Exploring the causal relationship between hospital length of stay and re-hospitalization among Japanese AMI patients |
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| Authors: | Satoshi Shimizutani Hiroyuki Yamada Haruko Noguchi Yuichiro Masuda Masafumi Kuzuya |
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| Institution: | 1. Institute for International Policy Studies, Minato-ku, Tokyo 105-0001, Japansshimizutani@iips.org;3. Osaka School of International Public Policy, Osaka University, Toyonaka, Osaka 560-0043, Japan;4. Faculty of Political Science and Economics, Waseda University, Shinjuku-ku, Tokyo 169-8050, Japan;5. Minokamo Nishi Clinic, Minokamo-city, Gifu Prefecture 505-0046, Japan;6. Department of Community Health and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya-city, Aichi Prefecture 466-8550, Japan |
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| Abstract: | We explore the causal relationship between hospital length of stay (LOS) and re-hospitalization for Acute Myocardial Infarction (AMI) patients in Japan, where the average LOS is the longest among OECD countries. Using chart-based data, we address the endogeneity between LOS and re-hospitalization probability by using an exogenous variation based on Rokuyo (the six basic labels allocated to each day), which is found to be irrelevant to admission day but relevant to discharge day. While we do find a significant and positive association between LOS and re-hospitalization probability in the OLS estimation, we do not find a significant relationship once LOS is instrumented by Rokuyo in various instrumental variable estimations. This implies that additional stay that was induced owing to patient’s choice of preferred Rokuyo at discharge has no effect on re-hospitalization probability. |
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| Keywords: | Japan Rokuyo length of stay hospitals re-hospitalization health expenditure acute myocardial infarction |
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