Primary Research Focus: Applied Microeconomics, Health Economics

Secondary Research Focus: Public Finance

References: 

• Joshua Gottlieb (Chair)
• Manasi Deshpande
• Zarek Brot

Job Market Paper: "Crowding out or crowding in? FQHC expansion and the health safety net"

[Abstract] To what extent does government support for safety-net providers add care in underserved markets, and to what extent does it crowd out care from unsubsidized providers? I study this in the context of the United States' Federally Qualified Health Center (FQHC) program. Using a sample of primary care markets with subsidized FQHC sentry during 2019--2024 and data on Medicaid claims by every provider in those markets, I estimate that the extent to which entry of FQHCs crowds out other providers. Using a difference-in-differences design, I find that a \$1 increase in FQHC billing is associated with a 33 cent reduction in billing by other primary-care providers. Beneficiary counts show the same provider shift. On the extensive margin, for every FQHC entrant, there is an associated 0.21 increase other primary-care providers that exit the Medicaid billing market. Lastly, an analysis of a longer county panel shows significant mortality reductions after FQHC entry, concentrated in maternal/neonatal mortality and HIV/AIDS mortality. This suggests that despite moderate crowd-out, the reallocation of care toward FQHCs may improve health outcomes through higher quality care.