title: The role of hospital heterogeneity in measuring marginal returns to medical care: a reply to Barreca, Guldi, Lindo, and Waddell.
abstract: In Almond et al. (2010), we describe how marginal returns to medical care can be estimated by comparing patients on either side of diagnostic thresholds. Our application examines at-risk newborns near the very low birth weight threshold at 1500 g. We estimate large discontinuities in medical care and mortality at this threshold, with effects concentrated at “low-quality” hospitals. Although our preferred estimates retain newborns near the threshold, when they are excluded the estimated marginal returns decline, although they remain large. In low-quality hospitals, our estimates are similar in magnitude regardless of whether these newborns are included or excluded.
authors.affiliation: Columbia University and National Bureau of Economic Research.
authors.forename: Douglas
authors.initials: D
authors.lastname: Almond
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Kowalski
authors.forename: Heidi
authors.initials: H
authors.lastname: Williams
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000208:ethnology / Q000266:history; D049673:History, 20th Century; D049674:History, 21st Century; D006761:Hospitals / Q000266:history; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology / Q000266:history; D007229:Infant Welfare / Q000208:ethnology / Q000266:history; D007230:Infant, Low Birth Weight / Q000502:physiology / Q000523:psychology; D007231:Infant, Newborn; D010820:Physicians / Q000191:economics / Q000266:history / Q000523:psychology; D024382:Professional Role / Q000266:history / Q000523:psychology; D011787:Quality of Health Care / Q000191:economics / Q000266:history