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Bayesian Inference for Hospital Quality in a Selection Model

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Author Info
John Geweke
Gautam Gowrisankaran
Robert J. Town

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Abstract

This paper develops new econometric methods to infer hospital quality in a model with discrete dependent variables and nonrandom selection. Mortality rates in patient discharge records are widely used to infer hospital quality. However, hospital admission is not random and some hospitals may attract patients with greater unobserved severity of illness than others. In this situation the assumption of random admission leads to spurious inference about hospital quality. This study controls for hospital selection using a model in which distance between the patient's residence and alternative hospitals are key exogenous variables. Bayesian inference in this model is feasible using a Markov chain Monte Carlo posterior simulator, and attaches posterior probabilities to quality comparisons between individual hospitals and groups of hospitals. The study uses data on 74,848 Medicare patients admitted to 114 hospitals in Los Angeles County from 1989 through 1992 with a diagnosis of pneumonia. It finds the smallest and largest hospitals to be of the highest quality. There is strong evidence of dependence between the unobserved severity of illness and the assignment of patients to hospitals, whereby patients with a high unobserved severity of illness are disproportionately admitted to high quality hospitals. Consequently a conventional probit model leads to inferences about quality that are markedly different from those in this study's selection model. Copyright The Econometric Society 2003.

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Publisher Info
Article provided by Econometric Society in its journal Econometrica.

Volume (Year): 71 (2003)
Issue (Month): 4 (07)
Pages: 1215-1238
Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
Handle: RePEc:ecm:emetrp:v:71:y:2003:i:4:p:1215-1238

