Meng Zhu, PhD, Professor, Johns Hopkins Carey Business School
Might the Introduction of Video Technology Amplify Inequalities in Accessing Healthcare Resources? An Empirical Analysis of Mental Health Therapies
Abstract: The distribution and allocation of healthcare resources are important indicators to address health inequalities. Telemedicine through virtual visits has become prominent since the pandemic. As an alternative to in-person office visits, virtual visits allow patients from regions with scarce health resources to access high-quality care. The convenience of teletherapy compared to office visits certainly attracts more people to choose online services. This is especially true for non-emergency care like mental health therapies, where the difference in service quality between the online and offline offerings is arguably not substantial. However, patients might face considerable uncertainty when selecting among therapists through traditional webpages that typically contain only texts and profile pictures. Introducing doctor profile videos allows therapists to provide detailed background information about their services as well as themselves (e.g., the therapist’s voice, style, and clinical environment). On one hand, such additional information conveyed through profile videos might facilitate preference matching, further enabling patients to choose the proper therapist. On the other hand, since the online population is less geographically restricted, the additional information conveyed through profile videos might generate increased demand, which could potentially raise the price of therapy, subsequently exacerbating inequalities in access to care. In our study, we investigate whether the introduction of profile videos affects the pricing of online versus offline therapy services (especially among patients from low-income regions). Using a dataset from one of the largest mental health teletherapy platforms in the U.S., we examined over 170,000 therapists and their decisions of whether to introduce profile videos. Leveraging a causal inference framework featuring the random forest method, we find that the introduction of profile videos is a double-edged sword. Specifically, while the introduction of profile videos increased the overall demand for the featured therapists, it also led to a premium for the price of offline, in-person therapy (with the price of the online teletherapy remaining unchanged). This effect was amplified in low-income regions, which further jeopardized inequalities in access to care. Our results carry policy implications for the nuanced interplay between technology adoption and healthcare inequalities.
Yashaswini Singh, PhD Candidate, Johns Hopkins Bloomberg School of Public Health
Can Private Equity Buy Referrals? Evidence from Multispecialty Physician Practice Acquisitions
Abstract: Multispecialty physician practices (MSP) incentivize referrals from generalists to be made to specialists within the practice. With growing acquisitions of MSP by private equity funds (PE), there is concern that high-powered for-profit incentives of PE may accelerate misalignments in patient-physician relationships to increase self-referrals with unknown implications for patient welfare. Using novel data on PE acquisitions linked to Medicare claims data, I advance the literature on PE and vertical integration in health care markets by studying the precise ways that acquisitions of MSP by PE change strategic referral behavior. I base my empirical analysis on 230 acquisitions of MSP over a 4-year period. Using a discrete choice model, I find that PE acquisitions increase self-referrals by 7 percent. I then consider the channels through which acquisitions produce such large changes in self referrals, finding that increased market power or endogenous acquisition selection cannot explain increases in self-referrals. Rather, my main results are driven by the adoption of PE’s managerial strategies. Finally, I consider the welfare implications for patients and payers. Self-referrals can reduce welfare if they foreclose competing specialists from accessing patient referrals; on the other hand, self-referrals can improve welfare if they facilitate care coordination between generalists and specialists. I find both forces to be present. Taken together, this paper contributes policy-relevant evidence that the heterogeneous effects of vertical integration depend on the managerial environment that shape provider incentives. As the United States continues to transition towards value-based care contracts that pay for clinical performance, corporate ownership in multispecialty settings may have the potential to leverage managerial skills to improve clinical in addition to financial outcomes.
Work-in-Progress Seminar Series
Are you committed to supporting your colleagues in the development of interdisciplinary research on the business of health? Are you open to meeting and collaborating with researchers at JHU you don't know? We invite you to join our work-in-progress (WIP) seminar series, at the heart of HBHI’s mission to promote a healthier America.
First Fridays @HBHI
12 to 1 p.m. ET via Zoom
Serving as incubator for bold new ideas, the WIP seminar provides an internal forum for Johns Hopkins scholars, both students and faculty to:
Present initial stage research
Receive feedback from an interdisciplinary audience
Explore potential partnerships
By pooling the collective subject matter expertise of Johns Hopkins faculty, the WIP series accelerates and enhances new research.
If you are an HBHI affiliate and interested in presenting in the WIP series, please email Michael Darden. Provide a proposed title for your presentation.
Email [email protected] to be added to the WIP listserv.