Exploring the relationship between costs and quality - Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?
Objective: The purpose is to assess whether the joint evaluation of costs and quality affects the ranking of hospital departments relative to performance based on cost performance alone. Methods: Using patient level data, in which 3,754 patients across six vascular departments are pooled we estimate fixed effect models for costs (linear) and quality (logistic). We consider two quality measures; mortality and wound complications. To assess whether the joint evaluation of costs and quality affects the ranking of departments, we construct joint confidence regions for each pair of departmental effects for costs and quality by using a bootstrap method and rank departments according to their costeffectiveness ratio. Results: The association between cost and quality differs depending on how which quality is measured. Lower costs tend to associate with higher mortality, implying a cost-quality trade-off. In contrast there is no clear association between costs and wound complications among vascular departments. Conclusions: Compared to benchmarking of departments based solely on their costs, we show that the ranking of departments may be altered considerably when quality is taken into account. Consequently, it is important to have a well-rounded view of departmental objectives when undertaking performance evaluation.
|Date of creation:||25 Jun 2010|
|Date of revision:|
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- Schmidt, Peter & Sickles, Robin C, 1984. "Production Frontiers and Panel Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(4), pages 367-74, October.
- Jeffrey M Wooldridge, 2010.
"Econometric Analysis of Cross Section and Panel Data,"
MIT Press Books,
The MIT Press,
edition 2, volume 1, number 0262232588, March.
- Jeffrey M. Wooldridge, 2001. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262232197, March.
- Diego Prior & Magda Solà, 2000. "Technical efficiency and economies of diversification in health care," Health Care Management Science, Springer, vol. 3(4), pages 299-307, September.
- Jan Clement & Vivian Valdmanis & Gloria Bazzoli & Mei Zhao & Askar Chukmaitov, 2008. "Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion," Health Care Management Science, Springer, vol. 11(1), pages 67-77, March.
- Kim Rose Olsen & Andrew Street, 2008. "The analysis of efficiency among a small number of organisations: How inferences can be improved by exploiting patient-level data," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 671-681.
- Diego Prior, 2006. "Efficiency and total quality management in health care organizations: A dynamic frontier approach," Annals of Operations Research, Springer, vol. 145(1), pages 281-299, July.
- Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128.
- Hauck, Katharina & Street, Andrew, 2006. "Performance assessment in the context of multiple objectives: A multivariate multilevel analysis," Journal of Health Economics, Elsevier, vol. 25(6), pages 1029-1048, November.
- Gertler, Paul J & Waldman, Donald M, 1992. "Quality-Adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry," Journal of Political Economy, University of Chicago Press, vol. 100(6), pages 1232-56, December.
- Erik SCHOKKAERT & Carine VAN DE VOORDE, 2000.
"Risk Selection and the Specification of the Conventional Risk Adjustment Formula,"
Working Papers Department of Economics
ces0011, KU Leuven, Faculty of Economics and Business, Department of Economics.
- Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
- Jaime Pinilla & Carles Murillo & Genís Carrasco & Carlos Humet, 2006. "Case-control analysis of the financial cost of medication errors in hospitalized patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 66-71, March.
- Niccie L. McKay & Mary E. Deily, 2008. "Cost inefficiency and hospital health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 833-848.
- Anni Ankjær-Jensen & Pernille Rosling & Lone Bilde, 2006. "Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system," Health Care Management Science, Springer, vol. 9(3), pages 259-268, August.
- Kathleen Carey & James F. Burgess, 1999. "On measuring the hospital cost|quality trade-off," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 509-520.
- Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819.
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