Online Program

The Effects of a Trauma Center Closure on Health Care Outcomes and Costs: An Instrumental Variable Based Approach

*Joseph Benitez, University of Illinois at Chicago 

Keywords: health economics, causal inference, instrumental variable, two stage least squares, trauma

In 2008, one of the major Level I trauma centers in southern Cook County, IL closed, leaving would be patients in surrounding community to travel further and longer when in need of advanced trauma care. The study takes on two approaches to explain the role of ambulatory travel time on patient health outcomes as well as health care costs borne to those in the affected area. Using the closure as an instrumental variable in a two stage least squares (2SLS) regression provides a pathway to identify the causal effect for ambulatory travel distance on health outcomes and health care costs borne to trauma patients in the sample. Trauma center closures force victims of trauma (e.g. heart attacks, falls, violent attacks) to travel further in the event of an emergency. Victims who experience such trauma near where a closure occurred suffer from severely reduced access to emergency care. It has been discussed heavily in the literature about the nature of response time as a critical determinant in the health and survival of patients in trauma centers and emergency departments. I will present the effects of the 2SLS models as means to describe the direct effect of increased travel distance, and I will also discuss difference – in – difference models to provide evidence of the indirect effect of the closure itself on patient health and economic outcomes.