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The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality

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  • Hollingsworth, Alex
  • Karbownik, Chris
  • Thomasson, Melissa
  • Wray, Anthony

Abstract

The past century witnessed a dramatic improvement in public health, the rise of modern medicine, and the transformation of the hospital from a fringe institution to one essential to the practice of medicine. Despite the central role of medicine in contemporary society, little is known about how hospitals and modern medicine contributed to this health transition. In this paper, we explore how access to the hospital and modern medicine affects mortality. We do so by leveraging a combination of novel data and a unique quasi-experiment: a large-scale hospital modernization program introduced by The Duke Endowment in the early twentieth century. The Endowment helped communities build and expand hospitals, obtain state-of-the-art medical technology, attract qualified medical personnel, and refine management practices. We find that access to a Duke-supported hospital reduced infant mortality by 10%, saving one life for every $20,000 (2017 dollars) spent. Effects were larger for Black infants (16%) than for White infants (7%), implying a reduction in the Black-White infant mortality gap by one-third. We show that the effect of Duke support persisted into later life with a 9% reduction in mortality between the ages of 56 and 65. We further provide evidence on the mechanisms that enabled these effects, finding that Endowment-supported hospitals attracted higher-quality physicians and were better able to take advantage of new medical innovations.

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  • Hollingsworth, Alex & Karbownik, Chris & Thomasson, Melissa & Wray, Anthony, 2022. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," OSF Preprints b5cfs, Center for Open Science.
  • Handle: RePEc:osf:osfxxx:b5cfs
    DOI: 10.31219/osf.io/b5cfs
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    1. Michael Greenstone & Rema Hanna, 2014. "Environmental Regulations, Air and Water Pollution, and Infant Mortality in India," American Economic Review, American Economic Association, vol. 104(10), pages 3038-3072, October.
    2. Sonia Bhalotra & Martin Karlsson & Therese Nilsson, 2017. "Infant Health and Longevity: Evidence from A Historical Intervention in Sweden," Journal of the European Economic Association, European Economic Association, vol. 15(5), pages 1101-1157.
    3. David S. Lee & Justin McCrary & Marcelo J. Moreira & Jack Porter, 2022. "Valid t-Ratio Inference for IV," American Economic Review, American Economic Association, vol. 112(10), pages 3260-3290, October.
    4. Daron Acemoglu & Simon Johnson, 2007. "Disease and Development: The Effect of Life Expectancy on Economic Growth," Journal of Political Economy, University of Chicago Press, vol. 115(6), pages 925-985, December.
    5. 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.
    6. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    7. Nicholas Bloom & John Van Reenen, 2007. "Measuring and Explaining Management Practices Across Firms and Countries," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(4), pages 1351-1408.
    8. Christopher R. Knittel & Douglas L. Miller & Nicholas J. Sanders, 2016. "Caution, Drivers! Children Present: Traffic, Pollution, and Infant Health," The Review of Economics and Statistics, MIT Press, vol. 98(2), pages 350-366, May.
    9. Daniela Scur & Raffaella Sadun & John Van Reenen & Renata Lemos & Nicholas Bloom, 2021. "The World Management Survey at 18: lessons and the way forward," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 37(2), pages 231-258.
    10. Douglas Almond & Janet Currie & Valentina Duque, 2018. "Childhood Circumstances and Adult Outcomes: Act II," Journal of Economic Literature, American Economic Association, vol. 56(4), pages 1360-1446, December.
    11. Rodrigo R. Soares, 2007. "On the Determinants of Mortality Reductions in the Developing World," Population and Development Review, The Population Council, Inc., vol. 33(2), pages 247-287, June.
    12. Timothy G. Conley & Christopher R. Udry, 2010. "Learning about a New Technology: Pineapple in Ghana," American Economic Review, American Economic Association, vol. 100(1), pages 35-69, March.
    13. Ciani Emanuele & Fisher Paul, 2019. "Dif-in-Dif Estimators of Multiplicative Treatment Effects," Journal of Econometric Methods, De Gruyter, vol. 8(1), pages 1-10, January.
    14. K. John McConnell & Richard C. Lindrooth & Douglas R. Wholey & Thomas M. Maddox & Nick Bloom, 2016. "Modern Management Practices and Hospital Admissions," Health Economics, John Wiley & Sons, Ltd., vol. 25(4), pages 470-485, April.
