Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland

This paper explores the cost structure of Swiss hospitals, focusing on differences due to teaching activities and those across different ownership and subsidization types. A stochastic total cost frontier with a Cobb-Douglas functional form has been estimated for a panel of 150 general hospitals over the six-year period from 1998 and 2003. Inpatient cases adjusted by DRG cost weights and ambulatory revenues are considered as two separate outputs. The adopted econometric specification allows for unobserved heterogeneity across hospitals. The results indicate that the time-invariant unobserved factors could account for considerable cost differences that could be only partly due to inefficiency. The results suggest that teaching activities are an important cost driving factor and hospitals that have a broader range of specialization are relatively more costly. The excess costs of university hospitals can be explained by more extensive teaching activities as well as the relatively high quality of medical units. However, even after controlling for such differences university hospitals have shown a relatively low cost-efficiency especially in the first two or three years of the sample period. The analysis does not provide any evidence of significant efficiency differences across ownership and subsidization categories.general hospitals, teaching hospitals, stochastic frontier, cost efficiency

Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals

The objective of this paper is to develop a methodology to incorporate measures of hospital quality in efficiency analysis, applied to Portuguese NHS hospitals, in order to assess whether there is a trade-off between efficiency and quality in Portuguese hospitals. We develop and compare two methodologies to compute DEA technical efficiency scores adjusted for output quality, for a sample of Portuguese NHS hospitals in 2009. When DEA efficiency scores are adjusted for output quality, the decision making units that lie on the technical efficiency frontier remain largely unaltered, even if a great weight is given to quality indicators over quantity indicators of output. Nevertheless, we find that outside of the frontier adjusting for quality does have an impact in efficiency scores.We conclude that the empirical evidence is not sufficient to identify a clear trade-off between efficiency and quality in the hospitals under review, implying the possibility that efficiency gains may achieved without a significant sacrifice of service quality. Nevertheless, there is enough evidence to conclude that analyzing hospital efficiency without consideration of differences in quality of service will generate biased results. When perceived quality is brought to the analysis, the gap between efficient and inefficient units tends to widen.Hospital efficiency, Hospital quality, Data Envelopment Analysis

Regulator Leniency and Mispricing in Beneficent Nonprofits

We posit that nonprofits that provide a greater supply of unprofitable services (beneficent nonprofits) face lenient regulatory enforcement for mispricing in price-regulated markets. Consequently, beneficent nonprofits exploit such regulatory leniency and exhibit higher mispricing. Drawing on organizational legitimacy theory, we argue that both regulators and beneficent nonprofits seek to protect their legitimacy with stakeholders, including those who demand access to unprofitable services. Using data from hospitals, we examine mispricing via “upcoding”, which involves misclassifying ailment severity. Archival analysis indicates less stringent regulatory enforcement of upcoding for beneficent nonprofit hospitals, defined as hospitals that provide higher charity care and medical education. After observing regulator leniency, beneficent hospitals demonstrate higher upcoding. Our results suggest that lenient enforcement assists beneficent nonprofits to obtain higher revenues in price-regulated markets

Nursing Voice

https://scholarlyworks.lvhn.org/nursing_voice/1015/thumbnail.jp

Nursing Voice

https://scholarlyworks.lvhn.org/nursing_voice/1015/thumbnail.jp

Eye health in Australia: a hospital perspective

Reducing preventable vision loss has recently been identified as a priority by Australian governments and non-government organisations. This report is the first in a series of national reports providing an overview of eye health in Australia. The report presents information about the treatment of eye disorders in Australian hospitals and includes trends in hospitalisations, differences across population groups, treatment costs, and waiting times.&nbsp

A conceptual framework of cost/benefit justification for ergonomic projects to reduce musculoskeletal disorders in the workplace

A framework for justifying ergonomic projects to the overall cost savings is developed which estimates the extent of musculoskeletal disorders (MSDs) exposures to a specific industry. A cost structure is developed to estimate the investment needed for an ergonomics program and the costs related to MSDs problems including workers\u27 compensation costs, work-related costs, and labor turnover costs. Data was adopted from sources including Bureau of Labor Statistics (BLS), the Healthcare Cost and Utilization Project (HCUP-3), and estimates suggested in OSHA\u27s former Ergonomics Standard. Top fifteen manufacturing industries with the highest MSDs rates were selected to apply the framework. Results showed that the overall cost savings among the fifteen selected industries come from ergonomics activities addressing the problem of overexertion (58%), bodily reaction (15%), and repetitive motion (27%). The study makes it possible to identify the proportion of exposure types that contribute to the overall costs of MSDs problems, so that managers can prioritize ergonomic analysis and control activities appropriately. Furthermore, based on the literature review, this is the first study to investigate the feasibility of using Real Options method to quantify ergonomic investment as well as an attempt to identify different types of real options in ergonomics program. Results showed that the value of ergonomics program could increase up to 2.43 times of the original value when real options are included

