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Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns

Author

Listed:
  • Joseph Doyle

    (MIT and NBER)

  • John Graves

    (Vanderbilt University)

  • Jonathan Gruber

    (MIT and NBER)

Abstract

Hospital quality measures are crucial to a key idea behind health care payment reforms: “paying for quality” instead of quantity. Nevertheless, such measures face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns when ranking hospitals. In this paper, we test whether patients treated at hospitals that score higher on commonly used quality measures have better health outcomes in terms of rehospitalization and mortality. To compare similar patients across hospitals in the same market, we exploit ambulance company preferences as an instrument for hospital choice. We find that a variety of measures that insurers use to measure provider quality are successful: choosing a high-quality hospital compared to a low-quality hospital results in 10% to 15% better outcomes.

Suggested Citation

  • Joseph Doyle & John Graves & Jonathan Gruber, 2019. "Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns," The Review of Economics and Statistics, MIT Press, vol. 101(5), pages 841-852, December.
    • Handle: RePEc:tpr:restat:v:101:y:2019:i:5:p:841-852
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    References listed on IDEAS

    as
    1. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    2. Joseph J. Doyle, Jr. & John A. Graves & Jonathan Gruber, 2017. "Evaluating Measures of Hospital Quality," NBER Working Papers 23166, National Bureau of Economic Research, Inc.
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    5. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
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