Working Papers

Understanding Variation in Cesarean Section Use: Supply-Side Drivers and Maternal Health Effects (Job market paper) 

with Helena Roy 

 We estimate the causes and consequences of regional variation in healthcare utilization in the setting of Cesarean sections (C-sections), the most common inpatient surgery in the United States. C-section rates differ up to 10-fold across hospitals, with substantial variation even for clinically similar patients. Using nationwide Medicaid administrative claims data, covering 42% of all US births, we leverage physician mobility across hospitals to disentangle the role of physician practice style from hospital environment. We find that differences in physician practice style can explain over one quarter of the across-hospital differences in C-section rates. This variation in practice style has meaningful consequences for patient health: low-risk patients quasi-randomly assigned to more C-section-intensive physicians are 10% more likely to deliver via unplanned C-section, leading to worse maternal health outcomes without measurable improvements in infant health. Our findings highlight physician practice style as an important driver of variation in obstetric care with direct consequences for maternal health. 

The Role of Physician Training in Racial Disparities in Maternal Healthcare with Helena Roy

Maternal mortality in the United States is two to three times higher than in most other high-income countries, with stark racial disparities. One potential avenue for reducing racial disparities is through physician training that addresses patient heterogeneity by race. In this paper, we examine whether racial disparities in treatment use and outcomes can be traced back to physicians’ OB/GYN residency training, as reflected in the practice patterns of their alumni. We find that residency programs have only modest effects on treatment use and outcomes across racial groups. Notably, a residency's relative effect on C-section use and delivery complications is not strongly correlated across Black versus White patients, suggesting non-uniform learning across different patient groups. We also examine if training at a residency with a more diverse patient mix, a feature advertised by multiple residencies as an important part of physician education, impacts physicians' deviation from clinical consensus in delivery decisions. Though we document that deviations from clinical consensus are more likely for Black patients, we find essentially no impact of training with a diverse patient population on this racial gap.

Selected Work In Progress

Birth Centers and Maternal and Infant Health (with Ambar La Forgia, Petra Persson, Maya Rossin-Slater and Helena Roy)

Willingness to Pay for Concordance in Healthcare (with Tamri Matiashvili and Helena Roy)

Shell-Shocked: Long Run Consequences of Wartime Stress  (with Boaz Abramson)