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Hospital production in a national health service: the physician's dilemma

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Author Info
Pedro P. Barros () (CEPR, Universidade Nova de Lisboa)
Clara E. Dismuke () (NIMA, Universidade do Minho)

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Abstract

There is a paucity of literature concerning the relation between the resource utilization decisions of the salaried hospital based physician and patient outcomes in a national health service. The purpose of our study is to model and test hospital production where the major decision makers are physicians. We view the output of the hospital as a distribution function over final health states of the patient. Our model contains a utility function for physicians whose arguments include the expected final health status of the patient and a pressure function which reflects the resource allocation and hospital financing policy of the Portuguese Health Ministry. Two sets of first order conditions derived from the theoretical model are estimated within a simultaneous equations framework using data consisting of inpatient discharges for the most frequent non-obstetric DRG during the 1992-1999 time period. We find evidence that budget setting methods and the possession of a third party payer outside of the NHS are important predictors for use of the resource in question. Moreover, we find that use of the resource is important in predicting the final health status of the patient.

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Publisher Info
Paper provided by Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho in its series Working Papers with number 6.

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Length: 28 pages
Date of creation: Dec 2000
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Handle: RePEc:nim:nimawp:6/2000

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Postal: Universidade do Minho, Escola de Economia e Gestão Gualtar, 4710-057 Braga,Portugal
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Web page: http://nima.eeg.uminho.pt/

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Postal: Universidade do Minho, Escola de Economia e Gestão Gualtar, 4710-057 Braga,Portugal
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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. Picone, Gabriel & Uribe, Martin & Mark Wilson, R., 1998. "The effect of uncertainty on the demand for medical care, health capital and wealth," Journal of Health Economics, Elsevier, vol. 17(2), pages 171-185, April. [Downloadable!] (restricted)
  2. Dionne, Georges & Contandriopoulos, Andre-Pierre, 1985. "Doctors and their workshops : A review article," Journal of Health Economics, Elsevier, vol. 4(1), pages 21-33, March. [Downloadable!] (restricted)
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  3. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January. [Downloadable!] (restricted)
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  4. Whynes, David K, 1996. "Towards an Evidence-Based National Health Service?," Economic Journal, Royal Economic Society, vol. 106(439), pages 1702-12, November. [Downloadable!] (restricted)
  5. Kees Folmer & Johnny Stevens & Frank Van Tulder & Ed Westerhout, 1997. "Towards an economic model of the Dutch health care sector," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 351-363.
  6. Clark, Derek & Olsen, Jan Abel, 1994. "Agency in health care with an endogenous budget constraint," Journal of Health Economics, Elsevier, vol. 13(2), pages 231-251, July. [Downloadable!] (restricted)
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(explanations, 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. Anabela Botelho & Lígia Pinto, 2003. "Students' expectations of the economic returns to college education Results of a controlled experiment," Working Papers 27, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho. [Downloadable!]
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