Pauline Mourot

Research

Working papers

Market Size and Trade in Medical Services

NBER WP #31030 (with Jonathan Dingel, Josh Gottlieb, and Maya Lozinski)

We measure the importance of increasing returns to scale and trade in medical services. Using Medicare claims data, we document that "imported" medical care — services produced by a medical provider in a different region — constitute about one-fifth of US healthcare consumption. Larger regions specialize in producing less common procedures, which are traded more. These patterns reflect economies of scale: larger regions produce higher-quality services because they serve more patients. Because of increasing returns and trade costs, policies to improve access to care face a proximity-concentration tradeoff. Production subsidies and travel subsidies can impose contrasting spillovers on neighboring regions. 

Media mention: Washington Post, The Center Square

Work in progress

Sorting and Complementarities in Healthcare: Hospitals and Surgeons

I quantify the role of surgeons in the production function of hospitals. Using Medicare data, I examine the joint production function of patients' survival in the context of Coronary Artery Bypass Graft (CABG) surgery. I separately estimate the contributions of the operating surgeon and the hospital to survival dispersion, and show that surgeons are crucial determinants of patients' survival: they explain six times more of the variance in patients' outcomes than hospitals. I find that cardiothoracic surgeons engage in positive assortative matching, where higher-survival surgeons practice at higher-survival hospitals. However, this matching minimizes rather than maximizes the benefits of complementarities: low-survival surgeons have much higher returns from practicing at a high-survival hospital than high-survival surgeons do. My results imply that we could increase the aggregate survival rate and lower inequality by allocating low-survival surgeons to high-survival hospitals. 

Firms, Markets, and the Division of Labor: The Case of Physicians

(with Maya Lozinski) 

Why and how do physicians co-locate to provide care? We establish several novel facts regarding this question. First, the number of healthcare establishments grows with an elasticity near one with market size, so that a doubling of population results in twice as many healthcare establishments. Notably, the average size of healthcare establishments does not increase measurably with the market size. We also show that the composition of establishments varies substantially with market size, even though they remain the same size. As market size grows, physicians co-locate more with same-specialty colleagues, individually produce a narrower set of services, and collectively produce a larger set and volume of services. These results suggest that coordination costs substantially constrain establishment size. In addition, they imply that same-specialty colleagues become more valuable as the market size grows due to an increasingly fine division of labor, allowing for production efficiencies.

Rapid Technological Advancements and the Organization of Expert Work

(with Maya Lozinski) 

Teaching

Health Economics (MBA, Winter 2022)

Prof. Matthew Notowidigdo

Data Driven Marketing (MBA and EMBA, Spring and Summer 2022)

Prof. Gunter Hitsch

Competitive Strategy (MBA, Spring 2021 and Winter 2022)

Prof. Yoad Shefi

Healthcare Analytics Lab (MBA, Spring 2020)

Prof. Daniel Adelman