The Health Impacts of Hospital Delivery Practices

Card, David; Fenizia, Alessandra; Silver, David

doi:10.3386/w25986

Cited by 27 publications

(34 citation statements)

References 67 publications

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“…We use a differential distance instrument (McClellan et al, 1994) to control for endogenous patient selection into nursing homes. The instrument exploits the well-known patient preference for nearby healthcare providers (Einav et al, 2016;Card et al, 2019;Currie and Slusky, 2020). This is especially true for nursing homes; for example, Hackmann (2019) finds that the median distance between a senior's residence and her nursing home is under 4.3 miles.…”

Section: Distance Instrumentmentioning

confidence: 99%

“…The second challenge is unobserved changes in patient composition following PE ownership, perhaps reflecting new advertising, hospital ties, or patient reactions to quality. We control for the patient-facility match with a differential distance instrumental variables (IV) strategy (McClellan et al, 1994;Grabowski et al, 2013;Card et al, 2019), exploiting patient preference for a nursing facility close to their home (the median distance is 4.6 miles). To our knowledge, no national study on PE or on ownership in healthcare has simultaneously addressed both challenges.…”

Section: Introductionmentioning

confidence: 99%

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Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

et al. 2020

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The past two decades have seen a rapid increase in Private Equity (PE) investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered forprofit incentives to be misaligned with the social goal of affordable, quality care. This paper studies the effects of PE ownership on patient welfare at nursing homes. With administrative patient-level data, we use a within-facility differences-in-differences design to address nonrandom targeting of facilities. We use an instrumental variables strategy to control for the selection of patients into nursing homes. Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.

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Section: Distance Instrumentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

et al. 2020

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“…[26][27][28] Our estimates for neonatal procedures were also comparable with or larger than those associated with factors such as incentives to fill empty NICU beds and delivering at a hospital with a high rate of cesarean delivery. 29,30 It is possible that clinicians in this study became more cautious following an unexpected newborn death in their county and may therefore have performed more obstetric and neonatal procedures. For example, at least one-third of deaths included in this analysis were associated with low oxygen levels in newborns.…”

Section: Discussionmentioning

confidence: 99%

Association of Unexpected Newborn Deaths With Changes in Obstetric and Neonatal Process of Care

et al. 2020

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IMPORTANCEThe death of a healthy term infant may signal patient safety and quality issues.Various initiatives aim to encourage clinicians to learn from these events, but little evidence exists regarding how exposure to an unexpected newborn death may alter clinician practice.OBJECTIVE To examine the association between an unexpected newborn death and changes in obstetric and newborn procedures that may be used in response to potential fetal distress or newborn complications. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used difference-in-differences analysis of 2011 to 2017 US vital statistics data from 477 US counties experiencing an unexpected newborn death during the study period. All in-hospital live births in the 477 counties during the study period were included. Data were analyzed from September 2019 to September 2020. EXPOSURESThe death of an infant aged 0 to 7 days following an unremarkable pregnancy owing to causes other than birth defects, accidents/assaults, or sudden infant death syndrome. MAIN OUTCOMES AND MEASURES Primary outcomes included binary variables capturingintervention in labor/delivery (induction, augmentation, cesarean delivery, forceps/vacuum) and procedures to avert and mitigate newborn complications (assisted ventilation, surfactant replacement therapy, antibiotics for suspected sepsis, neonatal intensive care unit admission). RESULTSThe main sample included 5.72 million births (2.54 million during preexposure time). Mean (SD) maternal age was 27.3 (5.8) years; 67% of mothers were White, and 12% were Black.Associations varied across the 4 estimated models. Following an unexpected newborn death, there was no significant increase in the probability of cesarean delivery in the full sample model (0.28 percentage points [pp]; 95% CI, −0.01 to 0.57 pp), but a significant increase in the other 3 models, with values ranging from 0.55 pp (95% CI, 0.21 to 0.88 pp) in the full sample model with matching to 0.66 pp (95% CI, 0.13 to 1.19 pp) in the 1-hospital county subsample with matching. There was a significant increase in the probability of newborn assisted ventilation in the full sample model with matching (0.46 pp; 95% CI, 0.08 to 0.83 pp), but no significant increase in the other 3 models, with estimates ranging from 0.33 pp (95% CI, −0.04 to 0.71 pp) to 0.69 pp (95% CI, −0.02 to 1.40 pp).An unexpected newborn death was not associated with a significant increase in antibiotic use in the full sample models (without matching: 0.19 pp; 95% CI, −0.00 to 0.39 pp; with matching: 0.22 pp; 95% CI: −0.02 to 0.46 pp), but was associated with a significant increase in both of the 1-hospital county subsample models (without matching: 0.38 pp; 95% CI, 0.02 to 0.73 pp; with matching: 0.39 pp; 95% CI, 0.01 to 0.77 pp). CONCLUSIONS AND RELEVANCEIn some study models, an unexpected newborn death was associated with statistically significant increases in subsequent use of procedures to avert and (continued) Key Points Question Was the occurrence of an unexpected newborn death associated with ch...

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“…In order to define LRFB births we closely follow Card and Silver (2019). Nevertheless, our data sets are different from theirs, hence it is not possible to use exactly the same definition as they use.…”

Section: Data Descriptionmentioning

confidence: 99%

Restricting the timing of Elective CS: evidence from Brazil

Melo

2021

Estud. Econ.

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Brazil has one of the highest Cesarean Section (CS) rates in the world. It is a share of 58.3% reported by the Living Births Information System (SINASC) 2015-2017. It is well above the maximum rate of 15% recommended by the World Health Organization (WHO). In this paper, we estimate impacts and unintended consequences of the Resolution 2,144 from the Federal council of Medicine (CFM) on outcomes of Low Risk First Born births (LRFB). The Resolution introduces a minimum of 39th weeks of gestation for Elective CS. Elective CS before the 39th week rate dropped 2.78 percentage points, which is statistically significant and equivalent to a 24% decrease in this outcome’s mean. We also find increases in birth’s time length: the percentage of births happening before the 39th week decreased 2.34 percentage points, which is a decrease of 6% in its average. Our results suggest that Elective CS’s were postponed from the 37-38th week to after the begin of the 39th week. We show that the policy had an unintended consequence once it seems to have changed the way potential spontaneous Natural Deliveries are anticipated from weekends to weekdays through Scheduled CS.

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The Health Impacts of Hospital Delivery Practices

Cited by 27 publications

References 67 publications

Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

Association of Unexpected Newborn Deaths With Changes in Obstetric and Neonatal Process of Care

Restricting the timing of Elective CS: evidence from Brazil

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