Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers
The emergency department (ED) is a complex node of healthcare delivery that is facing market and regulatory pressure across developed economies to reduce wait times. In this paper we study how ED doctors respond to such incentives, by focussing on a landmark policy in England that imposed strong incentives to treat ED patients within four hours. Using bunching techniques, we estimate that the policy reduced affected patients’ wait times by 19 minutes, yet distorted a number of medical decisions. In response to the policy, doctors increased the intensity of ED treatment and admitted more patients for costly inpatient care. We also find a striking 14% reduction in mortality. To determine the mechanism behind these health improvements, we exploit heterogeneity in patient severity and hospital crowding, and find strongly suggestive evidence that it is the reduced wait times, rather than the additional admits, that saves lives. Overall we conclude that, despite distorting medical decisions, constraining ED doctors can induce cost-effective reductions in mortality.
We thank Richard Blundell, Aureo de Paula, Eric French, Peter Hull, and Henrik Kleven for useful comments, as well as seminar participants at the Institute for Fiscal Studies, MIT, and UCL. The authors thank NHS Digital and the Office for National Statistics for access to the Hospital Episode Statistics and official mortality statistics under data sharing agreement CON-205762-B8S7B. Hoe and Stoye gratefully acknowledge financial support from the UK Economic and Social Research Council through the Centre for the Microeconomic Analysis of Public Policy (CPP) at IFS (ES/M010147/1). Author affiliations: Gruber (MIT and NBER); Hoe (University College London and Institute for Fiscal Studies); Stoye (University College London and Institute for Fiscal Studies). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
- Emergency departments (EDs) face the complex challenge of serving patients who arrive with a wide array of problems, some...