Job Market Paper

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.
2020
JMP Draft

Publications

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.
Health Economics,2020
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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.
Health Economics,2019
PDF Working Paper version

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.
Acta Médica Portuguesa (in Portuguese),2018
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Working papers

We study disease control in a game of imperfect information. While disease control games of perfect information tend to have multiple equilibria, we show that even a small amount of uncertainty leads to equilibrium uniqueness. In equilibrium, an epidemic may occur even though it is ineffcient and could have been avoided. Moreover, less harmful diseases may cause more deaths. We extend the game to study cooperation and let a subset of players commit to control the disease whenever the expected benefit of doing so is sufficiently high. The equilibrium is again unique. Selection of a more favorable equilibrium is facilitated by this type of cooperation.
2020
Draft

Work in Progress

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.
2020

CV

A full version of my CV is available here.

Recent & Upcoming Talks

November 2020:

  • Health Economics Bristol

  • Center for Health Economics at Monash University

  • DGGÖ Health Econometrics Workshop

Teaching

Tilburg University

Fall 2019 and fall 2020: Teaching assistant for Statistics & Data Management 2 (BSc course) and a grader for Statistics (Pre-MSc course).

Fall 2017 and fall 2018: Teaching assistant for Data-Analysis (BSc course) and Statistics (Pre-MSc course).

School of Public Health, Universidade Nova de Lisboa

Fall 2014: Teaching assistant for Health Economics (MSc course for the Healthcare Management, Hospital Management, and Public Health programs).

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