Developing countries increasingly use biometric identification technology in hopes of improving the reliability of administrative information and delivering social services more efficiently. This paper exploits the random placement of biometric tracking devices in tuberculosis treatment centers in urban slums across four Indian states to measure their effects both on disease control and on the quality of health records. The devices record health worker attendance and patient adherence to treatment, and they automatically generate prompts to follow up with patients who miss doses. Combining data from patient and health worker surveys, independent field visits, and government registers, we first find that patients enrolled at biometric-equipped centers are 25 percent less likely to interrupt treatment—an improvement driven by increased attendance and efforts by health workers and greater treatment adherence by patients. Second, biometric tracking decreases data forgery: it reduces overreporting of patient numbers in both NGO data and government registers and underreporting of treatment interruptions. Third, the impact of biometric tracking is sustained over time and it decreases neither health worker satisfaction nor patient satisfaction. Overall, our results suggest biometric tracking technology is both an effective and sustainable way to improve the state's capacity to deliver healthcare in challenging areas.
{"title":"Biometric Tracking, Healthcare Provision, and Data Quality: Experimental Evidence from Tuberculosis Control","authors":"T. Bossuroy, Clara Delavallade, V. Pons","doi":"10.3386/W26388","DOIUrl":"https://doi.org/10.3386/W26388","url":null,"abstract":"Developing countries increasingly use biometric identification technology in hopes of improving the reliability of administrative information and delivering social services more efficiently. This paper exploits the random placement of biometric tracking devices in tuberculosis treatment centers in urban slums across four Indian states to measure their effects both on disease control and on the quality of health records. The devices record health worker attendance and patient adherence to treatment, and they automatically generate prompts to follow up with patients who miss doses. Combining data from patient and health worker surveys, independent field visits, and government registers, we first find that patients enrolled at biometric-equipped centers are 25 percent less likely to interrupt treatment—an improvement driven by increased attendance and efforts by health workers and greater treatment adherence by patients. Second, biometric tracking decreases data forgery: it reduces overreporting of patient numbers in both NGO data and government registers and underreporting of treatment interruptions. Third, the impact of biometric tracking is sustained over time and it decreases neither health worker satisfaction nor patient satisfaction. Overall, our results suggest biometric tracking technology is both an effective and sustainable way to improve the state's capacity to deliver healthcare in challenging areas.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129741127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as "exits." Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients' longer-run health outcomes.
{"title":"Primary Care Physician Practice Styles and Patient Care: Evidence from Physician Exits in Medicare","authors":"Itzik Fadlon, Jessica Van Parys","doi":"10.3386/w26269","DOIUrl":"https://doi.org/10.3386/w26269","url":null,"abstract":"Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as \"exits.\" Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients' longer-run health outcomes.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128081483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.
{"title":"Do Health System Reforms Stand a Chance?","authors":"P. Zweifel","doi":"10.1111/ecaf.12343","DOIUrl":"https://doi.org/10.1111/ecaf.12343","url":null,"abstract":"While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126721417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We estimate racial differences in longevity using records from cohorts of Union Army veterans. Since veterans received pensions based on proof of disability at medical exams, estimates of the causal effect of income on mortality may be biased, as sicker veterans received larger pensions. To circumvent endogeneity bias, we propose an exogenous source of variation in pension income: the judgment of the doctors who certified disability. We find that doctors appeared to discriminate against black veterans. The discrimination we observe is acute—we would not observe any racial mortality differences had physicians not been racially biased in determining pension awards. The effect of income on health was indeed large enough to close the black-white mortality gap in the period. Our work emphasizes that the large effects of physicians’ attitudes on racial differentials in health, which persist today amongst both veterans and the civilian population, were equally prominent in the past.
