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The Quality of Health Care Providers

  • Mark McClellan
  • Douglas Staiger

Obtaining better information on the quality of health care providers is one of the most pressing issues in health policy today. In this paper we (1) develop a new method for measuring quality of care that overcomes the key limitations of available quality measures, and (2) apply this method to estimating the quality of hospital care for elderly patients with heart disease. Our approach optimally combines information from all available current and past quality indicators in order to more accurately estimate and forecast each provider's quality level. For patients with heart disease, the method is able to predict and forecast differences in patient outcomes across hospitals remarkably well - far better than existing methods. Our approach also provides an empirical basis for choosing among potential quality indicators. In particular, we find that differences across hospitals in short-term mortality rates following a heart attack, adjusted for patient demographics, are excellent indicators of quality of care: They vary dramatically across hospitals, are persistent over time, are highly correlated with alternative quality indicators, and are highly correlated with mortality rates that adjust more extensively for patient severity. Thus, comparing quality of care across providers may be far more feasible than many now believe.

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File URL: http://www.nber.org/papers/w7327.pdf
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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 7327.

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Date of creation: Aug 1999
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Publication status: published as Mark McClellan & Douglas Staiger, 2000. "Comparing the Quality of Health Care Providers," NBER Chapters, in: Frontiers in Health Policy Research, Volume 3, pages 113-136 National Bureau of Economic Research, Inc.
Handle: RePEc:nbr:nberwo:7327
Note: AG HC
Contact details of provider: Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
Phone: 617-868-3900
Web page: http://www.nber.org
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  1. Hamilton, James D., 1986. "State-space models," Handbook of Econometrics, in: R. F. Engle & D. McFadden (ed.), Handbook of Econometrics, edition 1, volume 4, chapter 50, pages 3039-3080 Elsevier.
  2. Kessler, Daniel & McClellan, Mark, 1996. "Do Doctors Practice Defensive Medicine?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 353-90, May.
  3. Daniel P. Kessler & Mark McClellan, 1996. "Do Doctors Practice Defensive Medicine?," NBER Working Papers 5466, National Bureau of Economic Research, Inc.
  4. 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.
  5. Holtz-Eakin, Douglas & Newey, Whitney & Rosen, Harvey S, 1988. "Estimating Vector Autoregressions with Panel Data," Econometrica, Econometric Society, vol. 56(6), pages 1371-95, November.
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