IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/24445.html
   My bibliography  Save this paper

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

Author

Listed:
  • Jonathan Gruber
  • Thomas P. Hoe
  • George Stoye

Abstract

The emergency department (ED) is a complex node of healthcare delivery that is facing market and regulatory pressure across developed economies to reduce wait times. In this paper we study how ED doctors respond to such incentives, by focussing on a landmark policy in England that imposed strong incentives to treat ED patients within four hours. Using bunching techniques, we estimate that the policy reduced affected patients’ wait times by 19 minutes, yet distorted a number of medical decisions. In response to the policy, doctors increased the intensity of ED treatment and admitted more patients for costly inpatient care. We also find a striking 14% reduction in mortality. To determine the mechanism behind these health improvements, we exploit heterogeneity in patient severity and hospital crowding, and find strongly suggestive evidence that it is the reduced wait times, rather than the additional admits, that saves lives. Overall 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, 2018. "Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers," NBER Working Papers 24445, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:24445
    Note: AG EH PE
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w24445.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Michael Carlos Best & James S Cloyne & Ethan Ilzetzki & Henrik J Kleven, 2020. "Estimating the Elasticity of Intertemporal Substitution Using Mortgage Notches," Review of Economic Studies, Oxford University Press, vol. 87(2), pages 656-690.
    2. Emmanuel Saez, 2010. "Do Taxpayers Bunch at Kink Points?," American Economic Journal: Economic Policy, American Economic Association, vol. 2(3), pages 180-212, August.
    3. Michael Carlos Best & Henrik Jacobsen Kleven, 2018. "Housing Market Responses to Transaction Taxes: Evidence From Notches and Stimulus in the U.K," Review of Economic Studies, Oxford University Press, vol. 85(1), pages 157-193.
    4. Liran Einav & Amy Finkelstein & Maria Polyakova, 2018. "Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 122-153, August.
    5. Einav, Liran & Finkelstein, Amy & Schrimpf, Paul, 2017. "Bunching at the kink: Implications for spending responses to health insurance contracts," Journal of Public Economics, Elsevier, vol. 146(C), pages 27-40.
    6. Rebecca Diamond & Petra Persson, 2016. "The Long-term Consequences of Teacher Discretion in Grading of High-stakes Tests," NBER Working Papers 22207, National Bureau of Economic Research, Inc.
    7. David C. Chan, 2016. "Teamwork and Moral Hazard: Evidence from the Emergency Department," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 734-770.
    8. Liran Einav & Amy Finkelstein & Paul Schrimpf, 2015. "The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D," The Quarterly Journal of Economics, Oxford University Press, vol. 130(2), pages 841-899.
    9. Gautam Gowrisankaran & Keith A. Joiner & Pierre-Thomas Léger, 2017. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," NBER Working Papers 24155, National Bureau of Economic Research, Inc.
    10. Henrik J. Kleven & Mazhar Waseem, 2013. "Using Notches to Uncover Optimization Frictions and Structural Elasticities: Theory and Evidence from Pakistan," The Quarterly Journal of Economics, Oxford University Press, vol. 128(2), pages 669-723.
    Full references (including those not matched with items on IDEAS)

    Citations

    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

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


    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. 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.
    3. 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).
    4. 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).
    5. 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.
    6. Woodworth, Lindsey, 2020. "Swamped: Emergency Department Crowding and Patient Mortality," Journal of Health Economics, Elsevier, vol. 70(C).
    7. 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.
    8. 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).
    9. 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).
    10. 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).
    11. Simon Bensnes, 2021. "Time to spare and too much care. Congestion and overtreatment at the maternity ward," Discussion Papers 963, Statistics Norway, Research Department.

