Questions about whether the benefits of additional medical spending exceed their costs have long been studied in the health economics literature, but the marginal returns to care during pregnancy have received little attention. I study gestational diabetes mellitus (GDM), an increasingly common pregnancy complication, and estimate the marginal returns to diagnosis. I use a regression discontinuity design and compare patients just above and just below the diagnostic threshold. Using MarketScan claims and laboratory data, I find that diagnosis at the margin increases a woman’s out-of-pocket spending on diabetes and nutrition services by approximately $28 per additional diagnosis, while producing no detectable increase in total pregnancy spending. For this modest increase in spending on these services, crossing the threshold yields substantial infant health benefits: women diagnosed at the margin have 1.36 percentage points lower rates of infant macrosomia and 1.33 percentage points lower rates of NICU admission. Relative to the rates just below the cutoff, these declines are roughly 60 and 55 percent.
Low fertility has emerged as a defining demographic challenge globally. Even within the United States, where overall fertility has trended downward, fertility rates exhibit substantial geographic heterogeneity. These wide and persistent differences raise a question: to what extent do they reflect causal effects of place, rather than compositional sorting or other socioeconomic factors? We leverage quasi-random military duty-station assignments to study place and peer effects on fertility. Linking duty-station histories to annual fertility outcomes, dependent-status records, and marital transitions, we estimate how exposure to different local family environments affects subsequent fertility, marriage, and divorce. Our design uses commuting-zone indicators and inverse-propensity score weights to adjust for branch- and occupation-based assignment patterns. We estimate gender-specific place effects and examine marriage and divorce as related behavioral margins, providing causal evidence on whether local norms, family structures, and community environments shape fertility decisions.
This study examines whether adoption of full nurse practitioner (NP) scope-of-practice laws expands the long-run primary care workforce by increasing entry into nursing and NP training pathways. Using 2000-2019 ACS, IPEDS, and National Council of State Boards of Nursing data, we estimate stacked difference-in-differences and event-study models to assess effects on college major choice, graduate degree attainment, nurse licensure, and RN exam candidates. Preliminary results indicate that full SOP adoption increases nursing majors, partly by drawing students away from life sciences, but provides limited evidence of increased graduate training or NP entry, suggesting that these policies expand RN supply more than the NP workforce.
I study whether GLP-1 initiation affects fertility and pregnancy outcomes among reproductive-age women with obesity using 2016-2024 Merative MarketScan Commercial claims. I document the size and composition of the GLP-1 candidate population, uptake among reproductive-age women, and medication use before, during, and after pregnancy. I then estimate effects on deliveries and related outcomes using an incident-user design and stacked cohort-specific difference-in-differences models with individual fixed effects to address endogenous treatment timing and fertility intent.
Using detailed national mortality records, we examine how the decline in US drug overdose mortality from 2022 to 2024 varied across counties. We assess differences across substances and examine how county characteristics and earlier overdose trends relate to these changes. Our findings show that declines were widespread but uneven across communities and were largest for deaths involving synthetic opioids, primarily fentanyl.
This project studies whether residential moves to higher- or lower-fertility areas affect subsequent childbearing among U.S. women of childbearing age. Using linked restricted-use ACS and administrative residence records, it reconstructs migration histories and fertility outcomes to estimate place effects on fertility while evaluating the quality of Census residence-history data.
This project examines how local disruptions to formal care supply, caused by nursing home and childcare facility closures, affect household behavior across the life cycle. Using linked administrative and survey data in a stacked difference-in-differences design, it estimates effects on mortality, residential arrangements, labor supply, earnings, migration, fertility, and household formation among elderly individuals, adult children, and parents of young children.
This study examines whether earlier access to COVID-19 vaccination improved academic outcomes among K-12 students in Indiana. Leveraging a sharp date-of-birth discontinuity in vaccine eligibility in May 2021, we use statewide student-level test score and attendance records from 2018-2024 to compare early-eligible and late-eligible cohorts in a difference-in-differences framework with student and year fixed effects. We estimate effects on standardized test performance and attendance during the 2021-2023 school years, assess pre-treatment trends using event-study models, and examine heterogeneity by socioeconomic status.