{"title":"Physician Bias and Racial Disparities in Health: Evidence from Veterans&Apos; Pensions","authors":"Shari Jane Eli, Trevon Logan, Boriana Miloucheva","doi":"10.3386/W25846","DOIUrl":"https://doi.org/10.3386/W25846","url":null,"abstract":"We estimate racial differences in longevity using records from cohorts of Union Army veterans. Since veterans received pensions based on proof of disability at medical exams, estimates of the causal effect of income on mortality may be biased, as sicker veterans received larger pensions. To circumvent endogeneity bias, we propose an exogenous source of variation in pension income: the judgment of the doctors who certified disability. We find that doctors appeared to discriminate against black veterans. The discrimination we observe is acute—we would not observe any racial mortality differences had physicians not been racially biased in determining pension awards. The effect of income on health was indeed large enough to close the black-white mortality gap in the period. Our work emphasizes that the large effects of physicians’ attitudes on racial differentials in health, which persist today amongst both veterans and the civilian population, were equally prominent in the past.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120975775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Americans’ right to access health care has been a national debate since 1912 when President Teddy Roosevelt ran on a health insurance platform. After the New Deal and America’s emergence from the social and economic hardships caused by the Great Depression, President Truman pressured Congress in 1945 to take action to develop a national health insurance fund for all Americans.
It wasn’t until 1965 that the “Original Medicare” program was signed into law, covering hospital and general medical care for people over the age of 65 along with a state option for low-income children. The law also required that participating hospitals meet certain minimum health and safety requirements, setting the first standards towards the delivery of quality health care. This was the first step toward entrenching affordable health care that meets a minimum standard for care quality.
The program has been expanded over the years to include individuals under the age of 65 with long-term disabilities (Medicaid), uninsured children whose families earn too much to be eligible for Medicaid, and to cover services and products for a variety of conditions that affect the Medicare and Medicaid populations. The Medicare and Medicaid programs provide health care for approximately 59 million Americans today.
The most significant expansion of health care since the Original Medicare enactment came with the Patient Protection and Affordable Care Act (ACA) in 2010 which created the health insurance market where Americans can apply for and enroll in private health insurance plans. This law allowed the Centers for Medicare & Medicaid Services (CMS) to test models that improve care quality, lower costs, and better align payment systems to support patient-centered practices. The ACA also directed CMS to establish the Hospital Readmission Reduction Program (HRRP) to reduce payments to hospitals with excess readmissions, with the goal to link payment to the quality of hospital care. More than half of Americans under age 65, approximately 158 million people, access health insurance through their employer, while about one-quarter have a plan through the individual insurance market or are enrolled in Medicaid.
The majority of Americans today have an expectation that they can access affordable health care that is delivered with quality in mind. Health care remains a national debate, particularly in relation to the constitutionality of the Affordable Care Act. In an unprecedented move, the Trump Administration has flipped positions moving away from defending the Act.
While courts are not willing to make substantive leaps on how health care is funded and the minimum level of care to which Americans are entitled, Congress has and should set the baseline. This Article examines the implied right to healthcare and how the judiciary and administrative agencies can favor health care as a right.
{"title":"Health Care as a Right: How Health Care Became Accessible","authors":"L. Dandrea","doi":"10.2139/ssrn.3415115","DOIUrl":"https://doi.org/10.2139/ssrn.3415115","url":null,"abstract":"Americans’ right to access health care has been a national debate since 1912 when President Teddy Roosevelt ran on a health insurance platform. After the New Deal and America’s emergence from the social and economic hardships caused by the Great Depression, President Truman pressured Congress in 1945 to take action to develop a national health insurance fund for all Americans. <br><br>It wasn’t until 1965 that the “Original Medicare” program was signed into law, covering hospital and general medical care for people over the age of 65 along with a state option for low-income children. The law also required that participating hospitals meet certain minimum health and safety requirements, setting the first standards towards the delivery of quality health care. This was the first step toward entrenching affordable health care that meets a minimum standard for care quality. <br><br>The program has been expanded over the years to include individuals under the age of 65 with long-term disabilities (Medicaid), uninsured children whose families earn too much to be eligible for Medicaid, and to cover services and products for a variety of conditions that affect the Medicare and Medicaid populations. The Medicare and Medicaid programs provide health care for approximately 59 million Americans today. <br><br>The most significant expansion of health care since the Original Medicare enactment came with the Patient Protection and Affordable Care Act (ACA) in 2010 which created the health insurance market where Americans can apply for and enroll in private health insurance plans. This law allowed the Centers for Medicare & Medicaid Services (CMS) to test models that improve care quality, lower costs, and better align payment systems to support patient-centered practices. The ACA also directed CMS to establish the Hospital Readmission Reduction Program (HRRP) to reduce payments to hospitals with excess readmissions, with the goal to link payment to the quality of hospital care. More than half of Americans under age 65, approximately 158 million people, access health insurance through their employer, while about one-quarter have a plan through the individual insurance market or are enrolled in Medicaid. <br><br>The majority of Americans today have an expectation that they can access affordable health care that is delivered with quality in mind. Health care remains a national debate, particularly in relation to the constitutionality of the Affordable Care Act. In an unprecedented move, the Trump Administration has flipped positions moving away from defending the Act.