Hospital Report Cards, Patients' Travel Distance, and Health Outcomes
Shin-Yi Chou, Mary E. Deily, Suhui Li
Department of Economics,
College of Business and Economics
Abstract
Public release of hospital report cards has two goals: to give hospitals an incentive to improve their services, and to give consumers the information they need to make informed choices about which hospital to use. One of the implications of the second goal is that patients may travel further than the closest available hospital if it has a poor grade. However, traveling to a hospital located farther away for treatment may affect a patient's health outcome in two ways: one, by improving it if they travel further to a hospital with a higher grade, second by degrading it, if the travel distance itself has a negative effect on outcomes. In this paper we study whether report card grades affected how far a patient traveled for CABG surgery in Pennsylvania, and estimate the impact of that travel on health outcomes.
We estimate whether the probability that, during the years 1995-2005, individual Pennsylvania CABG patients used the hospital closest to their home. Using these same data, we then examine the average marginal distance that a hospital's patients have traveled beyond their closest hospital. Overall, we find patients are increasingly more likely to use the closest hospital as its grade improves, and that patients are prompted to go beyond the closest hospital if the closest hospital does too few CABG surgeries to be rated, or if the distance they have to travel beyond it to a rated hospital is short.
We then estimate a model of each patient's health outcome as a function of whether they went to the closest hospital, or how far they traveled beyond their closest hospital to the admitting hospital. We use two different measures of health outcomes, in-hospital mortality and readmission within 12 months. Finally, we look to see whether patients' travel decisions affect the total charge recorded by the hospital for their case. We find some evidence that traveling further from home results in worse health outcomes, as well as more costly stays.
Bio
Suhui Li is a second year doctoral student in the Department of Economics under the guidance of Shin-Yi Chou. Her research interests focus on health economics, game theory, micro-econometrics, and industrial organization. After completing her degree, she plans to seek a research position in academia.
