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Does advanced medical technology encourage hospitalist use and their direct employment by hospitals?


Author Info

  • Guy David

    (The Wharton School, University of Pennsylvania, Philadelphia, PA, USA)

  • Lorens A. Helmchen

    (School of Public Health and Institute of Government and Public Affairs, University of Illinois at Chicago, Chicago, IL, USA)

  • Robert A. Henderson

    (School of Medicine, Duke University, Durham, NC, USA)

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    In the United States, inpatient medical care increasingly encompasses the use of expensive medical technology and, at the same time, is coordinated and supervised more and more by a rapidly growing number of inpatient-dedicated physicians (hospitalists). In the production of inpatient care services, Hospitalist services can be viewed as complementary to sophisticated and expensive medical equipment in the provision of inpatient medical care. We investigate the causal relationship between a hospital's access to three types of sophisticated diagnostic and therapeutic medical equipment - intensity-modulated radiation therapy, gamma knife, and multi-slice computed tomography - and its likelihood of using hospitalists. To rule out omitted variables bias and reverse causality, we use technology-specific Certificate of Need regulation to predict technology use. We find a strong positive association, yet no causal link between access to medical technology and hospitalist use. We also study the choice of employment modality among hospitals that use hospitalists, and find that access to expensive medical technology reduces the hospital's propensity to employ hospitalists directly. Copyright © 2008 John Wiley & Sons, Ltd.

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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 18 (2009)
    Issue (Month): 2 ()
    Pages: 237-247

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    Handle: RePEc:wly:hlthec:v:18:y:2009:i:2:p:237-247

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    1. Heckman, James J, 1978. "Dummy Endogenous Variables in a Simultaneous Equation System," Econometrica, Econometric Society, Econometric Society, vol. 46(4), pages 931-59, July.
    2. Noether, Monica, 1988. "Competition among hospitals," Journal of Health Economics, Elsevier, Elsevier, vol. 7(3), pages 259-284, September.
    3. Richard K. Crump & V. Joseph Hotz & Guido W. Imbens & Oscar A. Mitnik, 2006. "Moving the Goalposts: Addressing Limited Overlap in Estimation of Average Treatment Effects by Changing the Estimand," Working Papers, University of Miami, Department of Economics 0608, University of Miami, Department of Economics.
    4. Lanning, Joyce A & Morrisey, Michael A & Ohsfeldt, Robert L, 1991. "Endogenous Hospital Regulation and Its Effects on Hospital and Non-hospital Expenditures," Journal of Regulatory Economics, Springer, Springer, vol. 3(2), pages 137-54, June.
    5. Guy David & Lorens A. Helmchen, 2007. "The Choice of Employment Arrangement in the Market for Hospitalist Services," Southern Economic Journal, Southern Economic Association, vol. 73(3), pages 604–622, January.
    6. Vivian Ho, 2006. "Does certificate of need affect cardiac outcomes and costs?," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 6(4), pages 300-324, December.
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    Cited by:
    1. Gary D. Ferrier & Hervé Leleu & James Moises & Vivian Valdmanis, 2009. "The Size and Service Offering Efficiencies of U.S. Hospitals," Working Papers, IESEG School of Management 2009-ECO-09, IESEG School of Management.
    2. Gary Ferrier & Hervé Leleu & James Moises & Vivian Valdmanis, 2013. "The Focus Efficiency of U.S. Hospitals," Atlantic Economic Journal, International Atlantic Economic Society, International Atlantic Economic Society, vol. 41(3), pages 241-263, September.


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