About

Diane Alexander is an Assistant Professor of Health Care Management at the Wharton School at the University of Pennsylvania. Her research predominantly focuses on the economics of health care, studying the provision of health care services and the actions of health care providers. She is interested in the interactions between environmental policies and health, as well as the relationship between health care and education. Her work has been featured in media outlets including the Washington Post, Bloomberg, CityLab, Vox, and Scientific American, and she has contributed to podcasts such as Freakonomics Radio and Vox's The Weeds. Her research includes studying the roles played by new types of providers in health care delivery, such as retail and urgent care clinics, and examining the roles of nurse practitioners and physician assistants in improving access to health care. She investigates how payment incentives influence physician decision-making. Additionally, she has explored the impact of environmental factors on health outcomes, including the role of residential segregation in racial health disparities and the effects of pollution, utilizing natural experiments like the Volkswagen emissions scandal. Prior to her position at Wharton, she was an economist at the Federal Reserve Bank of Chicago. She holds a B.A. in economics from the University of California at Berkeley and a Ph.D. in economics from Princeton University.

Research topics

• Medicine
• Economics
• Business
• Natural resource economics
• Engineering
• Microeconomics
• Actuarial science
• Social psychology
• Finance
• Economic growth
• Chemistry
• Demographic economics
• Public economics
• Waste management
• Psychology
• Environmental health

Selected publications

• The Impacts of Physician Payments on Patient Access, Use, and Health

  American Economic Journal Applied Economics · 2024-06-26 · 34 citations

  article1st authorCorresponding

  We examine how supply-side health insurance generosity affects patient access, use, and health. Exploiting large, exogenous changes in Medicaid reimbursement rates for physicians, we find that increasing payments for new patient office visits reduces reports of providers turning away beneficiaries: closing the gap in payments between Medicaid and private insurers would reduce more than half of disparities in access among adults and would eliminate such disparities among children. We further find that higher physician reimbursement leads to more office visits, better self-reported health, and reduced school absenteeism among the program’s beneficiaries. (JEL G22, H51, I11, I13, I18, I38, J44)

  PublisherDOI

• Retail Health Clinic Growth as a Potential Primary Care Disruptor

  Medical Care Research and Review · 2023-02-09 · 3 citations

  article

  Retail health clinics (RHCs) have been described as a disruptive model of care delivery. We describe RHC market presence in the United States from 2008 to 2016 with a focus on the characteristics of counties where new clinics open. We merge national data on RHC openings and closings from Merchant Medicine with the Area Health Resources File. We examined county-level counts and ownership of RHCs over time. From 2008 to 2016, we found increasing ownership of RHCs by retail pharmacies, and, contrary to earlier predictions, RHCs continue to be located in affluent counties and did not open in underserved or provider shortage areas. Most new clinics opened in counties where RHCs already had a presence, and these counties also had greater primary care physician, nurse practitioner, and physician assistant density per capita (100,000). As RHCs expand and offer more services, they may place new competitive pressures on nearby primary care providers and practices.

  PublisherDOI

• Economic consequences of hospital closures

  Journal of Public Economics · 2023-03-22 · 22 citations

  article1st authorCorresponding
  PublisherDOI

• 6-LB: GPR119 Agonist PRM A Increases Glucagon Response to Hypoglycemia in Rats

  Diabetes · 2023-06-20 · 1 citations

  article

  Glucagon (Gcg) is crucial in the counter-regulatory response (CRR) to hypoglycemia yet this is severely impaired in T1D. This pathophysiology was recognized 50 years ago, but only recently have drug targets emerged to amplify Gcg CRR in T1D. One promising target is the receptor GPR119, expressed in gut endocrine cells and pancreatic islets with highest expression on α-cells, 10-fold greater than on β-cells. In the current study, a GPR119 agonist (PRM A) was given by oral gavage at doses of 3, 10 and 30 mg per kg (mpk), to rats (Sprague-Dawley, groups of 8) two hours prior to induction of hypoglycemia by an insulin tolerance test (ITT), using a dose of 1.25 Units per kg, given by intra-peritoneal injection at t=0 min. A vehicle-treated (V) control and a positive comparator group, given the GPR119 agonist MBX-2982 (10 mpk) were also studied. MBX-2982 is currently being used in a clinical trial to assess its effect on Gcg CRR in volunteers with T1D challenged with a hypoglycemic clamp. In rats in the current study, severe hypoglycemia was induced during the ITT; blood glucose nadir was achieved by 60 min in association with peak insulin ≥ 100 µU/ml. Glucose and insulin were similar across groups. The healthy V rats mounted a normal Gcg CRR, with a peak value of 26±10 pM, 5-fold above baseline. Pre-treatment with PRM A significantly amplified Gcg CRR relative to V (to 86±17, 79±18, and 85±12 pM; at 3, 10, and 30 mpk; p<0.0001 vs V). The Gcg AUC during the ITT was nearly 50% greater with all doses of PRM A (p<0.05 vs V) and the peak Gcg CRR was shifted earlier (p<0.01 vs V). MBX-2982 pre-treated rats, relative to V, trended to a higher peak (49±14 vs 26±10 pM) and AUC Gcg (7292±2039 vs 6855±1306 pM*h), but neither difference was significant, whereas the differences for PRM A were strongly significant for time and treatment. In summary, PRM A, a potent GPR119 agonist, tripled peak Gcg CRR during an ITT in healthy rats, affirming that the target of GPR119 holds promise as a novel means to mitigate the dangerous risk of hypoglycemia for individuals with T1D. Disclosure D. W. K. Kwok: None. D. Alexander: None. N. R. A. Beeley: None. D. Kelley: Consultant; Pramana Pharmaceuticals, Inc, Kallyope. Funding Pramana Pharmaceuticals Inc.

