Conventional outcomes report cards public disclosure of information about the patient-background-adjusted health outcomes of individual hospitals and physicians -- may help improve quality, but they may also encourage providers to %u201Cgame%u201D the system by avoiding sick and/or seeking healthy patients. In this paper, I propose an alternative approach: ranking hospitals on the basis of the travel distances of their Medicare patients. At least in theory, a distance report card could dominate conventional outcomes report cards: a distance report card might measure quality of care at least as well but suffer less from selection problems. I use data on elderly Medicare beneficiaries with heart attack and stroke from 1994 and 1999 to show that a distance report card would be both valid  that is, correlated with true quality  and able to distinguish confidently among hospitals  that is, able to reject at conventional significance levels the hypothesis that the true quality of a low-ranked hospital was the same as the quality of the average hospital. The hypothetical distance report card I propose compares favorably to (although does not necessarily dominate) the California AMI outcomes report card.
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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number
11419.
Length: Date of creation: Jun 2005 Date of revision: Handle: RePEc:nbr:nberwo:11419
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