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You got me curious about the empirical evidence on this and the first paper I found supports my priors that hospitals don't really keep people alive on net.
I use variation in access to hospitals caused by nearly 1,300 hospital entries and exits to show that hospital entries cause sharp increases and exits cause sharp decreases in the quantity of inpatient care and emergency department visits with no short-term effect on the mortality rate.
This is a top journal in this field of economics. I haven't scrutinized the paper but it would be shocking if the authors weren't put through the ringer for coming to this conclusion. They would definitely have had to do many robustness checks on their methodology.
Well if you are getting admitted to a hospital that alone increases your probability of dying I would assume so I’m not surprised it’s net negative.
But many more old people go to hospitals than younger folks who make up the majority of labor participation. The paper would have to make that distinction.
They don't find net negative. They find no significant impact and this is monitoring the local mortality statistics after a hospital either opens or closes in the area, so it should have no impact on how many people need to be admitted to a hospital, unless you think hospitals create their own demand somehow.
If anything, entry and exit of hospitals would be in response to local need, which would lead to an overly positive estimated impact due to selection bias.
My guess is that the lack of an observed effect comes down to four things:
- People usually get better on their own but attribute getting better to the treatment they receive (post hoc ergo proctor hoc)
- Hospitals are a source of two leading causes of death (doctor and pharmacist error)
- Hospitals provide diagnostics and symptom management more than remedies
- The most valuable hospitals have already been built and the returns to additional ones are very small.
#4 Makes a ton of sense.
unless you think hospitals create their own demand somehow.
Having a hospital exists and people know about it creates demand. Just think of a mother who rushes her child to the hospital everytime the kid has a slight fever. If the hospital doesn’t exist she doesn’t go. Maybe it’s a trip to CVS. The child recovers and the mental burden of a sick child is now alleviated.
If anything, entry and exit of hospitals would be in response to local need, which would lead to an overly positive estimated impact due to selection bias.
I would say a regional need. Hospitals provide higher levels of care that is justified by a large population set. Viewing the economic impact of hospital on death and errors made that lead to death I think ignores the overall objective of trying to keep people alive. And what that does for humans to take on more risks.
the mental burden of a sick child is now alleviated.
I didn't specifically mention peace of mind but that is part of what I was thinking about with item 3.
the overall objective of trying to keep people alive. And what that does for humans to take on more risks.
You're describing a moral hazard of expanded medical services and the implication is that the increase in risky behavior fully cancels out the gains in life-saving, which seems implausible to me unless the life-saving is very minimal.
So it’s the current system that inhibits growth not the act of keeping humans alive is what I am gathering.