Over the past twenty years, urgent care centers (UCCs) have become increasingly common across the United States. These facilities are intended to treat non-acute illness as a convenient alternative to traditional doctor’s office visits or costly emergency departments (EDs). UCCs accept walk-ins, require shorter wait times than EDs, and have extended hours, as many accept patients on weekends and after business hours. Using a sample of publicly and privately insured individuals, I find that the introduction of an urgent care center in a county measurably increases UCC utilization among residents, while decreasing the use of traditional physician's office visits. The impact on inpatient and emergency department visits is more ambiguous, as Medicare recipients and the commercially insured both experience an increase in inpatient and ED visits after treatment while Medicaid recipients experience a decrease. However, UCC availability decreases inpatient hospitalizations and ED use for non-emergent ailments such as urinary tract infections. I find no impact on patient health outcomes, as measured by complications attributable to UTIs.
The number of nurse practitioners (NPs) working in the United States has more than doubled in the past decade. Meanwhile, many states have adopted policies allowing nurse practitioners to diagnose and treat patients without physician oversight, with the goal of reducing physician shortages in underserved areas. I use the introduction of over 160 new nurse practitioner education programs between 2011 and 2022 in a stacked difference-in-differences design to estimate the impact of these programs on local labor markets and population health. While previous literature has primarily focused on the policy implications of expanding scope of practice at the state level, I investigate the impact of expanding the nurse practitioner workforce in states with both full and restricted scope of practice.
I find that the number of locally practicing NPs increases significantly following the introduction of a new NP education program to an area, as does the probability that patients seeking care locally have visited an NP in a given year. I find little evidence that these NPs crowd out substitutable physicians such as general practitioners, family physicians, and OBGYNs. Similarly, I find no effect on wages of these substitutable physicians. Ongoing analysis focuses on the health and mortality implications of expanding the NP workforce.
I investigate the barriers to prescription adherence for prescription oral contraceptives. I find that fifteen percent of women prescribed daily oral contraceptives experience a gap in prescription coverage of between one and three months in a given year. These coverage gaps are associated with a 1 percentage point (25 percent) increase in the probability of experiencing a pregnancy in the following eight months. The likelihood of experiencing a coverage gap increased significantly in early 2021, potentially due to barriers to physician access during the COVID19 pandemic. I do not find an effect of abortion bans on prescription adherence.
For many Americans, emergency departments are the only source of health care outside of business hours. This can result in overcrowding at emergency departments, decreased quality of care, and gaps in care over the weekends. Weekend office closures can delay physician visits for up to two days. Using hospital admissions data from the 1980s, I identify the health consequences of treatment delays by looking for variation in preventable complications from infection over days of the week. I find that conditional on being admitted to a hospital for antibiotic treatable infections including urinary tract infections, staph infections, and bacterial meningitis, those admitted in the early week (Monday-Tuesday) suffer worse health outcomes. This suggests that delaying treatment for common treatable illnesses for just two days results in significant negative health consequences.
I attempt to measure the extent to which credit access allows families to smooth consumption in the face of negative financial shocks. In 2011, the Andhra Pradesh Micro Finance Institutions (Regulation of Money Lending) Act created a series of restrictions on the activities of MFIs resulting in mass defaults and a liquidity crisis among MFIs. These defaults severely limited the ability of MFIs to issue loans across many states in India. I employ a triple difference design to explore the effect of the Act on consumption responses to rainfall shocks. Using data on household level finances and district-level rainfall data, I find suggestive evidence that household consumption among families without credit access is more responsive to rainfall shocks than households with credit access.
In response to the severe economic shock induced by the COVID-19 pandemic, Congress passed the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act. Using data on savings, income, and expenses from the Survey of Consumer Finances, we show that cash assistance included in the CARES Act allows almost all families to cover their normal, recurring expenses in the event of long-term unemployment. In the absence of government support, nearly half of families who lose their income for six months would not be able to cover their expenses due to low levels of liquid saving and standard unemployment insurance benefits that do not fully replace income.
Most financial advisors recommend storing three to six months of expenses in liquid assets in case of an emergency. Yet we estimate that more than half of U.S. families do not have at least three months of their non-discretionary expenses in liquid savings. We find that financial literacy is strongly predictive of having three months of liquid savings, controlling for income, income variability, and even parental resources. We also find that financial literacy predicts liquid savings across the income distribution. These results indicate that accumulation of an emergency fund is not simply a function of income. Finally, financial literacy is predictive of liquid savings even among high illiquid wealth households. This suggests that the phenomenon of “wealthy hand-to-mouth” families may reflect financial mistakes rather than portfolio optimization. Our paper highlights the importance of financial knowledge in explaining families’ preparedness to deal with unexpected expenses or disruption in their income.