Research

Working papers

Shocks to Hospital Occupancy and Mortality: Evidence from the 2009 H1N1 Pandemic 

(joint with Emilio Gutierrez) - submitted 

Abstract: What is the effect of increased hospital occupancy on in-hospital mortality? Using data from public hospitals in Mexico, we exploit the shock in hospitalizations induced by the 2009 H1N1 pandemic, instrumenting hospital admissions due to acute respiratory infections (ARIs) with measures of ARIs at nearby healthcare facilities. We estimate that a one standard deviation increase in ARI admissions leads to a 38% increase in non-ARI in-hospital mortality. We show that these effects are non-linear in the size of the local outbreak, and are concentrated in hospitals with limited infrastructure. We discuss policy implications for the current pandemic.  

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

Abstract: Private-market innovations may be a cost-effective solution to healthcare provision challenges. I exploit the expansion of retail clinics at private pharmacies in Mexico to analyze changes in provider choices and prescription quality. I find that the first entry in the local market leads to a 6-9% decline in public healthcare use. I also find large shifts toward stronger antibiotics in private-market sales. Hence, retail clinics shuffled patients away from existing providers toward doctors with stronger incentives to over-prescribe. These results illustrate how market solutions to congested public services may affect consumers due to agents' incentives that trade-off quality for access.  

Local Water Quality, Diarrheal Disease, and the Unintended Consequences of Soda Taxes 

(joint with Emilio Gutierrez) - under review

Abstract: We ask whether taxing sugar-sweetened beverages in areas where clean water is unavailable may increase diarrheal disease. Exploiting a tax in Mexico, we find a significant 6.6% increase in gastrointestinal disease rates throughout the first year of the tax, with evidence of a declining impact in the second year. We document 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 for vulnerable populations. 

Increasing Retirement Savings through Access Points and Persuasive Messages: Evidence from Mexico 

(joint with Mariano Bosch) - under review  

Abstract: We study how reducing transaction costs for deposits affects savings, and whether non-branded advertising matters for these effects. Focusing on retirement savings in the privatized pension system in Mexico, we analyze two policies: an expansion of access channels for additional contributions at 7-Eleven stores, and the subsequent media campaign providing information on this expansion and persuasive messages to save.  We find that access alone has small and weak effects, but including the campaign leads to a 10-12% increase in savings behavior. However, due to declines in the average contribution size, we find null effects on the total amount saved

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

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

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