Research

In progress

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, offering new insights into the determinants of transition outcomes. I construct measures of patient transitions and physician referral networks from patient utilization data, marking a key departure from the standard practice in empirical IO and health economics of relying on insurers’ coverage networks to referral relationships – an approach limited by its underlying assumption of mutually exclusive insurer-provider affiliations. Through reduced-form network analysis, I demonstrate that physician degree centrality negatively impacts transition timeliness, while eigenvector centrality positively influences it, highlighting the critical role of physicians’ network positions in shaping patient outcomes. To explore the mechanisms underlying 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

Working papers

Racial and Income-Based Inequities in Reversing Insurance Claim Denials with Michal Horný and Alex Hoagland

[R&R at Health Affairs]


Publications

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.