Research Interests: industrial organization, health economics, public economics, education
An applied microeconomist, Professor Swanson’s research focuses primarily on the economics of health care. In particular, she studies the effects of industrial organization and information on choices, costs, and health outcomes. Her recent work has examined the effect of physician ownership on health care quality and provider incentives; the effects of lack of transparency and other frictions on negotiations between hospitals and suppliers; the effects of complex prices and payments from pharmaceutical firms on prescription drug utilization and prices; and the effects of insurers’ provider and pharmacy networks on prices.
Professor Swanson also studies the factors affecting high achievement in secondary education. Recent work includes studies on gender disparities and school quality.
Abstract: In markets where consumers seek expert advice regarding purchases, firms seek to influence experts, raising concerns about biased advice. Assessing firm-expert interactions requires identifying their causal impact on demand, amidst frictions like market power. We study pharmaceutical firms' payments to physicians, leveraging instrumental variables based on regional spillovers from hospitals' conflict-of-interest policies and market shocks due to patent expiration. We find that the average payment increases prescribing of the focal drug by 73 percent. Our structural model estimates indicate that payments decrease total surplus, unless payments are sufficiently correlated with information (vs. persuasion) or clinical gains not captured in demand.
Abstract: Using a detailed dataset of hospitals’ purchase orders, we find that information on purchasing by peer hospitals leads to reductions in the prices hospitals negotiate for supplies. Identification is based on staggered access to information across hospitals over time. Within coronary stents, reductions are concentrated among hospitals previously paying relatively high prices and for brands purchased in large volumes, and are consistent with resolving asymmetric information problems. Estimates across a large number of other important product categories indicate that the effects of information are largest in both absolute and relative terms for physician preference items (PPIs). Among PPIs, high-price, high-quantity hospital-brand combinations average 3.9 percent savings, versus 1.6 percent for commodities
Ashley Swanson and Amanda Starc (Working), What Do Private Firms Bring to the (Bargaining) Table? Vertical Structure and Negotiated Prices of Pharmaceuticals.
Jason Abaluck, Ashley Swanson, Jonathan Gruber (Under Review), Prescription Drug Use under Medicare Part D: A Linear Model of Nonlinear Budget Sets.
Abstract: Medicare Part D enrollees face a complicated decision: they dynamically choose prescription drug consumption in each period given difficult-to-find prices and a non-linear budget set. We use Part D claims data to estimate a flexible model of consumption that accounts for non-linear prices, dynamic responses, and salience. We use reduced form price responses from a linear regression of consumption on coverage range prices to compare performance under several models of behavior. We find small price elasticities, substantial myopia, and that salient characteristics impact consumption beyond their effect on prices. A hyperbolic discounting model with salience ts the data best.
Mark V. Pauly and Ashley Swanson (2017), Social Impact Bonds in Nonprofit Health Care: New Product or New Package?, The Journal of Law, Economics, and Organization, 33 (4), pp. 718-760.
Abstract: This paper considers a relatively new form of financing for social services, the “social impact bond (SIB).” Proponents of SIBs argue that they present a solution to several problems in funding social services, including performance incentives and risk allocation. Using a simple model, we first demonstrate that, despite their apparent novelty, SIBs in concept need not produce any difference in outcome from standard financing arrangements with private nonprofit firms. We then argue that SIBs will lead to greater program success if investors’ effort responds to incentives and can positively influence outcomes, either directly (e.g., effort exerted in production) or indirectly (e.g., effort devoted to screening), but are unlikely to do so otherwise. We conclude that, as in the more general theoretical literature, the value of this particular application in terms of funding innovation will be strongly context-dependent.
Heidi Allen, Ashley Swanson, Jialan Wang, Tal Gross (2017), Early Medicaid Expansion Reduced Payday Borrowing in California, Health Affairs, 36 (10), pp. 1769-1776.
Abstract: We examined the impact of California’s early Medicaid expansion under the Affordable Care Act on the use of payday loans, a form of high-interest borrowing used by low- and middle-income Americans. Using a data set for the period 2009–13 (roughly twenty-four months before and twenty-four months after the 2011–12 Medicaid expansion) that covered the universe of payday loans from five large payday lenders with locations around the United States, we used a difference-in-differences research design to assess the effect of the expansion on payday borrowing, comparing trends in early-expansion counties in California to those in counties nationwide that did not expand early. The early Medicaid expansion was associated with an 11 percent reduction in the number of loans taken out each month. It also reduced the number of unique borrowers each month and the amount of payday loan debt. We were unable to determine precisely how and for whom the expansion reduced payday borrowing, since to our knowledge, no data exist that directly link payday lending to insurance status. Nonetheless, our results suggest that Medicaid reduced the demand for high-interest loans and improved the financial health of American families.
Daniel Polsky, Zuleyha Cidav, Ashley Swanson (2016), Marketplace Plans with Narrow Physician Networks Feature Lower Monthly Premiums than Plans with Larger Networks, Health Affairs, 35 (10), pp. 1842-1848.
