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Simultaneous relationships between procedure volume and mortality: do they bias studies of mortality at specialty hospitals?

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  • David Barker
  • Gary Rosenthal
  • Peter Cram

Abstract

Specialty hospitals have lower mortality rates for cardiac revascularization than general hospitals, but previous studies have found that this advantage disappears after adjusting for patient characteristics and hospital procedural volume. Questions have been raised about whether simultaneous relationships between volume and mortality might have biased these analyses. We use two‐stage least squares with Hospital Quality Alliance scores and estimated market size as instruments for mortality and volume to control for possible simultaneity. After this adjustment, it is still the case that specialty hospitals do not have an advantage over general hospitals in mortality rates after cardiac revascularization. We find evidence of simultaneity in the relationship between volume and mortality. Copyright © 2010 John Wiley & Sons, Ltd.

Suggested Citation

  • David Barker & Gary Rosenthal & Peter Cram, 2011. "Simultaneous relationships between procedure volume and mortality: do they bias studies of mortality at specialty hospitals?," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 505-518, May.
    • Handle: RePEc:wly:hlthec:v:20:y:2011:i:5:p:505-518
    DOI: 10.1002/hec.1606
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    References listed on IDEAS

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    1. Barton H. Hamilton & Vivian H. Hamilton, 1997. "Estimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 383-395, July.
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    1. Hentschker, Corinna & Mennicken, Roman, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 341, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    2. Hentschker, Corinna & Mennicken, Roman, 2014. "Selective-referral and unobserved patient heterogeneity - Bias in the volume-outcome relationship," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100299, Verein für Socialpolitik / German Economic Association.
    3. Corinna Hentschker & Roman Mennicken & Antonius Reifferscheid & Jürgen Wasem & Ansgar Wübker, 2018. "Volume-outcome relationship and minimum volume regulations in the German hospital sector – evidence from nationwide administrative hospital data for the years 2005–2007," Health Economics Review, Springer, vol. 8(1), pages 1-14, December.
    4. repec:zbw:rwirep:0527 is not listed on IDEAS
    5. Corinna Hentschker & Roman Mennicken, 2014. "Selective-referral and Unobserved Patient Heterogeneity – Bias in the Volume-outcome Relationship," Ruhr Economic Papers 0527, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    6. Trybou, Jeroen & De Regge, Melissa & Gemmel, Paul & Duyck, Philippe & Annemans, Lieven, 2014. "Effects of physician-owned specialized facilities in health care: A systematic review," Health Policy, Elsevier, vol. 118(3), pages 316-340.
    7. Corinna Hentschker & Roman Mennicken, 2015. "The Volume‐Outcome Relationship and Minimum Volume Standards – Empirical Evidence for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 644-658, June.
    8. Corinna Hentschker & Roman Mennicken, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 0341, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    9. Jakub Červený, 2023. "Selective referral or learning by doing? An analysis of hospital volume‐outcome relationship of vascular procedures," Health Economics, John Wiley & Sons, Ltd., vol. 32(6), pages 1344-1361, June.
    10. repec:zbw:rwirep:0341 is not listed on IDEAS

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