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Hospital quality variation matters – A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014

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  • Pross, Christoph
  • Busse, Reinhard
  • Geissler, Alexander

Abstract

Awareness of care variation and associated differences in outcome quality is important for patients to recognize and leverage the benefits of hospital choice and for policy makers, providers, and suppliers to adapt initiatives to improve hospital quality of care. We examine panel data on outcome quality in German hospitals between 2006 and 2014 for cholecystectomy, pacemaker implantation, hip replacement, percutaneous coronary intervention (PCI), stroke, and acute myocardial infarction (AMI). We use risk-adjusted and unadjusted outcomes based on 16 indicators. Median outcome and outcome variation trends are examined via box plots, simple linear regressions and quintile differences. Outcome trends differ across treatment areas and indicators. We found positive quality trends for hip replacement surgery, stroke and AMI 30-day mortality, and negative quality trends for 90-day stroke and AMI readmissions and PCI inpatient mortality. Variation of risk-adjusted outcomes ranges by a factor of 3–12 between the 2nd and 5th quintile of hospitals, both at the national and regional level. Our results show that simply measuring and reporting hospital outcomes without clear incentives or regulation – “carrots and sticks” – to improve performance and to centralize care in high performing hospitals has not led to broad quality improvements. More substantial efforts must be undertaken to narrow the outcome spread between high- and low-quality hospitals.

Suggested Citation

  • Pross, Christoph & Busse, Reinhard & Geissler, Alexander, 2017. "Hospital quality variation matters – A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014," Health Policy, Elsevier, vol. 121(8), pages 842-852.
    • Handle: RePEc:eee:hepoli:v:121:y:2017:i:8:p:842-852
    DOI: 10.1016/j.healthpol.2017.06.009
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    References listed on IDEAS

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    1. Manning, Willard G. & Basu, Anirban & Mullahy, John, 2005. "Generalized modeling approaches to risk adjustment of skewed outcomes data," Journal of Health Economics, Elsevier, vol. 24(3), pages 465-488, May.
    2. repec:imp:wpaper:9224 is not listed on IDEAS
    3. Kraska, Rike Antje & Krummenauer, Frank & Geraedts, Max, 2016. "Impact of public reporting on the quality of hospital care in Germany: A controlled before–after analysis based on secondary data," Health Policy, Elsevier, vol. 120(7), pages 770-779.
    4. Laudicella, Mauro & Li Donni, Paolo & Smith, Peter C., 2013. "Hospital readmission rates: Signal of failure or success?," Journal of Health Economics, Elsevier, vol. 32(5), pages 909-921.
    5. Ankit Kumar & Michael Schoenstein, 2013. "Managing Hospital Volumes: Germany and Experiences from OECD Countries," OECD Health Working Papers 64, OECD Publishing.
    6. George E. Battese, 1997. "A Note On The Estimation Of Cobb‐Douglas Production Functions When Some Explanatory Variables Have Zero Values," Journal of Agricultural Economics, Wiley Blackwell, vol. 48(1‐3), pages 250-252, January.
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    Cited by:

    1. Justus F. A. Vogel & Max Barkhausen & Christoph M. Pross & Alexander Geissler, 2022. "Defining minimum volume thresholds to increase quality of care: a new patient-oriented approach using mixed integer programming," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1085-1104, September.
    2. Christoph Strumann & Alexander Geissler & Reinhard Busse & Christoph Pross, 2022. "Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1229-1242, September.
    3. Christoph Pross & Christoph Strumann & Alexander Geissler & Helmut Herwartz & Nadja Klein, 2018. "Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-30, September.
    4. Pereira, Miguel Alves & Marques, Rui Cunha, 2022. "Is sunshine regulation the new prescription to brighten up public hospitals in Portugal?," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    5. Lobo, Mariana F & Azzone, Vanessa & Lopes, Fernando & Freitas, Alberto & Costa-Pereira, Altamiro & Normand, Sharon-Lise & Teixeira-Pinto, Armando, 2020. "Understanding the large heterogeneity in hospital readmissions and mortality for acute myocardial infarction," Health Policy, Elsevier, vol. 124(7), pages 684-694.

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