Worth the Wait? A Structural Analysis of Canada's Health Care Crisis
JEL codes. I11, I14, C78, D83, L11, L14
Growing Out of Pediatric Care: The Institutional Frictions Disrupting Patient Transition [SYP]
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
Presentations. ASHEcon 2025, Canadian Economics Association (CEA) Annual Conference 2025, Canadian Heath Economics Study Group (CHESG) Annual Meeting 2025.
Claim Denials: Low-Income Patients from Disadvantaged Racial and Ethnic Groups Experienced the Largest Burdens with Michal Horný and Alex Hoagland
Health Affairs, June 2025
Abstract. Insurance claim denials are a common source of administrative burden, especially for patients with private health insurance. Contesting denied claims requires considerable investment from physicians and patients or caregivers, including both institutional knowledge of health policies and billing practices and the means to engage in reconciliation. We used a novel national data set comprising remittance data and patient demographics to describe disparities in the rates of seeking and receiving claim denial corrections across demographic and socioeconomic dimensions. We found that patients from historically disadvantaged racial and ethnic groups or with low household incomes experienced the largest burdens from claim denials. Patients with household incomes less than $50,000 annually were least likely to have denied claims contested and, conditionally, have cost-sharing obligations reduced. Racial minority patients were more likely than non-Hispanic White patients to have cost-sharing obligations reduced but achieved lower mean savings per successfully contested denial. Policy makers working to promote equitable health care access should make available more resources for contesting and rectifying administrative errors and enact policies to prevent billing errors and consequent claim denials.
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.