NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

NBER Working Papers by Renee Y. Hsia

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Working Papers

November 2016Geographical Distribution of Emergency Department Closures and Consequences on Heart Attack Patients
with Yu-Chu Shen: w22861
We develop a conceptual framework and empirically investigate how a permanent emergency department (ED) closure affects patients with acute myocardial infarction (AMI). We first document that large increases in driving time to closest ED are more likely to happen in low-income communities and communities that had fewer medical resources at baseline. Then using a difference-in-differences design, we estimate the effect of an ED closure on access to cardiac care technology, treatment, and health outcomes among Medicare patients with AMI who lived in 24,567 ZIP codes that experienced no change, an increase of <10 minutes, 10 to <30 minutes, and ≥30 minutes in driving time to their closest ED. Overall, access to cardiac care declined in all communities experiencing a closure, with access t...
October 2015Private Safety-Net Clinics: Effects of Financial Pressures and Community Characteristics on Closures
with Suhui Li, Avi Dor, Jesse M. Pines, Mark S. Zocchi: w21648
In order to better understand what threatens vulnerable populations’ access to primary care, it is important to understand the factors associated with closing safety-net clinics. This paper examines how a clinic’s financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012. We use a discrete-time proportional hazard model to assess relative hazard ratios of covariates, and a random-effect hazard model to adjust for unobserved heterogeneity among PCCs. We find that lower net income from patient care, smaller amount of government grants, and lower productivity were associated with significantly higher risk of PCC closure. We also find ...
January 2011Does Decreased Access to Emergency Departments Affect Patient Outcomes? Analysis of AMI Population 1996-2005
with Yu-Chu Shen: w16690
We analyze whether decreased emergency department access (measured by increased driving time to the nearest ED) results in adverse patient outcomes or changes in the patient health profile for patients suffering from acute myocardial infarction. Data sources include 100% Medicare Provider Analysis and Review, AHA hospital annual surveys, Medicare hospital cost reports, and longitude and latitude information for 1995-2005. We define four ED access change categories and estimate a zip codes fixed-effects regression models on the following AMI outcomes: time-specific mortality rates, age, and probability of PTCA on the day of admission. We find a small increase in 30-day to 1-year mortality rates among patients in communities that experience <10-minute increase in driving time. Among patie...

Published: Shen, Y. and Hsia, RY. 2012. Does Decreased Access to Emergency Departments Affect Patient Outcomes? Analysis of AMI Population 1996-2005. Health Services Research, 47(1, Part 1): 188-210.

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