The principal aim of this paper is to evaluate the determinants and implications of differences in the pre-hospital and in-hospital emergency services adopted in a given community. To accomplish this goal, we evaluate the incentives to adopt emergency response systems and in-hospital technology, as well as the productivity gains from these investments. We focus in particular on the productivity and adoption of Basic and Enhanced 911 services, services which entail investments in information technology and telecommunications equipment.

As a service enbabled by investment in information technology, emergency response systems belong to the substantial portion of the economy which has defied accurate productivity measurment (Griliches, 1994; Bresnahan and Gordon’ 1997). For most services (including emergency response), it is difficult to measure quality. Each consumer’s valuation can depend on several factors which are difficult to observe, such as timeliness and the location of service delivery as well as on the extent to which the product is customized to the individual. In the case of 911 services, however, we are able to address some of these challenges using a unique combination of data sources. The primary database is composed of a set of ambulance calls responding to reported cardiac incidents in Pennsylvania in 1995. These ambulance records have been linked with hospital billing records, hospital characteristics, and data about the level of 911 technology available in the county in which the call takes place. We use this data to document how 911 is related to the benefits provided by the emergency response system, including its relationship to lower response times, more appropriate allocation of patients to hospitals, and reduced mortality of cardiac patients. financial services