IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v18y2009i6p697-711.html

Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona

Author

Listed:
  • Andrew Sfekas

Abstract

This paper sets out an empirical model of learning with forgetting and uses it to estimate how much hospital quality improves with experience. The size of the learning effect and the depreciation rate are estimated for two cardiac procedures in Maryland and Arizona. Models are estimated using patient survival as the outcome of interest. The results show that learning does not appear to be a factor in hospital quality for either procedure or for surgery generally. From a policy standpoint, based on these results, regulations in Maryland that seek to concentrate these two procedures among a small number of providers could not be justified on the grounds that higher volume would increase the quality of care. Copyright © 2008 John Wiley & Sons, Ltd.

Suggested Citation

  • Andrew Sfekas, 2009. "Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona," Health Economics, John Wiley & Sons, Ltd., vol. 18(6), pages 697-711, June.
    • Handle: RePEc:wly:hlthec:v:18:y:2009:i:6:p:697-711
    DOI: 10.1002/hec.1400
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.1400
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.1400?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    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. Newey, Whitney K., 1987. "Efficient estimation of limited dependent variable models with endogenous explanatory variables," Journal of Econometrics, Elsevier, vol. 36(3), pages 231-250, November.
    3. Chamberlain, Gary, 1984. "Panel data," Handbook of Econometrics, in: Z. Griliches† & M. D. Intriligator (ed.), Handbook of Econometrics, edition 1, volume 2, chapter 22, pages 1247-1318, Elsevier.
    4. Martin Gaynor & Harald Seider & William B. Vogt, 2005. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, American Economic Association, vol. 95(2), pages 243-247, May.
    5. C. Lanier Benkard, 2000. "Learning and Forgetting: The Dynamics of Aircraft Production," American Economic Review, American Economic Association, vol. 90(4), pages 1034-1054, September.
    6. Barton H. Hamilton & Vivian H. Hamilton, 1997. "Estimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 383-395, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gabriel Facchini, 2022. "Forgetting‐by‐not‐doing: The case of surgeons and cesarean sections," Health Economics, John Wiley & Sons, Ltd., vol. 31(3), pages 481-495, March.
    2. Rachet-Jacquet, Laurie & Gutacker, Nils & Siciliani, Luigi, 2021. "Scale economies in the health sector: The effect of hospital volume on health gains from hip replacement surgery," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 704-729.
    3. Frank R. Lichtenberg & Johannes Schoder, 2010. "Impact of Specialization on Health Outcomes – Evidence from U.S. Cancer Data," SOI - Working Papers 1011, Socioeconomic Institute - University of Zurich.
    4. Ho Vivian & Short Marah N. & Ku-Goto Meei-Hsiang, 2012. "Can Centralization of Cancer Surgery Improve Social Welfare?," Forum for Health Economics & Policy, De Gruyter, vol. 15(1), pages 1-25, October.
    5. Chang, C-L. & Chen, W. & McAleer, M.J., 2014. "Survival Analysis of Very Low Birth Weight Infant Mortality in Taiwan," Econometric Institute Research Papers EI2014-19, Erasmus University Rotterdam, Erasmus School of Economics (ESE), Econometric Institute.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Frank R. Lichtenberg & Johannes Schoder, 2010. "Impact of Specialization on Health Outcomes – Evidence from U.S. Cancer Data," SOI - Working Papers 1011, Socioeconomic Institute - University of Zurich.
    2. Hockenberry, Jason M. & Helmchen, Lorens A., 2014. "The nature of surgeon human capital depreciation," Journal of Health Economics, Elsevier, vol. 37(C), pages 70-80.
    3. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2019. "Estimating returns to hospital volume: Evidence from advanced cancer surgery," Journal of Health Economics, Elsevier, vol. 63(C), pages 81-99.
    4. Marco D. Huesch & Mariko Sakakibara, 2009. "Forgetting the learning curve for a moment: how much performance is unrelated to own experience?," Health Economics, John Wiley & Sons, Ltd., vol. 18(7), pages 855-862, July.
    5. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-Doing in a Highly Skilled Profession When Stakes Are High: Evidence from Advanced Cancer Surgery," IZA Discussion Papers 8099, Institute of Labor Economics (IZA).
    6. Rachet-Jacquet, Laurie & Gutacker, Nils & Siciliani, Luigi, 2021. "Scale economies in the health sector: The effect of hospital volume on health gains from hip replacement surgery," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 704-729.
    7. Katja Zajc Kej??ar, 2006. "The Role Of Foreign Direct Investment In The Firm Selection Process In A Host Country: Evidence From Slovenia," William Davidson Institute Working Papers Series wp841, William Davidson Institute at the University of Michigan.
    8. Corinna Hentschker & Roman Mennicken, 2015. "The Volume‐Outcome Relationship and Minimum Volume Standards – Empirical Evidence for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 644-658, June.
    9. Hentschker, Corinna & Mennicken, Roman, 2014. "Selective-referral and Unobserved Patient Heterogeneity – Bias in the Volume-outcome Relationship," Ruhr Economic Papers 527, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    10. Georgios Marios Chrysanthou, 2007. "Determinants of Trade Union Membership in Great Britain During 1991-2003," Discussion Papers 07/01, Department of Economics, University of York.
    11. Variyam, Jayachandran N. & Blaylock, James R. & Smallwood, David M., 1998. "Informational Effects Of Nutrient Intake Determinants On Cholesterol Consumption," Journal of Agricultural and Resource Economics, Western Agricultural Economics Association, vol. 23(01), pages 1-16, July.
    12. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-Doing in a High-Skill Profession when Stakes are High: Evidence from Advanced Cancer Surgery," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100278, Verein für Socialpolitik / German Economic Association.
    13. Hentschker, Corinna & Mennicken, Roman, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 341, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    14. Corinna Hentschker & Roman Mennicken, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 0341, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    15. Lundborg, Petter & James, Stefan & Lagerqvist, Bo & Vikström, Johan, 2021. "Learning-by-Doing and Productivity Growth among High-Skilled Workers: Evidence from the Treatment of Heart Attacks," IZA Discussion Papers 14744, Institute of Labor Economics (IZA).
    16. Santhakumar, Srinivasan & Meerman, Hans & Faaij, André, 2021. "Improving the analytical framework for quantifying technological progress in energy technologies," Renewable and Sustainable Energy Reviews, Elsevier, vol. 145(C).
    17. Guggenberger, Patrik, 2010. "The impact of a Hausman pretest on the size of a hypothesis test: The panel data case," Journal of Econometrics, Elsevier, vol. 156(2), pages 337-343, June.
    18. Jenny Williams, 2005. "Habit formation and college students' demand for alcohol," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 119-134, February.
    19. Corinna Hentschker & Roman Mennicken, 2014. "Selective-referral and Unobserved Patient Heterogeneity – Bias in the Volume-outcome Relationship," Ruhr Economic Papers 0527, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    20. José Leibovich & Thierry Magnac, 1996. "Demanda de educación en las zonas rurales colombianas," Coyuntura Económica, Fedesarrollo.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:18:y:2009:i:6:p:697-711. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.