Hybrideseminar: Long-term returns to local health care spending

This paper investigates the effects of health care spending on mortality rates of patients who experienced a heart attack. We distinguish in-hospital deaths and after hospital deaths and we distinguish between in-hospital endof-life spending and after-hospital health care spending. In our analysis we use administrative data from the National Health Information Center of Slovakia over the period 2014 to 2019. We distinguish between two types of patients, i.e., locals and visitors. Locals use hospital services in their region; visitors are hospitalized in different regions. The distinction between the two types of patients helps us to identify a causal effect of health-care costs on mortality. We find that mortality depends on age of the patient, the way the

heart attack was treated in hospital, residence characteristics, comorbidities and the elapsed time period since the heart attack occurred. We also find substantial regional variation in mortality that is to a large extent related to regional variation in health-care expenses. We interpret the negative effect of higher health care spending on mortality as a causal effect.