After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays
Patients who receive more hospital treatment tend to have worse underlying health, confounding estimates of the returns to such care. This paper compares the costs and benefits of extending the length of hospital stay following delivery using a discontinuity in stay length for infants born close to midnight. Third-party reimbursement rules in California entitle newborns to a minimum number of hospital "days," counted as the number of midnights in care. A newborn delivered at 12:05 a.m. will have an extra night of reimbursable care compared to an infant born minutes earlier. We use a dataset of all California births from 1991-2002, including nearly 100,000 births within 20 minutes of midnight, and find that children born just prior to midnight have significantly shorter lengths of stay than those born just after midnight, despite similar observable characteristics. Furthermore, a law change in 1997 entitled newborns to a minimum of 2 days in care. The midnight discontinuity can therefore be used to consider two distinct treatments: increasing stay length from one to two nights (prior to the law change) and from two to three nights (following the law change). On both margins, we find no effect of stay length on readmissions or mortality for either the infant or the mother, and the estimates are precise. The results suggest that for uncomplicated births, longer hospitals stays incur substantial costs without apparent health benefits.
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| Length: | |
| Date of creation: | Mar 2008 |
| Date of revision: | |
| Publication status: | published as American economic journal : a journal of the American Economic Association.- Nashville, Tenn. : AEA, ISSN 1945-7731, ZDB-ID 24423828. - Vol. 3.2011, 3, p. 1-34 |
| Handle: | RePEc:nbr:nberwo:13877 |
| Note: | CH HC HE LS |
| Contact details of provider: | Postal: Phone: 617-868-3900 Web page: http://www.nber.orgEmail: More information through EDIRC
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References listed on IDEAS
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- Orley Ashenfelter & Michael Greenstone, 2004. "Using Mandated Speed Limits to Measure the Value of a Statistical Life," Journal of Political Economy, University of Chicago Press, vol. 112(S1), pages S226-S267, February.
- Ashenfelter, Orley & Greenstone, Michael, 2002. "Using Mandated Speed Limits to Measure the Value of a Statistical Life," IZA Discussion Papers 571, Institute for the Study of Labor (IZA).
- Orley Ashenfelter & Michael Greenstone, 2002. "Using Mandated Speed Limits to Measure the Value of a Statistical Life," NBER Working Papers 9094, National Bureau of Economic Research, Inc.
- Abadie, Alberto, 2003. "Semiparametric instrumental variable estimation of treatment response models," Journal of Econometrics, Elsevier, vol. 113(2), pages 231-263, April.
- Justin McCrary, 2007. "Manipulation of the Running Variable in the Regression Discontinuity Design: A Density Test," NBER Technical Working Papers 0334, National Bureau of Economic Research, Inc.
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