Address correspondence to David J. Becker, Ph.D., Assistant Professor, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 330, 1530 3rd Avenue South, Birmingham, AL 35294-0022.
Do Hospitals Provide Lower Quality Care on Weekends?
Article first published online: 15 NOV 2006
Health Services Research
Volume 42, Issue 4, pages 1589–1612, August 2007
How to Cite
Becker, D. J. (2007), Do Hospitals Provide Lower Quality Care on Weekends?. Health Services Research, 42: 1589–1612. doi: 10.1111/j.1475-6773.2006.00663.x
- Issue published online: 15 NOV 2006
- Article first published online: 15 NOV 2006
- Temporal variation;
- myocardial infarction;
- Medicare beneficiaries
Objective. To examine the effect of a weekend hospitalization on the timing and incidence of intensive cardiac procedures, and on subsequent expenditures, mortality and readmission rates for Medicare patients hospitalized with acute myocardial infarction (AMI).
Data Sources. The primary data are longitudinal, administrative claims for 922,074 elderly, nonrural, fee-for-service Medicare beneficiaries hospitalized with AMI from 1989 to 1998. Annual patient-level cohorts provide information on ex ante health status, procedure use, expenditures, and health outcomes.
Study Design. The patient is the primary unit of analysis. I use ordinary least squares regression to estimate the effect of weekend hospitalization on rates of cardiac catheterization, angioplasty, and bypass surgery (in various time periods subsequent to the initial hospitalization), 1-year expenditures and rates of adverse health outcomes in various periods following the AMI admission.
Principal Findings. Weekend AMI patients are significantly less likely to receive immediate intensive cardiac procedures, and experience significantly higher rates of adverse health outcomes. Weekend admission leads to a 3.47 percentage point reduction in catheterization at 1 day, a 1.52 point reduction in angioplasty, and a 0.35 point reduction in by-pass surgery (p<.001 in all cases). The primary effect is delayed treatment, as weekend–weekday procedure differentials narrow over time from the initial hospitalization. Weekend patients experience a 0.38 percentage point (p<.001) increase in 1-year mortality and a 0.20 point (p<.001) increase in 1-year readmission with congestive heart failure.
Conclusions. Weekend hospitalization leads to delayed provision of intensive procedures and elevated 1-year mortality for elderly AMI patients. The existence of measurable differences in treatments raises questions regarding the efficacy of a single input regulation (e.g., mandated nurse staffing ratios) in enhancing the quality of weekend care. My results suggest that targeted financial incentives might be a more cost-effective policy response than broad regulation aimed at improving quality.