Job Market Paper
Regulating the Innovators: Approval Costs and Innovation in Medical Technologies
Selected for presentation at the 2023 NBER Economic Analysis of Regulation Conference
Winner of the Best Paper Award at the Southern California Graduate Conference in Applied Economics 2021
Media Coverage: Marginal Revolution
Abstract: How does FDA regulation affect innovation and market concentration? I examine this question by exploiting FDA deregulation events that affected certain medical device types but not others. I collect comprehensive data on medical device innovation, device safety, firm entry, prices, and regulatory changes and enhance these data using text analysis methods. My analysis of these data reveals three key findings. First, deregulation events significantly increased the quantity and quality of new technologies in affected medical device types relative to controls. These increases are particularly strong among small and inexperienced firms. Second, these events increased firm entry and reduced prices for medical procedures that utilize affected medical device types. Finally, rates of serious injuries and deaths attributable to defective devices did not significantly increase following these events. Interestingly, deregulating certain device types was associated with reduced adverse event rates, possibly due to firms increasing their emphasis on product safety in response to increased litigation risk.
Demand Shocks, Procurement Policies, and the Nature of Medical Innovation: Evidence from Wartime Prosthetic Device Patents
(with Jeffrey Clemens). Conditionally accepted at the Review of Economics and Statistics
Selected for presentation at the 2020 NBER Summer Institute Public Economics workshop
Media Coverage: VoxEU, The Conversation, Marginal Revolution
Abstract: We analyze wartime prosthetic device patents to investigate how procurement policy affects the cost, quality, and quantity of medical innovation. Analyzing whether inventions emphasize cost and/or quality requires generating new data. We do this by first hand-coding the economic traits emphasized in 1,200 patent documents. We then train a machine learning algorithm and apply the trained models to a century's worth of medical and mechanical patents that form our analysis sample. In our analysis of these new data, we find that the relatively stingy, fixed-price contracts of the Civil War era led inventors to focus broadly on reducing costs, while the less cost-conscious procurement contracts of World War I did not. We provide a conceptual framework that highlights the economic forces that drive this key finding. We also find that inventors emphasized dimensions of product quality (e.g., a prosthetic's appearance or comfort) that aligned with differences in buyers' preferences across wars. Finally, we find that the Civil War and World War I procurement shocks led to substantial increases in the quantity of prosthetic device patenting relative to patenting in other medical and mechanical technology classes. We conclude that procurement environments can significantly shape the scientific problems with which inventors engage, including the choice to innovate on quality or cost.
(first author with Aaron Boussina, Supreeth Shashikumar, Gabriel Wardi, Christopher Longhurst, Shamim Nemati)
Accepted at the Journal of Medical Internet Research, 2023.
Research Question: Are there ways to embed economics into AI models used in health care settings? Our research takes a cost-benefit approach to optimize the use of an AI algorithm that alerts healthcare providers to sepsis cases within a specific diagnostic group, such as heart disease. Our simulations show potential cost savings of $4.6 billion and higher accuracy using our implementation.
Works in Progress
Abstract: We study how government price reforms affect innovation and welfare in the health care sector. We exploit a Medicare payment reform that effectively reduced the reimbursement price for certain types of durable medical equipment (DME) by 45% but left other DME types unchanged. Using DME patents and the FDA medical device database, we find that manufacturers filed fewer patents and introduced fewer new models in DME types affected by the price cut compared to those unaffected. Text analysis of the patent documents suggests that patents filed after the price cut were more likely to emphasize cost efficiency relative to the control. However, reported device breakage and adverse events also increased relative to the control. These effects were largely driven by increased contracting with foreign manufacturers, which tend to cost less but produce lower quality devices. While price regulation in health care can effectively reduce spending, our results show that welfare gains from these savings can be offset by reduced innovation and product quality in the longer term. Our analysis highlights the importance of incorporating long-run dynamics into policy decisions.
The Effect of Deregulation on the Cost, Availability, and Quality of Health Care
(with Yunan Ji and Maggie Shi)
Funding received: $91,700 ($23,700 — NSF Dissertation Improvement; $35,000 — Mercatus Center at GMU; $33,000 — Georgetown Business of Health Initiative)
Abstract: We study the effects of FDA regulation on the cost, availability, and quality of health care. Our analysis exploits a deregulation event that removed pre-market testing requirements for over 250 medical device types. We leverage rich, transaction-level data on device purchases made by healthcare providers, as well as claims for medical procedures performed using purchased devices. We first consider the effects of deregulation on the prices, quantities, and characteristics of devices purchased and procedures performed. We then consider the implications for healthcare access and patient health. Our results will shed light on how government regulation affects the interactions between the key players in the healthcare supply chain, and how these interactions contribute to healthcare costs, quality, and accessibility in the United States.
The Unintended Effects of Social Media Nudges on SNAP Take-Up
Abstract: The incomplete take-up of US social safety net programs is an enduring puzzle. I test whether nudges delivered on Facebook increase the take-up of the Supplemental Nutritional Assistance Program using a field experiment in California with government and non-profit partners. Over 16,000 SNAP-eligible non-participants were randomly assigned to a control group or to receive ads in their news feeds that either provided information about benefit amounts, emphasized a low-cost, streamlined application process, or de-stigmatized participation. The experiment also used a separate Spanish speaker arm with Spanish-translated text. I find that nudges did not increase take-up. Surprisingly, outreach decreased take-up and increased withdrawals among Spanish speakers, an effect plausibly driven by stigma and confusion.