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Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching

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  • Jonas Schreyögg
  • Tom Stargardt
  • Oliver Tiemann

Abstract

Cross‐country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro‐level data from hospitals in different health care systems. To do so, we developed a multi‐level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi‐level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi‐level models are recommendable to consider the clustered structure of the data when patient‐level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. Copyright © 2010 John Wiley & Sons, Ltd.

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  • Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
    • Handle: RePEc:wly:hlthec:v:20:y:2011:i:1:p:85-100
    DOI: 10.1002/hec.1568
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    1. Stefan Voigt, 2016. "Determinants of judicial efficiency: a survey," European Journal of Law and Economics, Springer, vol. 42(2), pages 183-208, October.
    2. Li, Sung Ko & He, Xinju, 2019. "The impacts of marketization and subsidies on the treatment quality performance of the Chinese hospitals sector," China Economic Review, Elsevier, vol. 54(C), pages 41-50.
    3. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    4. Tom Stargardt & Jonas Schreyögg & Ivan Kondofersky, 2014. "Measuring The Relationship Between Costs And Outcomes: The Example Of Acute Myocardial Infarction In German Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 653-669, June.
    5. Cinaroglu, Songul, 2021. "Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    6. Häkkinen, Unto & Iversen, Tor & Peltola, Mikko & Seppälä, Timo T. & Malmivaara, Antti & Belicza, Éva & Fattore, Giovanni & Numerato, Dino & Heijink, Richard & Medin, Emma & Rehnberg, Clas, 2013. "Health care performance comparison using a disease-based approach: The EuroHOPE project," Health Policy, Elsevier, vol. 112(1), pages 100-109.
    7. Stargardt, Tom & Schreyögg, Jonas, 2012. "A framework to evaluate the effects of small area variations in healthcare infrastructure on diagnostics and patient outcomes of rare diseases based on administrative data," Health Policy, Elsevier, vol. 105(2), pages 110-118.
    8. Tor Iversen & Eline Aas & Gunnar Rosenqvist & Unto Häkkinen & on behalf of the EuroHOPE study group, 2015. "Comparative Analysis of Treatment Costs in EUROHOPE," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 5-22, December.
    9. Liliana Proskuryakova & Dirk Meissner & Pavel Rudnik, 2014. "A Policy Perspective On The Russian Technology Platforms," HSE Working papers WP BRP 26/STI/2014, National Research University Higher School of Economics.
    10. Helmut Herwartz & Christoph Strumann, 2012. "On the effect of prospective payment on local hospital competition in Germany," Health Care Management Science, Springer, vol. 15(1), pages 48-62, March.
    11. Songul Cinaroglu, 2024. "Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis," Health Care Management Science, Springer, vol. 27(1), pages 88-113, March.
    12. Xiaohui Zhang & Katharina Hauck & Xueyan Zhao, 2013. "Patient Safety In Hospitals – A Bayesian Analysis Of Unobservable Hospital And Specialty Level Risk Factors," Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1158-1174, September.
    13. Laura Haas & Tom Stargardt & Jonas Schreyoegg, 2012. "Cost-effectiveness of open versus laparoscopic appendectomy: a multilevel approach with propensity score matching," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 549-560, October.
    14. Seghieri, Chiara & Berta, Paolo & Nuti, Sabina, 2019. "Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy," Health Policy, Elsevier, vol. 123(5), pages 449-456.

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