Ohio State research reveals hospital modernization’s impact on health outcomes and racial inequality

COLUMBUS, Ohio -- A new study led by a researcher at The Ohio State University has unveiled the significant and enduring impacts of hospital modernization on health outcomes and racial inequality. The research, led by Alex Hollingsworth, an associate professor at Ohio State's College of Food, Agricultural, and Environmental Sciences (CFAES), was recently published in the American Economic Review.

The study reveals that a comprehensive hospital modernization program in North Carolina, managed by The Duke Endowment, led to substantial improvements in health outcomes and reduced racial health disparities. The modernization efforts, which included the construction and expansion of hospitals, the upgrade of medical technology, and the enhancement of management practices, resulted in a 7.5% decrease in infant mortality rates.

Notably, the reduction was three times larger for Black infants (13.6%) compared to white infants (4.7%), significantly reducing the Black-white infant mortality gap. Improved access also had enduring health effects, with long-term mortality rates for those exposed at birth declining by 9.0%.

"We discovered that these investments not only increased the quantity and quality of hospital beds, but also attracted top-tier physicians to underserved areas," said Hollingsworth, who is also a research associate at the National Bureau of Economic Research. "The improvements in health outcomes were both immediate and long-lasting, persisting for decades."

The Duke Endowment's funding led to a 40% increase in the number of not-for-profit hospitals, a 70% increase in the number of not-for-profit hospital beds, and a 60% increase in high-quality physicians. These changes contributed to a lasting improvement in health care capacity and quality.

The study also underscores the synergy between hospital modernization and medical innovation. Hospitals modernized by The Duke Endowment were better equipped to leverage new medical innovations, such as the introduction of the first effective antibiotics in 1937. The impact of Duke funding nearly tripled in the postantibiotic era.

"Our findings highlight the importance of investments in general-purpose health care, especially in areas with limited resources," said Melissa Thomasson, associate dean for faculty excellence and professor of economics at Miami University and a co-researcher on the study. "These investments are cost-effective and yield significant long-term health benefits, particularly for marginalized groups."

Financial barriers to health care access, physician shortages, rural hospital closures, and general difficulty in accessing the health care system are pressing issues in the United States today. In connection with these issues, Hollingsworth emphasizes that "our findings tell us how valuable the first access to high-quality medical care is, which underscores the critical importance of maintaining the last available medical provider."

The study also informs the value of health care investments in developing regions, where access to quality medical care is often severely limited. The historical successes observed in North Carolina suggest that in areas with no access to health care, similar investments in infrastructure, coupled with innovative medical technologies and strong oversight, could lead to large improvements in health outcomes in these regions.

The research was conducted in collaboration with Krzysztof Karbownik, assistant professor of economics at Emory University, and Anthony Wray, associate professor at the University of Southern Denmark.

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