My research agenda aims to understand the constraints that
vulnerable populations face in making decisions that affect their
health status, and in particular the effects of government policies
designed to benefit these populations. In practice, this has meant
my research focuses on several distinct areas related to the health
economics of vulnerable populations.
I plan on adding links to my papers on this
page at some point in the near future.
I am interested in understanding the effects of Medicare on vulnerable
populations, as well the future of Medicare in a changing health care
- I am closely involved as an investigator in a
research project funded by the Center for Medicare and Medicaid
Services (formerly the Health Care Financing Administration), which
aims to forecast the effects of changes in technology on future
Medicare expenditures. For this project, we assembled a
distinguished panels of experts in biology, various branches of
medicine, and health economics. We challenged these panels to make
their best assessments that each item in a detailed list of promising
medical technologies would come into widespread use-and to provide
some measure of the uncertainty in their predictions. My main role
in this project has been in developing and implementing a
state-of-the-art demographic model that allows projections of future
Medicare expenditures. This model takes into account the changing
demographics of life span and disease, and most importantly,
introduces the expert predictions on technological change-resulting
ultimately in improved forecasts of future Medicare expenditures.
- In a related project, newly funded by an R03 grant from the National
Institute on Aging (NIA), I (along with two RAND researchers)
am examining the redistributive consequences of Medicare and its
financing. While it is well known that Medicare induces an
intergenerational transfer from younger people to older people (mainly
because medical care expenditures by the elderly grow faster than
inflation each year and the "pay-as-you-go" structure of Medicare
financing), it is not clear what intra-generational transfers Medicare
induces. While the poor pay less in Medicare taxes, they also spend
less on medical care when older and survive for a shorter time than
the rich. This project is designed to determine whether Medicare, on
net, induces a transfer from rich to the poor within a generation.
- There is a long established line of research papers
demonstrating decreasing rates of disability among elderly populations
in the developed world over the past two decades. In recent research,
my colleagues and I have shown that the same cannot be said for
younger populations. The rate of severely limiting disabilities has
been increasing in the last decade for these populations.
- I am the Principal Investigator for a new grant from the Stanford
the Study of Demography and the Economics of Health and Aging (CDEHA)
designed to explain these trends. I am examining two competing
explanations for increasing disability: changes in the health of these
populations (increasing rates of diabetes, obesity, asthma, and so on)
and changes in the economic incentives to report disability.
- In related research, I am an investigator on a grant from the Robert
Woods Johnson Foundation that evaluates the importance of Medicare in
explaining trends in public disability insurance application rates.
- I am also working with a group from RAND and UC Berkeley on a
contract with the California Department of Industrial Relations to
evaluate the equity of the California Permanent Disability Schedule
for workers' compensation insurance. We have an article forthcoming
in the American Journal of Industrial Medicine on the topic.
I am a lead investigator on a research project aimed at
evaluating threats to adequate nutrition among the poor in America.
These projects are funded by the US Department of Agriculture and by
Northwestern University and University of Chicago's Joint Center for
Economics of HIV
- The first paper in this project, forthcoming at the
American Journal of Public Health, finds evidence in
nationally representative data that poor American families respond to
unusually cold weather shocks by increasing expenditures on fuel,
while decreasing expenditures on food. This is confirmed by other
data sources, which indicate poor families consume fewer calories in
winter relative to the rest of the year.
- The second paper in this
research agenda, submitted to the Journal of Human Resources
aims at evaluating a popular method in survey research
of assessing the availability of food, and the presence of hunger
among the poor in America. Questions on "food security" are
prominently featured in large government surveys of the American
population, and are used to measure the presence of hunger. This
second paper examines how well the answers to food security questions
correlate with serum measures of nutritional adequacy and caloric
intake. For elderly, food insecurity is a good measure of nutritional
adequacy, but it does not perform as well for children.
- The final
paper in this research arc, which is currently being revised,
evaluates the success of the school breakfast program in providing
adequate nutrition to its enrollees. The idea behind the paper is to
compare nutritional outcomes for kids in summer, when school
breakfasts are not offered, against outcomes during the school year.
- I am the co-PI on an R01 grant funded by the Agency
for Health Care Research and Quality that aims at exploring the links
between employment, insurance coverage, and the health of HIV
patients. One aim of this project is to evaluate the most effective
ways to shape the public provision of insurance for HIV
patients-especially in light of new and effective pharmaceutical
products which slow the course of HIV disease.
- In a related research
arc, I am the head of the only research team exploring the economics
of the viatical settlements market, a secondary market for life
insurance that can be a key financial resource for HIV patients.
While the R03 grant from the National Institute on Aging to study this
market has recently lapsed, it was quite productive.
- It funded a paper examining which HIV patients are most likely to
viaticate (and why).
- It funded a paper that evaluates the
effects of regulation of the viatical settlements markets.
a student on the team, Neeraj Sood, is in the process of drafting a
paper aimed at inferring, based on a unique data base of viatical settlement
transaction prices, an upper bound on what the market predicts the
probability of that a cure for HIV disease will develop.
I am a PI on a recently funded grant from
the Robert Woods Johnson foundation that aims to explore the dynamics
of uninsurance among the employed. While there is much research on
uninsured populations, this grant focuses on a subpopulation of
uninsured that has received little attention-the employed uninsured.
For most in this subpopulation, there is no government program that
provides insurance, and hence it is important to understand who this
population consists of, why the size of this population has been
rising in recent years, and how long people tend to remain in this
Economics of Alcohol and Smoking
Other Topics in Health Economics
- I am the PI on a grant from the
National Institute on Alcoholism and Alcohol Abuse aimed at estimating
the demand curve for alcohol treatment services in the context managed
care insurance. High deductibles, low stop-losses, and strict
lifetime limits make the extensive use of these services rare. This
grant is in its final year.
- I (along with a RAND researcher) have started a research
project on the optimal taxation on cigarettes when people are myopic.
This research asks whether it is possible at all to calculate an
optimal tax to discourage smoking when people behave irrationally.
Other Topics in Economics, Econometrics, and Medicine
- William Vogt and I have
submitted a paper to the Journal of Law and Economics that
proposes a new explanation for the odd fact that prices of branded
pharmaceutical products rise after
patent expiry and generic entry, when conventional model of
competition would predict price declines. The key to the explanation
lies in understanding the pharmaceutical firm's demand management
- A paper from my dissertation on the returns to
specialization in medicine is under review at the Review of Economics
- I (along with Neeraj Sood and Michael Schoenbaum) have
published a paper in Economics Letters that outlines a strategy of
calculating optimal contributions to flexible spending accounts. My
colleagues and I have applied for a patent for this technique.
- Finally, I have recently published a paper in Medical Care on the
health insurance choices of managed care experts.
We find that high income experts are less likely than similar,
non-expert controls to pick HMO-style plans.
I do work on a number of other topics in economics, econometrics, and
medicine, including the treatment for head and neck cancer, the
mortality effects of Swan-Ganz catheters, on overtime regulation in
California, and two projects on econometric topics: probit models with
endogenous regressors and random choice logit models. While these do
not fit nicely into my "theme" area of vulnerable populations, one has
to have fun somehow!