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Follow your Heart: Survival Chances and Costs after Heart Attacks - An Instrumental Variable Approach

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  • Alice Sanwald
  • Thomas Schober

Abstract

We analyze mortality and follow-up costs of heart attack patients using administrative data from Austria from 2002-2011. As treatment intensity in a hospital largely depends on whether it has a catheterization laboratory, we focus on the effects of patients' initial admission to these specialized hospitals. To account for the nonrandom selection of patients into hospitals, we exploit individuals' place of residence as a source of exogenous variation in an instrumental variable framework. We find that the initial admission to specialized hospitals increases patients' survival chances substantially. The effect on 3-year mortality is -9.5 percentage points. A separation of the sample into subgroups shows the strongest effects in relative terms for patients below the age of 65. We do not find significant effects on longterm inpatient costs and find only marginal increases in outpatient costs.

Suggested Citation

  • Alice Sanwald & Thomas Schober, 2014. "Follow your Heart: Survival Chances and Costs after Heart Attacks - An Instrumental Variable Approach," NRN working papers 2014-13, The Austrian Center for Labor Economics and the Analysis of the Welfare State, Johannes Kepler University Linz, Austria.
  • Handle: RePEc:jku:nrnwps:2014_13
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    References listed on IDEAS

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    1. Cutler, David M., 2007. "The lifetime costs and benefits of medical technology," Journal of Health Economics, Elsevier, vol. 26(6), pages 1081-1100, December.
    2. Cutler, David, 2007. "The Lifetime Costs and Benefits of Medical Technology," Scholarly Articles 2643640, Harvard University Department of Economics.
    3. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    4. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    5. Avdic, Danie, 2015. "A matter of life and death? Hospital distance and quality of care: evidence from emergency hospital closures and myocardial infarctions," Working Paper Series 2015:1, IFAU - Institute for Evaluation of Labour Market and Education Policy.
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    Cited by:

    1. Hentschker, C. & Wübker, A., 2016. "The impact of technology diffusion in health care markets - Evidence from heart attack treatment," Health, Econometrics and Data Group (HEDG) Working Papers 16/29, HEDG, c/o Department of Economics, University of York.
    2. R. Tamara Konetzka & Fan Yang & Rachel M. Werner, 2019. "Use of instrumental variables for endogenous treatment at the provider level," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 710-716, May.
    3. Corinna Hentschker & Ansgar Wübker, 2020. "Quasi-experimental evidence on the effectiveness of heart attack treatment in Germany," Applied Economics, Taylor & Francis Journals, vol. 52(50), pages 5531-5545, October.

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    More about this item

    Keywords

    Acute myocardial infarction; mortality; costs; instrumental variables;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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