IDEAS home Printed from https://ideas.repec.org/a/bla/randje/v39y2008i2p586-606.html
   My bibliography  Save this article

Short‐term fluctuations in hospital demand: implications for admission, discharge, and discriminatory behavior

Author

Listed:
  • Rajiv Sharma
  • Miron Stano
  • Renu Gehring

Abstract

We analyze admission and discharge decisions when hospitals become capacity constrained on high‐demand days, and develop a test for discrimination that, under certain circumstances, does not require controls for differences across patient groups. On high‐demand days, patients are discharged earlier than expected compared to those discharged on low‐demand days. High demand creates no statistically significant differences in hospitals' admission behavior. Thus, hospitals appear to ration capacity by hastening discharges rather than by restricting admissions. We could not reject a null hypothesis of no discrimination against Medicaid patients in discharges.

Suggested Citation

  • Rajiv Sharma & Miron Stano & Renu Gehring, 2008. "Short‐term fluctuations in hospital demand: implications for admission, discharge, and discriminatory behavior," RAND Journal of Economics, RAND Corporation, vol. 39(2), pages 586-606, June.
    • Handle: RePEc:bla:randje:v:39:y:2008:i:2:p:586-606
    DOI: 10.1111/j.0741-6261.2008.00029.x
    as

    Download full text from publisher

    File URL: https://doi.org/10.1111/j.0741-6261.2008.00029.x
    Download Restriction: no
    File URL: https://libkey.io/10.1111/j.0741-6261.2008.00029.x?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Friedman, Bernard & Pauly, Mark, 1981. "Cost Functions for a Service Firm with Variable Quality and Stochastic Demand: The Case of Hospitals," The Review of Economics and Statistics, MIT Press, vol. 63(4), pages 620-624, November.
    2. Keeler, Theodore E & Ying, John S, 1996. "Hospital Costs and Excess Bed Capacity: A Statistical Analysis," The Review of Economics and Statistics, MIT Press, vol. 78(3), pages 470-481, August.
    3. Paul L. Joskow, 1980. "The Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital," Bell Journal of Economics, The RAND Corporation, vol. 11(2), pages 421-447, Autumn.
    4. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.
    5. Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, March.
    6. Richard G. Frank & Judith R. Lave, 1989. "A Comparison of Hospital Responses to Reimbursement Policies for Medicaid Psychiatric Patients," RAND Journal of Economics, The RAND Corporation, vol. 20(4), pages 588-600, Winter.
    7. Shamena Anwar & Hanming Fang, 2006. "An Alternative Test of Racial Prejudice in Motor Vehicle Searches: Theory and Evidence," American Economic Review, American Economic Association, vol. 96(1), pages 127-151, March.
    8. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    9. Jeffrey E. Harris, 1977. "The Internal Organization of Hospitals: Some Economic Implications," Bell Journal of Economics, The RAND Corporation, vol. 8(2), pages 467-482, Autumn.
    10. Evans, William N. & Kim, Beomsoo, 2006. "Patient outcomes when hospitals experience a surge in admissions," Journal of Health Economics, Elsevier, vol. 25(2), pages 365-388, March.
    11. Baker, Laurence C. & Phibbs, Ciaran S. & Guarino, Cassandra & Supina, Dylan & Reynolds, James L., 2004. "Within-year variation in hospital utilization and its implications for hospital costs," Journal of Health Economics, Elsevier, vol. 23(1), pages 191-211, January.
    12. Emre Berk & Kamran Moinzadeh, 1998. "The Impact of Discharge Decisions on Health Care Quality," Management Science, INFORMS, vol. 44(3), pages 400-415, March.
    13. Esther Gal‐Or, 1994. "Excessive Investment in Hospital Capacities," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 53-70, March.
    14. Gal-Or, Esther, 1994. "Excessive Investment in Hospital Capacities," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 53-70, Spring.
    15. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    16. Carey, Kathleen, 1998. "Stochastic Demand for Hospitals and Optimizing "Excess" Bed Capacity," Journal of Regulatory Economics, Springer, vol. 14(2), pages 165-187, September.
    17. Dor, Avi & Farley, Dean E., 1996. "Payment source and the cost of hospital care: Evidence from a multiproduct cost function with multiple payers," Journal of Health Economics, Elsevier, vol. 15(1), pages 1-21, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Alejandro Arrieta & Ariadna García-Prado, 2012. "Non-elective cesarean sections in public hospitals: hospital capacity constraints and doctor´s incentives," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 1212, Departamento de Economía - Universidad Pública de Navarra.
    2. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2019. "Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics," NBER Working Papers 25706, National Bureau of Economic Research, Inc.
