Work in Progress
with David C. Chan, Nancy L. Keating, Bruce E. Landon, and Michael L. Barnett
Working Paper · NBER SI Presentation
Abstract
We estimate the returns to specialization in a knowledge-intensive profession. In medical oncology, subspecialists focus on specific cancer types, but access varies geographically. Using 2.2 million Medicare chemotherapy episodes from 2008–2020, we instrument for subspecialist access with differential distance to cancer-type-specific subspecialists versus general oncologists. Access to a relevant subspecialist reduces three-year mortality by 4.5 percentage points (10 percent), with no increase in Medicare spending. Subspecialists also increase the use of newer therapies and diagnosis-specific clinical trials. These findings show that specialization can raise productivity when expertise is closely matched to the task.
Working Paper
Abstract
The establishment of hydroelectric power plants resulted in a rapid structural transformation of Norwegian municipalities around the beginning of the 20th century. Using a novel dataset linking individuals born between 1890 and 1910 to historic death data, I find that experiencing childhood in rapidly transforming local areas leads to an increase of ten months in age at death for men. This effect is entirely driven by individuals born into higher socioeconomic status households. I find that incomes, manufacturing, immigration and economic inequality in local areas in the short/medium-term increase after the introduction of hydropower, while public health deteriorates at the same time. This suggests that, in the long term, economic development through structural transformation outweighs the negative consequences of a deteriorating public health environment and thereby increases the lifespan of individuals.