Research:
Clean Water Makes You Dirty: Water Supply and Sanitation Behavior
in the Philippines (under review)
Improving the water supply is a common policy response to endemic diarrhea in developing countries. However, water supply interventions may inadvertently worsen community sanitation by mitigating the consequences of unsanitary behavior. Since sanitation has large health externalities, the impact of declining sanitation may overwhelm the benefit of receiving clean water. This paper shows how the expansion of municipal piped water in Metro Cebu, the Philippines has exacerbated public defecation and garbage disposal. According to estimates, a neighborhood's complete adoption of piped water increases public defecation and garbage by 15-30 percent. I rely on fixed effects, instrumental variables, and other robustness checks to rule out competing explanations for this finding. Next I develop and test a simple model in which sanitation is a local public good. Empirical tests demonstrate that sanitation has large positive externalities and support the hypothesis that piped water may exacerbate diarrheal disease.
Competing Doctors, Antibiotic Use, and Antibiotic Resistance in Taiwan (under review)
(with Tsai-Ling Lauderdale and Che-Lun Hung)
Antibiotics are a cornerstone of modern medicine, but antibiotic resistance increasingly threatens to erode their effectiveness. The emergence of drug-resistant pathogens is a negative externality associated with antibiotic use. Many patients, who do not internalize this social cost, prefer physicians who casually prescribe antibiotics. If offering these drugs increases demand, physicians may respond to competition by prescribing antibiotics more frequently. This paper examines the effect of competition in outpatient health care markets on antibiotic use in Taiwan. In a large, nationally representative dataset of outpatient visits, an increase in competition of one standard deviation raises antibiotic use by up to 2.4 percent. Patient and physician fixed effects and the interaction with a policy to limit antibiotic use point to an effect of competition on behavior, rather than a spurious correlation. The paper then calibrates the relationship between antibiotic use and resistance to estimate the effect of competition on this outcome. An increase in competition of one standard deviation elevates resistance by up to 11.5 percent, leading to $1.36 billion in additional costs, or 35 percent of Taiwan's antibiotics budget over 60 years.
Ambiguity and Social Learning During the SARS Panic of 2003 (draft coming soon)
(with Chun-Fang Chiang and Anup Malani)
Market Structure and Pharmaceutical Quality in India (ongoing data collection)
(with Wesley Yin)