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Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers

Author

Listed:
  • Jonathan Gruber

    (MIT and NBER)

  • Thomas P. Hoe

    (Cornell University and Institute for Fiscal Studies)

  • George Stoye

    (Institute for Fiscal Studies)

Abstract

We study how emergency department (ED) doctors respond to incentives to reduce wait times. We use bunching techniques to study an English policy that imposed strong incentives to treat patients within four hours. The policy reduced time spent in the ED by 21 minutes for affected patients yet caused doctors to increase treatment intensity and admit more patients. We find a striking 14% reduction in mortality. Analysis of patient severity and hospital crowding strongly suggests it is the wait time reduction that saves lives. We conclude that, despite distorting medical decisions, constraining ED doctors can induce cost-effective reductions in mortality.

Suggested Citation

  • Jonathan Gruber & Thomas P. Hoe & George Stoye, 2023. "Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers," The Review of Economics and Statistics, MIT Press, vol. 105(1), pages 1-19, January.
    • Handle: RePEc:tpr:restat:v:105:y:2023:i:1:p:1-19
    DOI: 10.1162/rest_a_01044
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Thesis Thursday: Thomas Hoe
      by Chris Sampson in The Academic Health Economists' Blog on 2018-07-19 06:00:52

    Citations

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    Cited by:

    1. 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.
    2. Meredith M. Paker, 2025. "Review of periodical literature for 2023: (vi) 1945 to present," Economic History Review, Economic History Society, vol. 78(1), pages 387-397, February.
    3. Knutsson, Daniel & Tyrefors, Björn, 2020. "The Quality and Efficiency Between Public and Private Firms: Evidence from Ambulance Services," Working Paper Series 1365, Research Institute of Industrial Economics, revised 01 Jul 2021.
    4. Wilding, Anna & Munford, Luke & Guthrie, Bruce & Kontopantelis, Evangelos & Sutton, Matt, 2022. "Family doctor responses to changes in target stringency under financial incentives," Journal of Health Economics, Elsevier, vol. 85(C).
    5. Helen Hayes & Rachel Meacock & Jonathan Stokes & Matt Sutton, 2024. "How do family doctors respond to reduced waiting times for cancer diagnosis in secondary care?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(5), pages 813-828, July.
    6. Woodworth, Lindsey, 2020. "Swamped: Emergency Department Crowding and Patient Mortality," Journal of Health Economics, Elsevier, vol. 70(C).
    7. Agovino, Massimiliano & Musella, Gaetano & Scaletti, Alessandro, 2022. "Equilibrium and efficiency in the first aid services market: The case of the emergency department of Sorrento," Socio-Economic Planning Sciences, Elsevier, vol. 82(PB).
    8. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    9. Simon Bensnes, 2021. "Time to spare and too much care. Congestion and overtreatment at the maternity ward," Discussion Papers 963, Statistics Norway, Research Department.
    10. Aggarwal, Shilpa, 2021. "The long road to health: Healthcare utilization impacts of a road pavement policy in rural India," Journal of Development Economics, Elsevier, vol. 151(C).
    11. Elena Lucchese, 2020. "It could be worse...it could be raining: Ambulance response time and health outcomes," Working Papers 429, University of Milano-Bicocca, Department of Economics, revised Feb 2020.
    12. 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.
    13. Elena Lucchese, 2024. "How important are delays in treatment for health outcomes? The case of ambulance response time and cardiovascular events," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 652-673, April.
    14. 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).

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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