Alex Steiny Wellsjo

I am an Assistant Professor of Economics and Strategy at the Rady School of Management at UC San Diego. I received my PhD in Economics from UC Berkeley and completed my postdoctoral training at the Haas School of Business.

My research covers topics in applied microeconomics, with a focus on questions relating to health and household finance. As a behavioral economist, I incorporate insights from psychology into economic models to better understand individual behavior. I am especially interested in applications that relate to productivity at work, with insights for firms and individuals on how to effectively increase performance.

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email: awellsjo@ucsd.edu

Working Papers

The Medium Matters: Telemedicine versus In-person Care [VoxDev]

with Paul Gertler, Ada Kwan, Eric Remera, Piero Irakiza, Jeanine Condo, and James Humuza

Abstract: The use of telemedicine has been on the rise. Although telemedicine has increased access to health care, little is known about how the medium changes providers' medical decision-making. To evaluate how telemedicine differs from in-person care, we compare the quality and cost of in-person clinic visits and virtual visits over the phone for common conditions in Rwanda. To control for patient selection, we conduct an audit study with 2,532 standardized patient visits, where individuals portraying real patients presented standardized cases for malaria and upper respiratory infection (URI). We find that the quality of virtual care is higher than that of in-person care for URI and equally as good for malaria. Telemedicine providers also asked more questions about symptoms and medical history and prescribed more optional medicines for symptom management than in-person providers. We further find that telemedicine is more efficient than in-person care: virtual consultations were faster, had shorter wait times, resulted in fewer unnecessary medications and tests, and cost less for patients. Controlling for a rich set of provider characteristics, we show that provider selection does not appear to drive the results. Instead, better provider-patient communication over the phone emerges as a key mechanism. Providers report that it is easier to treat, get information from, and relate to patients over the phone.

Simple Actions, Complex Habits: Lessons from Hospital Hand Hygiene

Abstract: Routine tasks are often critical to performance but not consistently done. In the case of hospital hand hygiene, vital for infection prevention, guidelines are followed only half the time. Using data on whether 13,606 healthcare workers wash their hands 123M times that they are expected to, I document substantial heterogeneity consistent with a model of automatic cue-based habits. High performers fatigue 43% less than low performers but respond similarly when routines are disrupted. Behavior is also location-specific; healthcare workers wash more in rooms they have visited more in the past. These features of habit have implications for motivating routine behaviors.

Publications

Goals, Expectations, and Performance

with Avner Strulov-Shlain

Management Science, Accepted

Abstract: People and organizations often set goals to self-motivate and achieve better outcomes in challenging tasks. But goals, and their effectiveness, might depend on what people expect to happen. Do goals reflect expectations or do goals set expectations? How do goals and expectations affect performance? These distinctions are important for motivation and intervention design. We run an online real-effort task to answer these two questions by introducing exogenous variation in goals and expectations. First, we find that goals mostly reflect existing expectations rather than set expectations. Second, practicing an easier version of a task leads to higher expectations and higher performance. Third, eliciting a goal also leads to higher average performance, and changing the goal level has local effects that pull people toward the goal. However, revising goals has little effect on average performance. Our findings imply that increasing expectations is an important motivating tool that increases goals and performance. Having any goal helps performance; however, people cannot fool themselves into expecting and doing more simply by choosing a different goal.

Integrating Neuro-Psychological Habit Research into Consumer Choice Models

with Ryan Webb, Jessica Fong, Asaf Mazar, Julia Levine, Olivia Natan, Clarice Zhao, Phillippa Lally, Sanne de Wit, John O’Doherty, Andrew Ching, Raphael Thomadsen, Matthew Osborne, Peter Landry, Mark Bouton, Wendy Wood, and Colin Camerer

International Journal of Research In Marketing, Forthcoming

Abstract: We discuss how habit is defined across disciplines that study human choices. In particular, we examine the role of learning in forming habits, the roles of automaticity, context and cues, and attention, and whether habits reflect a change in preferences or a choice system which is partly decoupled from preferences. These constructs are used to create a framework for economics, psychology, and marketing research, suitable for analysis of consumer choice experiments and datasets.

Rent or Buy? Inflation Experiences and Homeownership within and across Countries [Published Version]

with Ulrike Malmendier

Journal of Finance, June 2024, vol. 79 (3), pp. 1977-2023.

Abstract: We show that past inflation experiences strongly predict homeownership within and across countries. First, we collect novel survey data, which reveals inflation protection to be a key motivation for homeownership, especially after personal experiences of high inflation. Second, using household data from 22 European countries, we find that higher personal exposure to historical inflation predicts higher homeownership rates. We estimate similar associations among immigrants to the US who experienced different past inflation in their home countries but face the same US housing market. As predicted by the experience-effects model, the relationship is strongest in countries with predominantly fixed-rate mortgages.

