The 1% Steps for Health Care Reform Project (including kidney exchange)

 The goal of the 1% Steps for Health Care Reform Project is to shift the way we think about health care spending in the US and offer a roadmap to policy makers of tangible steps we as a country can take to lower the cost of health care in the US. We want to leverage leading scholars’ work to identify discrete problems in the US health system and offer evidence-based steps for reform. We will continually update the project with new proposals that are based on the latest academic research.

Here is their full list of Policy Briefs.

Here's one on kidney exchange:

Expanding Kidney Exchange

Authors: Nikhil Agarwal, Massachusetts Institute of Technology; Itai Ashlagi, Stanford University; Michael Rees, The University of Toledo Medical Center; Alvin Roth, Stanford University

Here's one paragraph:

"Policy Proposal: This brief discusses three specific proposals for expanding kidney exchange. First, policy makers should eliminate financial disincentives for participating in kidney exchange platforms by including medical and administrative costs specific to kidney exchange in reimbursements from the Medicare program. Second, policy makers should direct the federal contractor UNOS (United Network for Organ Sharing) to allow kidney exchange chains to be initiated by deceased donors. Third, Medicare should pay for the costs of a global kidney exchange that allows exchanges involving patients in different nations."

And here's some discussion by Nikhil Agarwal with Zack Cooper:

The econometrics of deceased kidney donation

Two papers have made me think about the power of econometric methods applied to studies of medical issues related to matching deceased donor kidneys to patients.

I recently heard Chuck Manski give a seminar on this paper published last year in PNAS:

One thing I took away from it is that proportional hazard (Cox) models are very popular in the medical literature, but they assume that effects (e.g. rejection of a graft) are proportional to time, and there are immunological processes that don't in fact have a constant hazard rate, but build up over time, so that isn't a good model for those things.

Predicting kidney transplant outcomes with partial knowledge of HLA mismatch

Charles F. Manski,  Anat R. Tambur, and Michael Gmeiner, PNAS October 8, 2019 116 (41) 20339-20345

"Abstract: We consider prediction of graft survival when a kidney from a deceased donor is transplanted into a recipient, with a focus on the variation of survival with degree of human leukocyte antigen (HLA) mismatch. Previous studies have used data from the Scientific Registry of Transplant Recipients (SRTR) to predict survival conditional on partial characterization of HLA mismatch. Whereas earlier studies assumed proportional hazards models, we used nonparametric regression methods. These do not make the unrealistic assumption that relative risks are invariant as a function of time since transplant, and hence should be more accurate. To refine the predictions possible with partial knowledge of HLA mismatch, it has been suggested that HaploStats statistics on the frequencies of haplotypes within specified ethnic/national populations be used to impute complete HLA types. We counsel against this, showing that it cannot improve predictions on average and sometimes yields suboptimal transplant decisions. We show that the HaploStats frequency statistics are nevertheless useful when combined appropriately with the SRTR data. Analysis of the ecological inference problem shows that informative bounds on graft survival probabilities conditional on refined HLA typing are achievable by combining SRTR and HaploStats data with immunological knowledge of the relative effects of mismatch at different HLA loci."

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And here's a recent working paper that says that if we want to maximize life years added by transplant, more organs should go more quickly to healthier patients:

Choices and Outcomes in Assignment Mechanisms: The Allocation of Deceased Donor Kidneys

Nikhil Agarwal, Charles Hodgson, Paulo Somaini, August 17, 2020

"Abstract: While the mechanism design paradigm emphasizes notions of efficiency based on agent preferences, policymakers often focus on alternative objectives. School districts emphasize educational achievement; and transplantation communities focus on patient survival. However, it is unclear whether choice-based mechanisms perform well when assessed using these outcomes. This paper evaluates the assignment mechanism for allocating deceased donor kidneys on the basis of the additional patient life-years from transplantion (LYFT). We examine the role of choice in increasing LYFT and compare equilibrium assignments to benchmarks that remove choice. Our approach combines a model of choice and outcomes in order to study how selection induced in the mechanism produces the outcome of

interest, LYFT. We show how to identify and estimate the model using quasi-experimental variation resulting from the mechanism. The estimates suggest that the design in use selects patients with better survival prospects after a transplant and matches them well. It results in an average LYFT of 7.97, which is 0.88 years higher than a random assignment. However, there is scope for increasing the aggregate LYFT to 12.07. While some of this increase can be achieved by assigning transplanted patients to different donors, realizing the majority requires transplanting relatively healthy patients, who would have longer life-expectancy even without a transplant. Therefore, a policymaker faces a dilemma between transplanting patients that are sicker and those for whom life will be extended the longest."

