IDEAS home Printed from https://ideas.repec.org/a/tpr/restat/v94y2012i3p635-649.html
   My bibliography  Save this article

Estimating Heterogeneity in the Benefits of Medical Treatment Intensity

Author

Listed:
  • William N. Evans

    (Department of Economics, University of Notre Dame)

  • Craig Garthwaite

    (Department of Management and Strategy, Kellogg School of Management, Northwestern University)

Abstract

We exploit increases in postpartum length of stay generated by legislative changes in the late 1990s to identify the impact of greater hospital care on the health of newborns. Using all births in California over the 1995–2000 period, two-stage least-square estimates show that increased treatment intensity had a modest impact on readmission probabilities for the average newborn. Allowing the treatment effect to vary by two objective measures of medical need demonstrates that the law had large impacts for those with the greatest likelihood of a readmission. The results suggest that the returns to average and marginal patients vary considerably in this context. © 2012 The President and Fellows of Harvard College and the Massachusetts Institute of Technology.

Suggested Citation

  • William N. Evans & Craig Garthwaite, 2012. "Estimating Heterogeneity in the Benefits of Medical Treatment Intensity," The Review of Economics and Statistics, MIT Press, vol. 94(3), pages 635-649, August.
  • Handle: RePEc:tpr:restat:v:94:y:2012:i:3:p:635-649
    as

