Working Papers
When Uber Comes to Town: Transportation and Healthcare Access (Job Market Paper)
Managing Drug Benefit Through Administrative Burden: Evidence from Medicaid (with Abby Alpert) [Draft Coming Soon]
Abstract: Insurers have increasingly implemented prior authorization to reduce rapidly growing drug spending. Prior authorization could lower spending through two channels: limiting the set of patients eligible for treatment (screening effect) and increasing the hassles of prescribing by requiring a prior authorization request (hassle cost effect). We study the effects of prior authorization requirements on patient access to prescription drugs, focusing on ADHD treatments in the Pennsylvania Medicaid program. We use a novel Regression-Discontinuity (RD) research design leveraging age discontinuities in prior authorization restrictions which vary across Medicaid managed care plans. We find that prior authorization on ADHD drugs reduces spending by 13.7%, reduces the number of prescriptions filled by 14.7% and deters drug fills. We also find that both screening and hassle cost effects contribute to the reduction in use, with hassle costs accounting for a larger share. There are limited spillovers in prescribing practices across patients facing different prior authorization restrictions.
Taxing Prescription Drugs: Evidence from New York Opioid Tax (with Jackson Reimer) [Preliminary draft available upon request]
Abstract: Over-consumption of compulsive goods is often addressed by policymakers through corrective excise taxes. While sin taxes for prescription opioids are less common, they have been proposed at the state and federal levels in an effort to curb drug overdoses. It is unclear whether such a tax would reduce opioid consumption in practice because most opioids are purchased with some form of health insurance, dampening the price signal imposed by the tax. Even if the tax reduced consumption, the welfare implications are also ambiguous because patients might substitute towards a secondary market for illicit, more dangerous opioids. This study evaluates New York State's prescription opioid excise tax implemented in 2019, the first of its kind in the United States. The tax varies according to a drug product's morphine milligram equivalent, such that highly potent opioids are taxed more heavily than less potent opioids. Leveraging this variation in tax exposure, we find that the policy reduced opioid utilization among Medicaid beneficiaries. This reduction occurs through substitution from higher-dose opioids to lower-dose, less tax-exposed alternatives. We also find the policy slightly reduced prime-age county employment-to-population ratios. We do not observe an impact on drug-related deaths. Ongoing analysis of all-payer claims data is characterizing heterogeneity in substitution patterns and ultimate tax incidence.
Trends in Reporting and Representation in US Alzheimer’s Clinical Trials, 1997-2023. (with Zhuoer Lin, Joseph Ross, Kien Lau, Sophia Stumpf and Xi Chen) [Link] [Submitted]
Heterogeneity in Retirement and Hospitalization Among China’s Female Workers (with Tianyu Wang, Xi Chen and Jody Sindelar) [Submitted]
Selected Work-in-Progress
Do Regulated Price Cuts Expand Access? (with Hanming Fang, Gordon Liu, Huyang Zhang, Karen Zhang)
The Short-run and Long-run Impact of Regulated Price Cuts on Competition. (with Hanming Fang, Ming Li)
Publications
Occupational Differences in the Effects of Retirement on Hospitalizations for Mental Illness: Evidence from Administrative Data (with Tianyu Wang, Xi Chen and Jody Sindelar.) Economics & Human Biology, 53, 101367, 2023. [Link] [IZA No. 16545] [Media coverage: Yale Institute for Global Health, Yale Center Beijing (in Chinese)]
Small Money, Big Change: The Distributional Impact of Differentiated Doctor Visit Fee on Primary Care Utilization (with Tianyu Wang, Ke Wen and Qiuming Gao) Social Science & Medicine, 339 (2023) 116355, 2023. [Link]
Does Extreme Temperature Exposure Take a Toll on Mental Health? –Evidence from China Health and Retirement Longitudinal Study (with Yanran Chen, Xuezheng Qin and Xi Chen), Environment and Development Economics, 28(5), 486–510, 2023. [Link] [IZA No. 16092]
Economic Implications of Chinese Diagnosis-Related Group-Based Payment Systems for Critically Ill Patients in ICUs (with Zhaolin Meng, Yanan Ma, Suhang Song, Ye Li, Dan Wang, Yafei Si, Ruochen Zhang, Hao Xue, Limei Jing, Huazhang Wu). Critical Care Medicine, 48(7):e565-e573, 2020 [Link]