Essays in Health Economics

Abstract

This dissertation comprises three essays in health economics. The first paper studies how imperfect electronic health record (EHR) system compatibility, or interoperability, affects patients. My coauthors, Rebekah Dix and Thi Mai Anh Nguyen, and I find that improved EHR interoperability between hospitals leads to better health outcomes and lower costs for shared patients. We also show that hospitals prefer sending patients to facilities with more compatible EHR systems, causing patient reallocation across providers based on technological factors. Using a model of patient flows, we estimate that eliminating these frictions would generate substantial welfare gains by improving patient outcomes and reducing allocative distortions. The second paper examines how regulatory requirements influence hospital charity care by analyzing the Hill-Burton Act of 1946, which allocated $6 billion to over 3,500 hospitals in exchange for providing free care to uninsured patients. I find that after these obligations expire, hospitals strategically reduce charity care by 30% and decrease admissions of charity-eligible patients by 14%. These patients subsequently shift to neighboring public and non-profit hospitals, where they must pay for care and experience higher mortality rates. The third paper, co-authored with Ari Bronsoler, Joseph Doyle, and John Van Reenen, studies the broad impact of Health Information Exchange (HIE) on patient outcomes. Using a newly compiled database of state HIE laws as instruments for hospital HIE, we find that HIE significantly reduces mortality from infectious diseases and hospital readmission rates for common conditions. With HIE usage increasing by 50 percentage points from 2009 to 2019, we estimate this technology saved approximately 27,000 lives annually through improved care coordination and public health response.