JOB MARKET PAPER
Low Staffing in the Maternity Wards: Keep Calm and Call the Surgeon. [PDF] (new version!)
This paper examines how workload affects the provision of care in a large but understudied segment of the healthcare sector -- maternity wards. I use detailed patient-level administrative data on childbirth, and exploit quasi-random assignment of unscheduled patients to different staffing ratios. I find that patients who at admission observe a higher ratio of patients-to-midwives are more likely to receive a C-section. I show that this result is not attributable to patients' differential sorting across workload levels. Instead, I find evidence that C-sections are used to alleviate midwives' workload -they are faster than vaginal births and performed by physicians. I also exploit patient's civil status to determine whether the effect varies with patient's bargaining power -single women are on average more likely to be alone in the delivery room. Consistent with induced demand, only single patients are more likely to receive a C-section when admitted at high workload levels.
- Media briefing EEA-ESEM Geneva 2016 Meeting.
- Awarded Best Paper by Young Researcher at the Italian Health Economics Association-AIES Meeting 2015.
- Giorgio Rota Best Paper Award for Young Researchers by Centro Einaudi and Fondazione CRT (2018)
Productivity Effects of Dengue in Brazil. (with Sonia Bhalotra, Aline Menezes and Rudi Rocha) [PDF]
Although understanding the role of health in driving labor market outcomes is a matter of great importance, it has proven difficult to isolate this effect due to empirical challenges and a lack of compelling sources of identification. We obtain causal estimates of the effect of health on income and welfare dependency through two different channels: a negative health shock (dengue outbreak) and a positive health shock (opening of a health-care facility). To do this, we rely on instrumental variables and difference-in-difference methods, as well as on novel datasets. We find that dengue outbreaks lower the average working hours and income. This effect is particularly high for low-income individuals, but conditional cash transfer programs can insulate them from this shock. On the other hand, the opening of a new health-care facility in a families catchment area rises family per capita income and employment. All together, this evidence suggest that health shocks are an important part of income, poverty and welfare dependency.
Forgetting-by-not-doing: The Case of Surgeons and Cesarean Sections.
The understanding of the drivers behind the positive correlation between providers' volume and better health outcomes is still superficial. The two leading explanatory mechanisms are `learning-by-doing' and `selective referral', and previous studies testing for learning-by-doing have resorted to instrumental variables in order to alleviate issues of reverse causality. By using data from the Italian health care system, where patients are not allowed to choose a physician, I eliminate concerns regarding possible a selective referral bias. This paper investigates whether cesarean-section surgeons who have performed more procedures in the recent past observe an improvement in performance. Using four years of birth certificates data from one large hospital, I find that, for emergent cases, performing one additional procedure reduces the likelihood of neonatal intensive care unit admission by nearly 1.2 percentage points (5.5%) and of being born with a low Apgar Score by about 1.1 percentage points (10%), all else equal. This effect is not present for the case of elective C-sections. These findings should be taken into account as another positive outcome when considering policies of centralization of C-section services.
Work in Progress
Better Together? Bolsa Familia, School Segregation and Learning Outcomes. (with Gabriela Galassi)
The Effects of Cesarean Delivery on Mother's Fertility and Children's Long-term Health. (with Matilde Machado and Chiara Serra)