Economics serving society

Spatial Disparities in Hospital Performance

Laurent Gobillon and Carine Milcent

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Spatial disparities emerge regularly in the french debates about the labor market, education, economic development ... but also about health. This paper studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack in France between 1998 and 2003. Four components are considered: spatial differences in patient characteristics (sex, age...), treatments and innovations (angioplasty, stent), hospital characteristics (public/private), and local healthcare market structure.
Laurent Gobillon and Carine Milcent show a 80% difference in the propensity to die within 15 days following myocardial between extreme regions. If demographic characteristics contribute to these differences, spatial differences in the use of innovative treatments play a major role. Once the innovation part is taken into account, the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
Original title of the article: Spatial Disparities in Hospital Performance
Published : Journal of Economic Geography, Nov 2013, Vol. 13, Issue 6, p 1013-1040.
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