We study the role of person- and place-specific factors in explaining geographic variation in emergency department utilization using detailed data on 150,000 patients who moved regions within Israel. We document that about half of the destination-origin differences in the average emergency department utilization rate across districts translates to the change (up or down) in movers’ propensity to visit the emergency department. In contrast, we find no change in the probability of having a hospital admission through the emergency department. Similar results are obtained in a complementary event study, which uses hospital entry as a source of variation. The results from both approaches suggest that supply-side variation in emergency department access affects only the less severe cases—for which close substitutes likely exist—and that variation across emergency physicians in their propensity to admit patients is not explained by place-specific factors, such as differences in incentives, capacity, or diagnostic quality.

我们使用 150,000 名在以色列境内移动的患者的详细数据，研究了个人和地点特定因素在解释急诊科使用率的地理差异方面的作用。我们记录了大约一半的地区间平均急诊室利用率的目的地-起源差异转化为移动者访问急诊室的倾向的变化（上升或下降）。相比之下，我们发现通过急诊科住院的概率没有变化。在补充事件研究中获得了类似的结果，该研究使用医院进入作为变异来源。