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Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching

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Author Info

  • Jonas Schreyögg
  • Tom Stargardt
  • Oliver Tiemann

Abstract

Cross-country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro‐level data from hospitals in different health care systems. To do so, we developed a multi‐level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi‐level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi‐level models are recommendable to consider the clustered structure of the data when patient‐level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. Copyright (C) 2010 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1568
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Bibliographic Info

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

Volume (Year): 20 (2011)
Issue (Month): 1 (January)
Pages: 85-100

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Handle: RePEc:wly:hlthec:v:20:y:2011:i:1:p:85-100

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

Related research

Keywords: multilevel models ; propensity score matching ; hospital costs ; acute myocardial infarction ;

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Cited by:
  1. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
  2. Stargardt, Tom & Schreyögg, Jonas & Kondofersky, Ivan, 2012. "Measuring the relationship between costs and outcomes: The example of Acute Myocardial Infarction in German hospitals," hche Research Papers 2012/04, Hamburg Center for Health Economics (hche), University of Hamburg.
  3. Laura Haas & Tom Stargardt & Jonas Schreyoegg, 2012. "Cost-effectiveness of open versus laparoscopic appendectomy: a multilevel approach with propensity score matching," The European Journal of Health Economics, Springer, vol. 13(5), pages 549-560, October.
  4. Häkkinen, Unto & Iversen, Tor & Peltola, Mikko & Seppälä, Timo T. & Malmivaara, Antti & Belicza, Éva & Fattore, Giovanni & Numerato, Dino & Heijink, Richard & Medin, Emma & Rehnberg, Clas, 2013. "Health care performance comparison using a disease-based approach: The EuroHOPE project," Health Policy, Elsevier, vol. 112(1), pages 100-109.
  5. Stargardt, Tom & Schreyögg, Jonas, 2012. "A framework to evaluate the effects of small area variations in healthcare infrastructure on diagnostics and patient outcomes of rare diseases based on administrative data," Health Policy, Elsevier, vol. 105(2), pages 110-118.
  6. Helmut Herwartz & Christoph Strumann, 2012. "On the effect of prospective payment on local hospital competition in Germany," Health Care Management Science, Springer, vol. 15(1), pages 48-62, March.

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