    15. Kenneth Y. Chay & Michael Greenstone, 2003. "The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by a Recession," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 118(3), pages 1121-1167.
    16. Elder Todd E & Goddeeris John H & Haider Steven J, 2011. "A Deadly Disparity: A Unified Assessment of the Black-White Infant Mortality Gap," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-44, June.
    17. David W Brown & Amanda E Kowalski & Ithai Z Lurie, 2020. "Long-Term Impacts of Childhood Medicaid Expansions on Outcomes in Adulthood," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 87(2), pages 792-821.
    18. Marcella Alsan & Claudia Goldin, 2019. "Watersheds in Child Mortality: The Role of Effective Water and Sewerage Infrastructure, 1880–1920," Journal of Political Economy, University of Chicago Press, vol. 127(2), pages 586-638.
    19. Elder, Todd E. & Goddeeris, John H. & Haider, Steven J., 2016. "Racial and ethnic infant mortality gaps and the role of socio-economic status," Labour Economics, Elsevier, vol. 43(C), pages 42-54.
    20. Andrea Park Chung & Martin Gaynor & Seth Richards-Shubik, 2017. "Subsidies and Structure: The Lasting Impact of the Hill-Burton Program on the Hospital Industry," The Review of Economics and Statistics, MIT Press, vol. 99(5), pages 926-943, December.
    21. Sergio Correia & Paulo Guimarães & Tom Zylkin, 2020. "Fast Poisson estimation with high-dimensional fixed effects," Stata Journal, StataCorp LP, vol. 20(1), pages 95-115, March.
    22. Zhuan Pei & Jörn-Steffen Pischke & Hannes Schwandt, 2019. "Poorly Measured Confounders are More Useful on the Left than on the Right," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 205-216, April.
    23. Dora L. Costa, 2015. "Health and the Economy in the United States from 1750 to the Present," Journal of Economic Literature, American Economic Association, vol. 53(3), pages 503-570, September.
    24. Volha Lazuka, 2020. "Infant Health and Later-Life Labor Market Outcomes: Evidence from the Introduction of Sulfa Antibiotics in Sweden," Journal of Human Resources, University of Wisconsin Press, vol. 55(2), pages 660-698.
    25. Stefanie J. Fischer & Heather Royer & Corey D. White, 2022. "Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US," NBER Working Papers 30141, National Bureau of Economic Research, Inc.
    26. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    27. Escarce, JoseJ., 1996. "Externalities in hospitals and physician adoption of a new surgical technology: An exploratory analysis," Journal of Health Economics, Elsevier, vol. 15(6), pages 715-734, December.
    28. Clay, Karen & Egedesø, Peter Juul & Hansen, Casper Worm & Jensen, Peter Sandholt & Calkins, Avery, 2020. "Controlling tuberculosis? Evidence from the first community-wide health experiment," Journal of Development Economics, Elsevier, vol. 146(C).
    29. Hoehn-Velasco, Lauren, 2018. "Explaining declines in US rural mortality, 1910–1933: The role of county health departments," Explorations in Economic History, Elsevier, vol. 70(C), pages 42-72.
    30. Katherine Eriksson, 2020. "Education and Incarceration in the Jim Crow South: Evidence from Rosenwald Schools," Journal of Human Resources, University of Wisconsin Press, vol. 55(1), pages 43-75.
    31. Carolyn M. Moehling & Gregory T. Niemesh & Melissa A. Thomasson & Jaret Treber, 2020. "Medical education reforms and the origins of the rural physician shortage," Cliometrica, Journal of Historical Economics and Econometric History, Association Française de Cliométrie (AFC), vol. 14(2), pages 181-225, May.
    32. Seema Jayachandran & Adriana Lleras-Muney & Kimberly V. Smith, 2010. "Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs," American Economic Journal: Applied Economics, American Economic Association, vol. 2(2), pages 118-146, April.
    33. Daniel Aaronson & Fabian Lange & Bhashkar Mazumder, 2014. "Fertility Transitions along the Extensive and Intensive Margins," American Economic Review, American Economic Association, vol. 104(11), pages 3701-3724, November.
    34. Maya Rossin-Slater & Miriam Wüst, 2020. "What Is the Added Value of Preschool for Poor Children? Long-Term and Intergenerational Impacts and Interactions with an Infant Health Intervention," American Economic Journal: Applied Economics, American Economic Association, vol. 12(3), pages 255-286, July.
    35. Myoung-jae Lee & Sanghyeok Lee, 2021. "Difference in Differences and Ratio in Ratios for Limited Dependent Variables," Papers 2111.12948, arXiv.org, revised Aug 2023.
    36. Lechner, Michael, 2011. "The Estimation of Causal Effects by Difference-in-Difference Methods," Foundations and Trends(R) in Econometrics, now publishers, vol. 4(3), pages 165-224, November.