Abstract: The introduction of health insurance Marketplaces under the Affordable Care Act has been associated with growth of restricted provider networks. The value of this plan design strategy, including its association with lower premiums, is uncertain. We used data from all silver plans offered in the 2014 health insurance exchanges in the fifty states and the District of Columbia to estimate the association between the breadth of a provider network and plan premiums. We found that within a market, for plans of otherwise equivalent design and controlling for issuer-specific pricing strategy, a plan with an extra-small network had a monthly premium that was 6.7 percent less expensive than that of a plan with a large network. Because narrow networks remain an important strategy available to insurance companies to offer lower-cost plans on health insurance Marketplaces, the success of health insurance coverage expansions may be tied to the successful implementation of narrow networks.
Glenn Ellison and Ashley Swanson (2016), Do Schools Matter for High Math Achievement? Evidence from the American Mathematics Competitions, American Economic Reivew, 106 (6), pp. 1244-1277.
Abstract: This paper uses data from the American Mathematics Competitions to examine the rates at which different high schools produce high-achieving math students. There are large differences in the frequency with which students from seemingly similar schools reach high achievement levels. The distribution of unexplained school effects includes a thick tail of schools that produce many more high-achieving students than is typical. Several additional analyses suggest that the differences are not primarily due to unobserved differences in student characteristics. The differences are persistent across time, suggesting that differences in the effectiveness of educational programs are not primarily due to direct peer effects.
2017-present: The Economics of Health Care and Policy (PhD), Wharton School, University of Pennsylvania
2012-present: Cost-Benefit and Cost-Effectiveness Analysis (PhD), Health Care Strategy and Management: The Business of Health Care (UG), The Nonprofit Sector:
Economic Challenges and Strategic Responses (UG), Wharton School, University of Pennsylvania
2014-2015: Economics of Healthcare Service Delivery (MBA), Financing and Paying for Health Care (MBA), Economics and Management of the Biopharmaceuticals
Industry (MBA), Indian School of Business
2010-2012: Advanced Topics in Industrial Organization (TA) (PhD), Industrial Organization and Competitive Strategy (TA) (UG), MIT
The nonprofit sector plays a key role in the provision of many goods and services which are fundamental in our society and which may be difficult to provide using market mechanisms alone. Education, health care, charitable services, and the arts are some primary examples of these. Nonprofit organizations operate in service of specific social missions rather than profit maximization, but in order to serve those missions effectively while ensuring their own survival, they must also make many of the decisions typically associated with private firms. That is, they must compete for funding, human resources, and consumers of their services, they must manage and invest their resources efficiently, and they must innovate new products and services over time. Importantly, the latter requirements may at times come in conflict with the organizations' social values. As a result, nonprofit organizations as economic decision-makers confront a number of unique challenges to their success and growth. The goal of this course is to give students a broad overview of the economic, organizational, and strategic concerns facing the non-profit sector. Our objective is to characterize the unique economic environment, identify effective strategic governance, and management approaches, and explore how appropriate measurement techniques can can inform the policy treatment of nonprofits. This course is organized around a number of lectures, readings and outside speakers, a midterm exam and a required project.
This course presents an overview of the business of health and how a variety of health care organizations have gained, sustained, and lost competitive advantage amidst intense competition, widespread regulation, high interdependence, and massive technological, economic, social and political changes. Specifically, we evaluate the challenges facing health care organizations using competitive analysis, identify their past responses, and explore the current strategies they are using to manage these challenges (and emerging ones) more effectively. Students will develop generalized skills in competitive analysis and the ability to apply those skills in the specialized analysis of opportunities in producer (e.g. biopharmaceutical, medical product, information technology), purchaser (e.g. insurance), and provider (e.g. hospitals, nursing homes, physician) organizations and industry sectors. The course is organized around a number of readings, cases, presentations, and a required project.
The purpose of this doctoral level course is to investigate the theory and practice of cost-benefit and cost-effectiveness analysis as applied to health care. The three techniques to be examined are cost-effectiveness analysis with single dimensional outcomes, cost effectiveness analysis with multiple attributes (especially in the form of Quality Adjusted Life Years), and economic cost-benefit analysis. Valuation of mortality and morbidity relative to other goods will be emphasized. Students will be expected to develop written critiques of articles in the literature, and to design a new application of one of the techniques as a term project.
This course applies basic economic concepts to analyze the health care market and evaluate health policies. The course begins with a discussion of productivity in health care and of the theoretical and empirical effects of asymmetric information and market failure. The second part of the course explores several topic areas in the health care economics literature: health insurance and the labor market; health policy interventions; and health as human capital. The third part of the course examines competition and the behavior of health care providers, with emphasis on the impact of policy on competition, behavior, and finally, bringing us full circle, health care productivity.
Complexity, increasingly complex technologies and rapidly changing disease patterns make institutional partnerships for health care construction projects more viable.Knowledge @ Wharton - 2017/10/26