Prescription Drug Coupons: A Way to Get Around the Tiered Tormulary

I estimate the effect of prescription drug coupons on generic utilization, medication adherence, and preventable hospitalizations. Drug coupons are banned in Massachusetts (for all insurance types) and in Medicare, which allows me to estimate difference-in-differences and triple-difference models. I use claims data from a large national insurer from 2007-2016 as well as a dataset collected by scraping the Internet Archive to determine the availability/introduction of coupons across time.

Hospital Awnership and Admission Through the Emergency Department

Using the universe of ER discharge records for multiple states and years, I determine whether hospital ownership affects hospital admission rates for patients who show up in the emergency room. I use within-hospital variation from ownership conversions to estimate hospital fixed-effects regressions and event studies. The results indicate that conversion to for-profit from nonprofit or government ownership results in a 2-3 percentage point increase in admission rates, with the effects concentrated to Medicare and Medicaid patients. These results are consistent with whistleblower lawsuits which allege that for-profit hospitals admit patients through the ED when it is not medically necessary.

Non-Monetary Obstacles to Medical Care: Evidence from Postpartum Contraceptives

Since 2012, state Medicaid agencies have begun to offer increased reimbursement for inpatient postpartum long-acting reversible contraception (LARC). The reimbursement has come in the form of unbundling the device payment from the global hospital payment, i.e. reimbursing the hospital specifically for the insertion of LARC. We use variation across states and time to determine how the increased payments affect LARC use, fertility, and adverse birth outcomes. Preliminary event studies indicate a slight decrease in fertility, as well as a decrease in pre-term delivery among unmarried and teenage mothers. Consistent with our hypothesis, these effects are concentrated among women who have previously given birth. (with Barton Willage)