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Hospital Type and Patient Outcomes: An Empirical Examination Using AMI Re-admission and Mortality Records

  • Paul H. Jensen

    ()

    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

  • Elizabeth Webster

    ()

    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

  • Julia Witt

    ()

    (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)

This paper investigates whether there are differences in patient outcomes across different types of hospitals using patient-level data on re-admission and mortality associated with acute myocardial infarction (AMI). Hospitals are grouped according to their ownership status (private, teaching, non-teaching) and their location (metropolitan, country and remote country). Using data collected from 130 Victorian hospitals on 19,000 patients admitted to a hospital with their first AMI between January 2001 and December 2003, we consider how treatment affects the likelihood of various outcomes based on unplanned re-admission and mortality. A hazard rate model is used to assess the effect of hospital type on patient outcome. Control variables included in the estimating model are patient-level characteristics such as age, gender, co-morbidity, country of birth, and indigenous, marital and socio-economic status. We find that there are significant differences across hospital types in the outcomes observed for patients presenting with their first AMI – private hospitals persistently outperform teaching, non-teaching and country hospitals. Interestingly, we find that result is that the impact of hospital type is quite robust to the definition of “patient outcomes” that we adopt and our attribution strategy, but not to whether we include multiple-hospital patients.

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Paper provided by Melbourne Institute of Applied Economic and Social Research, The University of Melbourne in its series Melbourne Institute Working Paper Series with number wp2007n31.

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Length: 29 pages
Date of creation: Nov 2007
Date of revision:
Handle: RePEc:iae:iaewps:wp2007n31
Contact details of provider: Postal: Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Victoria 3010 Australia
Phone: +61 3 8344 2100
Fax: +61 3 8344 2111
Web page: http://www.melbourneinstitute.com/
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  1. Mehdi Farsi & Geert Ridder, 2006. "Estimating the out-of-hospital mortality rate using patient discharge data," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 983-995.
  2. Martin Gaynor & William Vogt, 2002. "Competition Among Hospitals," GSIA Working Papers 2003-E20, Carnegie Mellon University, Tepper School of Business.
  3. Karen Eggleston & Yu-Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362.
  4. Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
  5. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168.
  6. Sloan, Frank A., 2000. "Not-for-profit ownership and hospital behavior," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 21, pages 1141-1174 Elsevier.
  7. Mark B. McClellan & Douglas O. Staiger, 2000. "Comparing Hospital Quality at For-Profit and Not- for-Profit Hospitals," NBER Chapters, in: The Changing Hospital Industry: Comparing For-Profit and Not-for-Profit Institutions, pages 93-112 National Bureau of Economic Research, Inc.
  8. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
  9. Ching-to Albert Ma, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Papers 0047, Boston University - Industry Studies Programme.
  10. Tay, Abigail, 2003. " Assessing Competition in Hospital Care Markets: The Importance of Accounting for Quality Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 786-814, Winter.
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