Marika Cabral

Interviewers: Angela Esi Micah and James Buchanan

The Early Career Researcher Interview Series is a new initiative led by the IHEA Early Career Researcher Special Interest Group (ECR-SIG). The aim of this interview series is to showcase the diversity of people in the ECR subgroup in iHEA. By interviewing a variety of ECRs, we hope to describe the many interesting and emerging career paths available to ECRs in health economics, highlight the choices that individuals have made to help them to reach this point in their career, and reveal how ECRs are navigating the various challenges that they face.

The first interview of this series is with Marika Cabral. Marika is an Assistant Professor in the Department of Economics at the University of Texas in Austin. Prior to this appointment, Marika completed her PhD in Economics at Stanford University between 2006-2011. In May 2018, Marika was awarded the 26th Arrow Award for the best paper in health economics for her paper “Claim Timing and Ex Post Adverse Selection” (Review of Economic Studies 84(1): 1-44, January 2017). Angela Esi Micah and James Buchanan, two of the conveners of the ECR-SIG, spoke to Marika in July 2018 to discuss her career to date, the research that underpins her award winning paper, and the challenges that she has faced as an ECR.

Marika Cabral

Hi Marika, thanks for talking to us today. We would like to start by asking you about your PhD. Could you tell us where you did your PhD, why you chose that particular institution and how you funded your studies? How did you transition to becoming an ECR after completing your PhD?

I went to graduate school at Stanford University in the Department of Economics. There were two major factors that led me to choose Stanford. Stanford has a large community of economists both within and outside the economics department representing a lot of fields. As a student who didn’t know exactly what I was going to specialize in that was important to me. The other thing that was really important to me as a prospective graduate student was that Stanford graduate students seemed happy when I interacted with them at the prospective student day. Now, when I talk to prospective graduate students, I often tell them that the happiness of graduate students should be an important consideration when selecting a graduate program because those are the people in the position they are aiming to be in.

In terms of how my PhD was funded, I was very fortunate to have a fellowship from Stanford, as well as a National Science Foundation Graduate Research Fellowship, which allowed me to focus on research throughout graduate school.

After completing my PhD, I went directly to a tenure track Assistant Professor position in the Economics Department at the University of Texas at Austin (UT-Austin). It was a somewhat difficult transition from a graduate student to an Assistant Professor, as it is for most people, but eventually you learn how to balance all the obligations associated with an Assistant Professor position.

Can you elaborate further on what was difficult about the transition?

When I was a graduate student, I was very focused on specific tasks and sometimes I had full days to think about these tasks. In contrast, as an Assistant Professor you have a wide variety of activities to deal with on any given day, so there is a lot more divided attention for any given task. Learning how to manage that efficiently is a process and a learning curve, and I think most people experience this. I think I spent most of my first year as an Assistant Professor getting a handle of that learning curve and figuring out how to divide my attention and move between tasks efficiently. 

What are you currently working on?

I am currently working on several research projects on health-related insurance markets. For instance, one project that I am working on is related to workers’ compensation insurance. This is a state-regulated insurance program that provides employees with medical and income benefits if they get injured on the job. Historically in the USA, 49 of the 50 states have mandated that employers provide this coverage to their employees but there is one exception, which is the state of Texas. Texas actually provides a nice case study to explore questions such as why do we see mandates in the other 49 states? I have obtained administrative data from the state of Texas on their workers’ compensation system, and I am using this data to estimate the demand for workers’ compensation insurance, leveraging idiosyncratic regulatory updates to premiums across industries over time. I plan to use difference-in-difference estimation to estimate the demand for workers’ compensation insurance and then analyze the potential rationale for government interventions to increase insurance coverage through things like mandates and subsidies. Within this project, I am analyzing whether the typical market failure rationale for government intervention to increase coverage – such as adverse selection, market power, and externalities – are compelling justifications for the existence of workers’ compensation insurance coverage mandates. 

That has the potential to be a fascinating study.

