Patient Peer Effects: Evidence from Nursing Home Room Assignments / Alden Cheng, Martin B. Hackmann.

Format:

Book

Author/Creator:

Cheng, Alden.

Contributor:

Hackmann, Martin B.

National Bureau of Economic Research.

Series:

Working Paper Series (National Bureau of Economic Research) no. w34538.

NBER working paper series no. w34538

Language:

English

Physical Description:

1 online resource: illustrations (black and white);

Place of Publication:

Cambridge, Mass. National Bureau of Economic Research 2025.

Summary:

We provide causal evidence that patient peer effects generate mortality impacts comparable to provider quality differences. Drawing on administrative records covering 2.6 million stays (2000-2010) across 7,200 U.S. nursing homes, we exploit plausibly exogenous roommate assignments identified through unique room identifiers. We estimate that assignment to a roommate diagnosed with Alzheimer's disease (AD) or Alzheimer's disease related dementias (ADRD), relative to placement in a private room, increases 90-day mortality by 2.1 percentage points (14% of baseline)--equivalent to receiving care at a nursing home one full standard deviation worse in quality. Effects differ sharply by patient type: patients with AD/ADRD benefit substantially from cognitively healthy roommates but not from private rooms, suggesting important peer monitoring and support roles. In contrast, mortality of patients without AD/ADRD does not depend on roommate cognitive health but is reduced in private rooms. A simple assignment rule exploiting this heterogeneity could reduce overall mortality by 0.8 percentage points without additional resources.

Notes:

December 2025.

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