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Does the Quality of Hospital Treatment Vary by Days of the Week?


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  • Christoph Schwierz


  • Boris Augurzky
  • Jürgen Wasem


This paper investigates the relationship between health outcomes and variations in staffing levels as approximated by admissions on weekdays versus admissions on weekends. Because days of admission are potentially endogenous, we instrument on emergency admissions only, which are reasonably exogenous to the time of admission. Further,we introduce a direct measure for within- diagnosis variation in severity across days of admission to control for the unobservable selection of patients.We find that after controlling for patient heterogeneity and endogeneity of the day of admission there is still a significant variation in mortality rates between weekend and weekday admissions. Patients admitted during the weekend exhibit higher in-hospital mortality rates. We also find signs of premature discharge, as patients with short lengths of stay tend to exhibit higher probability to be readmitted as emergency cases.

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Paper provided by Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen in its series Ruhr Economic Papers with number 0105.

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Length: 22 pages
Date of creation: May 2009
Date of revision:
Handle: RePEc:rwi:repape:0105

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Keywords: Hospital quality; weekend effect; inpatient outcomes;

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  1. Ho, Vivian & Hamilton, Barton H., 2000. "Hospital mergers and acquisitions: does market consolidation harm patients?," Journal of Health Economics, Elsevier, vol. 19(5), pages 767-791, September.
  2. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
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Cited by:
  1. Katharina Hauck & Xueyan Zhao & Terri Jackson, 2010. "Adverse events in surgical inpatients: A comparative analysis of public hospitals in Victoria," Monash Econometrics and Business Statistics Working Papers 5/10, Monash University, Department of Econometrics and Business Statistics.
  2. Katharina Hauck & Xueyan Zhao, 2010. "A structural equation model of adverse events and length of stay in hospitals," Monash Econometrics and Business Statistics Working Papers 4/10, Monash University, Department of Econometrics and Business Statistics.


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