IDEAS home Printed from https://ideas.repec.org/p/ssb/dispap/890.html
   My bibliography  Save this paper

Regional variation in healthcare utilization and mortality

Author

Listed:

Abstract

Geographic variation in healthcare utilization has raised concerns of possible inefficiencies in healthcare supply, as differences are often not reflected in health outcomes. Using comprehensive Norwegian microdata, we exploit cross-region migration to analyze regional variation in healthcare utilization. Our results indicate that hospital region factors account for half of the total variation, while the rest reflect variation in patient demand. We find no statistically significant association between the estimated hospital region effects and overall mortality rates. However, we document a negative association with relative utilization-intensive causes of death such as cancer, suggesting high-supply regions may achieve modestly improved health outcomes.

Suggested Citation

  • Anna Godøy & Ingrid Huitfeldt, 2018. "Regional variation in healthcare utilization and mortality," Discussion Papers 890, Statistics Norway, Research Department.
    • Handle: RePEc:ssb:dispap:890
    as

    Download full text from publisher

    File URL: https://www.ssb.no/en/forskning/discussion-papers/_attachment/370528
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. David M. Cutler & Adriana Lleras-Muney & Tom Vogl, 2008. "Socioeconomic Status and Health: Dimensions and Mechanisms," NBER Working Papers 14333, National Bureau of Economic Research, Inc.
    2. David Card & Jörg Heining & Patrick Kline, 2013. "Workplace Heterogeneity and the Rise of West German Wage Inequality," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 128(3), pages 967-1015.
    3. C. Kirabo Jackson, 2013. "Match Quality, Worker Productivity, and Worker Mobility: Direct Evidence from Teachers," The Review of Economics and Statistics, MIT Press, vol. 95(4), pages 1096-1116, October.
    4. Raj Chetty & Nathaniel Hendren, 2018. "The Impacts of Neighborhoods on Intergenerational Mobility I: Childhood Exposure Effects," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 133(3), pages 1107-1162.
    5. Geert Dhaene & Koen Jochmans, 2015. "Split-panel Jackknife Estimation of Fixed-effect Models," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(3), pages 991-1030.
    6. Raj Chetty & John N. Friedman & Jonah E. Rockoff, 2014. "Measuring the Impacts of Teachers I: Evaluating Bias in Teacher Value-Added Estimates," American Economic Review, American Economic Association, vol. 104(9), pages 2593-2632, September.
    7. John M. Abowd & Francis Kramarz & David N. Margolis, 1999. "High Wage Workers and High Wage Firms," Econometrica, Econometric Society, vol. 67(2), pages 251-334, March.
    8. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
    9. Tatyana Deryugina & David Molitor, 2020. "Does When You Die Depend on Where You Live? Evidence from Hurricane Katrina," American Economic Review, American Economic Association, vol. 110(11), pages 3602-3633, November.
    10. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    11. David Molitor, 2018. "The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 326-356, February.
    12. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    13. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    14. Raj Chetty & John N. Friedman & Jonah E. Rockoff, 2014. "Measuring the Impacts of Teachers II: Teacher Value-Added and Student Outcomes in Adulthood," American Economic Review, American Economic Association, vol. 104(9), pages 2633-2679, September.
    15. Combes, Pierre-Philippe & Duranton, Gilles & Gobillon, Laurent, 2008. "Spatial wage disparities: Sorting matters!," Journal of Urban Economics, Elsevier, vol. 63(2), pages 723-742, March.
    16. Jesse Rothstein, 2010. "Teacher Quality in Educational Production: Tracking, Decay, and Student Achievement," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 175-214.
    17. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    18. Stéphane Bonhomme & Thibaut Lamadon & Elena Manresa, 2019. "A Distributional Framework for Matched Employer Employee Data," Econometrica, Econometric Society, vol. 87(3), pages 699-739, May.
    19. Murphy, Kevin M & Topel, Robert H, 2002. "Estimation and Inference in Two-Step Econometric Models," Journal of Business & Economic Statistics, American Statistical Association, vol. 20(1), pages 88-97, January.
