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Evaluating Measures of Hospital Quality


  • Joseph J. Doyle, Jr.
  • John A. Graves
  • Jonathan Gruber


In response to unsustainable growth in health care spending, there is enormous interest in reforming the payment system to “pay for quality instead of quantity.” While quality measures are crucial to such reforms, they face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns. In this paper we implement a methodology for estimating the causal relationship between hospital quality measures and patient outcomes. To compare similar patients across hospitals in the same market, we xploit ambulance company preferences as an instrument for patient assignment. We find that a variety of measures used by insurers to measure provider quality are successful: assignment to a higher-scoring hospital results in better patient outcomes. We estimate that a two-standard deviation improvement in a composite quality measure based on existing data collected by CMS is causally associated with reductions in readmissions and mortality of roughly 15%.

Suggested Citation

  • 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.
  • Handle: RePEc:nbr:nberwo:23166
    Note: AG HC HE

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    References listed on IDEAS

    1. Eichengreen, Barry & Irwin, Douglas A., 2010. "The Slide to Protectionism in the Great Depression: Who Succumbed and Why?," The Journal of Economic History, Cambridge University Press, vol. 70(04), pages 871-897, December.
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    4. Christian Broda & David E. Weinstein, 2006. "Globalization and the Gains From Variety," The Quarterly Journal of Economics, Oxford University Press, vol. 121(2), pages 541-585.
    5. Bown, Chad P. & Crowley, Meredith A, 2016. "The Empirical Landscape of Trade Policy," CEPR Discussion Papers 11216, C.E.P.R. Discussion Papers.
    6. James E. Anderson & Yoto V. Yotov, 2010. "The Changing Incidence of Geography," American Economic Review, American Economic Association, vol. 100(5), pages 2157-2186, December.
    7. Barbezat, Daniel, 1989. "Cooperation and Rivalry in the International Steel Cartel, 1926–1933," The Journal of Economic History, Cambridge University Press, vol. 49(02), pages 435-447, June.
    8. Dye, Alan & Sicotte, Richard, 2006. "How brinkmanship saved Chadbourne: Credibility and the International Sugar Agreement of 1931," Explorations in Economic History, Elsevier, vol. 43(2), pages 223-256, April.
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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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