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Exploring the causal relationship between length of stay in hospitals and treatment outcome: Evidence from Japanese AMI patients


  • Satoshi Shimizutani

    (Research Fellow, Gender Equality Bureau, Cabinet Office)

  • Hiroyuki Yamada

    (Associate Professor, Osaka School of International Public Policy (OSIPP))

  • Haruko Noguchi

    (Professor, Faculty of Political Science and Economics, Waseda University)

  • Yuichiro Masuda

    (MD, Director of Medicine, Gifu Health Management Center)

  • Masafumi Kuzuya

    (MD, Professor, Graduate School of Medicine, Nagoya University)


In this study, we explore the causal relationship between length of stay (LOS) in hospitals and the treatment outcome for Acute Myocardial Infarction (AMI) patients in Japan, where the average LOS (ALOS) is the longest among OECD countries. Using chart-based data, we address the endogeneity between LOS and treatment outcome by using an exogenous variation based on Rokuyo (the six basic labels allocated to each weekday), which is found to be irrelevant to admission day but relevant to discharge day. While we do find a significant association between LOS and rehospitalization probability in the ordinary least squares (OLS) estimation, we do not find a significant relationship once LOS is instrumented by the six basic labels in various instrumental variable estimations. This implies that additional stay that was induced owing to patient's choice of preferred Rokuyo at discharge has no effect on rehospitalization probability.

Suggested Citation

  • Satoshi Shimizutani & Hiroyuki Yamada & Haruko Noguchi & Yuichiro Masuda & Masafumi Kuzuya, 2013. "Exploring the causal relationship between length of stay in hospitals and treatment outcome: Evidence from Japanese AMI patients," OSIPP Discussion Paper 13E006, Osaka School of International Public Policy, Osaka University.
  • Handle: RePEc:osp:wpaper:13e006

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    References listed on IDEAS

    1. David M. Cutler & Mark McClellan & Joseph P. Newhouse & Dahlia Remler, 1998. "Are Medical Prices Declining? Evidence from Heart Attack Treatments," The Quarterly Journal of Economics, Oxford University Press, vol. 113(4), pages 991-1024.
    2. Șerban Georgescu, 2012. "Japan," Conjunctura economiei mondiale / World Economic Studies, Institute for World Economy, Romanian Academy.
    3. Haruko Noguchi & Satoshi Shimizutani & Yuichiro Masuda, 2008. "Regional variations in medical expenditure and hospitalization days for heart attack patients in Japan: evidence from the Tokai Acute Myocardial Study (TAMIS)," International Journal of Health Economics and Management, Springer, vol. 8(2), pages 123-144, June.
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    More about this item


    Japan; Rokuyo; Length of stay; Hospitals; Rehospitalization; Health expenditure.;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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