Market Design at 25, May 14-15 in Washington DC

The NBER is holding a conference in May, in Washington.

"The conference, which has been organized by Irene Lo, Michael Ostrovsky, and Parag Pathak, is timed to roughly commemorate the 25th anniversary of the first FCC spectrum auction, in 1994, the redesign of the National Resident Match Program (begun in 1995, completed in 1998), and the launch of the sulphur dioxide allowance-trading program under Title IV of the Clean Air Act Amendments (amended in 1990, initiated in 1995).  The conference goal is to assess the key contributions of market design in a number of specific fields and policy areas, and to identify key open questions that are priorities for future research."

Market Design @ 25

Authors Please upload your paper and slides here.

Irene Y. Lo, Michael Ostrovsky, and Parag A. Pathak, Organizers

May 14-15, 2020

JW Marriott Hotel, 1331 Pennsylvania Avenue, Washington, DC

Conference Code of Conduct

Thursday, May 14
8:00 am	Continental Breakfast
8:30 am	Spectrum Auctions
	- Opening speaker: Jessica Rosenworcel, FCC Commissioner
	- Overview: Paul Milgrom, Stanford University
	- Viewpoint: Evan Kwerel, FCC
9:55 am	Break
10:10 am	Matching and Broadening the Definition of Markets
	- Overview: Alvin Roth, Stanford University and NBER
	- Viewpoint 1: Edward Glaeser, Harvard University and NBER
	- Viewpoint 2: Susan Athey, Stanford University and NBER
11:20 am	Break
11:35 am	Market Design for the Environment
	- Overview: Michael Greenstone, University of Chicago and NBER
	- Viewpoint 1: Richard Schmalensee, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Nathan Keohane, Environmental Defense Fund
12:45 pm	Lunch
2:15 pm	Market Design in Healthcare
	- Overview: Amy Finkelstein, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Marc Miller, LJAF / Former MedPac
	- Viewpoint 2: Kate Ho, Princeton University and NBER
3:25 pm	Market Design in Transportation
	- Overview: Michael Ostrovsky, Stanford University and NBER
	- Viewpoint 1: David Shmoys, Cornell University
	- Viewpoint 2: TBA
4:35 pm	Break
4:50 pm	Market Design in Developing Countries
	- Overview: Kevin Lleyton-Brown, University of British Columbia
	- Viewpoint 1: Tavneet Suri, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jishnu Das, Georgetown University
6:00 pm	Adjourn
6:30 pm	Conference Dinner
Friday, May 15
7:45 am	Continental Breakfast
8:15 am	Market Design for Education
	- Overview: Parag Pathak, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Derek Neal, University of Chicago and NBER
	- Viewpoint 2: Neerav Kingsland, City Fund
9:25 am	Break
9:40 am	Market Design for Organ Transplantation
	- Overview: Tayfun Sonmez, Boston College
	- Viewpoint 1: Nikhil Agarwal, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jennifer Erickson, formerly White House OSTP
10:50 am	Break
11:05 am	Market Design for Public Housing
	- Overview: Nathan Hendren, Harvard University and NBER
	- Viewpoint 1: Winnie van Dijk, University of Chicago and NBER
	- Viewpoint 2: Marge Turner, Urban Institute
12:15 pm	Lunch
1:15 pm	Electricity Market Design
	- Overview: Mar Reguant, Northwestern University and NBER
	- Viewpoint 1: Bob Wilson, Stanford University
	- Viewpoint 2: Shmuel Oren, University of California at Berkeley
2:25 pm	Market Design in Online Markets
	- Overview: Preston McAfee, formerly Caltech and Microsoft
	- Viewpoint 1: Hal Varian, Google
	- Viewpoint 2: Irene Lo, Stanford University
3:35 pm	Break
3:50 pm	Market Design in Financial Markets
	- Overview: Darrell Duffie, Stanford University and NBER
	- Viewpoint 1: Eric Budish, University of Chicago and NBER
	- Viewpoint 2: Gary Gensler, Massachusetts Institute of Technology
5:00 pm	Adjourn

MIT celebrates Nikhil Agarwal

Optimizing kidney donation and other markets without money
MIT economist Nikhil Agarwal analyzes the efficiency of markets that match suppliers and consumers but don’t use prices.

