Provider-Insurer Integration and Healthcare Delivery (Job Market Paper) [paper]

I examine how integration between healthcare providers and insurers affects care delivery. Integration may align incentives between providers and insurers, encouraging integrated providers to internalize the financial responsibility of delivering care, but steer patients to the integrated providers. In the Massachusetts Individual Exchange, I find that integration reduces utilization, mainly by reducing patients' visits to specialists, while it increases the likelihood of patients visiting integrated specialists. This shift is concentrated among patients who have primary care practitioners (PCPs) who are integrated with the insurer. To assess whether changes in subsequent specialty care delivery stems from integrated PCPs' stricter gatekeeping, improved PCP-specialist coordination, or steering incentives, I develop and estimate a physician referral model. Counterfactual analyses reveal that 90\% of the reduction in specialist visits is explained by gatekeeping and about two-thirds of the internal referrals are explained by steering incentives. Conditional on visiting a specialist, integration improves patient-specialist match quality through better coordination.

Limiting For-Profit Provision in Nursing Home Markets (with Hans Zhu) [paper]

We examine whether policies that ban for-profit providers and allow for subsequent takeovers by not-for-profits can be effective at addressing quality shortfalls. We consider the US nursing home industry, where quality provision has been a concern for many decades. Our motivating evidence suggests that not-for-profit providers choose higher-quality inputs than their for-profit counterparts but are more prevalent in higher socioeconomic markets and serve wealthier residents. Thus, for-profit providers play an important role in providing access. To explain these facts and explore counterfactual policies, we estimate a structural model of nursing home demand and supply that allows firms to have nonpecuniary motives and costs that differ across provider types. The structural model reveals that for-profit providers have a strong cost advantage for serving needier residents. This results in them choosing a lower quality and lower priced product to maximise their margins. Not-for-profit providers choose higher quality, and therefore higher prices, not because of their nonpecuniary motive, but because they prefer to avoid directly competing with for-profit providers by serving residents with stronger preferences for quality. Therefore, banning for-profit providers while allowing for takeovers tends to reduce consumer surplus because not-for-profits that take over for-profits significantly raise prices to cover their higher costs. These results underscore the role that for-profit providers play in expanding access to nursing home care.

The Value of Staying at Home: Long-Term Care at Home vs. Facility [paper]

As the world population ages, understanding efficient ways to deliver long-term care becomes increasingly important. I compare the efficacy of the two most common modes of care: facility-based and home-based care. To control for patients' selection into different types of care, I exploit a natural experiment in the South Korean national long-term care insurance scheme and its detailed administrative data. I find that facility-based care increases first-year mortality by 19% compared to home-based care for compliers. Mortality is concentrated among individuals with physical impairments and access to informal care at the time of transitioning into facilities. I identify two potential mechanisms: (1) poor quality facility care due to understaffing or negligence results in life-threatening conditions, and (2) loss of a sense of community negatively impacts the physical health of old and frail residents. I show that further expanding home-based care improves chronic care management without increasing spending. These findings suggest that policies subsidizing home-based care would result in better health outcomes at lower costs.

Vertical Integration and Medical Loss Ratio Regulation

Regulated Prices and Labor Shortages (with Hans Zhu)

Provider-Sponsored Plans in the United States

I construct a data set of provider-sponsored plans in the United States and summarize enrollment and market outcomes.

I worked as a teaching assistant for Kellogg’s various Full-time and Executive MBA courses. [evaluations]