Yes, once I learnt that the system in Texas is a little bit different, I realized that there might be an interesting study there. The setting provides a unique opportunity to study the demand for workers’ compensation insurance since Texasis the only state that does not have a workers’ compensation coverage mandate and there exists comprehensive administrative data and plausibly exogenous premium variation. 

Beyond research, do you have additional responsibilities as an Assistant Professor?

I teach two courses: an undergraduate and a graduate course on public finance. These are both very fun courses to teach at UT-Austin because it is a large public university that attracts a very diverse student population. It is really exciting to teach students about the role of government in their lives and other people’s lives, and how the government functions in terms of taxation, benefits and social insurance. I particularly enjoy teaching students about social insurance, including health-related programs like Medicare and Medicaid, disability insurance and workers’ compensation insurance. I also advise PhD students who are working in the areas of public finance and health economics, and I have mentored masters and undergraduate students as well. I have been on several dissertation committees in my time at UT-Austin, and I have been a primary advisor for two PhD students.

How have you managed that transition from doing a PhD to supervising somebody else’s PhD?

It was an interesting transition to go straight from being someone’s advisee to being a mentor. However, even though it felt intimidating at first, I think it evolved naturally. At some point I realized that although I might not be the world’s foremost authority on a particular subject, I do have a lot to add as someone who has a lot of knowledge and experience compared to students who are just starting out. There are aspects of supervision that I was not prepared for starting out, but I think I have gotten a lot better at advising over time. 

Could you tell us some more about your journey to your current position after completing your PhD?

I went through the academic job market, which is the route taken by most economics PhD graduate students in the US. This is a once-in-a-lifetime experience that is interesting for anyone to go through. What I enjoyed about that process was the opportunity to communicate what I had been working on and discuss the broader implications of my work. This was especially refreshing after the focused period of work in graduate school leading up to the job market, where I could go an entire day working on a single research project without talking to anyone. Of course being on the job market was stressful, thinking about where you are going to go next and planning your life, but I thought there were lots of nice aspects about being on the job market as well.

Can you elaborate a bit more on the job market for economists, since this may not be a common experience for health economists in other countries?

The economics job market in the US is a very organized process. It involves applying for jobs and then going through a series of interviews at the Allied Social Sciences Associations (ASSA) annual meeting in January. Over the course of the three-day ASSA annual meeting, job market candidates typically have several first-round interviews and they move from hotel room to hotel room to interview in half hour slots. If you get a call back after, you are invited to fly out for an interview and if all goes well you may get an official offer. For me, it was a bit of a blur, but in retrospect it was really nice to be able to communicate my research findings. I enjoyed the opportunity to discuss research I was excited about, and it was great to find that other people thought these research findings were important too.

So moving on to the present day, obviously you are the most recent winner of the Arrow Award – congratulations from both of us! When and how did you find out about this achievement?

I found out when I got the official iHEA email, which was a couple of weeks before the announcement in the iHEA newsletter. I felt extremely honoured to hear that my paper had been selected for this award. I worked very hard on that paper – it was my job market paper when I was looking for my first job – so it was really nice to get the external recognition, and I felt incredibly honoured and humbled.

So this was your dissertation work – it’s great for other PhD students to see that iHEA recognises good quality doctoral work in this way. Could you summarise this work for readers who might not have read your paper yet?

The paper considers an issue that arises in healthcare markets, which is that many of the healthcare treatments that we engage with are not particularly urgent, and patients have some ability to choose when to time those treatments. That kind of latitude to choose when to time treatments is not a great thing for insurance markets. Because insurance coverage is typically determined by treatment date, individuals might have incentives to strategically delay treatment to minimise out-of-pocket costs. So I tried to look in the data to see whether people are strategically timing treatments to minimise their outof-pocket costs, and if they are, what are the implications for insurance market functioning.

