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At least 811 records · Page 45Linked to original sources
PubMed1994

Payment levels and hospital response to prospective payment.

Nearly ten years after the implementation of Medicare's Prospective Payment System (PPS), some of its major impacts remain hard to explain using existing economic models. We develop a simple model of the hospital's choice of intensity of care, which affects demand for admissions. The model suggests an important role for the level of prospective payment, independent of the effect of marginal incentives. Predictions from the model are compared first with aggregate utilization data from Medicare's PPS experience, and then with various hospital-level studies which control for interhospital differences in reimbursement rates.

Financial Management, Hospital↗
PubMed1994

Agency in health care with an endogenous budget constraint.

In this paper a doctor acts as a perfect agent for a group of patients in an environment where the health service is funded by a group of contributors. The contributor group donates resources to the health sector in accordance with its split preferences about the health care services which they would like for themselves and those which they would like for others. We show that the size of the health budget is endogenous and depends on the choices made by the doctor. The focus is on the division of the budget between health enhancing and non-health enhancing health care.

Budgets↗
PubMed1994

Measuring hospital efficiency with frontier cost functions.

This paper uses a stochastic frontier multiproduct cost function to derive hospital-specific measures of inefficiency. The cost function includes direct measures of illness severity, output quality, and patient outcomes to reduce the likelihood that the inefficiency estimates are capturing unmeasured differences in hospital outputs. Models are estimated using data from the AHA Annual Survey, Medicare Hospital Cost Reports, and MEDPAR. We explicitly test the assumption of output endogeneity and reject it in this application. We conclude that inefficiency accounts for 13.6 percent of total hospital costs. This estimate is robust with respect to model specification and approaches to pooling data across distinct groups of hospitals.

Data Collection↗
PubMed1994

Cost and efficiency in nursing homes: a stochastic frontier approach.

The average level of cost inefficiency in New York nursing homes is estimated at 29%, based on a two-year panel of 164 Skilled Nursing Facilities and 443 combination Skilled and Health Related Facilities. The stochastic frontier cost function is fit to the data utilizing the composed error model, wherein statistical noise and allocative and technical inefficiency are jointly estimated. There is no change in efficiency between 1987 and 1990, and it does not vary between for-profit and not-for-profit homes. Excessive managerial and supervisory personnel and diseconomies of size are linked to inefficient operation. Chronic excess demand is suggested as a cause of the high level of inefficiency.

Data Collection↗
PubMed1994

What do stochastic frontier cost functions tell us about inefficiency?

Recent studies using the stochastic frontier approach have suggested high levels of inefficiency in nursing home and hospital facilities. This paper makes two observations. First, one could falsely estimate high levels of inefficiency if a statistical assumption--zero skewness of the random component of the cost residual--is violated. Second, an inefficient industry may be difficult to distinguish either statistically or visually from an industry free of inefficiency. If available, panel data yields more robust estimates of cost differences among nursing homes or hospitals.

Costs and Cost Analysis↗
PubMed1994

A re-examination of the meaning and importance of supplier-induced demand.

Despite twenty years of work on supplier-induced demand (SID) there has been little discussion or investigation of how inducement affects the health of patients. We develop a conceptual framework for SID which includes the clinical effectiveness of the health services utilized as well as the effectiveness of the agency relationship between the physician and the patient. The framework is used to identify several conceptually distinct types of utilization--each with its own policy implications--which have been intermingled in the SID literature. After examining each type of utilization, we conclude that a continued focus by health economists on the phenomenon of inducement (even within an extended conceptual framework) may be too limited for the development of policies regarding health service utilization.

Decision Making, Organizational↗
PubMed1995

Economic conditions and alcohol problems.

This study investigates the relationship between macroeconomic conditions and two alcohol-related outcomes--liquor consumption and highway vehicle fatalities. Fixed-effect models are estimated for the 48 contiguous states over the 1975-1988 time period. Alcohol consumption and traffic deaths vary procyclically, with a major portion of the effect of economic downturns attributed to reductions in incomes, rather than employment. The intake of hard liquor is the most sensitive to the state of the macroeconomy. There is no evidence, however, that fluctuations in economic conditions have a disproportionate impact on the drunk-driving of young adults.

Accidents, Traffic↗
PubMed1996

Time preference, the discounted utility model and health.

The constant rate discounted utility model is commonly used to represent intertemporal preferences in health care program evaluations. This paper examines the appropriateness of this model, and argues that the model fails both normatively and descriptively as a representation of individual intertemporal preferences for health outcomes. Variable rate discounted utility models are more flexible, but still require restrictive assumptions and may lead to dynamically inconsistent behaviour. The paper concludes by considering two ways of incorporating individual intertemporal preferences in health care program evaluations that allow for complementarity of health outcomes in different time periods.

Decision Support Techniques↗
PubMed1991

Health care expenditure in Sweden--an international comparison.

This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.

Australia↗