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The Evolving Science of Quality Measurement for Hospitals: Implications for Studies of Competition and Consolidation

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  • Patrick S. Romano
  • Ryan Mutter

Abstract

The literature on hospital competition and quality is young; most empirical studies have focused on few conditions and outcomes. Measures of in-hospital mortality and complications are susceptible to bias from unmeasured severity and transfer/discharge practices. Only one research team has evaluated related process and outcome measures, and none has exploited chart-review or patient survey-based data. Prior studies have generated inconsistent findings, suggesting the need for additional research. We describe the strengths and limitations of various approaches to quality measurement, summarize how quality has been operationalized in studies of hospital competition, outline three mechanisms by which competition may affect hospital quality, and propose measures appropriate for testing each mechanism.

Suggested Citation

  • Patrick S. Romano & Ryan Mutter, 2004. "The Evolving Science of Quality Measurement for Hospitals: Implications for Studies of Competition and Consolidation," International Journal of Health Economics and Management, Springer, vol. 4(2), pages 131-157, June.
    • Handle: RePEc:kap:ijhcfe:v:4:y:2004:i:2:p:131-157
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    Citations

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    Cited by:

    1. Herr, Annika, 2009. "Product differentiation and welfare in a mixed duopoly with regulated prices: the case of a public and a private hospital," FAU Discussion Papers in Economics 08/2009, Friedrich-Alexander University Erlangen-Nuremberg, Institute for Economics.
    2. Hsien‐Ming Lien & Shin‐Yi Chou & Jin‐Tan Liu, 2010. "The Role Of Hospital Competition On Treatment Expenditure And Outcome: Evidence From Stroke And Cardiac Treatment In Taiwan," Economic Inquiry, Western Economic Association International, vol. 48(3), pages 668-689, July.
    3. Moscone, Francesco & Tosetti, Elisa & Vittadini, Giorgio, 2009. "Social Interaction in Patients'�Hospital Choice: Evidences from Italy," MPRA Paper 17783, University Library of Munich, Germany.
    4. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991–9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, January.
    5. Carol Propper & Deborah Wilson, 2012. "The Use of Performance Measures in Health Care Systems," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 33, Edward Elgar Publishing.
    6. Herr Annika, 2011. "Quality and Welfare in a Mixed Duopoly with Regulated Prices: The Case of a Public and a Private Hospital," German Economic Review, De Gruyter, vol. 12(4), pages 422-437, December.
    7. Chen, Chi-Chen & Cheng, Shou-Hsia, 2010. "Hospital competition and patient-perceived quality of care: Evidence from a single-payer system in Taiwan," Health Policy, Elsevier, vol. 98(1), pages 65-73, November.
    8. Jeong Hoon Choi & Imsu Park & Ilyoung Jung & Asoke Dey, 2017. "Complementary effect of patient volume and quality of care on hospital cost efficiency," Health Care Management Science, Springer, vol. 20(2), pages 221-231, June.
    9. Katz Michael L, 2011. "Insurance, Consumer Choice, and the Equilibrium Price and Quality of Hospital Care," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(2), pages 1-44, January.
    10. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    11. Giorgos Magoulios, 2005. "The Social Sector and Trans-Regional Collaboration Among Social Sector Institutions in Balkan Countries in Transition - A Case Study of Healthcare Institutions in Albania," South-Eastern Europe Journal of Economics, Association of Economic Universities of South and Eastern Europe and the Black Sea Region, vol. 3(2), pages 249-271.
    12. Pflueger, Dane, 2016. "Knowing patients: The customer survey and the changing margins of accounting in healthcare," Accounting, Organizations and Society, Elsevier, vol. 53(C), pages 17-33.
    13. Paolo Berta & Gianmaria Martini & Francesco Moscone & Giorgio Vittadini, 2016. "The association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 907-926, October.
    14. Wulan I.R. Sari, 2017. "The role of regulations on administrative and practices in improving quality of services in public organizations," Cogent Business & Management, Taylor & Francis Journals, vol. 4(1), pages 1396952-139, January.
    15. Angela Meggiolaro & Carl Rudolf Blankart & Tom Stargardt & Jonas Schreyögg, 2023. "An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(5), pages 785-802, July.
    16. Herr, Annika (Ed.), 2013. "Beiträge zum Wettbewerb im Krankenhaus- und Arzneimittelmarkt - Band 1: Krankenhäuser," DICE Ordnungspolitische Perspektiven 37, Heinrich Heine University Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
    17. José J. Escarce & Arvind K. Jain & Jeannette Rogowski, 2006. "Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence From Three States," NBER Working Papers 12335, National Bureau of Economic Research, Inc.
    18. M. Lippi Bruni & C. Ugolini & R. Verzulli, 2018. "Disentangling the effect of waiting times on hospital choice: Evidence from a panel data analysis," Working Papers wp1118, Dipartimento Scienze Economiche, Universita' di Bologna.

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