质量、选择与拥堵: Covid-19 期间的医院结果均衡

中文摘要

我们利用新冠疫情数据，考察医院质量、患者选择和拥挤状况在影响均衡健康结果方面的重要性。本文的主要结果变量为死亡率，并使用距离工具变量控制不可观测的选择。重症监护病房（ICU）压力提高了医院死亡率：若不存在拥挤，死亡率将下降9.6%。患者看重基线质量较高的医院，但其选择并未反映容量压力信息。均衡反事实分析表明，若患者获知容量压力信息并认为质量信号更为精确，死亡率将下降3.8%。然而，若使用更精确的信息但不考虑拥挤，新冠死亡率将上升3.8%。

Abstract

We examine the importance of hospital quality, patient selection, and congestion in affecting equilibrium health outcomes, using Covid-19 pandemic data. Our main outcome is mortality, controlling for unobserved selection with distance instruments. Intensive care unit strain increased hospital mortality: without congestion, deaths would fall 9.6%. Patients value hospitals with high baseline quality, but their choices did not reflect capacity strain information. Equilibrium counterfactuals show that if patients were informed about capacity strain and believed quality signals were more precise, deaths would drop 3.8%. However, using more precise information but not accounting for congestion would cause Covid-19 deaths to rise 3.8%.