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 led 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 develop a demand model with uncertainty in outcomes, for forward-looking consumers, and information revealed after the first interaction. We use data from a large cataract surgery provider in Mexico to estimate demand, and 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 efficient at increasing welfare and take-up than persuasive advertising.
Going Big in Health: Effect of a Large-Scale Preventive Health Policy
(joint with Arturo Aguilar and Ricardo Gómez)
Abstract: Despite the benefits of preventive healthcare, uptake is typically low. This paper studies how embedding healthcare in a conditional cash transfer program affects utilization by exploiting the roll-out of Progresa in Mexico. We estimate a sizable 12% increase in outpatient visits at public clinics, driven by children and women aged 20-49. This translates into improvements in reproductive healthcare and screenings for chronic diseases. However, these effects are also accompanied by increased congestion, measured with waiting times, and reductions in quality of care. Overall, this suggests that the benefits of this policy lever may carry unintended displacement effects.
LGBT+ Persons and Homophobia Prevalence Across Job Sectors: Survey Evidence from Mexico
(joint with Emilio Gutierrez) - under review
Abstract: Labor market outcomes for sexual minorities may be closely linked to the exclusion they face. An important first step is measuring the prevalence of both and exploring their relationship. This paper develops and implements an online survey in Mexico to estimate the size of the LGBT+ population and homophobia using two elicitation techniques. We find a larger prevalence of LGBT+ persons than a national survey, but no significant differences across methods. We document important heterogeneity across sectors. For homophobia, we obtain mixed results, with significant differences across methods for various items. Lastly, we estimate a strong negative association between homophobia and the share of LGBT+ persons in ad hoc defined labor markets.
Increasing Retirement Savings through Access Points and Persuasive Messages: Evidence from Mexico. Journal of Human Resources, forthcoming. (joint with Mariano Bosch)
Electoral Repercussions of a Pandemic: Evidence from the 2009 H1N1 Outbreak. Journal of Politics, 2022. (joint with Emilio Gutierrez and Jaakko Meriläinen)
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.