Working Paper: NBER ID: w10700
Authors: Thomas C. Buchmueller; Mireille Jacobson; Cheryl Wold
Abstract: Do urban hospital closures affect health care access or health outcomes? We study closures in Los Angeles County between 1997 and 2003, through their effect on distance to the nearest hospital. We find that increased distance to the nearest hospital shifts regular care away from emergency rooms and outpatient clinics to doctor's offices. While most residents are otherwise unaffected by closures, lower-income residents report more difficulty accessing care, working age residents are less likely to receive HIV tests, and seniors less likely to receive flu shots. We also find some evidence that increased distance raises infant mortality rates and stronger evidence that it increases deaths from unintentional injuries and heart attacks.
Keywords: hospital closures; health care access; health outcomes; Los Angeles County
JEL Codes: I11; I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| increased distance to the nearest hospital (I14) | lower probability of identifying an emergency room or outpatient clinic as a usual source of care (I11) |
| increased distance to the nearest hospital (I14) | increased likelihood of reporting a doctor's office as the primary care location (I11) |
| increased distance to the nearest hospital (I14) | negatively affects access to preventive care (I14) |
| increased distance to the nearest hospital (I14) | seniors less likely to receive flu shots (J14) |
| increased distance to the nearest hospital (I14) | lower-income individuals face greater difficulties in accessing care (I14) |
| increased distance to the nearest hospital (I14) | higher infant mortality rates (J13) |
| increased distance to the nearest hospital (I14) | increased deaths from unintentional injuries (I12) |
| increased distance to the nearest hospital (I14) | increased deaths from acute myocardial infarction (I12) |