    3. Bhalotra, Sonia & Nunes, Leticia & Rocha, Rudi, 2023. "Emergency Care Centers, Hospital Performance and Population Health," The Warwick Economics Research Paper Series (TWERPS) 1456, University of Warwick, Department of Economics.
    4. Sonia Bhalotra & Letícia Nunes & Rudi Rocha, 2020. "Urgent Care Centers, Hospital Performance and Population Health," Working Papers 10, Instituto de Estudos para Políticas de Saúde.
    5. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    6. Kleiner, Samuel A., 2019. "Hospital treatment and patient outcomes: Evidence from capacity constraints," Journal of Public Economics, Elsevier, vol. 175(C), pages 94-118.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, vol. 28(4), pages 771-780, July.
    2. André Madeira & Victor Moutinho & José Alberto Fuinhas, 2021. "Does waiting times decrease or increase operational costs in short and long-term? Evidence from Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1195-1216, November.
    3. Alvaro Almeida & Joana Cima, 2015. "Demand uncertainty and hospital costs: an application to Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 35-45, January.
    4. Ana Rodriguez‐Alvarez & David Roibás & Alan Wall, 2012. "Reserve Capacity Of Public And Private Hospitals In Response To Demand Uncertainty," Health Economics, John Wiley & Sons, Ltd., vol. 21(7), pages 839-851, July.
    5. Sean Ennis & Michael Schoenbaum & Theodore Keeler, 2000. "Optimal prices and costs for hospitals with excess bed capacity," Applied Economics, Taylor & Francis Journals, vol. 32(9), pages 1201-1212.
    6. Alexandre Marinho, 2015. "The Process of Public Resources Allocation for Investment in Hospital Capacities," Discussion Papers 0121, Instituto de Pesquisa Econômica Aplicada - IPEA.
    7. C. A. Knox Lovell & Ana Rodríguez‐Álvarez & Alan Wall, 2009. "The effects of stochastic demand and expense preference behaviour on public hospital costs and excess capacity," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 227-235, February.
    8. Alvaro Almeida & Joana Cima, 2013. "Demand Uncertainty and Hospital Costs: an Application to Portuguese NHS Hospitals," FEP Working Papers 499, Universidade do Porto, Faculdade de Economia do Porto.
    9. Baker, Laurence C. & Phibbs, Ciaran S. & Guarino, Cassandra & Supina, Dylan & Reynolds, James L., 2004. "Within-year variation in hospital utilization and its implications for hospital costs," Journal of Health Economics, Elsevier, vol. 23(1), pages 191-211, January.
    10. Ana Rodríguez-Álvarez & David Roibás-Alonso & Alan Wall, 2013. "The response of decentralized health services to demand uncertainty and the role of political parties in the Spanish public health system," Journal of Productivity Analysis, Springer, vol. 40(3), pages 357-365, December.
    11. Rodríguez-Álvarez, Ana & Roibás, David & Wall, Alan, 2009. "Factors determining the response of hospitals to demand uncertainty," Efficiency Series Papers 2009/04, University of Oviedo, Department of Economics, Oviedo Efficiency Group (OEG).
    12. Moura, Ana, 2022. "Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal," Journal of Health Economics, Elsevier, vol. 84(C).
    13. Tovar, Beatriz & Wall, Alan, 2014. "The impact of demand uncertainty on port infrastructure costs: Useful information for regulators?," Transport Policy, Elsevier, vol. 33(C), pages 176-183.
    14. Song, Lina & Saghafian, Soroush, 2019. "Do Hospital Closures Improve the Efficiency and Quality of Other Hospitals?," Working Paper Series rwp19-006, Harvard University, John F. Kennedy School of Government.
    15. Hughes, David & McGuire, Alistair, 2003. "Stochastic demand, production responses and hospital costs," Journal of Health Economics, Elsevier, vol. 22(6), pages 999-1010, November.
    16. Kleiner, Samuel A., 2019. "Hospital treatment and patient outcomes: Evidence from capacity constraints," Journal of Public Economics, Elsevier, vol. 175(C), pages 94-118.
    17. Jon Magnussen & Lee Rivers Mobley, 1999. "The Impact of Market Environment on Excess Capacity and the Cost of an Empty Hospital Bed," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 6(3), pages 383-398.
    18. R. Andrew Butters, 2020. "Demand Volatility, Adjustment Costs, and Productivity: An Examination of Capacity Utilization in Hotels and Airlines," American Economic Journal: Microeconomics, American Economic Association, vol. 12(4), pages 1-44, November.
    19. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    20. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:randje:v:39:y:2008:i:2:p:586-606. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: https://edirc.repec.org/data/randdus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.