In the last two decades, many European countries allowed the sale of Over-the- Counter (OTC) drugs outside pharmacies. This was expected to lower retail prices through increased competition. Evidence of such price reductions is scarce. We assess the impact of supermarket and outlet entry in the OTC drug market on OTC prices charged by incumbent pharmacies using a difference-in-differences strategy. We use price data on five popular OTC drugs for all retailers located in Lisbon for three distinct points in time (2006, 2010, and 2015). Our results suggest that competitive pressure in the market is mainly exerted by supermarkets, which charge, on average, 20% lower prices than pharmacies. The entry of a supermarket among the main competitors of an incumbent pharmacy is associated with an average 4 to 6% decrease in prices relative to the control group. These price reductions are long-lasting, but fairly localized. We find no evidence of price reductions following OTC outlet entry. Additional results from a reduced-form entry model and a propensity score matching difference-in-differences approach support the view that these effects are causal.

We assess the relative importance of demand and supply factors as determinants of regional variation in healthcare expenditures in the Netherlands. Our empirical approach follows individuals who migrate between regions. We use individual data on annual healthcare expenditures for the entire Dutch population between the years 2006 and 2013. Regional variation in healthcare expenditures is mostly driven by demand factors, with an estimated share of around 70%. Both demographics and other unobserved demand factors, e.g. patient preferences, are important components of the demand share. The relative importance of different causes varies with the groups of regions being compared.

We evaluate the evolution of the socioeconomic inequalities regarding registration with family physicians in Portugal between 2009 and 2014. We use data at the primary health care unit level on the number of individuals who are not registered with a family physician and the purchasing power of the population served by each unit. The analysis is done using concentration measures. We find a higher concentration of individuals not registered with a family physician among units serving populations with higher socioeconomic status, although this has been decreasing over the years analyzed. Amongst units serving the most disadvantaged populations, we find a situation close to perfect equality. Our findings convey a reduction in existing socioeconomic inequalities in terms of registration with a primary care physician, during the period under analysis. This reduction took place among the populations which experienced more inequality.

Excessive length of hospital stay is among the leading sources of inefficiency in healthcare. When a patient is clinically fit to be discharged but requires support outside the hospital, which is not readily available, they remain hospitalized until a safe discharge is possible —a phenomenon called bed-blocking. I study whether the entry of subsidized nursing homes (NH) and home care (HC) teams reduces hospital bed-blocking. I use individual data on emergency inpatient admissions at Portuguese hospitals during 2000-2015. My empirical approach exploits two sources of variation. First, variation in the timing of entry of NH and HC teams across regions, originating from the staggered implementation of a policy reform. Second, variation between patients in their propensity to bed-block. I find that the entry of HC teams in a region reduces the length of stay of individuals at increased risk of bed-blocking by 4 days relative to regular patients. Reductions in length of stay upon the entry of NH occur only for patients with high care needs. The reductions in length of stay do not affect the treatment received while at the hospital nor the likelihood of a readmission. The beds freed up by reducing bed-blocking are used to admit additional elective patients. I also provide evidence on the mechanisms preventing the complete elimination of bed-blocking.

We study disease control in a global game. While disease control games of perfect information have multiple equilibria, we show that even a vanishing amount of uncertainty forces selection of a unique equilibrium, leading to several new results. In well-identified cases, an epidemic will occur albeit it is inefficient and could be avoided. More harmful diseases are less likely to become an epidemic and pose a lower burden on society. We also study cooperation and let some players commit to control the disease whenever the expected benefit is sufficiently high. Cooperation facilitates selection of an efficient equilibrium.

Payments to healthcare providers are increasingly tied to their performance on various measures. We study the introduction of a program aimed at reducing c-section rates in public hospitals in Portugal by penalizing hospitals whose c-section rates are higher than government-set thresholds. Our empirical strategy exploits of the fact that c-section rates are persistent over time and thus hospitals were exposed to different penalty sizes, depending on their historical c-section rates. We find that the introduction of the penalty contributed to reduce c-section rates. Our results also suggest a potential unintended effect of the policy: women exhibiting some pregnancy risk-factors which are indicators for c-section in clinical guidelines experience a reduction in the likelihood of receiving a c-section. We also study spillover effects of the program to private hospitals.

A large literature in health economics seeks to understand the impact of geographic proximity to healthcare providers on health outcomes. This literature typically exploits hospital closures. Instead, I use highway network expansions, which reduce travel time to the hospital, to examine the impact of geographic proximity to a hospital on heart attack mortality. Preliminary findings suggest only modest improvements in survival for the average patient. The effects are concentrated in patients living in the most remote areas, which experienced the largest reductions in travel times.