Market structure and provider behavior
How ownership, consolidation, and facility entry and exit relate to access and treatment delivery.
I use industrial organization frameworks to study how market structure is associated with provider behavior and patient access. Papers study health-system affiliation and primary care access for new Medicare patients, the role of facility entry and exit in the effects of Medicaid waivers, and private equity acquisition of substance use disorder treatment facilities.
The main question in this work is whether changes in ownership and market structure are associated with changes in access, treatment intensity, retention, and the mix of services offered. My job market paper finds that wait times for new Medicare primary care appointments were longer where a clinic's parent firm held a larger share of the local Medicare market. In related work, private equity acquisition of substance use disorder treatment facilities was associated with higher buprenorphine patient volumes and shorter treatment retention.
Representative work
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Medicare Appointment Availability and Wait Times Vary Considerably Across Four Large US Urban Markets
Audit evidence that hospital-system-affiliated and multi-site primary care practices were less accessible to new Medicare patients than independent practices.
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Private Equity Acquisition and Buprenorphine Prescribing
Difference-in-differences study of private-equity acquisition of substance use disorder treatment facilities, finding higher buprenorphine volumes alongside shorter retention.
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Medicaid: Increased Patient Access To MOUD In Residential Treatment Associated With Facility Openings And Closures, 2012–22
Decomposition of access gains under Medicaid Section 1115 waivers into changes at existing facilities and facility entry and exit.
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Is access to crisis teams associated with changes in behavioral health mortality?
Crisis-team entry was associated with reductions in county drug overdose mortality; closures were associated with increases.