The reduction in mortality is particularly pronounced for deaths related to cardiovascular diseases and digestive system cancers, conditions strongly associated with excessive sugar intake and obesity. Furthermore, I explore whether soda taxes during childhood have a lasting impact on soda and sugar consumption in adulthood for mechanism analysis, using Nielsen Consumer Panel data. The findings underscore the potential for soda taxes to generate substantial long-term public health benefits.Maternal Health Programs and the Continuation of Unintended Pregnancies
Abstract
Maternal and Child Health (MCH) programs promote safe motherhood by linking financial incentives for institutional delivery with health-worker outreach and family-planning education. I study how MCH programs influence reproductive behavior through pre-conception margin, by affecting contraceptive use and fertility, and post-conception margin by affecting whether unintended pregnancies continue to birth. Using a difference-in-differences design exploiting India’s national MCH program, I find that it increased modern contraceptive use by 12 percent and reduced fertility among older women. In contrast, the program increased unintended pregnancies ending in births among younger women by four percentage points. Evidence from a later phase of the program that expanded health-worker incentives shows that greater contact with community health workers contributed to this rise. These findings reveal an unintended consequence of maternal health interventions: by simultaneously promoting planned and protected pregnancy, they can inadvertently constrain women's reproductive autonomy.JEL Classifications
- I1 - Health