When Gatekeeping Backfires: A Physician Allocation Problem in Decentralized Healthcare Markets
Abstract. Many healthcare systems require patients to obtain referrals before accessing specialty care, a policy aimed at controlling costs and managing specialist capacity. Although referrals help prioritize high-need patients and mitigate excessive use of costly specialty services, they can also create bottlenecks that delay access to specialized care. Such frictions contribute to potentially preventable hospitalizations and exacerbate disparities in healthcare access. This paper develops and estimates a model of decentralized patient allocation through physician referral choices, identifying inefficiencies in patient-provider matching and evaluating the trade-offs between cost containment and equitable, timely access to care.
JEL codes. I11, I14, C78, D83, L11, L14
Growing Out of Pediatric Care: The Institutional Frictions Disrupting Patient Transition
Abstract. Transitions from pediatric to adult health care are crucial for maintaining continuity of care but are often delayed by structural barriers in the health care system. This paper examines how physician network structures influence these delays. I estimate a structural model that incorporates pediatric patient demand, adult provider service costs, and the matching process between patients and providers. This model provides a framework for evaluating the impact of counterfactual policies that modify physicians’ referral consideration sets to alleviate congestion and reduce transition wait times.
JEL codes. I11, L14, L11, C41, I18
Racial and Income-Based Inequities in Reversing Insurance Claim Denials with Michal Horný and Alex Hoagland
Recently accepted at Health Affairs!
Inequities in Unexpected Cost-Sharing for Preventive Services with Alex Hoagland and Michal Horný
American Journal of Preventive Medicine, January 2025
Abstract. Unexpected out-of-pocket (OOP) costs for preventive care reduce future uptake. Because adherence to service guidelines differs by patient populations, understanding the role of patient demographics and social determinants of health (SDOH) in the incidence and size of unexpected cost-sharing is necessary to address these disparities. This study examined the associations between patient demographics and cost-sharing for common preventive services.
Social Determinants of Health and Insurance Claim Denials for Preventive Care with Alex Hoagland and Michal Horný
JAMA Network Open, September 2024
Abstract. What is the association between patient demographics and insurance denials for preventive care among privately insured patients in the U.S., and which denials underlie this association? In this cohort study of patients seeking preventive care, at-risk populations, including low-income patients, patients with a high school degree or less, and patients for minoritized racial and ethnic groups, experienced higher rates of claim denials. The most frequent denials were noncovered service-diagnosis code pairs and billing errors. These findings suggest that experiences of patients seeking free preventive care differ on the basis of their demographics, leading to inequities in accessing basic preventive care.