We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We find that the survey-based preference measures collected by Cutler et al. (2019) (CSSW) predict variations in utilization that are same-signed, though substantially muted, relative to the strong relationships CSSW uncovered for both treatment and expenditure for Medicare beneficiaries. Additionally, regions with aggressive practice styles receive sufficiently lower reimbursements from commercial insurers that variations in practice preferences have weak correlations with expenditures in the commercial market. We present a parsimonious model of commercial insurers’ pricing that can rationalize this fact pattern.

Residency decisions have large potential ramifications for the supply of health professionals in an area. Around half of residents continue to practice in the same state after completing their residency. As a result, policy changes that impact where individuals apply for residency may have meaningful impacts for healthcare access. This paper examines a policy change with the potential to impact the residency location decisions of obstetricians and gynecologists (OB-GYNs) — the 2022 Supreme Court decision in Dobbs v. Jackson, which revoked constitutional protections for the right to an abortion. Following this ruling, thirteen states immediately implemented full bans on abortions, with large consequences for physicians performing abortions in those states. We use a triple difference-in-differences design to examine whether these trigger bans enacted in the wake of Dobbs affect residency applications to OB-GYN programs in those states. We find that in the years following the Dobbs decisions, applications to residency programs in ban states decrease by 12%. Examining mechanisms, we find suggestive evidence that this change is driven by a shift in where OB-GYN applicants choose to apply rather than a shift away from applying to OB-GYN programs in general. Subgroup analyses reveal that this decrease is driven entirely by female applicants. These results suggest large potential ramifications of abortion bans for access to maternal healthcare in these states, many of which are existing maternity care deserts.

End-of-life expenditures account for 25% of all Medicare spending. Over the past few decades, hospice care, which provides palliative rather than curative care at the end of life, has increased in prominence, being used by 47% of Medicare decedents in 2021. The simultaneous increase in hospice expenditures during this period has resulted in several policy attempts to rein in spending. In this paper, I study hospice provider responses to a 2016 reform which decreased the profitability of long stays relative to short stays. Using variation in exposure to the policy and a difference-in-differences strategy, I find that the policy resulted in a 9% reduction in the share of long stays for more exposed hospices. The margins of response are heterogeneous across hospice type, with nonprofit hospices exhibiting larger responses through the admissions margin and for-profit hospices exhibiting larger responses through the discharge margin. At the patient level, in a sample of Medicare beneficiaries diagnosed with Alzheimer’s/dementia, I document a 7% reduction in hospice admission for those made less profitable by the policy, suggesting meaningful impacts on access to hospice care

We add to the understanding of DEI within the field of environmental economics by examining gender differences in a ubiquitous task in academia that has a large public goods component and where private rewards are uncertain: refereeing. We use the entire universe of submissions to JAERE from 2014-2021 in our analysis, assigning gender based on names of editors and referees. Using manuscript fixed effects and controlling for referee experience, we find that male and female referees in JAERE are similar on several dimensions. An important difference is when referees are late submitting a report, female referees are late by fewer days, and this effect is more pronounced when the handling editor is more senior. Since nearly all other dimensions of the report are the same, we interpret this as female referees putting in more effort conditional on being late. Because perceived reputational consequences are likely most salient along the dimension of lateness rather than other aspects of refereeing which are more subjective (e.g., rejection decisions, word count, etc.), this behavior is consistent with a model in which female referees perceive greater reputational costs for submitting late referee reports.