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Investigation of the Impact of the Massachusetts Health Care Reform on Hospital Costs and Quality of Care


  • Fabienne Miller

    () (Worcester Polytechnic Institute)

  • Justin Wang

    () (Worcester Polytechnic Institute)

  • Joe Zhu

    () (Worcester Polytechnic Institute)

  • Ya Chen

    () (University of Science and Technology of China)

  • Jason Hockenberry

    () (Emory University)


In 2006, the Massachusetts legislature passed a landmark health care reform bill (the Reform) that has served as a model for the national health care reform. By aiming to provide “access to affordable, quality, accountable health care,” the goals of this reform were to reduce the number of uninsured Massachusetts residents while containing the growth of health care costs and improving the quality of health care services. The current paper examines the impact of the Reform on the quality of care in addition to hospital costs simultaneously from a perspective of efficiency analysis. We develop an integer-valued non-radial Russell data envelopment analysis (DEA) model, which is unit variant and calculate the hospitals’ efficiency directly. However, the proposed integer-valued model is non-linear. The current paper thus transforms this model into a parametric integer linear programming. We develop a method to derive its optimal solutions. We then use the new DEA model to calculate and compare the efficiency scores of hospitals in Massachusetts and Connecticut pre- and post-Reform. The analysis shows that the Reform has achieved its cost containment and quality improvement goals at the same time. These analyses provide potentially useful information to hospital regulators and government regulators, especially in light of the national interest on health care legislation.

Suggested Citation

  • Fabienne Miller & Justin Wang & Joe Zhu & Ya Chen & Jason Hockenberry, 2017. "Investigation of the Impact of the Massachusetts Health Care Reform on Hospital Costs and Quality of Care," Annals of Operations Research, Springer, vol. 250(1), pages 129-146, March.
  • Handle: RePEc:spr:annopr:v:250:y:2017:i:1:d:10.1007_s10479-015-1856-y
    DOI: 10.1007/s10479-015-1856-y

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    References listed on IDEAS

    1. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2004. "Competitive effects on teaching hospitals," European Journal of Operational Research, Elsevier, vol. 154(2), pages 515-525, April.
    2. Bruce Hollingsworth & P.J. Dawson & N. Maniadakis, 1999. "Efficiency measurement of health care: a review of non‐parametric methods and applications," Health Care Management Science, Springer, vol. 2(3), pages 161-172, July.
    3. Kuosmanen, Timo & Matin, Reza Kazemi, 2009. "Theory of integer-valued data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 192(2), pages 658-667, January.
    4. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    5. Pastor, J. T. & Ruiz, J. L. & Sirvent, I., 1999. "An enhanced DEA Russell graph efficiency measure," European Journal of Operational Research, Elsevier, vol. 115(3), pages 596-607, June.
    6. Juan Du & Justin Wang & Yao Chen & Shin-Yi Chou & Joe Zhu, 2014. "Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach," Annals of Operations Research, Springer, vol. 221(1), pages 161-172, October.
    7. G D Ferrier & V G Valdmanis, 2004. "Do mergers improve hospital productivity?," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 55(10), pages 1071-1080, October.
    8. Cook, Wade D. & Tone, Kaoru & Zhu, Joe, 2014. "Data envelopment analysis: Prior to choosing a model," Omega, Elsevier, vol. 44(C), pages 1-4.
    9. J Harris & H Ozgen & Y Ozcan, 2000. "Do mergers enhance the performance of hospital efficiency?," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 51(7), pages 801-811, July.
    10. Mensah, Yaw M., 2000. "Accounting issues in health care," Journal of Accounting and Public Policy, Elsevier, vol. 19(1), pages 3-7.
    11. Ramji Balakrishnan & Leslie Eldenburg & Ranjani Krishnan & Naomi Soderstrom, 2010. "The Influence of Institutional Constraints on Outsourcing," Journal of Accounting Research, Wiley Blackwell, vol. 48(4), pages 767-794, September.
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