IDEAS home Printed from https://ideas.repec.org/p/amc/wpaper/10.html
   My bibliography  Save this paper

Urgent Care Centers, Hospital Performance and Population Health

Author

Listed:
  • Sonia Bhalotra
  • Letícia Nunes
  • Rudi Rocha

Abstract

Hospitals are under increasing pressure as they bear a growing burden of chronic disease while also dealing with emergency cases that do not all require hospital care. Many countries have responded by introducing alternative facilities that provide 24/7 care for basic and medium-complexity cases. Using administrative data, we investigate impacts of the opening of these intermediate facilities (UPA) in the state of Rio de Janeiro in Brazil. We find that an UPA opening in the catchment area of a hospital reduces hospital outpatient procedures and admissions and that this is associated with improved hospital performance, indicated by a decline in inpatient mortality. This does not appear to derive from a change in the risk profile of cases going to hospital but rather from hospital resources being re-focused. In a significant departure from related research, we identify displacement by investigating population-level outcomes. Our most striking result is that a large share of the decline in hospital mortality is offset by deaths in UPAs, though there remains a net decline in deaths from cardiovascular conditions that are typically amenable to primary care.
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Sonia Bhalotra & Letícia Nunes & Rudi Rocha, 2020. "Urgent Care Centers, Hospital Performance and Population Health," Working Papers 10, Instituto de Estudos para Políticas de Saúde.
  • Handle: RePEc:amc:wpaper:10
    as

    Download full text from publisher

    File URL: https://ieps.org.br/sdc_download/13370/?key=bl2n4umfis4ai80tosc2l50ub7djem
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Bruno Crépon & Esther Duflo & Marc Gurgand & Roland Rathelot & Philippe Zamora, 2013. "Do Labor Market Policies have Displacement Effects? Evidence from a Clustered Randomized Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 128(2), pages 531-580.
    2. Keeler, Theodore E & Ying, John S, 1996. "Hospital Costs and Excess Bed Capacity: A Statistical Analysis," The Review of Economics and Statistics, MIT Press, vol. 78(3), pages 470-481, August.
    3. Avdic, Daniel, 2016. "Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden," Journal of Health Economics, Elsevier, vol. 48(C), pages 44-60.
    4. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    5. Cutler, David M., 2007. "The lifetime costs and benefits of medical technology," Journal of Health Economics, Elsevier, vol. 26(6), pages 1081-1100, December.
    6. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    7. Gautam Gowrisankaran & Aviv Nevo & Robert Town, 2015. "Mergers When Prices Are Negotiated: Evidence from the Hospital Industry," American Economic Review, American Economic Association, vol. 105(1), pages 172-203, January.
    8. repec:hal:pseose:halshs-00840901 is not listed on IDEAS
    9. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    10. 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.
    11. Cathy J. Bradley & David Neumark & Lauryn Saxe Walker, 2017. "The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial," NBER Working Papers 24100, National Bureau of Economic Research, Inc.
    12. Kritee Gujral & Anirban Basu, 2019. "Impact of Rural and Urban Hospital Closures on Inpatient Mortality," NBER Working Papers 26182, National Bureau of Economic Research, Inc.
    13. Lindsay Allen & Janet R. Cummings & Jason Hockenberry, 2019. "Urgent Care Centers and the Demand for Non-Emergent Emergency Department Visits," NBER Working Papers 25428, National Bureau of Economic Research, Inc.
    14. Janet Currie & David Slusky, 2020. "Does the Marginal Hospitalization Save Lives? The Case of Respiratory Admissions for the Elderly," NBER Working Papers 26618, National Bureau of Economic Research, Inc.
    15. Cutler, David, 2007. "The Lifetime Costs and Benefits of Medical Technology," Scholarly Articles 2643640, Harvard University Department of Economics.
    16. Alexander, Diane & Currie, Janet & Schnell, Molly, 2019. "Check up before you check out: Retail clinics and emergency room use," Journal of Public Economics, Elsevier, vol. 178(C).
    17. David H. Autor, 2003. "Outsourcing at Will: The Contribution of Unjust Dismissal Doctrine to the Growth of Employment Outsourcing," Journal of Labor Economics, University of Chicago Press, vol. 21(1), pages 1-42, January.
    18. Rajiv Sharma & Miron Stano & Renu Gehring, 2008. "Short‐term fluctuations in hospital demand: implications for admission, discharge, and discriminatory behavior," RAND Journal of Economics, RAND Corporation, vol. 39(2), pages 586-606, June.
    19. Capps, Cory & Dranove, David & Satterthwaite, Mark, 2003. "Competition and Market Power in Option Demand Markets," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 737-763, Winter.
    20. Bhalotra, Sonia R. & Rocha, Rudi & Soares, Rodrigo R., 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," IZA Discussion Papers 12111, Institute of Labor Economics (IZA).
    21. Katherine Ho, 2006. "The welfare effects of restricted hospital choice in the US medical care market," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 21(7), pages 1039-1079.
    22. Buchmueller, Thomas C. & Jacobson, Mireille & Wold, Cheryl, 2006. "How far to the hospital?: The effect of hospital closures on access to care," Journal of Health Economics, Elsevier, vol. 25(4), pages 740-761, July.
    23. Diane Alexander & Lisa Camner McKay & Janet Currie & Molly Schnell, 2019. "Check Up Before You Check Out," Chicago Fed Letter, Federal Reserve Bank of Chicago, issue 428.
    24. Thomas E Cowling & Elizabeth V Cecil & Michael A Soljak & John Tayu Lee & Christopher Millett & Azeem Majeed & Robert M Wachter & Matthew J Harris, 2013. "Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-6, June.
    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. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.