<br><br>While courts are not willing to make substantive leaps on how health care is funded and the minimum level of care to which Americans are entitled, Congress has and should set the baseline. This Article examines the implied right to healthcare and how the judiciary and administrative agencies can favor health care as a right.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123126271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research has shown that higher cost-sharing lowers health care spending levels but less is known about whether cost-sharing also affects spending growth. From 2002 to 2016, private insurance deductibles more than tripled in magnitude. We use data from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality to estimate whether areas with relatively higher deductibles experienced lower spending growth during this period. We leverage panel variation in private deductibles across states and over time and address the potential endogeneity of deductibles using instrumental variables. We find that spending growth is significantly lower in states with higher average deductibles and observe this relationship with regard to both private insurance benefits and total spending (including Medicare and Medicaid), suggestive of potential spillovers. We hypothesize that the impact on spending growth happens because deductibles affect the diffusion if costly new technology.
{"title":"Does High Cost-Sharing Slow the Long-Term Growth Rate of Health Spending? Evidence from the States","authors":"Molly Frean, M. Pauly","doi":"10.3386/W25156","DOIUrl":"https://doi.org/10.3386/W25156","url":null,"abstract":"Research has shown that higher cost-sharing lowers health care spending levels but less is known about whether cost-sharing also affects spending growth. From 2002 to 2016, private insurance deductibles more than tripled in magnitude. We use data from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality to estimate whether areas with relatively higher deductibles experienced lower spending growth during this period. We leverage panel variation in private deductibles across states and over time and address the potential endogeneity of deductibles using instrumental variables. We find that spending growth is significantly lower in states with higher average deductibles and observe this relationship with regard to both private insurance benefits and total spending (including Medicare and Medicaid), suggestive of potential spillovers. We hypothesize that the impact on spending growth happens because deductibles affect the diffusion if costly new technology.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115820181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-03DOI: 10.17159/1727-3781/2018/V21I0A3400
M. Njotini
Health care services are recognised as a right. These services are available to "everyone" who needs them. This availability ensures that users, that is, persons who receive treatment in a health establishment or who are in need of health services, are able to have access to these services. Generally, health care services should be available without undue financial burden to users. This then means that the government is saddled with an added financial and administrative burden to ensure their availability to users. However, the availability of the services depends on the availability of resources. In cases where resources are diminished, users who may be in need of health care services may be excluded. Furthermore, the availability of access to health care services does not sufficiently guarantee the securing of users’ personal information. Thus, it is enquired what levels of safeguards do health establishments have to secure the personal information of users? Do these security mechanisms allow for the disclosure of personal information to third parties, and how?
{"title":"Preserving the Integrity of Medical-Related Information – How 'Informed' is Consent?","authors":"M. Njotini","doi":"10.17159/1727-3781/2018/V21I0A3400","DOIUrl":"https://doi.org/10.17159/1727-3781/2018/V21I0A3400","url":null,"abstract":"Health care services are recognised as a right. These services are available to \"everyone\" who needs them. This availability ensures that users, that is, persons who receive treatment in a health establishment or who are in need of health services, are able to have access to these services. Generally, health care services should be available without undue financial burden to users. This then means that the government is saddled with an added financial and administrative burden to ensure their availability to users. However, the availability of the services depends on the availability of resources. In cases where resources are diminished, users who may be in need of health care services may be excluded. Furthermore, the availability of access to health care services does not sufficiently guarantee the securing of users’ personal information. Thus, it is enquired what levels of safeguards do health establishments have to secure the personal information of users? Do these security mechanisms allow for the disclosure of personal information to third parties, and how? \u0000 \u0000 ","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130012081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with lifeor- death consequences. Using data from a large private-payer claims database, I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than patients arriving just before this date, despite the fact that the incidence of heart disease increases smoothly with age. Moreover, I show that this shock to diagnostic intensity has meaningful implications for patient health, as it reduces the number of missed IHD diagnoses among patients arriving in the emergency department just after their 40th birthday, thereby preventing future heart attacks. I then develop a model that ties this behavior to an existing literature on representativeness heuristics, and discuss the implications of this class of heuristics for diagnostic decision-making.
