TY  - JOUR
AU  - Gruber, Jonathan
AU  - Hoe, Thomas P
AU  - Stoye, George
TI  - Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 24445
PY  - 2018
Y2  - March 2018
DO  - 10.3386/w24445
UR  - http://www.nber.org/papers/w24445
L1  - http://www.nber.org/papers/w24445.pdf
N1  - Author contact info:
Jonathan Gruber
Department of Economics, E52-434
MIT
77 Massachusetts Avenue
Cambridge, MA 02139
Tel: 617/253-8892
Fax: 617/253-1330
E-Mail: gruberj@mit.edu

Thomas P. Hoe
Martha Van Rensselaer Hall
Cornell University
Ithaca, NY 14853
E-Mail: tomphoe@gmail.com

George Stoye
E-Mail: george_s@ifs.org.uk
AB  - 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.
ER  -