Job Market Paper
Patients Adapt: The Mitigated Impact of Retail Pharmacy Closures
Retail pharmacies are the most frequently visited healthcare provider in the United States. They dispense over 150 billion daily doses of prescription medication to Americans each year and offer an array of basic health services to the public. However, the number of retail pharmacies has declined significantly in recent years, with even more pharmacies scheduled to close in the near future. The surge of recent pharmacy closures has raised significant concern about pharmacy access, though there is little evidence on the effects of pharmacy access. This study aims to fill that gap. Using a stacked difference-in-difference approach, I find that patients decrease their prescription drug use following their primary pharmacy's closure, but only by less than two percent. Instead, patients strongly and rapidly adapt by using mail-order pharmacies and switching from 1-month prescriptions to 3-month prescriptions. There is little evidence that primary pharmacy closure significantly impacts downstream healthcare utilization.
Working Papers
Sedation and Selection: Restricting Antipsychotics in Nursing Homes
Antipsychotics have been a major source of policy debate in nursing home care since the 1980s. On one hand, antipsychotics are generally considered medically inappropriate for elderly populations as they increase the risk of cerebrovascular mortality. On the other hand, antipsychotics make caring for elderly patients easier. Use in nursing homes is common; 30-40% of long-stay nursing home patients receive antipsychotics. In this project, I study the effects of a federal policy intended to reduce antipsychotic prescribing in nursing homes on patient health and nursing home strategy. Antipsychotic prescribing in nursing homes decreases, but this reduction appears to be driven by change in patient mix.
Recreational Marijuana Dispensaries and Fatal Car Crashes
Car crashes are a leading cause of death among younger Americans and have become a central concern in the US marijuana policy debate. I construct a novel dataset of marijuana dispensary openings, which I use to present new evidence on the effect of marijuana on traffic fatalities. My intra-state differences-in-differences approach both increases power relative to past analyses and eliminates the potential of time-varying state-level confounding. I find that marijuana dispensary openings increase the rate of fatal car crashes by approximately 5.7%. I use a series of tests to discern between two plausible mechanisms – increased traffic and increased impairment – and ultimately find that the effect is primarily driven by impairment.
Publications
Dying or Lying? For-Profit Hospices and End-of-Life Care
The Medicare hospice program is intended to provide palliative care to terminal patients, but patients with long stays in hospice are highly profitable, motivating concerns about overuse among the Alzheimer's and Dementia (ADRD) population in the rapidly growing for-profit sector. We provide the first causal estimates of the effect of for-profit hospice on patient spending using the entry of for-profit hospices over 20 years. We find hospice has saved money for Medicare by offsetting other expensive care among ADRD patients. As a result, policies limiting hospice use including revenue caps and antifraud lawsuits are distortionary and deter potentially cost-saving admissions.