Research

Working papers

Trade-Offs Between Access and Quality in Healthcare: Evidence from Retail Clinics in Mexico - R&R, Journal of Public Economics 

Abstract: In settings with inefficient public provision, innovations in private-market healthcare delivery may be welfare-improving by increasing access, but may be sacrificing on quality. I study the expansion of retail clinics at private pharmacies in Mexico. I find that entry leads to large declines in public-sector emergency room visits and a small but significant reduction in public clinic visits for relatively mild respiratory infections. I also find a significant increase in public clinic visits for chronic conditions and a slight decline in emergency room visits, consistent with better disease management. However, I estimate a strong association between retail clinics and a shift toward stronger antibiotics in private-market sales. Hence, although retail clinics improve access to healthcare, they may be overselling their patients.  

Eye-opening Products: Uncertainty and Surprise in Cataract Surgery Outcomes 

(joint with Emilio Gutierrez and José Tudón) 

Abstract: For experience goods, benefits from consumption are ex-ante unknown but revealed after repeated interactions. This uncertainty might lead to underconsumption. We use data from a large cataract surgery provider in Mexico City to estimate demand, given uncertainty in surgical outcomes. We consider forward-looking consumers with a surgery demand per eye and information revealed after the first surgery. We exploit data from sales agents to identify structural demand parameters; namely, price elasticities and the value of the uncertain shock. We simulate counterfactual policies, showing that budget-neutral price changes are more effective at increasing welfare than persuasive advertising.

Publications

Electoral Repercussions of a Pandemic: Evidence from the 2009 H1N1 Outbreak. Journal of Politics, forthcoming. (joint with Emilio Gutierrez and Jaakko Meriläinen)

Increasing Retirement Savings through Access Points and Persuasive Messages: Evidence from Mexico. Journal of Human Resources, forthcoming. (joint with Mariano Bosch) 

Local Water Quality, Diarrheal Disease, and the Unintended Consequences of Soda Taxes. World Bank Economic Review, 2022. (joint with Emilio Gutierrez)

Information and Behavioral Responses during a Pandemic: Evidence from Delays in Covid-19 Death Reports. Journal of Development Economics, 2022. (joint with Emilio Gutierrez and Tiago Tavares) 

Shocks to Hospital Occupancy and Mortality: Evidence from the 2009 H1N1 Pandemic. Management Science, 2021. (joint with Emilio Gutierrez)

Illegal Drug Market Responses to State Recreational Cannabis Laws. Addiction, 2021. (joint with Angelica Meinhofer)

The Effect of a Cash Transfer Program for the Elderly in Mexico City on Co-Residing Children’s School Enrollment. World Bank Economic Review, 2017. (joint with Emilio Gutierrez and Laura Juarez)

Previous working papers

Delays in Death Reports and their Implications for Tracking the Evolution of COVID-19 

(joint with Emilio Gutierrez and Tiago Tavares; Covid Economics Working Paper)  

Abstract: Understanding the determinants and implications of delays in reporting COVID-19 deaths is important for managing the epidemic. Contrasting England and Mexico, we document that reporting delays in Mexico are larger on average, exhibit higher geographic heterogeneity, and are more responsive to the total number of occurred deaths in a given location-date. We then estimate simple SIR models for each country to illustrate the implications of not accounting for reporting delays. Our results highlight the fact that low and middle-income countries are likely to face additional challenges during the pandemic due to lower quality of real-time information.  

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.