    20. Richard K. Mansfield, 2015. "Teacher Quality and Student Inequality," Journal of Labor Economics, University of Chicago Press, vol. 33(3), pages 751-788.
    21. M. J. Andrews & L. Gill & T. Schank & R. Upward, 2008. "High wage workers and low wage firms: negative assortative matching or limited mobility bias?," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(3), pages 673-697, June.
    22. Raj Chetty & Nathaniel Hendren, 2018. "The Impacts of Neighborhoods on Intergenerational Mobility II: County-Level Estimates," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 133(3), pages 1163-1228.
    23. Salm, Martin & Wübker, Ansgar, 2017. "Causes of regional variation in healthcare utilization in Germany," Ruhr Economic Papers 675, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    24. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    25. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    26. Fiva, Jon H. & Hægeland, Torbjørn & Rønning, Marte & Syse, Astri, 2014. "Access to treatment and educational inequalities in cancer survival," Journal of Health Economics, Elsevier, vol. 36(C), pages 98-111.
    27. Amitabh Chandra & Douglas O Staiger, 2020. "Identifying Sources of Inefficiency in Healthcare [“The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care,”]," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 135(2), pages 785-843.
    28. Eric Chyn, 2018. "Moved to Opportunity: The Long-Run Effects of Public Housing Demolition on Children," American Economic Review, American Economic Association, vol. 108(10), pages 3028-3056, October.
    29. John M. Abowd & Robert H. Creecy & Francis Kramarz, 2002. "Computing Person and Firm Effects Using Linked Longitudinal Employer-Employee Data," Longitudinal Employer-Household Dynamics Technical Papers 2002-06, Center for Economic Studies, U.S. Census Bureau.
    30. Raj Chetty & Nathaniel Hendren & Lawrence F. Katz, 2016. "The Effects of Exposure to Better Neighborhoods on Children: New Evidence from the Moving to Opportunity Experiment," American Economic Review, American Economic Association, vol. 106(4), pages 855-902, April.
    31. Romano, Joseph P. & Wolf, Michael, 2016. "Efficient computation of adjusted p-values for resampling-based stepdown multiple testing," Statistics & Probability Letters, Elsevier, vol. 113(C), pages 38-40.
    32. Skinner, Jonathan, 2011. "Causes and Consequences of Regional Variations in Health Care," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 45-93, Elsevier.
    33. Stephen Gibbons & Henry G. Overman & Panu Pelkonen, 2014. "Area Disparities in Britain: Understanding the Contribution of People vs. Place Through Variance Decompositions," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 76(5), pages 745-763, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    2. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    3. Huitfeldt, Ingrid, 2021. "Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries," Health Policy, Elsevier, vol. 125(6), pages 732-738.
    4. Michael Berger & Thomas Czypionka, 2021. "Regional medical practice variation in high-cost healthcare services," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(6), pages 917-929, August.
    5. Jakub Cerveny & Jan C. van Ours, 2022. "Long-term returns to local health-care spending," Tinbergen Institute Discussion Papers 22-072/V, Tinbergen Institute.
    6. Anna Godøy & Venke Furre Haaland & Ingrid Huitfeldt & Mark Votruba, 2019. "Impacts of hospital wait time on patient health and labor supply," Discussion Papers 919, Statistics Norway, Research Department.
    7. Naimi Johansson & Mikael Svensson, 2022. "Regional variation in prescription drug spending: Evidence from regional migrants in Sweden," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1862-1877, September.
    8. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    9. Bensnes, Simon & Huitfeldt, Ingrid, 2021. "Rumor has it: How do patients respond to patient-generated physician ratings?," Journal of Health Economics, Elsevier, vol. 76(C).
    10. Berger, Michael & Czypionka, Thomas, 2021. "Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria," LSE Research Online Documents on Economics 112952, London School of Economics and Political Science, LSE Library.