To do this, I looked at administrative claims data in the setting of dental insurance. There are a handful of very urgent and expensive things that can happen with your dental health, but there are also a large number of delayable dental treatments, and there are interesting features within dental insurance contracts that incentivise people to potentially delay treatment. Dental insurance contracts in the US typically have an annual maximum benefit that can be around $1,000. That means if you require more than $1,000 worth of treatment, you have an incentive to delay seeking treatment until the following year when your benefits reset. I document that this kind of delay is very common, using administrative dental claims data, and then I use my findings to map out the implications for insurance market functioning. Specifically, I consider whether this delay contributes to adverse selection and whether policies can effectively address this behaviour, such as less frequent open enrolment periods or pricing of pre-existing conditions. Finally, I tried to benchmark how important this particular source of adverse selection is relative to the more traditional sources that people have studied before, and I find that they’re both quantitatively important in the setting of dental insurance. 

Are you planning any follow-up work related to the award winning paper?

That’s a good question. So far I haven’t done any direct follow-up work on the same topic, however a lot of my research looks at questions related to asymmetric information, adverse selection, and moral hazard in insurance markets, so I have worked on similar topics.

Can you share some of the challenges that you have faced in your career so far? Your journey will be aspirational for many ECRs, but we’re sure that this probably wasn’t a smooth journey.

I think everybody encounters a lot of challenges and I did as well. A couple of challenges stand out for me but I don’t think they’re at all unique to me – most researchers go through these challenges.

I already mentioned one: it was challenging to transition from being a student to an Assistant Professor. It was difficult to balance several new teaching and advising obligations, for which I had no specific preparation or training, as I was working to develop a research program.

Going further back, in graduate school I found it challenging to transition from coursework to research. I think many people struggle with that transition because it involves developing strategies to efficiently conduct your research, and, just as importantly, developing metrics by which you can measure and track your progress on research. Progress is not always linear, and it is important to learn that sometimes two steps forward and one step back is progress. Making that transition is difficult for many and it was difficult for me. One thing I enjoy about being an advisor for graduate students now is trying to help students to look at their own research progress honestly as they make the transition from coursework to research.

Navigating the publication process can also be challenging for an early career researcher. Sometimes rejection can be difficult – it can feel personal even when it’s not. Revising work can also be difficult because you don’t have the distance from the research to evaluate it in an effective way. I’ve often received requests to revise a paper and I have needed to take a week to step back from the work to consider these requests objectively before deciding on the best path forward. I think all of these things can be challenging for early career researchers, and I found them challenging as well.

Some great points there, thanks. So looking back, what one thing would you do differently if you were beginning your career now?

My honest answer is that I don’t think I would do anything differently – I’m happy with my current situation and I’m really risk averse! That said, it might have been helpful to take an extra year in graduate school or do a postdoc before starting an Assistant Professor position. I personally took 5 years to complete my PhD at a time when it was increasingly common to spend 6 years in grad school, and I then went straight to an Assistant Professor position after graduating. It might have been beneficial to have another year to develop a research agenda before taking on additional teaching and advising obligations, but overall I don’t think I would change anything. When I advise students now, I tell them to consider all of their options: they don’t have to take a certain amount of time at grad school or do a postdoc, for example, but these are viable options that could be beneficial for some. 

Finally, what are your goals going forward and what are you excited about over the next 5-10 years in terms of your career?

I think being an academic researcher is a really amazing job, in large part because you have the flexibility and the freedom to define what questions you work on. I think that this freedom and flexibility can be intimidating for some graduate students or even recent PhDs, but many people – including me – find this to be one of the most exciting and rewarding parts of the job. Defining what you work on means that you should (at least in theory) never get bored of what you’re working on, and I really enjoy that aspect of the job.

In terms of my career goals, 10 years is a really long time! I don’t really think in 10 year time horizons, but over the next few years my goal is to continue to work on high quality empirical research related to health, insurance, and the intersection of the two. As with my current and ongoing research, I expect that I’ll leverage a variety of applied micro research strategies and administrative datasets to achieve this. I hope that as I transition from being an early career researcher to being a mid-career researcher I will also spend more time advising, training and mentoring graduate students to help them to make the transition to becoming independent researchers.

Many thanks Marika for your time and for sharing so many interesting thoughts on your career to date as an early career researcher in health economics. Interested readers can learn more about Marika’s work by visiting her website. The next interview in the Early Career Researcher Interview Series will be published in September 2018.