Time is on my side! Mortality and distance to hospital care
Populations are usually against the substitution or closure of several hospitals and emergency departments since their access to health services becomes harder. However, it is not clear if harder access to healthcare leads to worse health results. Should I live longer just because my house is just across the street from the hospital?!
The place where we decide to live is often a function of our employment arrangements, personal relationships, financial constraints, and other preferences. Such a choice has important consequences in one’s life. It determines who we meet, what school should our kids attend and, among several other factors, the hospital we should go to.
Throughout the last decade, efforts for efficiency enhancement and scale economies have determined the substitution or closure of several hospitals and emergency departments in Portugal — a trend common to many other developed countries. Populations are usually against these measures since their access to health services becomes harder. However, it is not clear if harder access to healthcare leads to worse health results. Should I live longer just because my house is just across the street from the hospital?!
In Portugal, the time to access a medical-surgical emergency room is extremely asymmetric depending on the municipality. It is usually quicker to access the hospital if one is living in a large urban area, compared with rural areas. Such a pattern is explained not only by the number of hospitals but also by the quality of accessibilities such highways. 60 % of the Portuguese municipalities are less than half an hour away from a medical-surgical emergency department. Still, around 10 % of Portuguese municipalities are more than 45 minutes away from such services.
Distance to the closest Emergency room (minutes)
One could hypothesize that being farther from a hospital would be negative to one’s health through different channels: health services became less accessible, individuals face larger time and travel costs, and, for urgent situations, being farther from the hospital may prevent good outcomes.
However, when we compare the time to the closest emergency room with the average age of death for each municipality, we do not observe such a pattern. Residents with shorter travel times to closest ERs do not seem to live longer than the residents of municipalities who on average spend more time to reach the emergency room. Most surprisingly, the residents of municipalities who are the farthest (60 minutes or more) from the closest ER seem to have lived longer on average than those who spent 0 to 10 minutes. If anything, data suggests a slight positive relationship between distance and age of death.
So… Is it ok to close down hospitals? Can we say that living closer to the hospital will lead to lower life expectancies? No. Other factors might be at stake here. Namely, populations in large metropolitan areas (closer to hospitals) are different from populations in rural areas (in terms of demographics and health behaviors, for instance), which can explain part of the results. Further research will need to disentangle such effects.
Still, according to data, it is premature to claim that the closure of surrounding hospitals hurts populations. Obviously, if an individual has a heart attack, a stroke, or a traffic accident, the time to the emergency room will be key to define her survival or not. However, on average, no significant and persistent health problems were identified for the municipalities that live far from hospitals. Bottom line: when you are buying your next house… don’t worry too much if you are not right across the street from the hospital.
Eduardo Costa and Laman Orujova are both Ph.D. candidates in Economics and invited teaching assistants at Nova School of Business & Economics. He is an active member of the Nova SBE Nova Health Economics & Management Knowledge Center, with research interests in Health Economics. Her research interests are mainly focused on poverty and inequality.