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The Quality of Health Care Providers

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Author Info
Mark McClellan
Douglas Staiger
Abstract

Obtaining better information on the quality of health care providers is one of the most pressing issues in health policy today. In this paper we (1) develop a new method for measuring quality of care that overcomes the key limitations of available quality measures, and (2) apply this method to estimating the quality of hospital care for elderly patients with heart disease. Our approach optimally combines information from all available current and past quality indicators in order to more accurately estimate and forecast each provider's quality level. For patients with heart disease, the method is able to predict and forecast differences in patient outcomes across hospitals remarkably well - far better than existing methods. Our approach also provides an empirical basis for choosing among potential quality indicators. In particular, we find that differences across hospitals in short-term mortality rates following a heart attack, adjusted for patient demographics, are excellent indicators of quality of care: They vary dramatically across hospitals, are persistent over time, are highly correlated with alternative quality indicators, and are highly correlated with mortality rates that adjust more extensively for patient severity. Thus, comparing quality of care across providers may be far more feasible than many now believe.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 7327.

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Date of creation: Aug 1999
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Handle: RePEc:nbr:nberwo:7327

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Find related papers by JEL classification:
I10 - Health, Education, and Welfare - - Health - - - General
L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  2. Kessler, Daniel & McClellan, Mark, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 353-90, May. [Downloadable!] (restricted)
  3. Chamberlain, Gary, 1984. "Panel data," Handbook of Econometrics, in: Z. Griliches† & M. D. Intriligator (ed.), Handbook of Econometrics, edition 1, volume 2, chapter 22, pages 1247-1318 Elsevier. [Downloadable!] (restricted)
  4. Holtz-Eakin, Douglas & Newey, Whitney & Rosen, Harvey S, 1988. "Estimating Vector Autoregressions with Panel Data," Econometrica, Econometric Society, vol. 56(6), pages 1371-95, November. [Downloadable!] (restricted)
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  1. Gautam Gowrisankaran & Robert J. Town, 2000. "Inferring Hospital Quality from Patient Discharge Records Using a Bayesian Selection Model," Econometric Society World Congress 2000 Contributed Papers 1773, Econometric Society. [Downloadable!]
  2. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168. [Downloadable!]
  3. Anna Aizer & Adriana Lleras-Muney & Mark Stabile, 2005. "Access to Care, Provider Choice, and the Infant Health Gradient," American Economic Review, American Economic Association, vol. 95(2), pages 248-252, May. [Downloadable!]
  4. John Geweke & Gautam Gowrisankaran & Robert J. Town, 2002. "Bayesian inference for hospital quality in a selection model," Working Papers in Applied Economic Theory 2002-18, Federal Reserve Bank of San Francisco. [Downloadable!]
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  5. Magnus Lindelow, 2004. "Understanding spatial variation in the utilization of health," Development and Comp Systems 0409058, EconWPA. [Downloadable!]
  6. Thomas J. Kane & Douglas O. Staiger, 2001. "Improving School Accountability Measures," NBER Working Papers 8156, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  7. Maurice L. Moffett & Alok Bohara, 2005. "Hospital Quality Oversight by the Joint Commission on the Accreditation of Healthcare Organizations," Eastern Economic Journal, Eastern Economic Association, vol. 31(4), pages 629-647, Fall. [Downloadable!]
  8. Matilde P. Machado, & Ricardo Mora & Antonio Romero- Medina, 2006. "A Methodology To Measure Hospital Quality Using Physicians' Choices Over Training Vacancies," Economics Working Papers we060201, Universidad Carlos III, Departamento de EconomĂ­a. [Downloadable!]
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