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December. [Downloadable!] (restricted)
  2. John Geweke, 1998. "Using simulation methods for Bayesian econometric models: inference, development, and communication," Staff Report 249, Federal Reserve Bank of Minneapolis. [Downloadable!]
    Other versions:
  3. McClellan, Mark & Noguchi, Haruko, 1998. "Technological Change in Heart-Disease Treatment: Does High Tech Mean Low Value?," American Economic Review, American Economic Association, vol. 88(2), pages 90-96, May. [Downloadable!] (restricted)
  4. Mark McClellan & Douglas Staiger, 1999. "Comparing Hospital Quality at For-Profit and Not-for-Profit Hospitals," NBER Working Papers 7324, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  5. Burns, Lawton R. & Wholey, Douglas R., 1992. "The impact of physician characteristics in conditional choice models for hospital care," Journal of Health Economics, Elsevier, vol. 11(1), pages 43-62, May. [Downloadable!] (restricted)
  6. Keane, Michael P, 1992. "A Note on Identification in the Multinomial Probit Model," Journal of Business & Economic Statistics, American Statistical Association, vol. 10(2), pages 193-200, April.
  7. John Geweke, . "Posterior Simulators in Econometrics," Computing in Economics and Finance 1996 _019, Society for Computational Economics. [Downloadable!]
  8. Geweke, John F. & Keane, Michael P. & Runkle, David E., 1997. "Statistical inference in the multinomial multiperiod probit model," Journal of Econometrics, Elsevier, vol. 80(1), pages 125-165, September. [Downloadable!] (restricted)
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  9. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, MIT Press, vol. 115(2), pages 577-615, May. [Downloadable!] (restricted)
  10. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January. [Downloadable!] (restricted)
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  11. Chib, Siddhartha & Greenberg, Edward, 1996. "Markov Chain Monte Carlo Simulation Methods in Econometrics," Econometric Theory, Cambridge University Press, vol. 12(03), pages 409-431, August. [Downloadable!]
  12. Mark McClellan & Douglas Staiger, 1999. "The Quality of Health Care Providers," NBER Working Papers 7327, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  13. John Geweke & Gautam Gowrisankaran & Robert J. Town, 2001. "Bayesian Inference for Hospital Quality in a Selection Model," NBER Working Papers 8497, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
    Other versions:
  14. 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. [Downloadable!] (restricted)
  15. repec:cup:etheor:v:12:y:1996:i:3:p:409-31 is not listed on IDEAS
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168. [Downloadable!]
  2. John Geweke & Gautam Gowrisankaran & Robert J. Town, 2002. "Bayesian inference for hospital quality in a selection model," Working Papers in Applied Economic Theory 2002-18, Federal Reserve Bank of San Francisco. [Downloadable!]
    Other versions:
  3. Joseph J. Doyle, Jr. & Steven M. Ewer & Todd H. Wagner, 2008. "Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams," NBER Working Papers 14174, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  4. 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. [Downloadable!]
  5. 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. [Downloadable!]
  6. Mehdi Farsi & Geert Ridder, 2006. "Estimating the Out-of-Hospital Mortality Rate Using Patient Discharge Data," IEPR Working Papers 06.45, Institute of Economic Policy Research (IEPR). [Downloadable!]
  7. Murat K. Munkin & Partha Deb & Pravin K. Trivedi, 2006. "Bayesian analysis of the two-part model with endogeneity: application to health care expenditure," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 21(7), pages 1081-1099. [Downloadable!]
  8. Machado, Matilde Pinto & Mora, Ricardo & Romero-Medina, Antonio, 2008. "Can We Measure Hospital Quality from Physicians' Choices?," CEPR Discussion Papers 6850, C.E.P.R. Discussion Papers. [Downloadable!] (restricted)
  9. Jon H. Fiva, Torbjørn Hægeland and Marte Rønning, 2009. "Health Status After Cancer. Does It Matter Which Hospital You Belong To?," Discussion Papers 590, Research Department of Statistics Norway. [Downloadable!]
  10. Alfons Palangkaraya & Jongsay Yong, 2009. "Hospital Markets and the Effect of Competition on Quality," Melbourne Institute Working Paper Series wp2009n17, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne. [Downloadable!]
  11. Andrew M. Jones, 2007. "Identification of treatment effects in Health Economics," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1127-1131. [Downloadable!]
  12. Daniele Fabbri & Chiara Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," CHILD Working Papers wp06_06, CHILD - Centre for Household, Income, Labour and Demographic economics - ITALY. [Downloadable!]
    Other versions:
  13. John A. Romley & Dana Goldman, 2008. "How Costly Is Hospital Quality? A Revealed-Preference Approach," NBER Working Papers 13730, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  14. Munkin, M & Trivedi, P. K, 2009. "Incentives and Selection Effects of Drug Coverage on Total Drug Expenditure: a Finite Mixture Approach," Health, Econometrics and Data Group (HEDG) Working Papers 09/22, HEDG, c/o Department of Economics, University of York. [Downloadable!]
  15. D. Fabbri & C. Monfardini & R. Radice, 2004. "Testing exogeneity in the bivariate probit model: Monte Carlo evidence and an application to health economics," Working Papers 514, Dipartimento Scienze Economiche, Universita' di Bologna. [Downloadable!]
  16. Arild Aakvik, 2004. "The Relationship Between Economic Conditions, Access to Health Care, and Health Outcomes," Econometric Society 2004 Australasian Meetings 34, Econometric Society. [Downloadable!]
  17. Dana Goldman & John A. Romley, 2008. "Hospitals As Hotels: The Role of Patient Amenities in Hospital Demand," NBER Working Papers 14619, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  18. Maurice L. Moffett & Alok Bohara, 2005. "Hospital Quality Oversight by the Joint Commission on the Accreditation of Healthcare Organizations," Eastern Economic Journal, Eastern Economic Association, vol. 31(4), pages 629-647, Fall. [Downloadable!]
  19. Jiawei Chen, 2006. "Two-Sided Matching and Spread Determinants in the Loan Market," Working Papers 060702, University of California-Irvine, Department of Economics. [Downloadable!]
  20. Desiraju, Ramarao & Nair, Harikesh S. & Chintagunta, Pradeep, 2004. "Diffusion of New Pharmaceutical Drugs in Developing and Developed Nations," Research Papers 1950, Stanford University, Graduate School of Business. [Downloadable!]
  21. John P. Burkett, 2005. "The Labor Supply of Nurses and Nursing Assistants in the United States," Eastern Economic Journal, Eastern Economic Association, vol. 31(4), pages 585-599, Fall. [Downloadable!]
  22. Matilde P. Machado, & Ricardo Mora & Antonio Romero- Medina, 2006. "A Methodology To Measure Hospital Quality Using Physicians' Choices Over Training Vacancies," Economics Working Papers we060201, Universidad Carlos III, Departamento de Economía. [Downloadable!]
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