One might say that Adriana Corredor-Waldron, postdoctoral fellow at the Center for Health and Wellbeing (CHW), has a knack for numbers. She holds a Ph.D. in economics and launched her career as an analyst for the Central Bank of Colombia, assessing futures, currency options and foreign exchange risk to evaluate the financial stability of Colombian corporations. Nevertheless, finance was a self-described “detour” before Adriana shifted her specialization to health economics and applied microeconomics – with loftier goals in mind.
Over the past several years, Adriana has researched how public health policies shape people’s lives and wellbeing. In this Spotlight, we learn more about her background, scholarly contributions, and current work focused on disability, opioid addiction, and access to health care.
Q. Why did you choose to study economics?
A. When I was little, I wanted to be a doctor – a medical doctor. The thought of caring for people and making their lives better was very appealing. My goal changed in ninth grade when I realized that biology was not for me. I really liked the social sciences and statistics, leading me to economics… not only because I was good at math, but because it permeates everyone’s lives. Economics affects whether you’re employed or unemployed, how much you earn, how much you pay in taxes, and many other things. I felt that by studying economics, I could be an actor in how policies impact the health and welfare of people.
Q. After earning your B.A. in economics at Universidad de los Andes, in Bogota, Colombia, you worked for the Central Bank of Colombia. What attracted you to that opportunity?
A. I knew that I wanted to work for the government, in a position where I could influence the public and make a difference in society. The Central Bank of Colombia, which is similar to the Federal Reserve in the United States, suited me well. I joined the Research Department as a financial analyst, studying credit risk for small and medium sized businesses. I looked at what types of funding they need to survive and how the banking industry often perceives these companies as too “risky” for lending. Even within the field of finance, I liked doing research about fragile, vulnerable populations.
Q. You went on to earn a Master’s degree in economics during your employment. What drove your decision to continue your education? Were your career aspirations evolving?
A. When you’re working in the government, you tend to focus on urgent matters. You need to deliver and show results, without much time to explore and to learn about the underlying causes of the problem under study. At some point, I developed an interest in longer term projects. I wanted to improve my knowledge, understand interesting phenomena, and explore new tools and techniques. Fortunately, the bank was supportive of education; I was able to attend classes during the work day and studied at night and on weekends. At that time, I was also appointed as a teaching assistant, which led me to work closer with faculty at the University and offered a glimpse of academic life.
Q. In 2013, you left the bank – and your home country – to pursue your Ph.D. in economics at University of Illinois at Urbana-Champaign. What prompted this change in direction, and what was the subject of your dissertation?
A. Once I discovered that academia was another path I could follow, I decided to get my Ph.D. That offered the perfect opportunity for me to rethink my field of specialization. I did not want to remain in finance all my life, so I studied applied microeconomics and health economics.
My dissertation explored provision and regulation of health care services in the United States. First, I sought an alternative explanation for why nursing home utilization has decreased when the elderly population has increased. Many elderly Americans with intellectual disabilities and chronic illnesses or pain choose to receive in-home care, although institutional care is sometimes the best option. I found this disparity was not only associated with patients’ preference, but also with the nursing homes’ response to financial incentives. My research provided evidence that an increase in Medicare reimbursement, particularly in heavily regulated markets, incentivized nursing homes to accept Medicare patients at the expense of “less profitable” Medicaid beneficiaries in need of long-term care – an unintended consequence of a well-intentioned policy.
I also investigated the impact of prescription drug monitoring programs on suicides. By restricting the supply of prescription drugs, these programs often force addicts to choose between seeking treatment or suffering the effects of withdrawal, which can lead to suicide. I found that places with strong drug treatment networks had lower suicide rates than places with fewer treatment options. Thus, access to drug treatment centers is as important as supply restriction interventions, such as monitoring, in the fight against the opioid epidemic. As my third area of focus, I studied the effect of the Children’s Health Insurance Program, implemented in 1997, and learned that pediatricians reduced their work hours in response to the rise in Medicaid-enrolled children and often moved from solo practices to larger, group practices.
Q. What did you find most intriguing about your research?
A. In studying this market, I was surprised by the fragmentation of public health insurance in the United States. Medicare and Medicaid are very different in terms of benefits and the way they pay providers – and there are opportunities for further coordination between the two programs. This fragmentation encourages nursing homes to avoid certain types of patients, as a result of financial incentives. It varies state by state, depending on the degree of regulation, but it is happening.
Also, I gained a lot of insight through qualitative interviewing, a skill I developed during my time at the bank. The numbers don’t tell you everything. For example, talking to administrators, nurses and doctors completely changed my perspective on nursing homes. They helped me better understand the dynamics and challenges of caring for people whose health probably won’t get better.
Q. Did your doctoral research inspire any special interests? Would you say it led you to Princeton?
A. Yes, definitively. I wanted to continue studying health care markets and access to health care services. The Center for Health and Wellbeing offered a unique opportunity for me to learn, present my work, and receive feedback from top scholars in different fields. I like having the time to do research while having access to the resources, network and faculty available at Princeton. For instance, I took a course on grant-writing, which taught me how to convey my message in a clear, convincing way so funders will listen, recognize the importance of my work, and support my projects. It was life-changing!
Right now, my research is focused on issues related to the elderly, substance abuse, and mental health, which we know so little about. I’m collecting data to expand my study of Medicare reimbursement policy and capacity constraints affecting nursing homes, and starting a new project assessing the spillover effects of mental illness. I’m hoping my work provides evidence that will lead to better health care and better lives for people with chronic conditions.
Q. Can you elaborate on your new project researching mental illness? What kind of spillover effects will you investigate?
A. I am researching how mental illness affects the health and hospital utilization of families. For instance, how does the suicide attempt of a child affect the health needs and outcomes of the mother? Or how does addiction influence the patient’s siblings? I want to learn more about the broader consequences of mental illness – the ways in which an individual’s mental illness can impact other members of the family.
Q. What do you foresee as the most compelling issue or issues, within the realm of health economics, facing the global community today? Particularly, do you have any thoughts regarding the economic implications of the COVID-19 pandemic?
A. COVID-19 arrived in an economy that was weakening since last year. The pandemic is certainly the largest disruption to the system that we have experienced in a long time. But, the evolution of the economy in the coming months is the result of a bad cocktail: a pandemic in the middle of an oil-price and trade war. We are already seeing the devastating effects on the U.S. labor markets, with the number of unemployment benefits claims reaching 6.6 million as of early April. This will have unprecedented consequences for all, but particularly for demographically and economically vulnerable populations. Now more than ever, we need coordination, across countries and within countries. There is a lot of uncertainty around the virus, and a cohesive U.S. policy is essential to dealing with it.
We are also in the midst of a substance abuse crisis. The rise in addiction is pressuring us to evaluate the way we deal with these conditions. In fact, this pandemic and its economic consequences will likely exacerbate the problem by increasing the population at risk of addiction. We need to think about such issues as the best setting for treatment, and whether patients recover better at home or in residential facilities. Right now, many addicts end up in jail rather than treatment facilities. We must figure out what we’re missing and the best way to help them.
Q. On a lighter and more personal note, what are you passionate about outside your field of study? Any fun facts your colleagues may not know about you?
A. I love dancing… Salsa. It’s a way for me to enjoy Latin music and connect with where I come from. While work is fulfilling, dancing is another important aspect of my life in terms of fitness, health, and my overall wellbeing. I always make time for it!
I also love travelling and am an enthusiastic supporter of my country’s soccer team, which currently places top 10 in the FIFA ranking.