Working Paper: CEPR ID: DP17666
Authors: Kris Mitchener; Rui Esteves; Peter Nencka; Melissa Thomasson
Abstract: Using newly digitized U.S. city-level data on hospitals, we explore how pandemics alter preferences for healthcare. We find that cities with higher levels of mortality during the Great Influenza of 1918-1919 subsequently expanded hospital capacity by more than cities experiencing less influenza mortality: cities in the top half of the mortality distribution increased their count of hospitals by 8-10 percent in the years after the pandemic. This effect persisted to 1960 and was driven by increases in non-governmental hospitals. Growth responded most in richer cities, exacerbating existing inequalities in access to healthcare. We do not find evidence that government- run hospitals or other types of city-level spending related to healthcare responded to pandemic intensity, suggesting that large health shocks do not necessarily lead to increased public provision of health services.
Keywords: hospitals; healthcare; influenza; pandemics; local public goods
JEL Codes: I11; I14; J10; N32
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Hospital growth (I15) | Healthcare access inequality (I14) |
| Pandemic mortality (I12) | Government hospital growth (I18) |
| Pandemic mortality (I12) | Municipal healthcare spending (H51) |
| Pandemic mortality (I12) | Hospital capacity (I19) |
| Pandemic mortality (I12) | Private hospital expansion (I11) |
| Pandemic mortality (I12) | Hospital growth (I15) |