By Sebastian Tello-Trillo
Sebastian Tello-Trillo: As causal-inference methods have become more widely used across empirical fields, there may be more papers that do not pass the high-bar of causal evidence (even though they are using the known methods). To what extent do you think we have an issue in the health field regarding this phenomenon and if so, what is our role as researchers?
Kate Baicker: The more people who take causal inference seriously, the better – and we have a better tool kit to help identify causal effects than ever. But, as with any tools, there is a risk of misuse or misinterpretation, particularly as technology makes it easier for everyone to wield the tools. As a field, we have a responsibility to police ourselves to help enforce best practices and to make ourselves widely available as methodological experts and interpreters. Being providers of that public good requires a willingness to devote time and energy to the endeavor, and also to think broadly about evidence in a way that is free from disciplinary or personal bias.
Sebastian Tello-Trillo: How does this “policing” work? Or how is this done in our field?
Kate Baicker: There are many mechanisms through which field standards and norms are enforced – from the review process to seminar and conference interactions to how we train our students to informal discussions and debates. Academic journals certainly play a crucial role, but so do a wide range of interactions.
Sebastian Tello-Trillo: Another pattern that we have seen occurring is that for a given policy, several papers investigate the effect of this policy on a variety of outcomes. Some of those outcomes are metrics that the policy was intended to have an impact on, and other outcomes are spillover effects or “unintended” consequences from this policy. Looking into the set of “other outcomes” for these policies, is this something helpful to policy-makers? And when we are looking at a range of “treatment effects,” how can we help policy-makers interpret and incorporate the findings?
Kate Baicker: Highlighting the potential unintended consequences of policy decisions is a key contribution that researchers can make to improve policy. Having an analytical framework to understand the ways that incentives, prices, and regulations play out in markets and decision-making can point to places to look for such spillovers, and our empirical toolkit can help sort out the ripple effects. Policies are too often evaluated in silos, which can miss both the broader ramifications and the most effective ways to achieve the primary goals. Of course, identifying broader effects is just the first step. Incorporating those effects into policy decisions likely requires innovation in finance and budgeting as well.
Sebastian Tello-Trillo: Are there particular examples of surprising unintended consequences?
Kate Baicker: There are so many examples of unintended consequences – both “perverse” effects where we see an outcome change in the opposite direction from the intended one; and unexpected effects on entirely different outcomes. For example, programs that focus additional resources on specific health conditions, patients, or providers may actually end up drawing funds away from other programs that were intended to help the same populations. Requiring states to spend more on Medicaid may reduce their spending on other safety net programs. Measuring hospital quality based on outcomes for a narrow set of conditions may worsen outcomes for other conditions. Some unintended consequences are positive – improving management for one set of chronically-ill patients can improve management for the whole local population. Health economists can use the power of our analytical approach to inform where we look for such spillover effects and how we evaluate their presence.
Sebastian Tello-Trillo: How do you think economists should prioritize which consequences to investigate first?
Kate Baicker: Our analytical framework also helps to inform what questions we think are the most important. Where are effects likely to be the biggest? Are populations that are of particular policy focus likely to be affected? Can we learn something more profound that is more broadly applicable?
Sebastian Tello-Trillo: Some may say that as researchers we have a role in making our research accessible to broad audiences, with documents such as policy-briefs. However, in academia, there is a perception that this is not as valued and therefore a young economist should spend less time on it. What’s your take on this issue? Should the profession create more incentives for this? Or are there already enough incentives?
Kate Baicker: This is a real challenge for the profession and one that I spend much more time thinking about now in my role as Dean. The coin of the realm in academia is scholarship, and I do not see that changing. This means that rising academics really do need to prioritize their scholarly publications, but not necessarily to the exclusion of all other activities. We also value teaching, professional service, and – particularly in policy schools – impact. I think having an impact is a significant motivator for many researchers – a reason they got into this line of work in the first place. Finding more ways to recognize the real-world impact made by faculty research would be a service to the profession and to society. Universities can also provide more support for that translational work, both to reduce the burden on individual faculty members and to help build the skills and connections that amplify the impact of scholarship.
Sebastian Tello-Trillo: Do you think that tenure expectations for junior scholars should explicitly include broader dissemination of research? If so, what might that look like?
Kate Baicker: I’m not sure that we should put additional explicit expectations on junior scholars – junior scholars are already under a great deal of pressure. Rather, I think it would be helpful if we valued dissemination and translational work more highly as part of the impact that great scholarship can have.
Kate Baicker is the Dean and the Emmett Dedmon Professor at the University of Chicago Harris School of Public Policy.Sebastian Tello-Trillo is an Assistant Professor of Public Policy and Economics at the University of Virginia and a Co-editor of the ASHEcon Newsletter.