“In economics,” Agarwal says, “we often [assume] there’s the demand, the supply, the price, and the market clears, somehow. It just happens.” And yet, he says, “That’s not how a lot of markets work. There are all these different important markets where we do not allow prices.”

Scholars in the field of “market design,” therefore, closely examine these nonfinancial markets, observing how their rules and procedures affect outcomes. Agarwal calls himself a specialist in “resource allocation systems that do not use prices.” These include kidney donations: The law forbids selling vital organs. Many education systems and entry-level labor markets, for example, also fit into this category. "
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I've followed Nikhil's work for a long time--here are some other posts that mention his work.

Kidney exchange needs to be conducted at scale, in the AER by Agarwal, Ashlagi, Azevedo, Featherstone and Karaduman

Market Failure in Kidney Exchange

• Nikhil Agarwal
• Itai Ashlagi
• Eduardo Azevedo
• Clayton R. Featherstone
• Ömer Karaduman


AMERICAN ECONOMIC REVIEW (FORTHCOMING)


Abstract
We show that kidney exchange markets suffer from market failures whose remedy could increase transplants by 30%–63%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals only partly internalize their patients' benefits from exchange, and current platforms suboptimally reward hospitals for submitting patients and donors. Third, we calibrate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires either a mandate or a combination of new mechanisms and reimbursement reforms.
Forthcoming Article Downloads
• Preview (AEA members only) (966.12 KB)

Congratulations to the 2019 Sloan Fellows

The full list, across all disciplines is here:

2019 Sloan Research Fellows

 Here are the 2019 economists:

Economics

Nikhil Agarwal, Massachusetts Institute of Technology

Denis Chetverikov, University of California, Los Angeles

Rebecca Diamond, Stanford University

Will Dobbie, Princeton University

Michal Kolesár, Princeton University

Melanie Morten, Stanford University

Philipp Strack, University of California, Berkeley

Gabriel Zucman, University of California, Berkeley

And the computer scientists:

Computer Science

Yang Cai, McGill University

Alvin Cheung, University of Washington

Reetuparna Das, University of Michigan

Rong Ge, Duke University

Bernhard Haeupler, Carnegie Mellon University

Moritz Hardt, University of California, Berkeley

Haitham Hassanieh, University of Illinois, Urbana-Champaign

Gillat Kol, Princeton University

Jason D. Lee, University of Southern California

Sergey Levine, University of California, Berkeley

Wyatt Lloyd, Princeton University

Shayan Oveis Gharan, University of Washington

Emily Whiting, Boston University

Christopher Wilson, Northeastern University

Keith Winstein, Stanford University

Mary Wootters, Stanford University

Kidney exchange needs to be conducted at scale, in Vox

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton Featherstone,  and Omer Karaduman summarize their recent paper in Vox..eu:

Market failure in kidney exchange
03 November 2018

National kidney exchange platforms significantly boost the number of life-saving kidney transplants by finding complicated exchange arrangements that are not possible within any single hospital. This column examines US data and finds that the majority of kidney exchanges continue to be performed within hospitals, suggesting a fragmented market that comes at a large efficiency cost. National platforms may need to be redesigned to encourage full participation, with reimbursement reform.

NBER Market Design Conference at Stanford, October 19-20

Here's the program and participant list:

