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• W2079710910 abstract "In Almond, Doyle, Kowalski and Williams (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 grams. We estimate large discontinuities in medical care and mortality at this threshold, with effects concentrated at “lowquality” hospitals. While 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. In Almond, Doyle, Kowalski and Williams (2010, ADKW), we describe how diagnostic thresholds can provide plausibly exogenous variation in medical care for patients near the threshold. Regression discontinuity estimates for differences in medical care and health outcomes at the threshold can then be combined to estimate marginal returns to medical care. Our application is the very low birth weight (VLBW) threshold at 1500 grams: newborns weighing slightly less than 1500g receive more medical care and have lower mortality compared to those weighing slightly more. The empirical estimates suggest large returns to medical care for these at-risk newborns. Figure I of ADKW is a histogram of reported births near 1500g, showing pronounced mass points at whole ounces and smaller mass points at 100g intervals. Motivated by this histogram, Barreca, Guldi, Lindo, and Waddell (BGLW) examine a series of alternative specifications. Initially, they exclude newborns with reported birth weights at exactly 1500g. The estimated mortality discontinuity on this sample is smaller in magnitude, although it continues to be both statistically and economically significant. Subsequently, they exclude successively larger sets of newborns, up to a maximum of 1497g to 1503g (inclusive)—a sample restriction that removes 25% of the control observations and 0.38% of the treatment observations, with the asymmetry due to a mass point at 1503g (3lbs 5oz). The estimated mortality discontinuity on this sample declines somewhat and is no longer statistically significant. Although there is no general economic or statistical case for exclusion of observations at or around the threshold in a regression discontinuity (RD) design, given the specific details of our" @default.
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• W2079710910 date "2011-10-01" @default.
• W2079710910 modified "2023-09-28" @default.
• W2079710910 title "The Role of Hospital Heterogeneity in Measuring Marginal Returns to Medical Care: A Reply to Barreca, Guldi, Lindo, and Waddell" @default.
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