Climate change and quality of health care: evidence from extreme heat. Issue 1 (October 2019)

• Record Type: Journal Article
• Authors: Si, Yafei; Zhou, Zhongliang; Su, Min; Chen, Xi
• Is Part Of: Lancet. Volume 394(2019)Special Issue 1
• Page Start: S94
• Publication Date: 2019-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(19)32430-4
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: Extreme temperatures, one of the most notable consequences of climate change, can reduce worker productivity in physically demanding occupations and even inhibit cognitive skill development. We aimed to examine whether heat waves can affect access to and quality of health care provided by physicians. Methods: We investigated the effect of heat waves on physicians using unique data on the quality of health care provided at 63 community health centres in urban Xi'an, China. We used standardised patients recruited from the local community and trained them to present consistent cases of illness to providers. Adherence to two clinical checklists, thoroughness of physical examination, and accuracy of diagnoses were used to assess quality of primary care through 492 interactions between physicians and standardised patients in Aug 17–28, 2017, and July 30 to Aug 10, 2018. Exploiting random fluctuations in temperature and other weather patterns (air pollution, wind speed, rainfall, sunlight hours, barometric pressure, and humidity) according to the exact time and geographical locations of the interviews, we identified the effect of transitory exposures to heat waves on quality of health service delivery in models with day-specific and community health centre-specific fixed effects. Findings: Extremely hot days are associated with improved quality of care. One Fahrenheit temperature increase improves the adherence to clinical checklists by 1·51 units, representing an increase of 36·92% over the mean number of checklist items completed by physicians (4·09 items; p<0·001). This improvement could be explained by fewer patients waiting for services during hot days. However, the improved adherence to the clinical checklists was not accompanied with a larger chance of physicians offering correct diagnoses or appropriate treatments. On average, examinations ordered by physicians during heatwaves were 7·91 CNY more costly with one Fahrenheit temperature increase. Interpretation: Higher temperatures improve quality of care via inducing fewer patients to seek necessary health service and increasing physician adherence to clinical checklists when interacting with patients. Funding: National Natural Science Foundation of China, Shaanxi Social Science Foundation, Shaanxi Soft Science, Shaanxi Provincial Youth Star of Science and Technology 2016, Xi'an Jiaotong University, Top-notch Young Professionals of China and China Medical Board, China Scholarship Council, the US PEPPER Center Scholar Award, National Institutes of Health, National Institute on Aging.