My current research analyzes the effects of public policies affecting children’s outcomes and household decision-making. My other recent research interest is analyzing consolidation and location decisions in the hospital industry, and the effects of such decisions on the quality of health care.
“Referee Bias and Stoppage Time in Major League Soccer: A Partially Adaptive Approach” with Steven B. Caudill and Franklin G. Mixon Jr., Econometrics, vol. 2(1), February 2014.
“The Effect of Free School Meals on Household Food Purchases: Evidence from the Community Eligibility Provision” with Michelle Marcus [Job Market Paper]
Designed to increase access to meals for low income students, the Community Eligibility Provision (CEP) eliminates applications for free and reduced price school meals and allows high poverty schools to provide free meals for all students, regardless of their family income. As of 2017, this program was available to more than 9.5 million students in more than 20,000 schools across the US. This paper considers the effects of providing free school meals through this program on household food spending and diet composition. CEP decreases the price of school meals (to zero) for families of children that would previously have been ineligible for free school meals based on family income. In addition, application costs and stigma costs are eliminated for previously eligible students. However, the overall effects of this program on household grocery store purchases are ambiguous, depending on whether the substitution or income effects dominate as school meals become relatively cheaper. We examine the effect of this decrease in the price of school meals on the pattern of grocery store purchases for households with elementary, middle, and high school aged children using the Nielsen household panel data from 2004-2016. We link households to school-level data on the year of CEP adoption using school attendance boundaries and zip code of household residence. We use data on household income to study the effect of CEP adoption on households with and without access to free or reduced price school meals before the program. We find that household spending on food purchases decreases after children gain access to free school meals. The effect is larger for households in areas where more primary schools are adopting CEP. The effect is also larger for households that were previously eligible for free school meals, suggesting that stigma costs play a large role in accessibility of free school meals. We further explore diet composition and heterogeneous effects across households.
(Presented at APPAM, November 2020; Accepted for presentation at ASHEcon, June 2020; Presented poster at ASHEcon, June 2019)
“The Effect of Baby Friendly Hospital Laws on Breastfeeding and Parental Time Use” with Emily Lawler
We study the effects of state “Baby Friendly Hospital” laws, which are intended to support breastfeeding by requiring certain care standards for new mothers and their babies during their immediate postpartum hospital stay. We find that these laws significantly increased breastfeeding initiation by 4.1 percentage points and also led to significant increases in the probability of breastfeeding at 6 months and 1 year, with the largest effects for low-educated mothers. Our results additionally show that the laws reduced maternal smoking during the postpartum period, and resulted in significant reallocation of maternal time: after the laws were implemented, mothers spend more time caring for the infant, and less time on formal work or personal care. Finally, we provide evidence on the mechanisms of the laws, and show that they increased the number of lactation consultants in the state, as well as the probability that breastfeeding mothers report being helped to breastfeed by hospital staff, being allowed to breastfeed on demand, or being connected with a breastfeeding support group.
(Accepted for presentation at ASHEcon, June 2020)
“The Effects of Universal Access to Free School Meals on Teen Health”
Food insecurity is associated with several adverse health outcomes, including anemia, asthma, depression, and diabetes. With over 14 million households facing food insecurity every year, these health issues are of policy importance. This paper leverages the roll out of a novel program that provides universal free school meals for school-aged children to study the impact of increased access to food on teen health behaviors and outcomes. I use data from the CDC’s Youth Risk Behavior Surveillance System (YRBSS) for 2001-2017 to examine teen access to food, asthma, sleep, and mental health. I supplement this with the National immunization Survey of Teens (NIS-Teen) for 2008-2017 which has information on teen doctor visits, and the American Time Use Survey (ATUS) for 2003-2018 which has information on how much time respondents spend on food-related activities. Using a difference-in-differences design and event studies that leverage plausibly exogenous variation in program availability, I find that high school students go to the doctor less, have fewer incidences of asthma, are more likely to get 8 or more hours of sleep, and report improved mental health following the increased access to meals at school. I also show additional evidence that the incidence of teens going hungry because of a lack of food in the household decreases after universal free school meals become more available, and that households with school-aged children report spending more time eating and drinking.
“The Effects of Consolidation on Inpatient Safety and Mortality”
This study analyzes the effect of hospital consolidation on inpatient safety indicators and mortality as a clinical measure of hospital quality. The hospital industry is unique in several aspects, including price structure and the role of insurance networks in determining consumer choice sets, which makes understanding the effect of consolidation on consumer welfare important. Additionally, the high value of life and health imply that even modest improvements in clinical quality may justify hospital mergers that would potentially raise prices or otherwise decrease consumer welfare. To study the effect on quality, I analyze within- hospital changes in mortality rates and rates of adverse safety events for various patient subsets, before and after consolidation. Fixed effects estimates reveal mixed results on the effect of hospital acquisitions on quality of inpatient health care and outcomes. There is evidence of longer lengths of stay for some groups of patients with specific admitting diagnoses (increasing their costs), but no associated change in mortality. Instead, I found that hospitals improved mortality rates only in the specific procedure of coronary artery bypass grafts, but not the others studied, and slightly improved quality of care by decreasing the number of postoperative hip fractures and preventing respiratory failure for surgical patients after surgery in hospitals. Conversely, there is also a worsening of quality of caring for perioperative hemorrhages or hematomas after an acquisition. Given that the overall the welfare changes are specific to the patient’s diagnosis and the procedures performed, and that the number of patients involved in these specific procedures is relatively low, the high value of health and life improvements might not outweigh the economic costs associated with decreased competition.
(Presented at Vanderbilt University Empirical Applied Microeconomics seminar, December 2015, Vanderbilt University/Indiana University Health Economics and Policy Conference, December 2015, Tennessee Empirical Applied Microeconomics Festival student session, May 2016)
“Quantifying Travel Costs: A Case Study Analyzing the Welfare Effects of a Hospital Merger in South Carolina”
This study analyzes the predicted effects of a proposed hospital merger in South Carolina utilizing a travel cost model of demand similar to that used by the Federal Trade Commission. The model examines the change in consumer welfare that results from counterfactually removing each of the relevant hospitals from the consumer choice sets. Since consumers do not generally pay prices directly for health services, but instead have insurance that covers some portion of the costs, travel time is used as a proxy for the price that consumers pay when choosing any given hospital. The travel cost method of analyzing hospital mergers used by the FTC has been criticized in the literature for generating unrealistic estimates of the opportunity cost of time. Within this study, I compare the travel cost model predictions to those generated in a model that does not use time in determining the consumer choice. I then calculate the predicted merger effects. I find that features of the travel cost model account for about 52% of the explained change in willingness to pay that drives bargaining and market power for merging hospitals.
Works in Progress
“The Effect of Increased Access to Free School Meals on Emergency Department Visits and Inpatient Hospital Utilization” with Carmen Astorne-Figari and Michelle Marcus
“State Education Requirements for Substance Use Prevention and Household Purchases of Alcohol and Tobacco”
“Academic Benefits of Universal Access to Free School Meals: Evidence from the Community Eligibility Provision”