    11. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Koen Jochmans & Martin Weidner, 2019. "Fixed‐Effect Regressions on Network Data," Econometrica, Econometric Society, vol. 87(5), pages 1543-1560, September.
    2. Hinnosaar, Marit & Liu, Elaine M., 2022. "Malleability of Alcohol Consumption: Evidence from Migrants," Journal of Health Economics, Elsevier, vol. 85(C).
    3. Patrick Kline & Raffaele Saggio & Mikkel Sølvsten, 2020. "Leave‐Out Estimation of Variance Components," Econometrica, Econometric Society, vol. 88(5), pages 1859-1898, September.
    4. Valentin Verdier, 2020. "Estimation and Inference for Linear Models with Two-Way Fixed Effects and Sparsely Matched Data," The Review of Economics and Statistics, MIT Press, vol. 102(1), pages 1-16, March.
    5. Michael Geruso & Timothy J. Layton & Jacob Wallace, 2023. "What Difference Does a Health Plan Make? Evidence from Random Plan Assignment in Medicaid," American Economic Journal: Applied Economics, American Economic Association, vol. 15(3), pages 341-379, July.
    6. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    7. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2021. "Place-Based Drivers of Mortality: Evidence from Migration," American Economic Review, American Economic Association, vol. 111(8), pages 2697-2735, August.
    8. Chaudhary, Amit, 2021. "Do workers, managers, and stations matter for effective policing? A decomposition of productivity into three dimensions of unobserved heterogeneity," The Warwick Economics Research Paper Series (TWERPS) 1377, University of Warwick, Department of Economics.
    9. Marit Hinnosaar & Elaine M. Liu, 2020. "Persistence in alcohol consumption: evidence from migrants," Carlo Alberto Notebooks 620, Collegio Carlo Alberto.
    10. Mittag, Nikolas, 2016. "A Simple Method to Estimate Large Fixed Effects Models Applied to Wage Determinants and Matching," IZA Discussion Papers 10447, Institute of Labor Economics (IZA).
    11. Peter Hull & Michal Kolesár & Christopher Walters, 2022. "Labor by design: contributions of David Card, Joshua Angrist, and Guido Imbens," Scandinavian Journal of Economics, Wiley Blackwell, vol. 124(3), pages 603-645, July.
    12. Paul Anand & Jere R. Behrman & Hai-Anh H. Dang & Sam Jones, 2019. "Does sorting matter for learning inequality?Evidence from East Africa," PIER Working Paper Archive 20-006, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.
    13. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    14. Ning Jia & Raven Molloy & Christopher Smith & Abigail Wozniak, 2023. "The Economics of Internal Migration: Advances and Policy Questions," Journal of Economic Literature, American Economic Association, vol. 61(1), pages 144-180, March.
    15. Achyuta Adhvaryu & Vittorio Bassi & Anant Nyshadham & Jorge A. Tamayo, 2020. "No Line Left Behind: Assortative Matching Inside the Firm," NBER Working Papers 27006, National Bureau of Economic Research, Inc.
    16. Michael Bailey & Drew Johnston & Martin Koenen & Theresa Kuchler & Dominic Russel & Johannes Stroebel, 2022. "The Social Integration of International Migrants: Evidence from the Networks of Syrians in Germany," CESifo Working Paper Series 9680, CESifo.
    17. Ben Sprung-Keyser & Sonya Porter, 2023. "The Economic Geography of Lifecycle Human Capital Accumulation: The Competing Effects of Labor Markets and Childhood Environments," Working Papers 23-54, Center for Economic Studies, U.S. Census Bureau.
    18. Heath Milsom, Luke, 2023. "Spatial inequality of opportunity in West Africa," Journal of Public Economics, Elsevier, vol. 225(C).
    19. Jean-William Laliberté, "undated". "Long-term Contextual Effects in Education: Schools and Neighborhoods," Working Papers 2019-01, Department of Economics, University of Calgary.
    20. Devereux, Kevin, 2018. "Identifying the value of teamwork: Application to professional tennis," CLEF Working Paper Series 14, Canadian Labour Economics Forum (CLEF), University of Waterloo.

    More about this item

    Keywords

    healthcare supply; healthcare demand; healthcare spending; regional variation; health outcomes;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ssb:dispap:890. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: L Maasø (email available below). General contact details of provider: https://edirc.repec.org/data/ssbgvno.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.