Forthcoming, Review of Economics and Statistics.
Research Question: How do hospitals respond to changes in the price of an inpatient admission?
Abstract: We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients’ severity of illness. We construct a simulated instrument that predicts a hospital’s policy-induced change in reimbursement using pre-reform patients and post-reform rules. The reform led to large persistent changes in Medicare payment rates across hospitals. Hospitals that faced larger gains in Medicare reimbursement increased the volume of Medicare patients they treated. The estimates imply a volume elasticity of 1.2. To accommodate greater volume, hospitals increased nurse employment, but also lowered length of stay, with ambiguous effects on quality.
Research Question: How does extending health insurance coverage to young adults affect their parents' labor supply?
Abstract: A common feature of employer-sponsored insurance is coverage for dependents. While prior work shows that employees trade off job mobility for their own coverage, there is less evidence on the intra-family spillovers of dependent coverage onto parental labor supply. We study this using a panel of insurance claims that links dependent insurance enrollment with a proxy for parental job tenure. We develop a regression discontinuity design that exploits variation in coverage eligibility by dependent birth date from the Affordable Care Act. We find that a one percent increase in the dependent enrollment likelihood increases parental job retention by 0.20 percent.
Research Question: How does decentralization affect local revenue and expenditure?
Abstract: We consider how decentralization of fiscal autonomy to local governments affects their budgetary decisions. We study an Italian reform which expanded municipal discretion and responsibility over property taxation, using novel data on what the national government would have done in a more centralized system. Municipalities on average picked higher tax rates than the national government would have. Municipalities respond to additional responsibility by raising more revenue and spending more on public services. Local conditions shape these municipal responses: those with greater political competition or worse economic conditions spend more on public services, but less on administration and public official remuneration.
Work in Progress
Research Question: How do healthcare providers respond to policies that limit the quantity of care they can provide, and how does adaptation mitigate the effectiveness of these policies over time?