Hollingsworth, Alex
[Author];
Karbownik, Krzysztof
[Author];
Thomasson, Melissa A.
[Author];
Wray, Anthony
[Author]
;
National Bureau of Economic Research
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The past century witnessed a dramatic improvement in public health, the rise of modern medicine, and the transformation of the hospital from a fringe institution to one essential to the practice of medicine. In this paper, we explore how access to the hospital and modern medicine affects mortality. We do so by leveraging a combination of novel data and a unique quasi-experiment: a large-scale hospital modernization program introduced by The Duke Endowment in the early twentieth century. The Endowment helped communities build and expand hospitals, obtain state-of-the-art medical technology, attract qualified medical personnel, and refine management practices. We find that access to a Duke-supported hospital reduced infant mortality by 10%, saving one life for every $20,000 (2017 dollars) spent. Effects were larger for Black infants (16%) than for White infants (7%), implying a reduction in the Black-White infant mortality gap by one-third. We show that the effect of Duke support persisted into later life with a 9% reduction in mortality between the ages of 56 and 65. We further provide evidence on the mechanisms that enabled these effects, finding that Endowment-supported hospitals attracted higher-quality physicians and were better able to take advantage of new medical innovations