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Measuring The Relationship Between Costs And Outcomes: The Example Of Acute Myocardial Infarction In German Hospitals

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  • Tom Stargardt
  • Jonas Schreyögg
  • Ivan Kondofersky

Abstract

In this paper, we propose a methodological approach to measure the relationship between hospital costs and health outcomes. We propose to investigate the relationship for each condition or disease area by using patient‐level data. We examine health outcomes as a function of costs and other patient‐level variables by using the following: (1) two‐stage residual inclusion with Murphy–Topel adjustment to address costs being endogenous to health outcomes, (2) random‐effects models in both stages to correct for correlation between observation, and (3) Cox proportional hazard models in the second stage to ensure that the available information is exploited. To demonstrate its application, data on mortality following hospital treatment for acute myocardial infarction (AMI) from a large German sickness fund were used. Provider reimbursement was used as a proxy for treatment costs. We relied on the Ontario Acute Myocardial Infarction Mortality Prediction Rules as a disease‐specific risk‐adjustment instrument. A total of 12,284 patients with treatment for AMI in 2004–2006 were included. The results showed a reduction in hospital costs by €100 to increase the hazard of dying, that is, mortality, by 0.43%. The negative association between costs and mortality confirms that decreased resource input leads to worse outcomes for treatment after AMI. Copyright © 2013 John Wiley & Sons, Ltd.

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  • 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.
    • Handle: RePEc:wly:hlthec:v:23:y:2014:i:6:p:653-669
    DOI: 10.1002/hec.2941
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    1. Milstein, Ricarda & Schreyögg, Jonas, 2022. "Activity-based funding based on diagnosis-related groups: The end of an era? A review of payment reforms in the inpatient sector in ten high-income countries," hche Research Papers 28, University of Hamburg, Hamburg Center for Health Economics (hche).
    2. Terje P. Hagen & Unto Häkkinen & Eva Belicza & Giovanni Fatore & Fanny Goude & on behalf of the EuroHOPE study group, 2015. "Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 88-101, December.
    3. Laia Bosque-Mercader & Luigi Siciliani, 2023. "The association between bed occupancy rates and hospital quality in the English National Health Service," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 209-236, March.
    4. Qing Wang & Huyang Zhang & John A. Rizzo & Hai Fang, 2018. "The Effect of Childhood Health Status on Adult Health in China," IJERPH, MDPI, vol. 15(2), pages 1-16, January.
    5. Mareike Heimeshoff & Jonas Schreyögg & Lukas Kwietniewski, 2014. "Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data," Health Care Management Science, Springer, vol. 17(2), pages 150-161, June.
    6. Tamara Schmid, 2015. "Costs of treating cardiovascular events in Germany: a systematic literature review," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    7. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
    8. Hofer, Florian & Birkner, Benjamin & Spindler, Martin, 2021. "Power of machine learning algorithms for predicting dropouts from a German telemonitoring program using standardized claims data," hche Research Papers 24, University of Hamburg, Hamburg Center for Health Economics (hche).
    9. Laura Haas & Tom Stargardt & Jonas Schreyoegg & Rico Schlösser & Burghard Klapp & Gerhard Danzer, 2013. "The Trade-off Between Costs and Quality of Care in the Treatment of Psychosomatic Patients with Somatoform Pain Disorder," Applied Health Economics and Health Policy, Springer, vol. 11(4), pages 359-368, August.
    10. Yuxi Wang & Simone Ghislandi & Aleksandra Torbica, 2020. "Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1149-1168, November.
    11. Milstein, Ricarda & Schreyoegg, Jonas, 2016. "Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries," Health Policy, Elsevier, vol. 120(10), pages 1125-1140.
    12. Sverre A. C. Kittelsen & Kjartan S. Anthun & Fanny Goude & Ingrid M. S. Huitfeldt & Unto Häkkinen & Marie Kruse & Emma Medin & Clas Rehnberg & Hanna Rättö & on behalf of the EuroHOPE study group, 2015. "Costs and Quality at the Hospital Level in the Nordic Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 140-163, December.
    13. Unto Häkkinen & Gunnar Rosenqvist & Tor Iversen & Clas Rehnberg & Timo T. Seppälä & on behalf of the EuroHOPE study group, 2015. "Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 116-139, December.

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