Spatial Disparities in Hospital Performances

Spatial disparities in mortality can result from spatial differences in patientcharacteristics, treatments, hospital characteristics, and local healthcare marketstructure. To distinguish between these explanatory factors, we estimate a fexibleduration model on stays in hospital for a heart attack using a French exhaustivedataset. Over the 1998-2003 period, the raw disparities in the propensity to die within15 days between the extreme regions reaches 80%. It decreases to 47% after takinginto account the patients' characteristics and their treatments. We conduct a varianceanalysis to explain regional disparities in mortality. Whereas spatial variations in theuse of innovative treatments play the most important role, spatial differences in thelocal concentration of patients also play a significant role.