    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. Bhalotra, Sonia & Nunes, Leticia & Rocha, Rudi, 2023. "Emergency Care Centers, Hospital Performance and Population Health," The Warwick Economics Research Paper Series (TWERPS) 1456, University of Warwick, Department of Economics.
    2. Mensen, Anne, 2022. "Concentration of hospital capacities and patients' access to care," Ruhr Economic Papers 952, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    3. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
    4. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    5. Stefanie Fischer & Heather Royer & Corey White, 2022. "Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US," Monash Economics Working Papers 2022-06, Monash University, Department of Economics.
    6. Christopher T. Conlon & Julie Holland Mortimer, 2013. "Empirical Properties of Diversion Ratios," Boston College Working Papers in Economics 864, Boston College Department of Economics, revised 01 Jan 2019.
    7. Devesh Raval & Ted Rosenbaum & Nathan E. Wilson, 2022. "Using disaster‐induced closures to evaluate discrete choice models of hospital demand," RAND Journal of Economics, RAND Corporation, vol. 53(3), pages 561-589, September.
    8. Christopher Conlon & Julie Holland Mortimer, 2021. "Empirical properties of diversion ratios," RAND Journal of Economics, RAND Corporation, vol. 52(4), pages 693-726, December.
    9. Mateus Dias & Luiz Felipe Fontes, 2020. "The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil," Working Papers 09, Instituto de Estudos para Políticas de Saúde.
    10. Kate Ho & Robin S. Lee, 2019. "Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets," American Economic Review, American Economic Association, vol. 109(2), pages 473-522, February.
    11. Bhalotra, Sonia R. & Clarke, Damian & Gomes, Joseph & Venkataramani, Atheendar, 2018. "Maternal Mortality and Women's Political Participation," IZA Discussion Papers 11590, Institute of Labor Economics (IZA).
    12. Stuart Craig & Matthew Grennan & Ashley Swanson, 2018. "Mergers and Marginal Costs: New Evidence on Hospital Buyer Power," NBER Working Papers 24926, National Bureau of Economic Research, Inc.
    13. Contreras Juan & Patel Elena & Tristao Ignez, 2013. "Production Factors, Productivity Dynamics and Quality Gains as Determinants of Healthcare Spending Growth in U.S. Hospitals," Working Papers 2013-13, Banco de México.
    14. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    15. Michael Vita & Keith Brand & Miriam Larson-Koester & Nathan Petek & Charles Taragin & William Violette & Daniel H. Wood, 2022. "Economics at the FTC: Estimating Harm from Deception and Analyzing Mergers," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 61(4), pages 405-438, December.
    16. Sonia Bhalotra & Damian Clarke & Joseph Flavian Gomes & Atheendar Venkataramani, 2023. "Maternal Mortality and Women’s Political Power," Journal of the European Economic Association, European Economic Association, vol. 21(5), pages 2172-2208.
    17. Charris, Carlos & Branco, Danyelle & Carrillo, Bladimir, 2024. "Economic shocks and infant health: Evidence from a trade reform in Brazil," Journal of Development Economics, Elsevier, vol. 166(C).
    18. Szklo, Michel & Clarke, Damian & Rocha, Rudi, 2024. "Does Increasing Public Spending in Health Improve Health? Lessons from a Constitutional Reform in Brazil," IZA Discussion Papers 16829, Institute of Labor Economics (IZA).
    19. Dias, Mateus & Fontes, Luiz Felipe, 2020. "The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil," MPRA Paper 104753, University Library of Munich, Germany.
    20. Devesh Raval & Ted Rosenbaum & Steven A. Tenn, 2017. "A Semiparametric Discrete Choice Model: An Application To Hospital Mergers," Economic Inquiry, Western Economic Association International, vol. 55(4), pages 1919-1944, October.

    More about this item

    Keywords

    urgent care centers; hospital performance; displacement effects; health outcomes;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • 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:amc:wpaper:10. 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: Helena Ciorra (email available below). General contact details of provider: https://edirc.repec.org/data/iepssbr.html .

    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.