How Far to the Hospital? The Effect of Hospital Closures on Access to Care

Buchmueller, Thomas C.; Jacobson, Mireille; Wold, Cheryl

doi:10.3386/w10700

Cited by 99 publications

(153 citation statements)

References 16 publications

(19 reference statements)

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“…Additionally, a 100% increase in the number of hospital beds per kilometer implies a decrease in traffic fatality rates of about 3%. Thus, we confirm that countries that provide a better geographical coverage of health care for road accidents are able to reduce the likelihood of death once the accident has taken place (Buchmueller et al 2006) by enabling a quick medical response and pre-hospital care (Arroyo et al 2013;Sánchez-Mangas et al 2010;Wilde, 2012). This effect is relevant not just in statistical terms (the coefficients associated with these variables are statistically significant) but also from a quantitative point of view because the derived elasticities are quite high.…”

Section: [Insert Table 3]supporting

confidence: 57%

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

2013

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Abstract:This study uses data for the EU-27 countries in the period 1999-2009 to estimate determinants of road traffic fatality rates. Controlling for country attributes and road safety policy variables, we examine the influence of variables related with the national health systems; the number of hospital beds per kilometer and the percentage of health expenditures over gross domestic product. We find evidence that the density of hospital beds contributes substantially to the fall in traffic-related fatalities. Furthermore, the quality of general medical facilities and technology associated with increases in health expenditure may be also a relevant factor in reducing road traffic fatalities..

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Section: [Insert Table 3]supporting

confidence: 57%

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

2013

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“…5,25 Our finding that most of the potential pathway variables in our study had minimal or no effect on the relationship between segregation and heart disease or stroke death rates was unexpected because racial residential segregation is hypothesized to operate through the spatial distribution of economic, educational, and health-care-related resources. [5][6][7][8][9][10] Although this finding does not indicate that the remaining potential pathway variables are not important contributors to the relationship between segregation and cardiovascular mortality rates, it may reflect that the mechanisms of these potential pathways are slightly different than female-headed households or these mechanisms are inadequately measured using census variables alone. For example, within school districts, there can be heterogeneity in quality of education.…”

Section: Discussionmentioning

confidence: 75%

“…Metropolitan areas with high black-white residential segregation are characterized by isolation of black residents from quality schools, employment, and healthy environments when compared to white residents, [5][6][7][8][9][10] as well as greater exposure to spatially concentrated poverty, violent crime, and related manifestations of social disorganization. 11 Segregation may therefore fundamentally influence race-place variation in health outcomes such as heart disease and stroke mortality because of the associated health consequences of differential geographies of opportunity and distribution of exposures.…”

Section: Introductionmentioning

confidence: 99%

Metropolitan Racial Residential Segregation and Cardiovascular Mortality: Exploring Pathways

et al. 2013

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Racial residential segregation has been associated with an increased risk for heart disease and stroke deaths. However, there has been little research into the role that candidate mediating pathways may play in the relationship between segregation and heart disease or stroke deaths. In this study, we examined the relationship between metropolitan statistical area (MSA)-level segregation and heart disease and stroke mortality rates, by age and race, and also estimated the effects of various educational, economic, social, and health-care indicators (which we refer to as pathways) on this relationship. We used Poisson mixed models to assess the relationship between the isolation index in 265 U.S. MSAs and countylevel (heart disease, stroke) mortality rates. All models were stratified by race (non-Hispanic black, non-Hispanic white), age group (35-64 years, ≥65 years), and cause of death (heart disease, stroke). We included each potential pathway in the model separately to evaluate its effect on the segregation-mortality association. Among blacks, segregation was positively associated with heart disease mortality rates in both age groups but only with stroke mortality rates in the older age group. Among whites, segregation was marginally associated with heart disease mortality rates in the younger age group and was positively associated with heart disease mortality rates in the older age group. Three of the potential pathways we explored attenuated relationships between segregation and mortality rates among both blacks and whites: percentage of female-headed households, percentage of residents living in poverty, and median household income. Because the percentage of female-headed households can be seen as a proxy for the extent of social disorganization, our finding that it has the greatest attenuating effect on the relationship between racial segregation and heart disease and stroke mortality rates suggests that social disorganization may play a strong role in the elevated rates of heart disease and stroke found in racially segregated metropolitan areas.

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“…Funded by debt relief funds under a 2009 Appropriations Act, its key feature was the recruitment and deployment of newly qualified, unemployed, and retired midwives to public primary health Buchmueller et al 2006. who study the effect of hospital closures in California on adult mortality, and Valente who studies the effect of the opening of abortion centers on neonatal outcomes in Nepal (Buchmueller, Jacobson & Wold 2006;Valente 2014).…”

Section: The Midwives Service Schemementioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report SummaryLimited availability of skilled providers, particularly in rural areas, is thought to be an important constraint to increasing rates of use of maternal and child health services in low-and middle-income countries. There are, however, few well-identified studies of the relationship between the supply of skilled workers and outcomes. In this project, we studied the effects of a government program in Nigeria that sought to alleviate supply-side constraints by deploying skilled midwives to primary health facilities in rural communities, to provide round-the-clock access to skilled care.We evaluate the impact of the Midwives Service Scheme (MSS), a government program introduced in 2009 to increase access to skilled care in underserved rural areas in Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, we surveyed 7,104 women with a birth within the preceding five years in 386 communities across 12 states. The intervention group consisted of communities that participated in the initial rollout; the comparison group consisted of communities that would receive the program approximately three years later. To understand implementation challenges and contextualize the quantitative results, we carried out a nested qualitative study in three states, consisting of in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups.Overall, we found that the program's effects were smaller than anticipated. The main effect was a 7.3-percentage-point increase in antenatal care use in program clinics (about 12 percent relative to baseline levels) and a 5-percentage-point increase in overall use of antenatal care (6 percent relative to baseline levels) within the first year of the program. We found suggestive but not conclusive evidence of a small increase in skilled birth attendance, but this was confined to the south, where there were fewer challenges with midwife retention. We did not find any significant improvements in postnatal visits or child immunizations. Given this, it is not surprising that we did not find any evidence of improvements in maternal and child health.Our data allow us to shed some light on why ...

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How Far to the Hospital? The Effect of Hospital Closures on Access to Care

Cited by 99 publications

References 16 publications

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

Metropolitan Racial Residential Segregation and Cardiovascular Mortality: Exploring Pathways

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

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