Predicting Mid-Life Capital Formation with Pre-School Delay of Gratification and Life-Course Measures of Self-Regulation

with Daniel Benjamin, David Laibson, Walter Mischel, Philip Peake, Yuichi Shoda, and Nicole Wilson

Journal of Economic Behavior and Organization, November 2020, vol. 179, pp. 743-756. Special Issue "Understanding Cognition and Decision Making by Children".

Abstract: How well do pre-school delay of gratification and life-course measures of self-regulation predict mid-life capital formation? We surveyed 113 participants of the 1967–1973 Bing pre-school studies on delay of gratification when they were in their late 40’s. They reported 11 mid-life capital formation outcomes, including net worth, permanent income, absence of high-interest debt, forward-looking behaviors, and educational attainment. To address multiple hypothesis testing and our small sample, we pre-registered an analysis plan of well–powered tests. As predicted, a newly constructed and pre-registered measure derived from preschool delay of gratification does not predict the 11 capital formation variables (i.e., the sign-adjusted average correlation was 0.02). A pre-registered composite self-regulation index, combining preschool delay of gratification with survey measures of self-regulation collected at ages 17, 27, and 37, does predict 10 of the 11 capital formation variables in the expected direction, with an average correlation of 0.19. The inclusion of the preschool delay of gratification measure in this composite index does not affect the index’s predictive power. We tested several hypothesized reasons that preschool delay of gratification does not have predictive power for our mid-life capital formation variables.

Other Papers

New Players in Fintech Markets

with Laura Chioda, Paul Gertler, and Isabel Macdonald

Abstract: In this paper, we explore how technologies from new players in fintech differ from traditional financial services in the problems they solve, requirements for success at-scale, and unintended consequences. We highlight key questions from the academic literature that have already been addressed and those that are outstanding. While we focus on applications for consumers in developing countries, we also draw on insights from examples in developed economies that may serve as both potential areas of opportunity and pitfalls to avoid. First, we discuss how new players aim to increase access to financial services for those outside of the traditional banking systems, build new technologies and infrastructure to lower costs, and even create new markets to solve problems not addressed with traditional financial services. With large dispersion in the sources of innovation, each of these new players is approaching these problems in unique ways. To have any real impact on consumers, these fintech technologies must be brought to scale. While the large number of new players has been critical for innovation, it has made the challenge of scalability that much harder. Not only does the number of players increase direct competition between fintech solutions, but the fragmented nature of the market makes it difficult to establish trust, proper regulatory oversight, and the necessary infrastructure. While these technologies have a lot of potential benefit for consumers, they are not without consequences. Increased financial access has clear benefits, but it poses a challenge when bringing in less technically or financially sophisticated consumers. As access is expanded, consumers should be empowered to make informed decisions and avoid security risks. Removing frictions in financial markets can improve efficiency, but it also allows consumers to act more impulsively. We also discuss how new markets can lead to novel behaviors or a resurfacing of traditional challenges in finance, highlighting the need for careful research on the implications of these new players. Beyond the direct benefits and consequences for consumers, fintech can have broader impacts on markets, prices, intra-household dynamics, mobility, and even the environment. The paper concludes with a discussion of these broader impacts.

Novel Use of Data in Fintech

with Laura Chioda, Paul Gertler, and Isabel Macdonald

Abstract: Advances in big data (large, detailed datasets with many more observations and variables) and non-traditional data (datasets with variables that are not traditionally collected and analyzed for a certain purpose) have grounded many of the innovations in fintech in the past two decades. In this paper, we survey empirical evidence about the benefits of these innovations, as well as the constraints to scaling and the unintended consequences. Where product innovations have outpaced the production of quality research, we also draw on industry reports and case studies to highlight potential impacts. The benefits of data advances for fintech are numerous. First, they can expand financial access to populations who have been historically excluded due to lack of credit history. Second, large datasets can help financial companies better analyze and mitigate risks, such as through enhanced fraud detection. Third, data can reduce the costs of administration by automating activities like loan approval, insurance payouts, and identity verification, all while boosting accuracy. Fourth, data allows for greater personalization, increasing the appeal of financial products to consumers and improving the ability of tools to meet individual needs. While these technologies hold great promise, to achieve broad scale they require large sources of data. Early algorithmic lending relied heavily on mobile phone data, but increasing restrictions on this data have created a need for alternatives. Skill gaps are also a significant barrier to scale, as many organizations that are interested in applying new data-related innovations currently lack the requisite skills. There are also unintended consequences to consider. First, non-traditional data sources raise concerns about privacy and responsible use of consumer data. Second, expanding credit access might lead to overindebtedness as less educated consumers gain access to borrowing. Third, it is possible for discrimination to be baked into algorithms, though evidence of this in practice is mixed. Finally, consumers might attempt to "game the system" by conducting activities favored by algorithms, which in turn reduces algorithmic effectiveness. Further regulation and research can help address many of these concerns. The challenge will be for these mechanisms to keep pace with these novel uses of data.

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