Abstract

http://ssrn.com/abstract=215376
 
 

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Inferring Hospital Quality from Patient Discharge Records Using a Bayesian Selection Model


John Geweke


University of Technology Sydney - Economics Discipline Group

Gautam Gowrisankaran


University of Arizona - Eller College of Management; National Bureau of Economic Research (NBER)

Robert J. Town


University of Pennsylvania - The Wharton School; National Bureau of Economic Research (NBER)



Abstract:     
This paper develops new econometric methods to estimate hospital quality and other models with discrete dependent variables and non-random 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 77,937 Medicare patients admitted to 117 hospitals in Los Angeles County from 1989 through 1992 with a diagnosis of pneumonia. It finds higher quality in smaller hospitals than larger, and in private for-profit hospitals than in hospitals in other ownership categories. Variations in unobserved severity of illness across hospitals is at least a great as variation in hospital quality. Consequently a conventional probit model leads to inferences about quality markedly different than those in this study?s selection model.

Number of Pages in PDF File: 55

JEL Classification: C11, C25, I12, L15

working papers series


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Date posted: April 9, 2000  

Suggested Citation

Geweke, John and Gowrisankaran, Gautam and Town, Robert J., Inferring Hospital Quality from Patient Discharge Records Using a Bayesian Selection Model. Available at SSRN: http://ssrn.com/abstract=215376 or http://dx.doi.org/10.2139/ssrn.215376

Contact Information

John Geweke
University of Technology Sydney - Economics Discipline Group ( email )
645 Harris Street
Sydney, NSW 2007
Australia
0295149797 (Phone)
HOME PAGE: http://www.censoc.uts.edu.au/about/members/jgeweke_papers.html
Gautam Gowrisankaran (Contact Author)
University of Arizona - Eller College of Management ( email )
McClelland Hall
P.O. Box 210108
Tucson, AZ 85721-0108
United States
HOME PAGE: http://econ.arizona.edu/faculty/gowrisankaran.asp
National Bureau of Economic Research (NBER) ( email )
1050 Massachusetts Avenue
Cambridge, MA 02138
United States
Robert J. Town
University of Pennsylvania - The Wharton School ( email )
3641 Locust Walk
Philadelphia, PA 19104-6365
United States
National Bureau of Economic Research (NBER)
1050 Massachusetts Avenue
Cambridge, MA 02138
United States
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References:  34
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Footnotes:  33

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