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Kai Shen Lim

Postdoctoral Research Fellow

kaishenlim@g.harvard.edu

I am a Postdoctoral Research Fellow at the Harvard Kennedy School working alongside Professor Mark Shepard on U.S. health insurance market design.

My research focuses on global health care markets and health insurance in the United States, using tools from industrial organization, health economics and development economics.

I have five years of policy-making experience in health, housing, and disaster reconstruction at the World Bank, UNDP, and Harvard T.H. Chan School.

I received a Ph.D. in Health Systems and Economics from Harvard in 2024, and B.Sc. and M.Sc. in Economics and Econometrics from the University of Nottingham.

[ CV ]

Working Papers:

  1. Competing Complements in Public-Private Hospital Markets
    Public provision in mixed markets can either crowd-in private investment through complementarities or crowd-out through competition. This paper quantifies these competing effects using the staggered construction of public hospitals across districts in Malaysia between 1996 and 2013. I show that new public hospitals generate two opposing effects: patient competition via heavily subsidized flat fees, versus positive labor spillovers from expanded physician supply. The net effect depends on the type of public hospital—specialist hospitals substantially increase physician pools and crowd-in private entry, while non-specialist hospitals compete for patients and crowd-out private hospitals. To disentangle these effects, I estimate a dynamic model of strategic entry and competition. The estimates show that a new public hospital reduces a private hospital's entry costs by 22 percent while capturing (on average) 46 percent of market share after entry. These results show that the design of public provision determines whether it complements or competes with private markets.
  2. Hospital Allocation and Political Interests: Evidence from Malaysia (Revise and Resubmitted, Journal of Development Economics)
    Political interests potentially distort the allocation of public goods, yet when and at which allocation stage politicians exert their influence remains poorly understood. This paper examines how politicians influence where public hospitals are built in Malaysia between 1959 and 2013. Hospital allocation in Malaysia involves first allocating funding to districts, followed by choosing specific locations within districts for new hospitals. I find that electoral seats with deputy ministers are significantly more likely to receive new hospitals, but only during the location selection within districts. The decision of selecting which districts receive funding remains largely driven by needs-based criteria, with funding directed to districts far from existing hospitals. These findings show how allocation rules at different stages can mitigate political influence, potentially minimizing distortions in public goods provision.

Publications:

  1. Consumer Choice and Public-Private Providers: The Role of Perceived Prices (with Wei Aun Yap and Winnie Yip). Health Economics 2022.
    Governments often encourage health service providers to improve quality of care and reduce prices through competition. The efficacy of competition hinges on the assumption that consumers demand high quality care at low prices for any given health condition. In this paper, we examine this assumption by investigating the role of perceived price and quality on consumer choice for four different health conditions across public and private providers. We use a nationally representative survey in Malaysia to elicit respondents' perception on prices and quality, and their preferred choice of provider. We estimate a mixed logit model and show that consumers value different dimensions of quality depending on the health condition. Furthermore, increasing perceived prices for private providers reduces demand for minor, more frequent health conditions such as flu fever or cough, but increases demand for more complex, severe conditions such as coronary artery bypass graft. These findings provide empirical support for price regulation which differentiates the severity of underlying health conditions.

Selected Work-In-Progress:

  1. Strategic Auto-Enrollment and Health Insurance Market Design (with Mark Shepard and Myles Wagner).
  2. Word-of-Mouth in Low-Income Health Care Markets (with Bijetri Bose and Terence Cheng).