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dc.contributor.authorTurner, AJ
dc.contributor.authorAnselmi, L
dc.contributor.authorLau, YS
dc.contributor.authorSutton, M
dc.date.accessioned2020-11-27T00:48:08Z
dc.date.available2020-11-27T00:48:08Z
dc.date.issued2020-12-01
dc.identifier.citationTurner, A. J., Anselmi, L., Lau, Y. S. & Sutton, M. (2020). The effects of unexpected changes in demand on the performance of emergency departments. Health Economics (United Kingdom), 29 (12), pp.1744-1763. https://doi.org/10.1002/hec.4167.
dc.identifier.issn1057-9230
dc.identifier.urihttp://hdl.handle.net/11343/252597
dc.description.abstractCrowding in emergency departments (EDs) is increasing in many health systems. Previous studies of the relationship between crowding and care quality are limited by the use of data from single hospitals, a focus on particular patient groups, a focus on a narrow set of quality measures, and use of crowding measures which induce bias from unobserved hospital and patient characteristics. Using data from 139 hospitals covering all major EDss in England, we measure crowding using quasi-exogenous variation in the volume of EDs attendances and examine its impacts on indicators of performance across the entire EDs care pathway. We exploit variations from expected volume estimated using high-dimensional fixed effects capturing hospital-specific variation in attendances by combinations of month and hour-of-the-week. Unexpected increases in attendance volume result in substantially longer waiting times, lower quantity and complexity of care, more patients choosing to leave without treatment, changes in referral and discharge decisions, but only small increases in reattendances and no increase in mortality. Causal bounds under potential omitted variable bias are narrow and exclude zero for the majority of outcomes. Results suggest that physician and patient responses may largely mitigate the impacts of demand increases on patient outcomes in the short-run.
dc.languageEnglish
dc.publisherJohn Wiley & Sons Ltd.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleThe effects of unexpected changes in demand on the performance of emergency departments
dc.typeJournal Article
dc.identifier.doi10.1002/hec.4167
melbourne.affiliation.departmentMelbourne Institute of Applied Economic and Social Research
melbourne.source.titleHealth Economics
melbourne.source.volume29
melbourne.source.issue12
melbourne.source.pages1744-1763
dc.rights.licensecc-by
melbourne.elementsid1467596
melbourne.contributor.authorSutton, Matthew
dc.identifier.eissn1099-1050
melbourne.accessrightsOpen Access


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