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The Effects of Leveraged Buyouts on Health Outcomes

by Robert Williams

Private equity firms first began acquiring hospitals in the United States during the early 1990s, yet the effects of private equity ownership on patient outcomes and treatment costs are still not clear. Some argue that although private equity firms are adept at improving operating efficiencies and introducing managerial expertise, these cost-cutting measures may come at the expense of patient outcomes.

Because acute myocardial infarctions (AMIs) serve as proxies for patient outcomes and treatment costs, I collect information on 30-day mortality rates and Medicare reimbursements for treatments of AMIs at US Medicare-certified short-term acute care general hospitals from 2014 to 2019. This paper uses fixed effects models to analyze the impact of leveraged buyouts, relative to strategic acquisitions, on patient outcomes. After integrating both hospital and time fixed effects, I find that private equity ownership does not lead to significant changes in Medicare reimbursements or mortality rates for AMI treatments.

View Thesis

Advisors: Professor Ryan McDevitt, Professor Grace Kim, Professor Michelle Connolly | JEL Codes: I0, I110, G340

A Franchise Education: The Impact of High School Quality on the Operations of Quick Service Restaurant Franchises in Texas

By Joseph Yetter

While the franchise business model provides customers with a certain level of consistency, there is still considerable variation in service quality across locations. Among other factors, a franchise’s quality of human capital (i.e., its workers) contributes to the quality of its operations, one of the strongest determinants of its revenue. Assuming that low wage workers have minimal geographical mobility, this paper studies how worker education impacts operation scores at the Texas locations of a quick service restaurant franchise brand by studying local school quality. This analysis controls for internal and external operations influences, such as the franchisee, designated market area, retail location type, the location’s proximity to a highway, and per capita income of the area to isolate the effect of school quality on operations. Ultimately, this study finds that higher school quality ratings have a significant and positive impact on the operations of franchises, and that operations have a significant and positive impact on sales revenue. Decomposing operations scores, this study finds that school quality ratings primarily impact operations by reducing customer complaints.

Honors Thesis

Advisor: Michelle Connolly, Ryan Mcdevitt | JEL Codes: J24, L8, L83 | Tagged: Business Operations, Education Quality, Franchise, Worker Productiviity

Questions?

Undergraduate Program Assistant
Matthew Eggleston
dus_asst@econ.duke.edu

Director of the Honors Program
Michelle P. Connolly
michelle.connolly@duke.edu