Research

Working papers

Trade-Offs Between Access and Quality in Healthcare: Evidence from Retail Clinics in Mexico 

Abstract: Private market innovations may be an efficient solution to healthcare provision challenges in developing countries. This paper exploits the expansion of retail clinics at private pharmacies in Mexico to analyze changes in provider choices and to characterize quality in terms of prescriptions. I find that the first retail clinic entry in the vicinity of a public clinic leads to a 6% decline in public use, no evidence of new doctor visits, and a large shift toward stronger antibiotics in private-market sales. This suggests that retail clinic expansion shuffled patients away from existing providers toward doctors with stronger incentives to over-prescribe.

Short-Term Health Effects of Soda Taxes in Areas with Low Access to Safe Drinking Water (joint with Emilio Gutierrez) - under review

Abstract: We ask whether taxing sugary beverages may have negative health effects in areas where clean water is unavailable. Focusing on a tax in Mexico, we find a significant but localized 7% increase in outpatient gastrointestinal disease rates throughout the first year of the tax, with evidence of a declining impact by the end of the second year. We provide evidence of avoidance behavior by affected households through differential consumption of bottled beverages two years post-tax. The costs implied by our results are small. However, our findings inform the need for accompanying soda taxes with interventions that guarantee safe drinking water. 

Increasing Retirement Savings through Access Points and Persuasive Messages: Evidence from Mexico (joint with Mariano Bosch)  

Abstract: Transaction costs impose a barrier to savings, but lowering them may have smaller impacts than expected due to other constraints, such as psychological biases. Within the context of retirement savings under defined contributions in the privatized pension system in Mexico, we analyze two staggered policies: an expansion of access channels for additional contributions through 7-Eleven stores, and the bundling of this policy with a media campaign providing persuasive reminders to save. We find that access alone has small and weak effects on savings, but including the persuasive message leads to a 10-12% increase in savings behavior that is long-lasting. 

Over-the-Counter Access Regulations: Evidence from an Antibiotics Law in Mexico

Abstract: Regulations restricting over-the-counter (OTC) access to drugs are important policy tools for mitigating self-medication and encouraging doctor visits. However, they may have unintended consequences when access to affordable healthcare is lacking. This paper estimates the effect of a law restricting OTC sales of antibiotics in Mexico on public hospital admission rates. I find a temporary but significant decline of around 40% in admission rates due to infections. This effect is driven by viral infections, adult patients, and patients from higher education municipalities. OTC regulations may inadvertently increase the socioeconomic health gradient unless accompanied by policies that expand affordable healthcare. 

Publications

The Effect of a Cash Transfer Program for the Elderly in Mexico City on Co-Residing Children’s School Enrollment. World Bank Economic Review, 2016. (joint with Emilio Gutierrez and Laura Juarez) link

Work in progress

Utility Disconnection Policies and Health Outcomes (joint with William Violette)

 

Gasoline Pipeline Leaks, Health and Crime (joint with Emilio Gutierrez and Fernanda Marquez-Padilla)

Allocation of Government Resources and Service Provision: Evidence from the Quality of Healthcare

Climate Change and Tourism: Evidence from Algae Outbreaks