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Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data

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  • Laudicella, Mauro
  • Olsen, Kim Rose
  • Street, Andrew

Abstract

Studies of hospital efficiency seldom lead to changes in practice, partly because recommendations are unspecific or results are not seen as robust. We describe a method to compare hospital costs that utilises patient-level data. We perform a two-stage analysis in which we first consider factors that explain costs among patients and then across hospital departments. We illustrate our approach by examining the costs and characteristics of almost one million patients admitted to 136 English NHS hospital obstetrics departments in 2005/2006. We identify those departments with significantly higher costs that need to take action.

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  • Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
  • Handle: RePEc:eee:socmed:v:71:y:2010:i:10:p:1872-1881
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    References listed on IDEAS

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    Cited by:

    1. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    2. Adrian Gheorghe & Tracy Roberts & Karla Hemming & Melanie Calvert, 2015. "Evaluating the Generalisability of Trial Results: Introducing a Centre- and Trial-Level Generalisability Index," PharmacoEconomics, Springer, vol. 33(11), pages 1195-1214, November.
    3. Daidone, Silvio & Street, Andrew, 2013. "How much should be paid for specialised treatment?," Social Science & Medicine, Elsevier, vol. 84(C), pages 110-118.
    4. Carine Milcent, 2017. "Premier bilan de la T2A sur la variabilité des coûts hospitaliers," PSE Working Papers halshs-01649554, HAL.
    5. G. Fiorentini & S. Robone & R. Verzulli, 2016. "How do hospital-specialty characteristics influence health system responsiveness? An empirical evaluation of in-patient care in the Italian Region of Emilia-Romagna," Working Papers wp1077, Dipartimento Scienze Economiche, Universita' di Bologna.
    6. Thanassoulis, Emmanuel & Silva Portela, Maria C.A. & Graveney, Mike, 2014. "Using DEA to estimate potential savings at GP units at medical specialty level," Socio-Economic Planning Sciences, Elsevier, vol. 48(1), pages 38-48.
    7. Carine Milcent, 2014. "Coût des soins hospitaliers : effet de la concurrence par la qualité," PSE Working Papers halshs-01010327, HAL.
    8. Carine Milcent, 2015. "Tarification et variabilité des coûts hospitaliers : Le cas de l'infarctus du myocarde," Working Papers halshs-01202684, HAL.
    9. Kristensen, Troels & Rose Olsen, Kim & Sortsø, Camilla & Ejersted, Charlotte & Thomsen, Janus Laust & Halling, Anders, 2013. "Resources allocation and health care needs in diabetes care in Danish GP clinics," Health Policy, Elsevier, vol. 113(1), pages 206-215.
    10. Johns, Benjamin & Steinhardt, Laura & Walker, Damian G. & Peters, David H. & Bishai, David, 2013. "Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: A seemingly unrelated regression approach," Social Science & Medicine, Elsevier, vol. 89(C), pages 25-31.
    11. J. Buckell & A. Smith & R. Longo & D. Holland, 2015. "Efficiency, heterogeneity and cost function analysis: empirical evidence from pathology services in the National Health Service in England," Applied Economics, Taylor & Francis Journals, vol. 47(31), pages 3311-3331, July.
    12. Marie Kruse & Jan Christensen, 2013. "Is quality costly? Patient and hospital cost drivers in vascular surgery," Health Economics Review, Springer, vol. 3(1), pages 1-13, December.
    13. Bache, Stefan Holst Milton & Kristensen, Troels, 2013. "A simple but efficient approach to the analysis of multilevel data," COHERE Working Paper 2013:6, University of Southern Denmark, COHERE - Centre of Health Economics Research.
    14. Carine Milcent, 2014. "Coût des soins hospitaliers : effet de la concurrence par la qualité," Working Papers halshs-01010327, HAL.
    15. James Gaughan & Anne Mason & Andrew Street & Padraic Ward, 2012. "English Hospitals Can Improve Their Use of Resources: An Analysis of Costs and Length of Stay for Ten Treatments," Working Papers 078cherp, Centre for Health Economics, University of York.
    16. Troels Kristensen & Kim Olsen & Henrik Schroll & Janus Thomsen & Anders Halling, 2014. "Association between fee-for-service expenditures and morbidity burden in primary care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(6), pages 599-610, July.
    17. Carine Milcent, 2015. "Tarification et variabilité des coûts hospitaliers : Le cas de l'infarctus du myocarde," PSE Working Papers halshs-01202684, HAL.
    18. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.
    19. John Buckell & Andrew Smith & Roberta Longo & David Holland, 2013. "Health inefficiency and unobservable heterogeneity - empirical evidence from pathology services in the UK National Health Service," Working Papers 1307, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    20. Thanassoulis, Emmanuel & Silva Portela, Maria & Graveney, Mike, 2016. "Identifying the scope for savings at inpatient episode level: An illustration applying DEA to chronic obstructive pulmonary disease," European Journal of Operational Research, Elsevier, vol. 255(2), pages 570-582.
    21. Gyrd-Hansen, Dorte & Olsen, Kim R. & Sørensen, Torben H., 2012. "Socio-demographic patient profiles and hospital efficiency: Does patient mix affect a hospital's ability to perform?," Health Policy, Elsevier, vol. 104(2), pages 136-145.

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