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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

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    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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    Cited by:

    1. Martin Gaynor & Adam Sacarny & Raffaella Sadun & Chad Syverson & Shruthi Venkatesh, 2021. "The Anatomy of a Hospital System Merger: The Patient Did Not Respond Well to Treatment," NBER Working Papers 29449, National Bureau of Economic Research, Inc.
    2. Elena Lucchese, 2020. "It could be worse...it could be raining: Ambulance response time and health outcomes," Working Papers 429, University of Milano-Bicocca, Department of Economics, revised Feb 2020.
    3. Stefanie Fischer & Heather Royer & Corey White, 2022. "Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the US," Monash Economics Working Papers 2022-06, Monash University, Department of Economics.
    4. Amitabh Chandra & Pragya Kakani & Adam Sacarny, 2020. "Hospital Allocation and Racial Disparities in Health Care," NBER Working Papers 28018, National Bureau of Economic Research, Inc.
    5. Bar, M.; & Bakx, P.; & Wouterse, B.; & van Doorslaer, Eddy.;, 2022. "Estimating the health value added by nursing homes," Health, Econometrics and Data Group (HEDG) Working Papers 22/12, HEDG, c/o Department of Economics, University of York.
    6. Amitabh Chandra & Maurice Dalton & Douglas O. Staiger, 2023. "Are Hospital Quality Indicators Causal?," NBER Working Papers 31789, National Bureau of Economic Research, Inc.
    7. Anand Acharya & Lynda Khalaf & Marcel Voia & Myra Yazbeck & David Wensley, 2021. "Severity of Illness and the Duration of Intensive Care," Working Papers 2021-003, Human Capital and Economic Opportunity Working Group.
    8. Johannes S. Kunz & Carol Propper, 2022. "Is Hospital Quality Predictive of Pandemic Deaths? Evidence from US Counties," Papers 2022-01, Centre for Health Economics, Monash University.
    9. Bensnes, Simon & Huitfeldt, Ingrid, 2021. "Rumor has it: How do patients respond to patient-generated physician ratings?," Journal of Health Economics, Elsevier, vol. 76(C).
    10. Marcella Alsan & Amitabh Chandra & Kosali Simon, 2021. "The Great Unequalizer: Initial Health Effects of COVID-19 in the United States," Journal of Economic Perspectives, American Economic Association, vol. 35(3), pages 25-46, Summer.
    11. Sebastian Calonico & Rafael Di Tella & Juan Cruz Lopez Del Valle, 2022. "Causal Inference During a Pandemic: Evidence on the Effectiveness of Nebulized Ibuprofen as an Unproven Treatment for COVID-19 in Argentina," NBER Working Papers 30084, National Bureau of Economic Research, Inc.
    12. Joseph J. Doyle Jr. & Becky Staiger, 2021. "Physician Group Influences on Treatment Intensity and Health: Evidence from Physician Switchers," NBER Working Papers 29613, National Bureau of Economic Research, Inc.
    13. Van Parys, Jessica & Brown, Zach Y., 2024. "Broadband Internet access and health outcomes: Patient and provider responses in Medicare," International Journal of Industrial Organization, Elsevier, vol. 95(C).
    14. Bär, Marlies & Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy, 2022. "Estimating the health value added by nursing homes," Journal of Economic Behavior & Organization, Elsevier, vol. 203(C), pages 1-23.
    15. Elena Lucchese, 2024. "How important are delays in treatment for health outcomes? The case of ambulance response time and cardiovascular events," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 652-673, April.
    16. Atul Gupta & Ambar La Forgia & Adam Sacarny, 2024. "Turbocharging Profits? Contract Gaming and Revenue Allocation in Healthcare," NBER Working Papers 32564, National Bureau of Economic Research, Inc.
    17. Kunz, Johannes S. & Propper, Carol, 2023. "JUE Insight: Is hospital quality predictive of pandemic deaths? Evidence from US counties," Journal of Urban Economics, Elsevier, vol. 133(C).
    18. Kollerup, Anna, 2022. "Worth the trip? The effect of hospital clinic closures for patients undergoing scheduled surgery," Social Science & Medicine, Elsevier, vol. 314(C).
    19. Johannes S. Kunz & Carol Propper & Kevin E. Staub & Rainer Winkelmann, 2023. "Assessing the Quality of Public Services: For-profits, Chains, and Concentration in the Hospital Market," Papers 2023-01, Centre for Health Economics, Monash University.
    20. Russ Kashian & Nicholas Lovett & Yuhan Xue, 2020. "Has the affordable care act affected health care efficiency?," Journal of Regulatory Economics, Springer, vol. 58(2), pages 193-233, December.

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