Job Market Paper
“Deferring Agency at End-of-Life: The Role of Information, Nudges, and Advance Directives“ (with Allyson B. Root and Benjamin Handel)
My job market paper involves a randomized control trial in partnership with a large Northwest U.S. health care system to improve advance directive completion in older adults through written reminders and gentle nudges in a behavioral economics framework.
Abstract: Despite the substantial economic and personal implications of end-of-life health care decisions, many fail to document their wishes or select a representative to make medical decisions on their behalf. Descriptive evidence suggests that this can result in sub-optimal outcomes including dissatisfaction and unnecessary medical spending, but it is not well understood why patients fail to engage in this high-value planning. We conduct an initial and subsequent intervention to facilitate advance directive (AD) completion in the patient population of our partner, Providence St. Joseph Health (PSJH). Using a randomized control trial, we find a significant 5 percentage point increase in AD completion with physical letter reminders tied to future primary care appointments, doubling the completion rate in the patient population from the start of the study. In addition, we find that including the physical AD form with paper letters as a nudge to decrease hassle costs increases AD completion 9 percentage points compared to no intervention. Our evidence also suggests that these interventions are more effective for older individuals, who are also less sensitive to the type of intervention. Back-of-the-envelope calculations suggest that it would cost $38 for every additional AD form completion using paper letters and included AD forms, compared to costless electronic reminders. However, we find no significant effects in AD completion from the initial intervention involving in-person AD drives and electronic videos.
- Initial study trial registration: https://doi.org/10.1257/rct.3038-1.0
- Subsequent study trial registration: https://doi.org/10.1257/rct.4212-1.0
- J-PAL initiative
“Risky Business: Plan Choice, Risk Adjustment, and Inertia in the CalPERS Health Insurance Market” (with Benjamin Handel, Lynn M. Hua, and Yuki Ito)
“Consumption and Retirement Changes from Medical Anxiety: Long-Term Effects of False Positives in Breast Cancer“
“Early Impact of the State Innovation Models Initiative on Diagnosed Diabetes Prevalence Among Adults and Hospitalizations Among Diagnosed Adults” (with Brent Fulton and Hector Rodriguez; Medical Care)