Healthcare providers often deviate from guidelines, leading to worse outcomes. I study the impact of academic detailing (also known as educational outreach) to primary care teams on safer pain management, risk evaluation, harm reduction, and opioid use disorder treatment. Using data from over 5 million patients, I find detailing improves provider behavior: it increases naloxone prescribing, prescription drug monitoring queries, and reduces opioid prescriptions for three years. Patients have fewer emergency visits and hospitalizations for overdoses, suicides, and accidents, especially heavy opioid users. Importantly, pain scores remain stable despite reduced opioid use, highlighting detailing's role in fostering safer, effective care.

We use data from the Veterans Administration to examine the efficacy of primary care providers (PCPs). Leveraging quasi-random assignment of veterans to PCPs, we measure effectiveness using ambulatory care sensitive conditions (ACSC) and hospitalizations/emergency department (ED) visits for mental health or circulatory conditions. PCPs variation along these dimensions predicts future outcomes. For example, a one standard deviation improvement in mental health effectiveness reduces patient risk of death by 3.8% and lowers costs by 4.4% over the next three years. More effective PCPs do more with less: their patients have fewer primary care visits, specialist referrals, lab panels, or imaging tests.

We leverage spatial variation in the severity of the Great Recession across the United States to examine its impact on mortality and explore the quantitative implications. We estimate that an increase in the unemployment rate of the magnitude of the Great Recession reduces the average annual age-adjusted mortality rate by 2.3%, with effects persisting for at least 10 years. Mortality reductions appear across causes of death and are concentrated in the half of the population with a high school degree or less. We estimate similar percentage reductions in mortality at all ages, with declines in elderly mortality thus responsible for about three-quarters of the total mortality reduction. Recession-induced mortality declines are driven primarily by external effects of reduced aggregate economic activity on mortality, and reduced air pollution appears to be a quantitatively important mechanism. Incorporating our estimates of procyclical mortality into a standard macroeconomic framework substantially reduces the welfare costs of recessions, particularly for people with less education, and at older ages.