I am an economist and PhD Candidate in Economics at UCLA. I study regulatory design and firm behavior using tools from industrial organization and applied microeconomics.

Several of my current projects focus on hospitals: developing a better understanding of how hospitals produce healthcare and using this knowledge of the production process to inform the design of regulation aimed at low performers.

My work links academic research with policy. I received my MPA in Public and Economic Policy from the London School of Economics and I have professional experience as a competition economist and as an empirical economist for the World Bank.

Email: chandni [dot] raja [at] gmail [dot] com.

My CV

Peer-Reviewed Publications

[1] How Do Hospitals Respond to Input Regulation? Evidence from the California Nurse Staffing Mandate, Journal of Health Economics, 92, 102826, December 2023

[Paper] [Gated version]

Mentions in media and policy: [Hawaii Legislative Reference Bureau Report]

Show Abstract Abstract: Mandated minimum nurse-to-patient ratios have been the subject of active debate in the U.S. for over twenty years and are under legislative consideration today in several states and at the federal level. This paper uses the 1999 California nurse staffing mandate as an empirical setting to estimate the causal effects of minimum ratios on hospitals. Minimum ratios led to a 58 minute increase in nursing time per patient day and 9 percent increase in the wage bill per patient day in the general medical/surgical acute care unit among treated hospitals. Hospitals responded on several margins: increased their use of lower-licensed and younger nurses, reduced capacity by 16 beds (14 percent), and increased bed utilization rates by 0.045 points (8 percent). Using administrative data on discharges for acute myocardial infarction (AMI), I find a significant reduction in length of stay (5 percent) and no effect on the 30-day all-cause readmission rate. The null effect on readmissions suggests that length of stay declined not because hospitals were discharging AMI patients ``quicker and sicker", rather, AMI patients recovered more quickly due to an improvement in care quality per day.


Working Papers

[2] Input Regulation and the Production of Hospital Quality

[Paper]

Show Abstract Abstract: We have a limited understanding of how nurses, physicians, and patients interact to produce high quality medical care but these interactions are central to efficient regulatory design. This paper estimates a value-added production model for hospital quality in nurses and physicians that allows labor productivity to vary with observed patient type and unobserved hospital productivity. I exploit identifying variation from the 1999 California nurse staffing mandate – one of the first pieces of comprehensive legislation worldwide to establish minimum nurse-to-patient ratios in hospitals. I find nurses and physicians to be highly complementary (near Leontief) in production. I show that minimum nurse-to-patient ratios that do not account for these complementarities increase healthcare labor costs by 1.4 percent holding quality constant amounting to $24 million in costs across hospitals affected by the mandate. I recover hospital productivities and I show that on average there was no across-hospital misallocation of nurses to low productivity hospitals due to the ratio regulation – low staffing hospitals are as productive as their high staffing neighbors. However, I find efficiency gains can be made by reallocating nurses to hospitals with higher severity patients where they are more valuable.