Spatial Disparities in Hospital Performance

56 Pages Posted: 20 Oct 2012

See all articles by Laurent Gobillon

Laurent Gobillon

National Institute of Statistics and Economic Studies (INSEE) - Center for Research in Economics and Statistics (CREST); National Institute of Demographic Studies (INED)

Carine Milcent

CNRS

Abstract

Using a French exhaustive dataset, this paper studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.

Keywords: spatial health disparities, economic geography, stratified duration model

JEL Classification: I11, C41

Suggested Citation

Gobillon, Laurent and Milcent, Carine, Spatial Disparities in Hospital Performance. IZA Discussion Paper No. 6936, Available at SSRN: https://ssrn.com/abstract=2164665 or http://dx.doi.org/10.2139/ssrn.2164665

Laurent Gobillon (Contact Author)

National Institute of Statistics and Economic Studies (INSEE) - Center for Research in Economics and Statistics (CREST) ( email )

15 Boulevard Gabriel Peri
Malakoff Cedex, 1 92245
France

National Institute of Demographic Studies (INED) ( email )

133, Boulevard Davout
Paris cedex 20, France 75980
France
+33 1 5606 2016 (Phone)
+33 1 5606 2199 (Fax)

HOME PAGE: http://laurent.gobillon.free.fr/

Carine Milcent

CNRS ( email )

3, rue Michel-Ange
Paris, 75794
France

Do you have negative results from your research you’d like to share?

Paper statistics

Downloads
40
Abstract Views
446
PlumX Metrics