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Research
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My research interests generally lie in
Applied Microeconomics and specifically Health Economics, Public Policy, Industrial
Organization and Labor Economics. Job Market Paper: “A Structural Model of Obstetrician
Location and Treatment Decisions” (pdf here) Dissertation Abstract: This paper develops and estimates a joint
model of an obstetrician’s choices of practice location, and treatments by cesarean section or
vaginal birth. The model specifically incorporates the impacts of medical malpractice risk,
expected health outcomes of patients, and earned income from procedures on obstetricians’
decisions. Liability risk may affect an obstetrician’s location choice and may cause unnecessary medical
services to be supplied in an effort to reduce that liability risk, an action referred to as
“defensive medicine.” Outside of the obstetrician’s incentive to insulate against this risk,
there may be a profit motive for the obstetrician to induce demand for a particular method of delivery.
The information asymmetry between obstetrician and patient can be exploited to provide the
obstetrician with higher income or to protect against a potential lawsuit. Nonstructural results
suggest that this is in fact a serious and potentially harmful concern. Specifically, I predict
that, on average, the marginal effect of performing a cesarean decreases the probability of
facing a lawsuit by 35% but increases the probability of a poor health outcome by 23%. Malpractice liability risk is measured by
explicitly modeling the market for liability insurance using data
on damages from the National Practitioner Data Bank (NPDB), insurance premiums from the Medical
Liability Monitor (MLM), and legal expenses from the Physician Insurers Association of 1999 and obstetrician counts from the
American Medical Association, a model of obstetrician choice is estimated and structural
parameters of the obstetrician’s utility function recovered. Estimation of this model illuminates how
obstetricians choose locations based on the values of these parameters and allows comparisons of
the endogenous distributions of these parameters across areas. Differences in the underlying
parameters of obstetricians may help explain why treatment styles vary dramatically across
areas. The recovery of these preference parameters enables me to simulate the effects of
potential policy changes, such as changes to financial reimbursement schemes or certain tort reforms,
on obstetrician behavior. I
have previously conducted research on the effects of the supply of health
professionals on county level suicide rates as well as some repair/replace
decisions for the Virginia Transportation Research Council
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