Friday, October 19
8:30 am	Continental Breakfast
9:00 am	Olivier Terceiux, Top Trading Cycles in Prioritized Markets, a synthesis of:
	Yeon-Koo Che, Columbia University Olivier Tercieux, Paris School of Economics Top Trading Cycles in Prioritized Matching: An Irrelevance of Priorities in Large Markets
	Atila Abdulkadiroglu, Duke University and NBER Yeon-Koo Che, Columbia University Parag A. Pathak, Massachusetts Institute of Technology and NBER Alvin E. Roth, Stanford University and NBER Olivier Tercieux, Paris School of Economics Minimizing Justified Envy in School Choice: The Design of New Orleans’ OneApp
9:45 am	Surender Baswana, IIT Kanpur Partha Pratim Chakrabarti, IIT Kharagpur Sharat Chandran, IIT Bombay Yash Kanoria, Columbia University Utkarsh Patange, Columbia University Centralized Admissions for Engineering Colleges in India
10:30 am	Break
11:00 am	Onur Kesten, Carnegie Mellon University Selcuk Ozyurt, Sabanci University Efficient and Incentive Compatible Mediation: An Ordinal Market Design Approach
11:45 am	Dirk Bergemann, Yale University Benjamin A. Brooks, University of Chicago Stephen Morris, Princeton University Revenue Guarantee Equivalence
12:30 pm	Lunch Talk Michael Schwarz, Microsoft Market Design, Reputation Systems, UX, and the Cost of User Time
2:00 pm	Xiao Liu, Tsinghua University Zhixi Wan, Didi Chuxing Technology Co. Chenyu Yang, University of Rochester The Efficiency of A Dynamic Decentralized Two-Sided Matching Market
2:45 pm	Hongyao Ma, Harvard University Fei Fang, Carnegie Mellon University David Parkes, Harvard University Spatio-Temporal Pricing for Ridesharing Platforms
3:30 pm	Break
4:00 pm	Mohammad Akbarpour, Stanford University Farshad Fatemi, Sharif University of Technology Negar Matoorian, Stanford University A Monetary Market for Kidneys
4:45 pm	Alvin E. Roth, Stanford University and NBER Recent Developments in Kidney Exchange: Market Design in a Large World
5:30 pm	Adjourn
6:30 pm	Dinner Joya Restaurant 339 University Avenue Palo Alto, CA
Saturday, October 20
8:30 am	Continental Breakfast
9:00 am	Atila Abdulkadiroglu, Duke University and NBER Joshua Angrist, Massachusetts Institute of Technology and NBER Yusuke Narita, Yale University Parag A. Pathak, Massachusetts Institute of Technology and NBER Impact Evaluation in Matching Markets with General Tie-Breaking
9:45 am	Yuichiro Kamada, Harvard University Fuhito Kojima, Stanford University Fair Matching under Constraints: Theory and Applications (slides)
10:30 am	Break
11:00 am	Tamas Fleiner, Budapest University of Technology and Economics Ravi Jagadeesan, Harvard University Zsuzsanna Jankó, Corvinus University Alexander Teytelboym, University of Oxford Trading Networks with Frictions
11:45 am	Piotr Dworczak, Northwestern University Scott Duke Kominers, Harvard University Mohammad Akbarpour, Stanford University Redistribution through Markets
12:30 pm	Adjourn

Participant List

Atila Abdulkadiroglu Duke University and NBER

Nikhil Agarwal Massachusetts Institute of Technology and NBER

Mohammad Akbarpour Stanford University

Nick Arnosti Columbia University

Susan Athey Stanford University and NBER

Lawrence Ausubel University of Maryland

Moshe Babaioff Microsoft Research

Aaron L. Bodoh-Creed University of California at Berkeley

Eric Budish University of Chicago and NBER

Jeremy I. Bulow Stanford University and NBER

Gabriel Carroll Stanford University

Yeon-Koo Che Columbia University

Laura Doval California Institute of Technology

Jeremy T. Fox Rice University and NBER

Guillaume Haeringer Baruch College

Jonathan Hall Uber Technologies

John W. Hatfield University of Texas, Austin

Yinghua He Rice University

Ravi Jagadeesan Harvard University

Yuichiro Kamada Harvard University

Yash Kanoria Columbia University

Adam Kapor Princeton University and NBER

Jakub Kastl Princeton University and NBER

Onur Kesten Carnegie Mellon University

Fuhito Kojima Stanford University

Scott Duke Kominers Harvard University

Nicolas S. Lambert Stanford University

Shengwu Li Harvard University

Shuya Li Carnegie Mellon University

Hongyao Ma Harvard University

Mohammad Mahdian Google Research

Negar Matoorian Stanford University

Stephen Morris Princeton University

Yusuke Narita Yale University

Hamid Nazerzadeh University of Southern California

Afshin Nikzad Stanford University

Michael Ostrovsky Stanford University and NBER

Selcuk Ozyurt Sabanci University

Utkarsh Patange Columbia University

Parag A. Pathak Massachusetts Institute of Technology and NBER

Ali O. Polat Carnegie Mellon University

Daniel Quint University of Wisconsin

David H. Reiley Jr. Pandora Media, Inc

Alvin E. Roth Stanford University and NBER

Daniela Saban Stanford University

Michael Schwarz Microsoft

Ilya Segal Stanford University

Sven Seuken University of Zurich

Kane Sweeney eBay Research Labs

Steven Tadelis University of California at Berkeley and NBER

Olivier Tercieux Paris School of Economics

Zhixi Wan Didi Chuxing Technology Co.

