In addition, we document that in Pennsylvania, many patients reside in counties which do not include a hospital with certain high-level cardiac-specific technologies (such as a cardiac catheterization laboratory); as a consequence, these patients are not treated by hospitals with high-level cardiac technology in response to a cardiac emergency. It is interesting to observe that, in contrast to the general population, nearly all of the cardiac patients in our sample have some form of insurance (almost 99%). Instead, it seems to be the availability of medical technology in nearby hospitals which most significantly limits the access of patients to high levels of cardiac care in emergency situations.

Among the patients who do have access to high levels of cardiac care technology, we show that the allocation of patients to hospitals with cardiac catheterization laboratories depends on the presence of 911 services, where counties with higher levels of 911 technology are more likely to allocate patients to hospitals with higher levels of cardiac care technology. This can affect the incentives of hospitals to invest in high levels of technology. While these incentives can potentially lead to increased investment in technology by hospitals, we do not see strong evidence of strategic complementarity between 911 and hospital technology in our national sample. Despite the fact that the level of in-hospital emergency technology is positively correlated with the level of 911 technology at the national level, most of that positive interrelationship is accounted for by the fact that both in-hospital and pre-hospital care respond positively to the population and income of a county. loans