Research

Working Papers

Mis(sed) Diagnosis: Physician Decision Making and ADHD

Revise & Resubmit, Journal of Political Economy

While the presence of disparities in mental healthcare is well documented, the mechanisms of such disparities are less understood. In this paper, I develop and estimate a structural model of diagnosis for a prevalent child mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). The model incorporates both patient and physician influences to highlight various mechanisms of mental health diagnosis and sources of disparities. Using electronic health record data and novel natural language processing techniques applied to doctor note text, I estimate gender-specific model parameters and decompose the male: female ADHD diagnostic difference of 2.5:1 observed in the data. Counterfactual simulations show that only 33% of this diagnostic difference can be explained by underlying symptom prevalence, with the remainder driven by differences in diagnostic thresholds. I find that physicians view missed diagnosis to be costlier than misdiagnosis, especially for their male patients, and I discuss reasons why this may be economically warranted.

The Role of Information in Pharmaceutical Advertising: Theory and Evidence -with Conor Ryan

Revise & Resubmit, Review of Economics and Statistics

This paper theoretically and empirically examines the role of information in the practice of pharmaceutical detailing (promotional interactions between drug representatives and physicians). We start with a theoretical framework in which pharmaceutical firms target detailing visits to physicians who potentially learn about drug quality and prescribe it to their patients. We derive several predictions about the role of information in these visits, which we then test empirically using Medicare Part D prescriptions and pharmaceutical detailing visit data. We find there is little empirical evidence to support learning as a primary mechanism of detailing visits and, in fact, document strong evidence to the contrary.

Physician Practice Style for Mental Health Conditions: The Case of ADHD

There is a robust literature documenting the importance of physician practice style (e.g., the propensity to perform certain operations) in explaining outcomes related to patients' physical health. Yet, little is known about the role of physicians in explaining patients' mental health outcomes. This paper uses novel data on doctor note text together with natural language processing techniques to estimate and document heterogeneity in physician practice style for diagnosing Attention Deficit Hyperactivity Disorder (ADHD). I find significant variation in both diagnostic intensity (the mean propensity to diagnose) and diagnostic compliance (the weight that physicians place on medical guidelines). I show that physician characteristics can explain some of this heterogeneity, with both female physicians and recent graduates having higher diagnostic compliance and lower diagnostic intensity than their respective counterparts.

Works in Progress

Measuring Hospital Quality Response to the Coronavirus Pandemic -with Gautam Gowrisankaran and Robert Town

Common Ownership Effects and the Market for Nursing Homes -with Anthony LoSasso and Aryan Safi

Missing Stars: Gender Differences in the Assessment of Gifted Students -with Beatrix Eugster and Aurelien Sallin

Publications

Journal Articles

Societal Disruptions and Childhood ADHD Diagnosis During the COVID-19 Pandemic.
-with Seth Freedman, Dario Salcedo, Kosali Simon, and Coady Wing
2023. Journal of Human Resources 59(S), S187-S226.
NBER working paper version <here>

Local Economic Conditions and Fertility from the Great Depression through the Great Recession.
-with Jessamyn Schaller and Price Fishback
2020. AEA Papers and Proceedings (Vol. 110, pp. 236-40) 

Nonparametric Estimation of Production Functions.
-with Trevor Collier and John Ruggiero
2016. Data Envelopment Analysis Journal 2(1), pp. 35-52.

Book Reviews

Liran Einav and Amy Finkelstein: “We’ve got you Covered: Rebooting American Health Care”
2024. Business Economics 59, 190–192.

Software

GGT: STATA module to implement Geweke, Gowrisankaran, and Town Model Quality Estimator.
-with Gautam Gowrisankaran and Robert Town. Uploaded December 2019. Version 2- August 2021.

Available for download at: https://ideas.repec.org/c/boc/bocode/s458713.html

RESTING PaperS

A Re-Examination of Parental Divorce and Child Mental Health in the 21st Century -draft available upon request.