Research

Working Papers

Mis(sed) Diagnosis: Physician Decision Making and ADHD
[Conditionally accepted, Journal of Political Economy]

The mechanisms driving disparities in mental healthcare are not well understood. This paper develops a structural model of diagnosis for Attention Deficit Hyperactivity Disorder (ADHD), highlighting how patient and physician factors can result in disparities. Using electronic health record data, I estimate model parameters and decompose the observed male:female ADHD diagnostic difference of 2.3:1. Simulations show that only 20-25% of this diagnostic difference can be explained by underlying symptom prevalence, with the majority driven by differences in diagnostic thresholds. I find that physicians view missed diagnosis to be costlier for their male patients, which I argue may have economic justifications.

The Role of Information in Pharmaceutical Advertising: Theory and Evidence -with Conor Ryan
[Conditionally accepted, Review of Economics and Statistics]

This paper theoretically and empirically examines the role of information in the practice of pharmaceutical detailing (promotional interactions between drug representatives and physicians). We start with a theoretical framework in which pharmaceutical firms target detailing visits to physicians who potentially learn about drug quality and prescribe it to their patients. We derive several predictions about the role of information in these visits, which we then test empirically using Medicare Part D prescriptions and pharmaceutical detailing visit data. We find limited empirical support of learning as the dominant mechanism, though cannot rule it out completely. We conclude with discussing alternative models that may be more consistent with the observed empirical patterns.

Hospital Quality and Capacity Strain: Equilibrium Effects on Health Outcomes -with Gautam Gowrisankaran and Robert Town

We examine the importance of capacity strain, patient information, and hospital learning in affecting hospital outcomes, using Covid-19 pandemic data. Our main outcome is mortality, controlling for unobserved selection using distance instruments. Intensive care unit strain increased hospital mortality: without strain, deaths would fall 9.3%. Patients value hospitals with high baseline quality, but their choices did not account for capacity strain. Equilibrium counterfactuals show that if patients accounted for capacity strain and believed quality signals were more precise, Covid-19 deaths would drop 4.5%. However, using more precise information but not accounting for strain would cause Covid-19 deaths to rise 12.5%.

Health Care Reform and Firm Dynamics: Evidence from Medicare Part D and the Retail Pharmacy Industry -with Brandyn Churchill and Georgina Cisneros

Retail pharmacies fill over 4 billion prescriptions each year and are the most frequent healthcare touchpoint in the U.S. Yet relatively little is known about the economic factors driving pharmacy access. We provide new evidence on how Medicare Part D shaped the retail pharmacy industry using 2000-2009 National Establishment Time-Series data and a difference-in-differences strategy leveraging pre-period variation in the share of the customers likely enrolled in Medicare. The two-year period between Part D’s passage and implementation was marked by substantial uncertainty about its financial implications for pharmacies. Though Part D ultimately increased prescription utilization, it also reduced drug prices and raised administrative costs. We find that Part D was associated with a 5 percent reduction in the number of pharmacies, driven entirely by a reduction in the number of openings rather than an increase in closures. Finally, we find suggestive evidence that the mortality reduction attributable to Part D was smaller in counties that experienced a reduction in pharmacy access.

Physician Practice Style for Mental Health Conditions: The Case of ADHD

There is a robust literature documenting the importance of physician practice style (e.g., the propensity to perform certain operations) in explaining outcomes related to patients' physical health. Yet, little is known about the role of physicians in explaining patients' mental health outcomes. This paper uses novel data on doctor note text together with natural language processing techniques to estimate and document heterogeneity in physician practice style for diagnosing Attention Deficit Hyperactivity Disorder (ADHD). I find significant variation in both diagnostic intensity (the mean propensity to diagnose) and diagnostic compliance (the weight that physicians place on medical guidelines). I show that physician characteristics can explain some of this heterogeneity, with both female physicians and recent graduates having higher diagnostic compliance and lower diagnostic intensity than their respective counterparts.

Works in Progress

The Effect of Acquiring Health Insurance on Health Outcomes: Evidence from Turning 65 Using the American Communities Surveys from 2008 to 2023 -with Kristin Butcher, Luojia Hu, and Ryan Perry

Missing Stars: Gender Differences in the Assessment of Gifted Students -with Beatrix Eugster and Aurelien Sallin

Publications

Journal Articles

Societal Disruptions and Childhood ADHD Diagnosis During the COVID-19 Pandemic.
-with Seth Freedman, Dario Salcedo, Kosali Simon, and Coady Wing
2023. Journal of Human Resources 59(S), S187-S226.
NBER working paper version <here>

Local Economic Conditions and Fertility from the Great Depression through the Great Recession.
-with Jessamyn Schaller and Price Fishback
2020. AEA Papers and Proceedings (Vol. 110, pp. 236-40) 

Nonparametric Estimation of Production Functions.
-with Trevor Collier and John Ruggiero
2016. Data Envelopment Analysis Journal 2(1), pp. 35-52.

Book Reviews

Liran Einav and Amy Finkelstein: “We’ve got you Covered: Rebooting American Health Care”
2024. Business Economics 59, 190–192.

Software

GGT: STATA module to implement Geweke, Gowrisankaran, and Town Model Quality Estimator.
-with Gautam Gowrisankaran and Robert Town. Uploaded December 2019. Updated Version- March 2026.
Full Documentation- here.
Download Sample Dataset- here.

RESTING PaperS

A Re-Examination of Parental Divorce and Child Mental Health in the 21st Century -draft available upon request.