Do Health Care Report Cards Cause Providers to Select Patients and Raise Quality of Care?
AbstractWe exploit a brief period of asymmetric information during the implementation of Pennsylvania’s “report card” scheme for coronary artery bypass graft surgery to test for improvements in quality of care and selection of patients by health care providers. During the ?rst three years of the 1990s, providers in Pennsylvania had an incentive to bias report cards by selecting patients strategically, with patients having no access to the report cards. This dichotomy enables us to separate providers’ selection of patients from patients’ selection of providers. Using data from the Nationwide Inpatient Sample, we estimate a non–linear difference–in– differences model and derive asymptotic standard errors. The mortality rate for bypass patients decreases by only 0.05 percentage points due to the report cards, which we interpret as evidence that quality of bypass surgery did not improve (at least in the short–term) nor did patient selection by providers occur. Our timing, estimation, and asymptotics are readily applicable to many other report card schemes.
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Bibliographic InfoPaper provided by Centre for Economic Policy Research, Research School of Economics, Australian National University in its series CEPR Discussion Papers with number 657.
Date of creation: Jan 2012
Date of revision:
health care report cards; provider moral hazard; quality improvement; difference–in–differences estimation;
Other versions of this item:
- Bruce Hollingsworth & Anthony Scott & Yijuan Chen & Juergen Meinecke, 2012. "Do Healthcare Report Cards Cause Providers To Select Patients And Raise Quality Of Care?," Health Economics, John Wiley & Sons, Ltd., vol. 21, pages 33-55, 06.
- C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
- D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
This paper has been announced in the following NEP Reports:
- NEP-ALL-2012-02-20 (All new papers)
- NEP-CTA-2012-02-20 (Contract Theory & Applications)
- NEP-ECM-2012-02-20 (Econometrics)
- NEP-HEA-2012-02-20 (Health Economics)
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