    Download full text from publisher

    File URL: http://www.mitpressjournals.org/doi/pdf/10.1162/REST_a_00198
    File Function: link to full text PDF
    Download Restriction: Access to full text is restricted to subscribers.
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    2. James J. Heckman & Sergio Urzua & Edward Vytlacil, 2006. "Understanding Instrumental Variables in Models with Essential Heterogeneity," The Review of Economics and Statistics, MIT Press, vol. 88(3), pages 389-432, August.
    3. Marianne P. Bitler & Jonah B. Gelbach & Hilary W. Hoynes, 2006. "What Mean Impacts Miss: Distributional Effects of Welfare Reform Experiments," American Economic Review, American Economic Association, vol. 96(4), pages 988-1012, September.
    4. Amy Finkelstein & Robin McKnight, 2005. "What Did Medicare Do (And Was It Worth It)?," NBER Working Papers 11609, National Bureau of Economic Research, Inc.
    5. Alberto Abadie & Joshua Angrist & Guido Imbens, 2002. "Instrumental Variables Estimates of the Effect of Subsidized Training on the Quantiles of Trainee Earnings," Econometrica, Econometric Society, vol. 70(1), pages 91-117, January.
    6. James J. Heckman & Edward Vytlacil, 2005. "Structural Equations, Treatment Effects, and Econometric Policy Evaluation," Econometrica, Econometric Society, vol. 73(3), pages 669-738, May.
    7. Douglas Almond & Joseph J. Doyle & Amanda E. Kowalski & Heidi Williams, 2010. "Estimating Marginal Returns to Medical Care: Evidence from At-risk Newborns," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(2), pages 591-634.
    8. Douglas Almond & Joseph J. Doyle, 2011. "After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays," American Economic Journal: Economic Policy, American Economic Association, vol. 3(3), pages 1-34, August.
    9. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: an application to treatments of breast cancer patients," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1133-1157.
    10. Evans, William N. & Garthwaite, Craig & Wei, Heng, 2008. "The impact of early discharge laws on the health of newborns," Journal of Health Economics, Elsevier, vol. 27(4), pages 843-870, July.
    11. James J. Heckman & Jeffrey Smith & Nancy Clements, 1997. "Making The Most Out Of Programme Evaluations and Social Experiments: Accounting For Heterogeneity in Programme Impacts," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 487-535.
    12. Cutler David M. & Meara Ellen, 2000. "The Technology of Birth: Is It Worth It?," Forum for Health Economics & Policy, De Gruyter, vol. 3(1), pages 1-37, January.
    13. Duggan Mark G & Evans William N, 2008. "Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments," Forum for Health Economics & Policy, De Gruyter, vol. 11(2), pages 1-39, January.
    14. David M. Cutler & Ellen Meara, 2000. "The Technology of Birth: Is It Worth It?," NBER Chapters, in: Frontiers in Health Policy Research, Volume 3, pages 33-68, National Bureau of Economic Research, Inc.
    15. David M. Cutler & Mark McClellan & Joseph P. Newhouse & Dahlia Remler, 1998. "Are Medical Prices Declining? Evidence from Heart Attack Treatments," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 113(4), pages 991-1024.
    16. James Heckman & Justin L. Tobias & Edward Vytlacil, 2003. "Simple Estimators for Treatment Parameters in a Latent-Variable Framework," The Review of Economics and Statistics, MIT Press, vol. 85(3), pages 748-755, August.
    17. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: An application in breast cancer patients," Health, Econometrics and Data Group (HEDG) Working Papers 07/07, HEDG, c/o Department of Economics, University of York.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Seojeong Lee, 2018. "A Consistent Variance Estimator for 2SLS When Instruments Identify Different LATEs," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 36(3), pages 400-410, July.
    2. N. Meltem Daysal & Jonas Cuzulan Hirani, 2021. "Early-life medical care and human capital accumulation," IZA World of Labor, Institute of Labor Economics (IZA), pages 217-217, September.
    3. Dzhamilya Nigmatulina & Charles Becker, 2016. "Is high-tech care in a middle-income country worth it?," The Economics of Transition, The European Bank for Reconstruction and Development, vol. 24(4), pages 585-620, October.
    4. Sievertsen, Hans Henrik & Wüst, Miriam, 2017. "Discharge on the day of birth, parental response and health and schooling outcomes," Journal of Health Economics, Elsevier, vol. 55(C), pages 121-138.
    5. Mindy Marks & Moonkyung Kate Choi, 2019. "Baby Boomlets and Baby Health: Hospital Crowdedness, Hospital Spending, and Infant Health," American Journal of Health Economics, MIT Press, vol. 5(3), pages 376-406, Summer.
    6. Daysal, N. Meltem & Trandafir, Mircea & van Ewijk, Reyn, 2016. "Heterogeneous Effects of Medical Interventions on the Health of Low-Risk Newborns," IZA Discussion Papers 9810, Institute of Labor Economics (IZA).
    7. Mindy Marks & Kate Choi, 2011. "Baby Boomlets and Baby Health: Hospital Crowdedness, Treatment Intensity, and Infant Health," Working Papers 201440, University of California at Riverside, Department of Economics.
    8. David B. Audretsch, 2015. "Knowledge spillovers and future jobs," IZA World of Labor, Institute of Labor Economics (IZA), pages 218-218, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Daysal, N. Meltem & Trandafir, Mircea & van Ewijk, Reyn, 2019. "Low-risk isn’t no-risk: Perinatal treatments and the health of low-income newborns," Journal of Health Economics, Elsevier, vol. 64(C), pages 55-67.
    2. Anirban Basu, 2012. "Estimating Person-Centered Treatment (PeT) Effects Using Instrumental Variables," NBER Working Papers 18056, National Bureau of Economic Research, Inc.
    3. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    4. N. Meltem Daysal & Mircea Trandafir & Reyn van Ewijk, 2015. "Saving Lives at Birth: The Impact of Home Births on Infant Outcomes," American Economic Journal: Applied Economics, American Economic Association, vol. 7(3), pages 28-50, July.
    5. Gelo, Dambala & Dikgang, Johane, 2019. "Collective action and heterogeneous welfare effects: Evidence from Ethiopian villages," World Development Perspectives, Elsevier, vol. 16(C).
    6. Daysal, N. Meltem & Trandafir, Mircea & van Ewijk, Reyn, 2016. "Heterogeneous Effects of Medical Interventions on the Health of Low-Risk Newborns," IZA Discussion Papers 9810, Institute of Labor Economics (IZA).
    7. Domenico Depalo, 2020. "Explaining the causal effect of adherence to medication on cholesterol through the marginal patient," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 110-126, October.
    8. Walters, Lurleen M. & Emerson, Robert D. & Iwai, Nobuyuki, 2008. "Proposed Immigration Policy Reform & Farm Labor Market Outcomes," 2008 Annual Meeting, July 27-29, 2008, Orlando, Florida 6285, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    9. David J. Vanness & John Mullahy, 2012. "Moving Beyond Mean-based Evaluation of Health Care," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 52, Edward Elgar Publishing.
    10. Słoczyński, Tymon, 2012. "New Evidence on Linear Regression and Treatment Effect Heterogeneity," MPRA Paper 39524, University Library of Munich, Germany.
    11. Radchenko, Natalia, 2014. "Heterogeneity in Informal Salaried Employment: Evidence from the Egyptian Labor Market Survey," World Development, Elsevier, vol. 62(C), pages 169-188.
    12. James J. Heckman, 2008. "Econometric Causality," International Statistical Review, International Statistical Institute, vol. 76(1), pages 1-27, April.
    13. Sakos, Grayson & Cerulli, Giovanni & Garbero, Alessandra, 2021. "Beyond the ATE: Idiosyncratic Effect Estimation to Uncover Distributional Impacts Results from 17 Impact Evaluations," 2021 Annual Meeting, August 1-3, Austin, Texas 314017, Agricultural and Applied Economics Association.
    14. Guilhem Bascle, 2008. "Controlling for endogeneity with instrumental variables in strategic management research," Post-Print hal-00576795, HAL.
    15. H. Evans & A. Basu, 2011. "Exploring comparative effect heterogeneity with instrumental variables: prehospital intubation and mortality," Health, Econometrics and Data Group (HEDG) Working Papers 11/26, HEDG, c/o Department of Economics, University of York.
    16. Cornelissen, Thomas & Dustmann, Christian & Raute, Anna & Schönberg, Uta, 2016. "From LATE to MTE: Alternative methods for the evaluation of policy interventions," Labour Economics, Elsevier, vol. 41(C), pages 47-60.
    17. Steven F. Lehrer & R. Vincent Pohl & Kyungchul Song, 2022. "Multiple Testing and the Distributional Effects of Accountability Incentives in Education," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 40(4), pages 1552-1568, October.
    18. Lina Zhang & David T. Frazier & D. S. Poskitt & Xueyan Zhao, 2020. "Decomposing Identification Gains and Evaluating Instrument Identification Power for Partially Identified Average Treatment Effects," Papers 2009.02642, arXiv.org, revised Sep 2022.
    19. Magne Mogstad & Andres Santos & Alexander Torgovitsky, 2018. "Using Instrumental Variables for Inference About Policy Relevant Treatment Parameters," Econometrica, Econometric Society, vol. 86(5), pages 1589-1619, September.
    20. Jinhyun Lee, 2013. "Sharp Bounds on Heterogeneous Individual Treatment Responses," Discussion Paper Series, School of Economics and Finance 201310, School of Economics and Finance, University of St Andrews.

    More about this item

    Keywords

    hospital stay; hospital care; birth; newborns;
    All these keywords.

    JEL classification:

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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:tpr:restat:v:94:y:2012:i:3:p:635-649. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Kelly McDougall (email available below). General contact details of provider: https://direct.mit.edu/journals .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.