Research

Working Papers

• How Recreational Cannabis Legalization Affects Hospital Operations with Maria R. Ibanez.
  • Invited for Major Revision at Management Science

  Problem definition: Cannabis is the most common federally illegal drug in the United States. The federal stance contrasts with the growing trend of recreational cannabis legalization (RCL) across states. A vital implementation question is how legalization affects hospitals. We propose that as cannabis spreads throughout society, its effects permeate healthcare systems, reaching inpatient wards. Cannabis peculiar symptoms—including aggravated chronic conditions, psychosis, agitation, and intractable vomiting—will increase workload complexity, restrict staff time and hospital capital resources available to other patients, and cause disturbance. Methodology/results: Using a difference-in-differences approach, we find that hospitals speed up care, with legalization shortening inpatient lengths of stay by 2.6%. Second, patient satisfaction with hospital noise levels at night, staff helpfulness, and information received about home recovery decrease by 5-10%, with potential reputational and financial damages for hospitals. Third, disciplinary actions against doctors, physician assistants, and nurses increase by 34%. Managerial implications: These findings underscore the need for policymakers to consider the broader implications of RCL, including its impact on hospital operations, amidst shifting societal norms. Strategies to mitigate the adverse effects of RCL should be explored, focusing on maintaining quality care. By understanding and addressing the challenges posed by RCL, healthcare providers can adapt their practices to ensure optimal patient care in an evolving regulatory landscape.

• Racial Disparity in Maternal Care and Moderating Factors: Role of Specialization, Exposure, and Ownership in Eliminating the Gap with Maria R. Ibanez. Manuscript available upon request.

  Annually, approximately 60,000 U.S. women experience severe maternal morbidity (SMM)—unexpected labor or delivery outcomes with serious short- or long-term health impacts. Many of these outcomes are preventable with appropriate care choices and applications. However, demographic and socioeconomic disparities in obstetric care and outcomes persist, and Black mothers consistently experience higher odds of labor complications (BCBS 2022). Using cross-sectional data of all labor and delivery admissions across six U.S. states, we confirm that Black mothers receive C-sections disproportionately more frequently than other mothers with comparable health conditions and face higher readmission rates after a first-time unscheduled C-section. Encouragingly, we uncover operational factors mitigating these disparities: stronger hospital- and physician-level C-section specialization reduces the gap, as does greater exposure to treating patients from underserved groups. For instance, the odds of C-section for a Black mother are 45% lower when receiving care at a hospital in the top quartiles for C-section specialization, maternal care expertise, and exposure to Black patients, compared to hospitals outside these top quartiles. Notably, hospital ownership status also impacts disparities: giving birth at a non-profit hospital entails relatively lower odds of receiving a riskier procedure for a Black mother, whereas receiving treatment at a government-owned facility corresponds to higher odds of experiencing riskier procedures and 90-day readmissions. These findings highlight the importance of more efficient patient-provider matching, continuous education on diversity, equity, and inclusion, and more rigorous provider evaluations by regulators. Such measures are crucial to promoting unbiased decision-making and advancing equitable health outcomes.

Work in Progress

• Impact of Health Incentives on Workers’ Productivity and Retention: Evidence from Germany In progress.
• Quality Through the Lens of Compliance: How Medical Providers’ Misconduct and Incompliance Impacts Operational Performance with Eric Johnson. In progress.
• Call the Midwife: Maternal Care Continuity and Midwifery Care Referral Decisions with Eric Johnson. In progress.
• Catalyst or Outsider? Travelling Nurses And Surgical Performance with Eric Johnson and Vikram Tiwari. In progress.