    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. Michael Carlos Best & James S Cloyne & Ethan Ilzetzki & Henrik J Kleven, 2020. "Estimating the Elasticity of Intertemporal Substitution Using Mortgage Notches," Review of Economic Studies, Oxford University Press, vol. 87(2), pages 656-690.
    2. Marx, Benjamin M., 2018. "Dynamic Bunching Estimation with Panel Data," MPRA Paper 88647, University Library of Munich, Germany.
    3. Lu, Yi & Shi, Julie & Yang, Wanyu, 2019. "Expenditure response to health insurance policies: Evidence from kinks in rural China," Journal of Public Economics, Elsevier, vol. 178(C).
    4. Marinho Bertanha & Andrew H. McCallum & Nathan Seegert, 2021. "Better Bunching, Nicer Notching," Papers 2101.01170, arXiv.org, revised Jun 2023.
    5. Einav, Liran & Finkelstein, Amy & Schrimpf, Paul, 2017. "Bunching at the kink: Implications for spending responses to health insurance contracts," Journal of Public Economics, Elsevier, vol. 146(C), pages 27-40.
    6. Aronsson, Thomas & Jenderny, Katharina & Lanot, Gauthier, 2022. "The quality of the estimators of the ETI," Journal of Public Economics, Elsevier, vol. 212(C).
    7. Homonoff, Tatiana & Spreen, Thomas Luke & St. Clair, Travis, 2020. "Balance sheet insolvency and contribution revenue in public charities," Journal of Public Economics, Elsevier, vol. 186(C).
    8. Vincent Dekker & Karsten Schweikert, 2021. "A Comparison of Different Data-driven Procedures to Determine the Bunching Window," Public Finance Review, , vol. 49(2), pages 262-293, March.
    9. Dhammika Dharmapala, 2016. "Estimating the Compliance Costs of Securities Regulation: A Bunching Analysis of Sarbanes-Oxley Section 404(b)," CESifo Working Paper Series 6180, CESifo.
    10. Li Liu & Benjamin Lockwood, 2015. "VAT Notches," CESifo Working Paper Series 5371, CESifo.
    11. Bachas, Natalie & Kim, Olivia S. & Yannelis, Constantine, 2021. "Loan guarantees and credit supply," Journal of Financial Economics, Elsevier, vol. 139(3), pages 872-894.
    12. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
    13. Miguel Almunia & David Lopez-Rodriguez, 2014. "Heterogeneous Responses to Effective Tax Enforcement: Evidence from Spanish Firms," Working Papers 1412, Oxford University Centre for Business Taxation.
    14. Carozzi, Felipe & Hilber, Christian A.L. & Yu, Xiaolun, 2024. "On the economic impacts of mortgage credit expansion policies: Evidence from help to buy," Journal of Urban Economics, Elsevier, vol. 139(C).
    15. Katrine Jakobsen & Kristian Jakobsen & Henrik Kleven & Gabriel Zucman, 2020. "Wealth Taxation and Wealth Accumulation: Theory and Evidence From Denmark," The Quarterly Journal of Economics, Oxford University Press, vol. 135(1), pages 329-388.
    16. Glogowsky, Ulrich, 2021. "Behavioral responses to inheritance and gift taxation: Evidence from Germany," Journal of Public Economics, Elsevier, vol. 193(C).
    17. Goupille-Lebret, Jonathan & Garbinti, Bertrand & Munoz, Mathilde & Stantcheva, Stefanie & Zucman, Gabriel, 2023. "Tax Design, Information, and Elasticities: Evidence From the French Wealth Tax," CEPR Discussion Papers 18206, C.E.P.R. Discussion Papers.
    18. Leonard Goff, 2022. "Treatment Effects in Bunching Designs: The Impact of Mandatory Overtime Pay on Hours," Papers 2205.10310, arXiv.org, revised Nov 2023.
    19. Rodrigo Carril, 2021. "Rules Versus Discretion in Public Procurement," Working Papers 1232, Barcelona School of Economics.
    20. Fan, Elliott & Lien, Hsienming & Ma, Ching-to Albert, 2019. "Uterus at a price: Disability insurance and hysterectomy," Journal of Health Economics, Elsevier, vol. 66(C), pages 1-17.

    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

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:nbr:nberwo:24445. 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: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.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.