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Can We Measure Hospital Quality from Physicians' Choices?

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Author Info
Machado, Matilde Pinto
Mora, Ricardo
Romero-Medina, Antonio

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Abstract

In this paper, we propose an alternative methodology for ranking hospitals based on the choices of Medical School graduates over hospital training vacancies. Our methodology is therefore a revealed preference approach. Our methodology for measuring relative hospital quality has the following desirable properties: a) robust to manipulation from hospital administrators; b) conditional on having enough observations, it allows for differences in quality across specialties within a hospital; c) inexpensive in terms of data requirements, d) not subject to selection bias from patients nor hospital screening of patients; and e) unlike other rankings based on experts' evaluations, it does not require physicians to provide a complete ranking of all hospitals. We apply our methodology to the Spanish case and find, among other results, the following: First, the probability of choosing the best hospital relative to the worst hospital is statistically significantly different from zero. Second, physicians value proximity and nearby hospitals are seen as more substitutable. Third, observable time-invariant city characteristics are unrelated to results. Finally, our estimates for physicians' hospital valuations are significantly correlated to more traditional hospital quality measures.

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Paper provided by C.E.P.R. Discussion Papers in its series CEPR Discussion Papers with number 6850.

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Date of creation: Jun 2008
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Handle: RePEc:cpr:ceprdp:6850

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Related research
Keywords: Hospital Quality; Hospital Rankings; Nested Logit; Physicians' Labour Market; Revealed Preference;

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Find related papers by JEL classification:
I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
I12 - Health, Education, and Welfare - - Health - - - Health Production
J24 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Human Capital; Skills; Occupational Choice; Labor Productivity
J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations

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  1. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December. [Downloadable!] (restricted)
  2. Burgess, Simon & Gossage, Denise & Propper, Carol, 2003. "Explaining Differences in Hospital Performance: Does the Answer Lie in the Labour Market?," CEPR Discussion Papers 4118, C.E.P.R. Discussion Papers. [Downloadable!] (restricted)
    Other versions:
  3. David Dranove & Daniel Kessler & Mark McClellan & Mark Satterthwaite, 2003. "Is More Information Better? The Effects of "Report Cards" on Health Care Providers," Journal of Political Economy, University of Chicago Press, vol. 111(3), pages 555-588, June. [Downloadable!] (restricted)
  4. Kenneth E. Train & Daniel L. McFadden & Moshe Ben-Akiva, 1987. "The Demand for Local Telephone Service: A Fully Discrete Model of Residential Calling Patterns and Service Choices," RAND Journal of Economics, The RAND Corporation, vol. 18(1), pages 109-123, Spring. [Downloadable!] (restricted)
  5. Herriges, Joseph A. & Kling, Catherine L., 1996. "Testing the consistency of nested logit models with utility maximization," Economics Letters, Elsevier, vol. 50(1), pages 33-39, January. [Downloadable!] (restricted)
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  6. Heckman, James J, 1979. "Sample Selection Bias as a Specification Error," Econometrica, Econometric Society, vol. 47(1), pages 153-61, January. [Downloadable!] (restricted)
  7. Louise Allsopp & John Hey, 2000. "Two Experiments to Test a Model of Herd Behaviour," Experimental Economics, Springer, vol. 3(2), pages 121-136, October. [Downloadable!] (restricted)
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  8. John Geweke & Gautam Gowrisankaran & Robert J. Town, 2003. "Bayesian Inference for Hospital Quality in a Selection Model," Econometrica, Econometric Society, vol. 71(4), pages 1215-1238, 07. [Downloadable!] (restricted)
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  9. Mingshan Lu, 1999. "Separating the True Effect from Gaming in Incentive-Based Contracts in Health Care," Journal of Economics & Management Strategy, Blackwell Publishing, vol. 8(3), pages 383-431, 09. [Downloadable!] (restricted)
  10. Roth, Alvin E, 1984. "The Evolution of the Labor Market for Medical Interns and Residents: A Case Study in Game Theory," Journal of Political Economy, University of Chicago Press, vol. 92(6), pages 991-1016, December. [Downloadable!] (restricted)
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