Please use this identifier to cite or link to this item: https://hdl.handle.net/10419/336037 
Year of Publication: 
2025
Series/Report no.: 
CESifo Working Paper No. 12335
Publisher: 
Munich Society for the Promotion of Economic Research - CESifo GmbH, Munich
Abstract: 
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.
Subjects: 
peer effects
mortality
nursing homes
Alzheimer's disease and related dementias (AD/ADRD)
long-term care
room assignments
health care quality
JEL: 
D62
I11
I12
I18
J14
Document Type: 
Working Paper
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