BIO
Ernest Dorilas is a Ph.D. Candidate in Economics and a Second Century Initiative (2CI) University Doctoral Fellow at Georgia State University (GSU). His research utilizes quasi-experimental econometrics methods to study issues in Health, Public, and Labor economics. His most recent work aims at evaluating the tradeoff between hospital quality and distance traveled by rural mothers. He also has several other studies on tobacco policy, traffic fatality, emergency department visits, and teenage pregnancy.

RISK COMPONENT OF THE THESIS
In the United States, mothers living in rural areas face a substantial risk of not delivering their babies in time and at a hospital of good quality (Douthit et al. (2015), Kozhimannil et al. (2019)). This risk is mainly characterized by severe obstetric care shortage and low-quality care in rural areas. Currently, 35% of all US counties have no hospital providing obstetric services (Dimes, 2018), and 56% of all counties have no nurse-midwives (ACNM, 2018). Over 10% of rural women drive more than 100 miles for maternity care (CMS, 2018). Evidence also supports that several patients who access rural hospitals report on their low-quality care and poor reputation (Taylor and Cosenza (1999); Liu et al. (2007)). In this paper, we answer the following questions: how many more miles are rural mothers willing to travel to avoid the risk of going to a low-quality hospital? And, how does this tradeoff vary by age, race, education, risk level, and types of insurance coverage? These questions matter because obstetric care shortages and additional distance traveled have significant social costs (Nesbitt et al., 1990, Robbins et al., 2019). We use the 2007-2017 Vital Statistics Data Files (birth records) and the American Hospital Association (AHA) annual surveys to estimate the tradeoff between hospital quality and distance. This yields over 113 million hospital-birth matched observations. The results show that rural pregnant women have negative marginal utility for distance traveled and have strong preferences for well-functioning hospitals. They value the characteristics of obstetrics beds, bassinets (beds for babies), Neonate Intensive Care Unit (NICU) facilities, hospitals accredited by the Joint Commission, public and non-profit hospitals. More specifically, high-risk pregnant mothers are willing to travel an additional 3.08 miles (or 9.5% more relative to the mean) to go to any NICU hospital. Also, high-risk teenage girls are willing to travel 32% more miles to go to any NICU hospital. A high-risk pregnant mother is a mother that is below 17 years old, or that is 35 and older and have had at least one previous c-section, or that is 44 years and older, or that has a plural birth (e.g., twins, triplets) and have had at least one previous c-section, or that has at least one pre-pregnancy risk factors such as diabetes, chronic hypertension, and eclampsia (Mayo Clinic, 2017; Bladder, 2000). The results suggest that Neonate Intensive Care Units may represent a contingency plan for high-risk women who expect a challenging birth.