Working Paper: CEPR ID: DP7826
Authors: Laurent Gobillon; Carine Milcent
Abstract: Spatial disparities in mortality can result from spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these explanatory factors, we estimate a fexible duration model on stays in hospital for a heart attack using a French exhaustive dataset. Over the 1998-2003 period, the raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after taking into account the patients' characteristics and their treatments. We conduct a variance analysis to explain regional disparities in mortality. Whereas spatial variations in the use of innovative treatments play the most important role, spatial differences in the local concentration of patients also play a significant role.
Keywords: Economic Geography; Spatial Health Disparities; Stratified Duration Model
JEL Codes: C41; I11
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Hospital characteristics (I23) | Mortality rates (I12) |
| Innovative treatments (O35) | Mortality rates (I12) |
| Local concentration of patients (Herfindahl index) (I11) | Mortality rates (I12) |
| Patient characteristics (I11) | Mortality rates (I12) |
| Hospital attributes (I11) | Mortality rates (I12) |
| Spatial disparities in treatment utilization (I14) | Mortality rates (I12) |
| Patient demographics (I11) | Mortality rates (I12) |