CPPR Health Policy Seminar: "Provider-Targeted 'Nudges' and Primary Care Appointment Availability"

The CPPR Health Policy Seminars are a series of workshops that bring together faculty and distinguished speakers from numerous disciplines across Tulane’s campuses to connect with a network of professionals and produce interdisciplinary research that addresses critical policy issues.

Organized by Mary Olson, Associate Professor of Economics at Tulane and leader of CPPR's Health Policy program, these working groups provide scholars with the opportunity to present new work to an incisive audience of researchers and practitioners. Papers are distributed beforehand to the participants who read the paper and prepare discussion questions for the presenter. 

Brigham Walker is an Assistant Professor in the Department of Health Policy and Management at the Tulane Celia Scott Weatherhead School of Public Health and Tropical Medicine. His research generally focuses on how providers, payers, and patients behave in response to new information or incentives. He is also interested in discrimination and equity topics generally.  He is a Research Affiliate at the Institute of Labor Economics (IZA), and his CV can be found at www.brigwalker.com/cv.

ABSTRACT 
Racial and ethnic disparities in access to primary care appointments have been well-documented, but suggestions for how to reduce unequal access are in short supply. We develop a simple framework for examining the effects of provider-targeted interventions (“nudges”), and conducted two field experiments to evaluate them as a way to reduce disparities in access to primary care: (1) a cross-sectional study where providers in Texas were randomly assigned to receive a mailer describing recent research findings on discrimination in their health care market; and (2) a longitudinal randomized study where providers in Louisiana, Mississippi, and Alabama were mailed a letter that informed the provider of ongoing discrimination in their market, its illegality, and its consequences for affected patients. In both settings, research assistants placed calls to practices as, or on behalf of, White, Black, or Hispanic simulated prospective patients. The longitudinal study also included baseline measures allowing for difference-in-differences estimation. Both studies found that White patients had baseline higher levels of access that were partly reduced (in the case of the cross-sectional study) or fully reduced (in the case of the longitudinal study) due to the nudges. We find limited evidence, however, that these reductions were associated with similar increases in access to Black or Hispanic patients. These results suggest that simple provider-targeted nudges may be effective in reducing discrimination in access to primary care appointments, but existing advantage may not be completely eradicated as a result.