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Does Decreased Access to Emergency Departments Affect Patient Outcomes? Analysis of Acute Myocardial Infarction Population 1996–2005


  • Yu-Chu Shen Ph.D.,

    Associate Professor of Economics, Corresponding author
    1. Graduate School of Business and Public Policy, Naval Postgraduate School, National Bureau of Economic Research, Monterey, CA
    • Address correspondence to Yu-Chu Shen, Ph.D., Associate Professor of Economics, Graduate School of Business and Public Policy, Naval Postgraduate School, 555 Dyer Road, Monterey, CA 93943; e-mail:

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    • Dr. Shen is also a Faculty Research Fellow at the National Bureau of Economic Research
  • Renee Y. Hsia M.D., M.Sc.

    Assistant Professor of Emergency Medicine
    1. Department of Emergency Medicine, University of California at San Francisco, San Francisco, CA
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We analyze whether decreased emergency department (ED) access results in adverse patient outcomes or changes in the patient health profile for patients with acute myocardial infarction (AMI).


We merge Medicare claims, American Hospital Association annual surveys, Medicare hospital cost reports, and location information for 1995–2005.

Study Design

We define four ED access change categories and estimate a ZIP Code fixed-effects regression models on the following AMI outcomes: mortality rates, age, and probability of percutaneous transluminal coronary angioplasty (PTCA) on day of admission.

Principal Findings

We find a small increase in 30-day to 1-year mortality rates among patients in communities that experience a <10-minute increase in driving time. Among patients in communities with >30-minute increases, we find a substantial increase in long-term mortality rates, a shift to younger ages (suggesting that older patients die en route), and a higher probability of immediate PTCA. Most of the adverse effects disappear after the transition years.


Deterioration in geographic access to ED affects a small segment of the population, and most adverse effects are transitory. Policy planners can minimize the adverse effects by providing assistance to ensure adequate capacity of remaining EDs, and facilitating the realignment of health care resources during the critical transition periods.

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