Volume 47 | Number 1pt1 | February 2012

Abstract List

Yu‐Chu Shen Ph.D., Renee Y. Hsia M.D., M.Sc.


We analyze whether decreased emergency department () access results in adverse patient outcomes or changes in the patient health profile for patients with acute myocardial infarction ().


We merge edicare claims, merican ospital ssociation annual surveys, edicare hospital cost reports, and location information for 1995–2005.

Study Design

We define four access change categories and estimate a Code fixed‐effects regression models on the following outcomes: mortality rates, age, and probability of percutaneous transluminal coronary angioplasty () 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 . Most of the adverse effects disappear after the transition years.


Deterioration in geographic access to 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 , and facilitating the realignment of health care resources during the critical transition periods.