  PublisherDOI

• The Impact of Car Pollution on Infant and Child Health: Evidence from Emissions Cheating

  The Review of Economic Studies · 2022 · 60 citations

  1st authorCorresponding
  • Environmental health
  • Natural resource economics
  • Economics

  Abstract In 2008, Volkswagen introduced a new generation of “Clean Diesel” cars and heavily marketed them to environmentally conscious US consumers. Unknown to the public, these cars were anything but clean, emitting pollutants up to 150 times the level of comparable gas-fuelled cars. We study the rollout of these emissions-cheating diesel cars across the United States from 2008 to 2015 as a natural experiment to examine the impact of moderate levels of car pollution on infant and child health in the general population. Using the universe of vehicle registrations, we find that an additional cheating diesel car per 1,000 cars increases $\mathrm{PM_{2.5}}$, $\mathrm{PM_{10}}$, and ozone by 2, 2.2, and 1.3$\%$, respectively, while the low birth weight rate and infant mortality rate increase by 1.9 and 1.7$\%$, respectively. Similar impacts are found for acute asthma attacks in children. These health impacts occur at all pollution levels and across the socioeconomic spectrum.

  PublisherDOI

• Enrollment Brokers Did Not Increase Medicaid Enrollment, 2008–18

  Health Affairs · 2022-09-01 · 1 citations

  article

  Between 2008 and 2018, six states and Washington, D.C., began contracting with enrollment brokers to facilitate enrollment into Medicaid, joining the eighteen states that already had such contracts in place as of 2008. Using newly collected data covering all contracts between state Medicaid agencies and independent enrollment brokers during this period, we compared changes in Medicaid participation following the initiation of contracts with enrollment brokers with contemporaneous changes in Medicaid participation in states that never contracted with brokers. We found that contract initiation had no statistically significant effects on state-level Medicaid participation. We further found no evidence of other enrollment-related benefits, such as improved application processing times.

  PublisherDOI

• Replication Data for: Do Stay-at-Home Orders cause People to Stay at Home? Effects of Stay-at-Home Orders on Consumer Behavior

  Harvard Dataverse · 2021-08-20

  datasetOpen access1st authorCorresponding

  Alexander, D., and Karger, E. (2023). “Do Stay-at-Home Orders Cause People to Stay at Home? Effects of Stay-at-Home Orders on Consumer Behavior.” Review of Economics and Statistics 105:4, 1017–1027.

  PublisherDOI

• Economic Consequences of Hospital Closures

  SSRN Electronic Journal · 2021-01-01 · 2 citations

  articleOpen access1st authorCorresponding
  PublisherDOI

• Economic Consequences of Hospital Closures

  National Bureau of Economic Research · 2021-07-01 · 4 citations

  reportOpen access1st author

  Hospitals anchor much of US health care and receive a third of all medical spending, including various subsidies. Nevertheless, some become insolvent and exit the market. Research has documented subsequent access problems; however, less is understood about broader implications. We examine over 100 rural hospital closures spanning 2005-2017 to quantify the effects on the local economy. We find sharp and persistent reductions in employment, but these localize to health care occupations and are more impactful in areas experiencing complete closures. Aggregate consumer financial health and housing markets appear unaffected by the shuttering of a rural hospital.

  PublisherOA PDFDOI

• Do Stay-at-Home Orders Cause People to Stay at Home? Effects of Stay-at-Home Orders on Consumer Behavior

  The Review of Economics and Statistics · 2021 · 121 citations

  1st authorCorresponding
  • Business
  • Demographic economics
  • Economics

  Abstract We link the county-level rollout of stay-at-home orders during the COVID-19 pandemic to anonymized cell phone records and consumer spending data. We document three patterns. First, stay-at-home orders caused people to stay home: county-level measures of mobility declined 6% to 7% within two days of when the stay-at-home order went into effect. Second, stay-at-home orders caused large reductions in spending in sectors associated with mobility: small businesses and large retail chains. Third, we estimate fairly uniform responses to stay-at-home orders across the country; effects do not vary by county-level income, political leanings, or urban/rural status.

  PublisherOA PDFDOI

Frequent coauthors

• Janet Currie

  Princeton University

  36 shared

• Molly Schnell

  Hegau-Bodensee-Klinikum Singen

  21 shared

• Andrzej Bytnerowicz

  US Forest Service

  5 shared

• Witold Frączek

  Environmental Systems Research Institute (United States)

  5 shared

• Susan Schilling

  Pacific Southwest Research Station

  5 shared

• Michael R. Richards

  Brown University

  4 shared

• David A. Leib

  Dartmouth Hospital

  4 shared

• Lisa Camner McKay

  Princeton University

  4 shared