There is growing evidence that inappropriate prescribing is harming patients and raising costs in the US health care system. Through a partnership between the federal government and academics, we seek to develop evidence on reducing this prescribing. We conduct several randomized letter interventions targeting high-volume prescribers of drugs that can harm patients. We take a continuous improvement approach, rapidly evaluating each round and using the results to inform subsequent work. The first round of letters yielded no effects, and we responded with new interventions that are now under evaluation. We discuss lessons our work provides for future government-academic partnerships.

We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients’ severity of illness. We construct a simulated instrument that predicts a hospital’s policy-induced change in reimbursement using pre-reform patients and postreform rules. The reform led to large persistent changes in Medicare payment rates across hospitals. Hospitals that faced larger gains in Medicare reimbursement increased the volume of Medicare patients they treated. The estimates imply a volume elasticity of 1.2. To accommodate greater volume, hospitals increased nurse employment, but also lowered length of stay.

Administrative barriers to social insurance program take-up are pervasive, including in subsidized health insurance. We conducted a randomized controlled trial with Massachusetts' Affordable Care Act marketplace to reduce these barriers and other behavioral frictions. We find that a “check the box” streamlined enrollment intervention raises enrollment by 10.5%, more than personalized reminder letters (7.6% increase) or generic reminder letters (4.3% increase). Effects are concentrated among individuals eligible for zero-premium plans, who faced no further administrative burdens of setting up payments. Producing this enrollment effect through premium reduction would cost about $7 million in subsidies, highlighting the importance of these burdens.

Despite the continuing U.S. hospital merger wave, it remains unclear how mergers change, or fail to change, hospital behavior and performance. We open the black box of hospital practices through a megamerger between two for-profit chains. Benchmarking the merger's effects against the acquirer's stated aims, we show they achieved some of their goals, harmonizing electronic medical records and sending managers to target hospitals. Postacquisition managerial processes were similar across the merged chain. However, these interventions failed to drive detectable gains in performance. Our findings demonstrate the importance of organizations for merger research in health care and the economy more generally.