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

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  • Pedro P. Barros

    ()
    (CEPR, Universidade Nova de Lisboa)

  • Clara E. Dismuke

    ()
    (NIMA, Universidade do Minho)

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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Bibliographic Info

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

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

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Cited by:
  1. Botelho, Anabela & Pinto, Ligia Costa, 2004. "Students' expectations of the economic returns to college education: results of a controlled experiment," Economics of Education Review, Elsevier, vol. 23(6), pages 645-653, December.
  2. Ana Rute Cardoso & Priscila Ferreira, 2001. "The dynamics of job creation and destruction for University graduates: why a rising unemployment rate can be misleading," NIMA Working Papers 10, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  3. Elvira Lima & Teresa J. Esquerdo, 2003. "The economic costs of alcohol misuse in Portugal," NIMA Working Papers 24, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  4. Pinto, Ligia M. & Harrison, Glenn W., 2003. "Multilateral negotiations over climate change policy," Journal of Policy Modeling, Elsevier, vol. 25(9), pages 911-930, December.
  5. Anabela Botelho & Ligia Costa Pinto, 2002. "Hypothetical, real, and predicted real willingness to pay in open-ended surveys: experimental results," Applied Economics Letters, Taylor & Francis Journals, vol. 9(15), pages 993-996.
  6. Aslan Zorlu & Joop Hartog, 2002. "The effect of immigration on wages in three European countries," NIMA Working Papers 19, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  7. Anabela Botelho & Ligia Costa Pinto & Miguel Portela & Antonio Silva, 2001. "The determinants of success in university entrance," NIMA Working Papers 13, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  8. Elvira Lima & David K. Whynes, 2003. "Finance and performance of Portuguese hospitals," NIMA Working Papers 20, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  9. Anabela Botelho, 2001. "Strategic behavior at trial-The production, reporting, and evaluation of complex evidence," NIMA Working Papers 14, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  10. Pedro Portugal & Ana Rute Cardoso, 2001. "Disentangling the minimum wage puzzle: an analysis of job accessions and separations from a longitudinal matched employer- employee data set," NIMA Working Papers 9, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  11. Paulo Guimaraes, 2001. "The state of Portuguese research in economics: an anlysis based on publications in international journals," NIMA Working Papers 15, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
  12. Joao Cerejeira da Silva, 2002. "Identification of the Portuguese industrial districts," NIMA Working Papers 17, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.

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