Robert Wilson Stanford University

Xingye Wu Tsinghua University

Chenyu Yang University of Rochester

Haoxiang Zhu Massachusetts Institute of Technology and NBER

Kidney exchange on NPR

Two friends told me that they'd heard me on NPR yesterday, and so I searched and found this program on kidney exchange. (At the link below you can read the transcript, and also see a 9 minute video that apparently played on tv.) They interview patients, donors, and kidney docs, and feature two economists, me and Nikhil Agarwal.  (My part seems to be pieced together from footage from a talk I gave at a Google conference, and a video made by the National Academy of Sciences, but it looks like they actually interviewed Nikhil...)

The economic principle that powers this kidney donor market
Aug 16, 2018 6:20 PM EDT

I can't figure out how to embed the video in this post, but here's a picture that's just a screen shot, not a link:

Kidney exchange is fragmented in the U.S.

Market Failure in Kidney Exchange

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton R. Featherstone, Ömer Karaduman

NBER Working Paper No. 24775
Issued in June 2018

Abstract: "We show that kidney exchange markets suffer from traditional market failures that can be fixed to increase transplants by 25%-55%. First, we document that the market is fragmented and inefficient: most transplants are arranged by hospitals instead of national platforms. Second, we propose a model to show two sources of inefficiency: hospitals do not internalize their patients’ benefits from exchange, and current mechanisms sub-optimally reward hospitals for submitting patients and donors. Third, we estimate a production function and show that individual hospitals operate below efficient scale. Eliminating this inefficiency requires a combined approach using new mechanisms and solving agency problems."

Here's a key sentence:

"The three largest multi-hospital platforms together only account for a minority share of the kidney exchange market. 62% of kidney exchange transplants are within hospital transplants that are not facilitated by the NKR, APD or UNOS. Moreover, over 100 hospitals performed kidney exchanges outside these three platforms during this period."

Ariel Pakes gives the Arrow Lecture in Jerusalem

If you're in Jerusalem tomorrow, you have a chance to hear Ariel Pakes' Arrow Lecture:

17:00-18:00 Ariel Pakes, Arrow lecture:

Learning and Equilibrium in A New Market

It is part of

The 29th Jerusalem Summer School of Economics

Industrial Organization

Event date: June 26 - July 5, 2018 

Organizers:

Eric Maskin, General Director (Harvard University)
Ariel Pakes, Codirector (Harvard University)
Elchanan Ben-Porath,Codirector (The Hebrew University)





Industrial Organization studies how markets are structured and the way they respond to changes in conditions (e.g., to policy revisions). The field draws heavily on both theory and empirical work, and both will be amply represented in the Summer School. We will focus on several topics of current research interest: vertical markets, allocation in markets without prices, market dynamics, and regulation.


  
List of speakers:


NAME AFFILIATION EMAIL TOPICS Nikhil Agarwal Massachusetts Institute of Technology agarwaln@mit.edu The analysis of centralized market allocation mechanisms John Asker The University of California johnaskecr@econ.ucla.edu The analysis of regulation Alon Eizenberg  The Hebrew University of Jerusalem       aloneiz@mscc.huji.ac.il The analysis of regulation Myrto Kalouptsidi Harvard University  myrto@fas.harvard.edu The analysis of market dynamics Robin Lee Harvard University robinlee@fas.harvard.edu The   analysis of   vertical markets Eric Maskin          Harvard University emaskin@fas.harvard.edu  The analysis of market dynamics Ariel Pakes Harvard University apakes@fas.harvard.edu The analysis of market dynamics Parag Pathak Massachusetts Institute of Technology ppathak@mit.edu The analysis of centralized market allocation mechanisms Mike Whinston Massachusetts Institute of Technology whinston@mit.edu The analysis of vertical markets Ali Yurukoglu Stanford University ayurukog@stanford.edu The analysis of regulation

Here's a link to the full program.

There will be several sessions on matching markets:

Wednesday, July 4

9:30-11:00 Parag Pathak: Introduction to Matching Theory

11:00-11:30 Coffee Break

11:30-13:00 Nikhil Agarwal: Revealed Preference for Matching Markets

Thursday, July 5

9:30-11:00 Parag Pathak: Market Design Meets Research Design

11:00-11:30 Coffee break

11:30-13:00 Nikhil Agarwal: The Organization of Organ Markets