医疗服务整合是否损害患者健康？来自产科病房关闭的证据
Does Health-Care Consolidation Harm Patients? Evidence from Maternity Ward Closures
American Economic Journal: Economic Policy · 2024 · [{"name": "Daniel Avdic", "affiliation": ["Deakin University"]}, {"name": "Petter Lundborg", "affiliation": ["Lund University"]}, {"name": "Johan Vikström", "affiliation": ["Uppsala University", "Institute for Evaluation of Labour Market and Education Policy"]}]
中文摘要
我们研究产科病房关闭如何影响孕产妇和新生儿健康。利用瑞典1990年至2004年间所有医院分娩的数据，我们比较了受病房关闭影响程度不同的医院服务区域在分娩相关结果上的变化。研究发现，病房关闭增加了孕产妇产科创伤，但也减少了新生儿的胎儿应激和婴儿创伤。孕产妇不良结果主要由病房过度拥挤驱动，而出行距离的增加没有可区分的影响。婴儿健康方面的正向效应反映了分娩从规模较小的病房转移至质量更高、规模更大的病房。（JEL D24, G34, I11, I12, I18, J13, J16）
Abstract
We study how closures of maternity wards affect maternal and neonatal health. Using data on all hospital births in Sweden between 1990 and 2004, we compare changes in birth-related outcomes across hospital catchment areas that were differently exposed to ward closures. Our findings show that the closures increased maternal obstetric trauma but also decreased fetal stress and infant trauma among newborns. Adverse maternal outcomes are mainly driven by ward overcrowding, whereas increases in travel distance have no distinguishable effects. Positive effects on infant health reflect a shift of births from smaller to larger wards of higher quality. (JEL D24, G34, I11, I12, I18, J13, J16)