The impact of early discharge laws on the health of newborns

Evans, William N.; Garthwaite, Craig; Wei, Heng

doi:10.1016/j.jhealeco.2007.12.003

Cited by 28 publications

(36 citation statements)

References 42 publications

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“…The legislation invoked longer average stay lengths observed in Europe and Japan as motivation (Nancy Kassebaum 1996). Between 1995 and1998, 42 states passed laws requiring insurers to cover a minimum postpartum stay (Evans, Garthwaite and Wei 2008). In January 1998, the federal government followed suit, mandating a minimum stay of two days.…”

Section: B Postpartum Hospital Care In the Usmentioning

confidence: 99%

“…Previous work has attempted to estimate the causal effect of stay length by using passage of state laws as natural experiments, which can eliminate this bias (JM Madden, SB Soumerai, TA Lieu, KD Mandl, F Zhang and D Ross-Degnan 2002, Ellen Meara, Uma R. Kotagal, Harry D. Atherton and Tracy A. Lieu 2004, Ashlesha Datar and Neeraj Sood 2006, Evans, Garthwaite and Wei 2008, Evans and Garthwaite 2009. While these studies have consistently found that those born shortly after the laws stayed longer in the hospital, evidence on health impacts has been mixed.…”

Section: Analysis Of Minimum Stay Lawsmentioning

confidence: 99%

“…Coupled with insurance coverage of at least 1 or 2 days, those born just after midnight are covered for an additional night of care compared to those born just prior to midnight. This type of variation lies at the heart of recent policy debates over the appropriate minimum level of coverage, which led 42 US states and ultimately the federal government to mandate minimum stays of 2 days (William N. Evans, Craig Garthwaite and Heng Wei 2008).…”

Section: Introductionmentioning

confidence: 99%

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After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays

Almond

Doyle

2011

American Economic Journal: Economic Policy

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Estimates of moral hazard in health insurance markets can be confounded by adverse selection. This paper considers a plausibly exogenous source of variation in insurance coverage for childbirth in California. We find that additional health insurance coverage induces substantial extensions in length of hospital stay for mother and newborn. However, remaining in the hospital longer has no effect on readmissions or mortality, and the estimates are precise. Our results suggest that for uncomplicated births, minimum insurance mandates incur substantial costs without detectable health benefits. * Josh Angrist, Janet Currie, David Cutler, Carlos Dobkin, Lena Edlund, Randall Ellis, Michael Greenstone, Hilary Hoynes, Rick Hornbeck, Ellen Meara, Doug Miller, Roberto Rigobon, Jon Skinner, Tom Stoker, Tavneet Suri, and seminar participants at Harvard University, Boston University, BYU, and UC Irvine provided helpful comments and discussions. We also thank Jan Morgan of the California Healthcare Information Resource Center for helpful advice and discussions, Nicole Radmore for help with the National Hospital Discharge Survey data, and Sammy Burfeind, whose birth inspired our identification strategy.† Columbia University and NBER: da2152@columbia.edu ‡ MIT and NBER: jjdoyle@mit.edu 1 VOL. VOLUME NO. ISSUE LENGTH OF POSTPARTUM HOSPITAL STAYS 1 AbstractEstimates of moral hazard in health insurance markets can be confounded by adverse selection. This paper considers a plausibly exogenous source of variation in insurance coverage for childbirth in California. We find that additional health insurance coverage induces substantial extensions in length of hospital stay for mother and newborn. However, remaining in the hospital longer has no effect on readmissions or mortality, and the estimates are precise. Our results suggest that for uncomplicated births, minimum insurance mandates incur substantial costs without detectable health benefits.

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Section: B Postpartum Hospital Care In the Usmentioning

confidence: 99%

Section: Analysis Of Minimum Stay Lawsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays

Almond

Doyle

2011

American Economic Journal: Economic Policy

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“…Therefore, reducing repeat hospitalisation is one of the key indicators used to assess hospital performance and the impact of health service organisation for the average patient. 116,123 Our indicator evaluates socioeconomic inequality in repeat hospitalisation between small-area populations from 2001/2 to 2013/14. We define repeat hospitalisation as a proportion of inpatients with one or more subsequent any-cause emergency readmission in the same year.…”

Section: Doi: 103310/hsdr04260 Health Services and Delivery Researchmentioning

confidence: 99%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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“…Moreover, a considerable amount of empirical studies used readmission rates also to evaluate other important issues in health research as the impact of new technologies (Xian et al, 2011) and the impact of specific new policy changes (Evans et al, 2008). Therefore, moving from this argument that hospital readmissions might be somehow "quality dependent", in recent years there has been a large interest in introducing incentives for hospitals to avoid postdischarge complications potentially preventable.…”

Section: Introductionmentioning

confidence: 99%