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

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  • Schwierz, Christoph
  • Augurzky, Boris
  • Wasem, Jürgen

Abstract

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.

Suggested Citation

  • Schwierz, Christoph & Augurzky, Boris & Wasem, Jürgen, 2009. "Does the Quality of Hospital Treatment Vary by Days of the Week?," Ruhr Economic Papers 105, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:105
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    References listed on IDEAS

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    1. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
    2. 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.
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    Cited by:

    1. Christoph Schwierz & Boris Augurzky & Axel Focke & Jürgen Wasem, 2012. "Demand, selection and patient outcomes in German acute care hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 21(3), pages 209-221, March.
    2. Hentschker, Corinna, 2017. "From dusk till dawn - Are nights a dangerous time for hospital admissions?," VfS Annual Conference 2017 (Vienna): Alternative Structures for Money and Banking 168056, Verein für Socialpolitik / German Economic Association.
    3. 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.
    4. 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.

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    More about this item

    Keywords

    Hospital quality; weekend effect; inpatient outcomes;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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