DP7826 Spatial Disparities in Hospital Performances

Author(s):	Laurent Gobillon, Carine Milcent
Publication Date:	May 2010
Keyword(s):	economic geography, spatial health disparities, stratified duration model
JEL(s):	C41, I11
Programme Areas:	International Trade and Regional Economics
Link to this Page:	cepr.org/active/publications/discussion_papers/dp.php?dpno=7826

Spatial disparities in mortality can result from spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these explanatory factors, we estimate a fexible duration model on stays in hospital for a heart attack using a French exhaustive dataset. Over the 1998-2003 period, the raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after taking into account the patients' characteristics and their treatments. We conduct a variance analysis to explain regional disparities in mortality. Whereas spatial variations in the use of innovative treatments play the most important role, spatial differences in the local concentration of patients also play a significant role.