Geographic Competition in Emergency Department Services

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Geographic Competition in Emergency Department Services

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The utilization of emergency services in the United States has increased substantially in the last 20 years. Despite this trend, the number of emergency departments (EDs) has not increased on par with the volume of patients that seek emergency services. Hospitals are expanding the provision of emergency services through freestanding emergency departments (FSEDs), independent facilities managed by hospitals (but not physically attached to them) that can provide the same services as traditional EDs. It is not clear how the entry or exit of EDs affect emergency care utilization. I analyze the effect of ED entry and exit on ED utilization and emergency-related health care outcomes. In addition, I analyze how FSEDs affect the risk profile of the inpatient population at hospitals with FSEDs nearby and at hospitals that operate FSEDs. I find an asymmetric effect on incumbent ED number of visits of entry and exit of EDs. Increases in the number of visits due to ED entry are not correlated with changes in emergency-related mortality rates. Hospitals that operate FSEDs have an inpatient population with higher acuity than hospitals that don’t operate FSEDs, and hospitals with FSEDs nearby have an inpatient population with lower acuity than hospitals that don’t.


University of Minnesota Ph.D. dissertation. 2021. Major: Health Services Research, Policy and Administration. Advisors: Roger Feldman, Jean Abraham. 1 computer file (PDF); 132 pages.

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Higuera, Lucas. (2021). Geographic Competition in Emergency Department Services. Retrieved from the University Digital Conservancy,

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