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Free-for-all: Does crowding impact outcomes because hospital emergency departments do not prioritise effectively?

Author

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  • Francetic, Igor
  • Meacock, Rachel
  • Sutton, Matt

Abstract

Unexpected peaks in volumes of attendances at hospital emergency departments (EDs) have been found to affect waiting times, intensity of care and outcomes. We ask whether these effects of ED crowding on patients are caused by poor clinical prioritisation or a quality-quantity trade-off generated by a binding capacity constraint. We study the effects of crowding created by lower-severity patients on the outcomes of approximately 13 million higher-severity patients attending the 140 public EDs in England between April 2016 and March 2017. Our identification approach relies on high-dimensional fixed effects to account for planned capacity. Unexpected demand from low-severity patients has very limited effects on the care provided to higher-severity patients throughout their entire pathway in ED. Detrimental effects of crowding caused by low-severity patients materialise only at very high levels of unexpected demand, suggesting that binding resource constraints impact patient care only when demand greatly exceeds the ED's expectations. These effects are smaller than those caused by crowding induced by higher-severity patients, suggesting an efficient prioritisation of incoming patients in EDs.

Suggested Citation

  • Francetic, Igor & Meacock, Rachel & Sutton, Matt, 2024. "Free-for-all: Does crowding impact outcomes because hospital emergency departments do not prioritise effectively?," Journal of Health Economics, Elsevier, vol. 95(C).
    • Handle: RePEc:eee:jhecon:v:95:y:2024:i:c:s0167629624000262
    DOI: 10.1016/j.jhealeco.2024.102881
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    1. Sergio Correia, 2016. "reghdfe: Estimating linear models with multi-way fixed effects," 2016 Stata Conference 24, Stata Users Group.
    2. Anderson, Michael L., 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Journal of the American Statistical Association, American Statistical Association, vol. 103(484), pages 1481-1495.
    3. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 63-77, September.
    4. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    5. Beth Parkinson & Rachel Meacock & Matt Sutton, 2019. "How do hospitals respond to price changes in emergency departments?," Health Economics, John Wiley & Sons, Ltd., vol. 28(7), pages 830-842, July.
    6. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    7. Turner, Alex J & Francetic, Igor & Watkinson, Ruth & Gillibrand, Stephanie & Sutton, Matt, 2022. "Socioeconomic inequality in access to timely and appropriate care in emergency departments," Journal of Health Economics, Elsevier, vol. 85(C).
    8. Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    9. Bruno Martins & Luís Filipe, 2020. "Doctors' response to queues: Evidence from a Portuguese emergency department," Health Economics, John Wiley & Sons, Ltd., vol. 29(2), pages 123-137, February.
    10. repec:boc:pcon20:13 is not listed on IDEAS
    11. Alex J. Turner & Laura Anselmi & Yiu‐Shing Lau & Matt Sutton, 2020. "The effects of unexpected changes in demand on the performance of emergency departments," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1744-1763, December.
    12. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    13. Caroline Berchet, 2015. "Emergency Care Services: Trends, Drivers and Interventions to Manage the Demand," OECD Health Working Papers 83, OECD Publishing.
    14. Peter Sivey, 2018. "Should I stay or should I go? Hospital emergency department waiting times and demand," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 30-42, March.
    15. Zhuan Pei & Jörn-Steffen Pischke & Hannes Schwandt, 2019. "Poorly Measured Confounders are More Useful on the Left than on the Right," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 205-216, April.
    16. Sergio Correia & Paulo Guimarães & Tom Zylkin, 2020. "Fast Poisson estimation with high-dimensional fixed effects," Stata Journal, StataCorp LLC, vol. 20(1), pages 95-115, March.
    17. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    18. Thomas P. Hoe, 2022. "Does Hospital Crowding Matter? Evidence from Trauma and Orthopedics in England," American Economic Journal: Economic Policy, American Economic Association, vol. 14(2), pages 231-262, May.
    19. Carol Propper & John Van Reenen, 2010. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 222-273, April.
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    1. Francetic, I.; & Meacock, R.; & Siciliani, L.; & Sutton, M.;, 2024. "Disorderly queues: How does unexpected demand affect queue prioritisation in emergency care?," Health, Econometrics and Data Group (HEDG) Working Papers 24/14, HEDG, c/o Department of Economics, University of York.

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • H4 - Public Economics - - Publicly Provided Goods
    • D2 - Microeconomics - - Production and Organizations

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