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Table of Contents
1. Is there a well-defined objective? 4
2. Is the regression discontinuity design valid? 5
3. Is the index score smooth at the cut-off point? 7
4. Is the cut-off unique to the program being evaluated? 8
5. Is the RDD fuzzy or sharp? 8
6. Is the discontinuity a valid instrument to control for non-compliers? 9
7. Is the selection on observables balanced? 10
8. Were sensitivity analyses performed to characterize uncertainty? 10
9. Are there limitations of the study? 12
10. Are the results generalizable? 13
Conclusion 14
 Douglas Almond and Joseph J. Doyle Jr (2011) “After midnight: a regression discontinuity design in length of
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With increasing costs of healthcare in the 1990s (Sekhri, 2000), health maintenance organizations (HMOs) under pressure to provide cost-effective care denied reimbursement for hospital stays longer that 1 midnight for uncomplicated vaginal deliveries (Hospital Stay for Healthy Term Newborns, 2004).

As the percentage of vaginal births with stays under 2 days doubled between 1990 and 1995 (figure 1), there was evidence of increasing hospital re-admission rates for neonatal jaundice resulting from early discharges (Maisels and Kring, 1998). The California Newborns’ and Mothers’ Health Act of 1997 (NMHA), which went into effect on 26 August 1997, mandated insurance coverage of a minimum of 48-hours for hospital births (Evans, Garthwaite and Wei, 2008).

Figure 1: U.S. births with fewer than 2 days in hospital: 1970 -2004
Source: National Center for Health Statistics (NCHS)
(Almond and Doyle, 2011; page 6, figure 1)

Figure 2: Percentage of newborns discharged early from vaginal deliveries without complications in California 1995-2000
(Evans, Garthwaite and Wei, 2008; fig. 1, page 852)

Since all hospital-based deliveries are covered either by private health insurance or Medicaid (figure 2), post partum care is reimbursed by a predetermined number of midnights. Therefore, for newborns born 5 minutes before midnight, their length of stay determined by the first midnight would start immediately after birth. On the other hand,
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