Working Papers

Understanding Variation in Cesarean Section Use: Supply-Side Drivers and Maternal Health Effects 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, 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 approximately 20% 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 28% more likely to deliver via unplanned C-section, leading to higher rates of maternal and infant health complications and worse maternal mental health postpartum. Our findings highlight physician practice style as an important driver of variation in obstetric care with direct consequences for maternal and infant 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.

Worth the Wait? Willingness to Pay for Gender-Concordant Physicians Across Medical Specialties with Tamri Matiashvili and Helena Roy

Patients increasingly select physicians through online “find a doctor” tools, which display information such as physician gender and patient ratings, rather than relying on physician referral, word-of-mouth, or soonest availability. Medical literature documents female patients’ stated preferences for female physicians in certain specialties, but whether and how patients act on these preferences when given the tools to do so remains an open question. Using a randomized hypothetical choice experiment that mirrors the information presented in typical online physician-search platforms, we find that female patients have strong preferences for gender-concordant physicians in gender-sensitive specialties. Women are willing to wait 1.6 additional weeks for a female urologist and 2.2 additional weeks for a female psychiatrist, two specialties with more gender-sensitive components, but show no statistically significant concordance preference in orthopedics, a more gender-neutral specialty. Men exhibit no significant concordance preference in any specialty. Among women, the gender concordance preference is stronger among those who report prior negative healthcare experiences due to gender. We complement these experimental findings with evidence from Medicare claims data on bladder cancer patients. We find that female patients are more likely than male patients to see female urologists, and women who match with a female urologist wait longer than women who match with a male urologist. Male patients exhibit no corresponding wait-time difference by physician gender. These findings suggest that patient preferences over physician characteristics, and patients’ growing capacity to act on those preferences, mean that the availability of female healthcare providers may affect patterns of health-seeking behavior such as provider choice and timing of care.

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 Wait for Racially Concordant Physicians (with Tamri Matiashvili and Helena Roy)

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