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Hospital Type and Patient Outcomes: An Empirical Examination Using AMI Re-admission and Mortality Records

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Author Info

  • Paul H. Jensen

    ()
    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

  • Elizabeth Webster

    ()
    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

  • Julia Witt

    ()
    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

Abstract

This paper investigates whether there are differences in patient outcomes across different types of hospitals using patient-level data on re-admission and mortality associated with acute myocardial infarction (AMI). Hospitals are grouped according to their ownership status (private, teaching, non-teaching) and their location (metropolitan, country and remote country). Using data collected from 130 Victorian hospitals on 19,000 patients admitted to a hospital with their first AMI between January 2001 and December 2003, we consider how treatment affects the likelihood of various outcomes based on unplanned re-admission and mortality. A hazard rate model is used to assess the effect of hospital type on patient outcome. Control variables included in the estimating model are patient-level characteristics such as age, gender, co-morbidity, country of birth, and indigenous, marital and socio-economic status. We find that there are significant differences across hospital types in the outcomes observed for patients presenting with their first AMI – private hospitals persistently outperform teaching, non-teaching and country hospitals. Interestingly, we find that result is that the impact of hospital type is quite robust to the definition of “patient outcomes” that we adopt and our attribution strategy, but not to whether we include multiple-hospital patients.

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Bibliographic Info

Paper provided by Melbourne Institute of Applied Economic and Social Research, The University of Melbourne in its series Melbourne Institute Working Paper Series with number wp2007n31.

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Length: 29 pages
Date of creation: Nov 2007
Date of revision:
Handle: RePEc:iae:iaewps:wp2007n31

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Postal: Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Victoria 3010 Australia
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Web page: http://www.melbourneinstitute.com/
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Keywords: mortality; acute myocardial infarction; hospital performance; hazard model;

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References

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  1. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168.
  2. Martin Gaynor & William B. Vogt, 2003. "Competition Among Hospitals," NBER Working Papers 9471, National Bureau of Economic Research, Inc.
  3. Ching-to Albert Ma, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Papers 0047, Boston University - Industry Studies Programme.
  4. Tay, Abigail, 2003. " Assessing Competition in Hospital Care Markets: The Importance of Accounting for Quality Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 786-814, Winter.
  5. Sloan, Frank A., 2000. "Not-for-profit ownership and hospital behavior," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 21, pages 1141-1174 Elsevier.
  6. Mark McClellan & Douglas Staiger, 1999. "Comparing Hospital Quality at For-Profit and Not-for-Profit Hospitals," NBER Working Papers 7324, National Bureau of Economic Research, Inc.
  7. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
  8. Mehdi Farsi & Geert Ridder, 2006. "Estimating the Out-of-Hospital Mortality Rate Using Patient Discharge Data," IEPR Working Papers 06.45, Institute of Economic Policy Research (IEPR).
  9. Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
  10. Karen Eggleston & Yu-Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362.
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Citations

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Cited by:
  1. Alfons Palangkaraya & Jongsay Yong, 2013. "Effects of competition on hospital quality: an examination using hospital administrative data," The European Journal of Health Economics, Springer, vol. 14(3), pages 415-429, June.
  2. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2012. "Quality competition with profit constraints," Journal of Economic Behavior & Organization, Elsevier, vol. 84(2), pages 642-659.
  3. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, 2011. "Quality competition with profit constraints: Do non-profit firms provide higher quality than for-profit firms?," NIPE Working Papers 05/2011, NIPE - Universidade do Minho.

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