A matter of life and death? Hospital distance and quality of care: Evidence from emergency room closures and myocardial infarctions

Recent health care centralization trends raise the important question of the extent to which the quality of emergency medical services may offset effects from decreased access to emergency health care. This article analyzes whether residential proximity from an emergency room affects the probability of surviving an acute myocardial infarction (AMI). The critical time aspect in AMI treatment provides an ideal application forevaluating this proximity-outcome hypothesis. Previous studies have encountered empirical difficulties relating to potential endogenous health-based spatial sorting of involved agents and data limitations on out-of-hospital mortality. Using policy-induced variation in hospital distance arising from emergency room closures in the highly regulated Swedish health care sector and data on all AMI deaths in Sweden over two decades, estimation results show a clear and gradually declining probability of surviving an AMI as residential distance from an emergency room increases. The results further show that spatial sorting is likely to significantly attenuate the distance effect unless accounted for.