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Demand, Selection and Patient Outcomes in German Acute Care Hospitals

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  • Schwierz, Christoph
  • Augurzky, Boris
  • Focke, Axel
  • Wasem, Jürgen

Abstract

In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically. We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days without excess demand. We find that when this variation is ignored in the regression framework, the effect of demand on outcomes is biased upwards. The reason is that when demand is high more patients with a higher unobservable frailty are admitted to the hospitals. After having controlled for this selection of patients, excess demand does not negatively affect patient outcomes.

Suggested Citation

  • Schwierz, Christoph & Augurzky, Boris & Focke, Axel & Wasem, Jürgen, 2008. "Demand, Selection and Patient Outcomes in German Acute Care Hospitals," Ruhr Economic Papers 74, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:74
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    References listed on IDEAS

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    1. David M. Cutler & Robert S. Huckman & Mary Beth Landrum, 2004. "The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery," American Economic Review, American Economic Association, vol. 94(2), pages 342-346, May.
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    4. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
    5. Schwierz, Christoph & Augurzky, Boris & Wasem, Jürgen, 2009. "Does the Quality of Hospital Treatment Vary by Days of the Week?," Ruhr Economic Papers 105, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
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    Cited by:

    1. Nan Jiang & Gail Pacheco, 2014. "Demand in New Zealand hospitals: expect the unexpected?," Applied Economics, Taylor & Francis Journals, vol. 46(36), pages 4475-4489, December.
    2. Bhalotra, Sonia R. & Nunes, Letícia & Rocha, Rudi, 2020. "Urgent Care Centers, Hospital Performance and Population Health," IZA Discussion Papers 13992, Institute of Labor Economics (IZA).
    3. Emilio Gutierrez & Adrian Rubli, 2021. "Shocks to Hospital Occupancy and Mortality: Evidence from the 2009 H1N1 Pandemic," Management Science, INFORMS, vol. 67(9), pages 5943-5952, September.
    4. Bhalotra, Sonia & Nunes, Letícia & Rocha, Rudi, 2023. "Emergency Care Centers, Hospital Performance and Population Health," CAGE Online Working Paper Series 659, Competitive Advantage in the Global Economy (CAGE).
    5. Jonas Krämer & Jonas Schreyögg & Reinhard Busse, 2019. "Classification of hospital admissions into emergency and elective care: a machine learning approach," Health Care Management Science, Springer, vol. 22(1), pages 85-105, March.

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    More about this item

    Keywords

    Hospital staffing; inpatient outcomes;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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