    37. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    38. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    39. D. Mark Anderson & Ryan Brown & Kerwin Kofi Charles & Daniel I. Rees, 2020. "Occupational Licensing and Maternal Health: Evidence from Early Midwifery Laws," Journal of Political Economy, University of Chicago Press, vol. 128(11), pages 4337-4383.
    40. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    41. 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 226-267, February.
    42. Law, Marc T. & Kim, Sukkoo, 2005. "Specialization and Regulation: The Rise of Professionals and the Emergence of Occupational Licensing Regulation," The Journal of Economic History, Cambridge University Press, vol. 65(3), pages 723-756, September.
    43. Thomasson, Melissa A. & Treber, Jaret, 2008. "From home to hospital: The evolution of childbirth in the United States, 1928-1940," Explorations in Economic History, Elsevier, vol. 45(1), pages 76-99, January.
    44. Diane E. Alexander & Michael R. Richards, 2021. "Economic Consequences of Hospital Closures," NBER Working Papers 29110, National Bureau of Economic Research, Inc.
    45. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    46. Douglas Almond & Janet Currie, 2011. "Killing Me Softly: The Fetal Origins Hypothesis," Journal of Economic Perspectives, American Economic Association, vol. 25(3), pages 153-172, Summer.
    47. Baker, Andrew C. & Larcker, David F. & Wang, Charles C.Y., 2022. "How much should we trust staggered difference-in-differences estimates?," Journal of Financial Economics, Elsevier, vol. 144(2), pages 370-395.
    48. Rask, Kevin N. & Rask, Kimberly J., 2000. "Public insurance substituting for private insurance: new evidence regarding public hospitals, uncompensated care funds, and medicaid," Journal of Health Economics, Elsevier, vol. 19(1), pages 1-31, January.
    49. Clay, Karen & Lewis, Joshua & Severnini, Edson R., 2016. "Canary in a Coal Mine: Infant Mortality, Property Values, and Tradeoffs Associated with Mid-20th Century Air Pollution," IZA Discussion Papers 9884, Institute of Labor Economics (IZA).
    50. Viscusi, W. Kip, 2018. "Best Estimate Selection Bias in the Value of a Statistical Life," Journal of Benefit-Cost Analysis, Cambridge University Press, vol. 9(2), pages 205-246, July.
    51. William J. Collins & Melissa A. Thomasson, 2004. "The Declining Contribution of Socioeconomic Disparities to the Racial Gap in Infant Mortality Rates, 1920‐1970," Southern Economic Journal, John Wiley & Sons, vol. 70(4), pages 746-776, April.
    52. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    53. Fishback, Price V. & Horrace, William C. & Kantor, Shawn, 2005. "Did New Deal Grant Programs Stimulate Local Economies? A Study of Federal Grants and Retail Sales During the Great Depression," The Journal of Economic History, Cambridge University Press, vol. 65(1), pages 36-71, March.
    54. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    55. Carolyn Moehling & Melissa Thomasson, 2014. "Saving Babies: The Impact of Public Education Programs on Infant Mortality," Demography, Springer;Population Association of America (PAA), vol. 51(2), pages 367-386, April.
    56. Fischer, Martin & Karlsson, Martin & Prodromidis, Nikolaos, 2021. "The Long-Term Effects of Hospital Deliveries," IZA Discussion Papers 14562, Institute of Labor Economics (IZA).
    57. Dan A. Black & Seth G. Sanders & Evan J. Taylor & Lowell J. Taylor, 2015. "The Impact of the Great Migration on Mortality of African Americans: Evidence from the Deep South," American Economic Review, American Economic Association, vol. 105(2), pages 477-503, February.
    58. Sarah Miller & Laura R. Wherry, 2019. "The Long-Term Effects of Early Life Medicaid Coverage," Journal of Human Resources, University of Wisconsin Press, vol. 54(3), pages 785-824.
    59. Ferrie, Joseph P. & Troesken, Werner, 2008. "Water and Chicago's mortality transition, 1850-1925," Explorations in Economic History, Elsevier, vol. 45(1), pages 1-16, January.
    60. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
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    Cited by:

    1. Philipp Ager & Casper Worm Hansen & Peter Z. Lin, 2023. "Medical Technology and Life Expectancy: Evidence from the Antitoxin Treatment of Diphtheria," Working Papers 0241, European Historical Economics Society (EHES).

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination
    • L31 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Nonprofit Institutions; NGOs; Social Entrepreneurship
    • N32 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - U.S.; Canada: 1913-
    • O31 - Economic Development, Innovation, Technological Change, and Growth - - Innovation; Research and Development; Technological Change; Intellectual Property Rights - - - Innovation and Invention: Processes and Incentives

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