{"title":"Behaving Discretely: Heuristic Thinking in the Emergency Department","authors":"S. Coussens","doi":"10.2139/ssrn.3743423","DOIUrl":"https://doi.org/10.2139/ssrn.3743423","url":null,"abstract":"This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with lifeor- death consequences. Using data from a large private-payer claims database, I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than patients arriving just before this date, despite the fact that the incidence of heart disease increases smoothly with age. Moreover, I show that this shock to diagnostic intensity has meaningful implications for patient health, as it reduces the number of missed IHD diagnoses among patients arriving in the emergency department just after their 40th birthday, thereby preventing future heart attacks. I then develop a model that ties this behavior to an existing literature on representativeness heuristics, and discuss the implications of this class of heuristics for diagnostic decision-making.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123979726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huilan Zhang, Hassan R. HassabElnaby, Amal A. Said
This study examines the relationship between lean implementation and managerial ability in the healthcare industry. Using a panel data set from U.S. short-term, general, acute care hospitals from 2000 to 2015, we conduct unidirectional analysis and two-stage Probit least squares regression to investigate whether lean implementation improves managerial ability and the possible two-way relation lean implementation and managerial ability. We find evidence that lean implementation and managerial ability are simultaneously determined. In addition, we quantify the simultaneity bias by comparing the 2PSLS regression results to those results using unidirectional approach. The findings of this study are of great interest to hospital decision makers and researchers as they assess the benefits of lean implementation and managerial ability. Specifically, the study provides implications to managers in hospitals as it suggests the importance of considering the possible simultaneity bias as they make informed lean implementation decisions. Any policy to improve lean implementation is likely to succeed if it takes into consideration managerial ability, and vice versa.
{"title":"Lean Implementation and Managerial Ability-Evidence from the Healthcare Industry","authors":"Huilan Zhang, Hassan R. HassabElnaby, Amal A. Said","doi":"10.2139/ssrn.3234099","DOIUrl":"https://doi.org/10.2139/ssrn.3234099","url":null,"abstract":"This study examines the relationship between lean implementation and managerial ability in the healthcare industry. Using a panel data set from U.S. short-term, general, acute care hospitals from 2000 to 2015, we conduct unidirectional analysis and two-stage Probit least squares regression to investigate whether lean implementation improves managerial ability and the possible two-way relation lean implementation and managerial ability. We find evidence that lean implementation and managerial ability are simultaneously determined. In addition, we quantify the simultaneity bias by comparing the 2PSLS regression results to those results using unidirectional approach. The findings of this study are of great interest to hospital decision makers and researchers as they assess the benefits of lean implementation and managerial ability. Specifically, the study provides implications to managers in hospitals as it suggests the importance of considering the possible simultaneity bias as they make informed lean implementation decisions. Any policy to improve lean implementation is likely to succeed if it takes into consideration managerial ability, and vice versa.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129608603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I study the impact of transportation on health in the rural United States, 1820–1847. Measuring health by average stature, I find that greater transportation linkage, as measured by market access, in a cohort’s county-year of birth had an adverse impact on its health. A one-standard-deviation increase in market access reduced average stature by 0.14 inches, and rising market access over the study period can explain 37 percent of the contemporaneous decline in average stature, known as the Antebellum Puzzle. I find evidence that transportation affected health by increasing population density, leading to a worse epidemiological environment.
{"title":"Transportation and Health in the Antebellum United States 1820-1847","authors":"A. Zimran","doi":"10.3386/w24943","DOIUrl":"https://doi.org/10.3386/w24943","url":null,"abstract":"I study the impact of transportation on health in the rural United States, 1820–1847. Measuring health by average stature, I find that greater transportation linkage, as measured by market access, in a cohort’s county-year of birth had an adverse impact on its health. A one-standard-deviation increase in market access reduced average stature by 0.14 inches, and rising market access over the study period can explain 37 percent of the contemporaneous decline in average stature, known as the Antebellum Puzzle. I find evidence that transportation affected health by increasing population density, leading to a worse epidemiological environment.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117244285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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