Essays On The Intersection Of Healthcare Operations And Economics

The essays in this dissertation wrestle with unique challenges presented by multiple, interacting entities within the healthcare industry. The essay, Searching for the Best Yardstick: Cost of Quality Improvements in the U.S. Hospital Industry, takes the perspective of the regulator in improving incentive programs designed to induce hospitals to invest in quality. The key challenge in evaluating potential changes to such programs is to understand the underlying incentives that hospitals have in responding to the new incentives. Using structural estimation methods, the parameters of each hospital’s decision-making process are estimated. The counterfactual analyses quantify the effects of recalibrating the Hospital Value-based Purchasing Program. The essay, The Spillover Effects of Capacity Pooling in Hospitals, focuses on the unintended effects of off-service placement, a common capacity pooling strategy. Building on previous studies that document negative first-order effects on patients who are placed off service themselves, the spillover effects onto patients who are placed on service are analyzed. The instrumental variables approach reveals that there is a significant causal impact of off-service placement on patients who are placed on service. The essay, Should We Worry About Moral Hazard? Estimation of the Slutsky Equation Using Indemnity Health Insurance Contracts, uncovers the differential response of consumers to different designs of health insurance. While previous studies have convincingly shown that ex-post moral hazard in health care does exist, there has been a lack of empirical evidence on the degree in which such moral hazard is welfare-reducing. Using a novel setting, the analysis provides evidence that moral hazard can lead to a significant welfare loss

Competition and Waiting Times in Hospital Markets

This paper studies the impact of hospital competition on waiting times. We use a Salop-type model, with hospitals that differ in (geographical) location and, potentially, waiting time, and two types of patients; high-benefit patients who choose between neighbouring hospitals (competitive segment), and low-benefit patients who decide whether or not to demand treatment from the closest hospital (monopoly segment). Compared with a benchmark case of monopoly, we find that hospital competition leads to longer waiting times in equilibrium if the competitive segment is sufficiently large. Given a policy regime of hospital competition, the effect of increased competition depends on the parameter of measurement: Lower travelling costs increase waiting times, higher hospital density reduces waiting times, while the effect of a larger competitive segment is ambiguous. We also show that, if the competitive segment is large, hospital competition is socially preferable to monopoly only if the (regulated) treatment price is sufficiently high.hospitals, competition, waiting times

Analyse der komplexen CED-Fälle in Bezug auf Komplikationen, Intervention, Zusatzentgelte sowie Kosten mit gesonderter Evaluation von Zentrumseffekten

Introduction and Objectives: It is assumed that inflammatory bowel disease (IBD) is partly treated in a non-cost-covering manner in German hospitals. Consequently, this pa- per examines the reimbursement situation of IBD in Germany. In particular, we investigate the effects of complexity on profitability and the potential differences among different hospital types. Methods: We used anonymized case data, including cost data from the Institute for reim- bursement in hospitals (InEK) calculation (§21-4 Hospital Remuneration Act (KHEntgG) of the Diagnosis Related Groups (DRG) project of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) from 2019. We analyzed 3,385 cases with IBD as the principal diagnosis, 1876 cases with Crohn’s disease, and 1509 with ulcerative colitis. The cases are distributed across 49 hospitals. To examine the impact of the complexity of a case on the reimbursement situation, we explored different variables, including gastroenterological complications, infections, specific procedures, admission reasons, and additional charges. We grouped hospitals by type of care to examine potential center effects. To ensure com- parability of profitability across different diagnosis groups, the standardized metric of relative profitability per case was determined. Results: We found that all types of hospitals are treating IBD in a non-cost-covering manner. Therefore, the average revenue earned per case is lower than its attributable cost. The financial loss averages 10% (€296 absolute financial loss) and varies depending on the type of hospital (primary and focus care providers: 3%, focus care providers: 10%, maximum care providers: 13%, university hospitals: 13%). The costs per case differ among the types of care; hospitals with more beds bear higher costs. On average, university hospitals incur costs €2,296 higher than those of primary care providers, with personnel costs accounting for €902 of this difference. Cases with higher complexity display higher financial losses than cases with lower complexity. Discussion: This analysis demonstrates that the costs of treating IBD in German hospitals are not recovered. A reduction of the financial loss may be achieved, for example, by adjusting the reimbursement for gastroenterological complications and infections and a corresponding surcharge for the reason for admission (e.g., transfer). Furthermore, a surcharge could be introduced for university hospitals to account for the increased complexity and contingency costs.Es wird davon ausgegangen, dass die Behandlung von CED in deutschen Krankenhäusern teilweise nicht kostendeckend erfolgt. In dieser Arbeit untersuchen wir die Vergütungssituation von entzündlichen Darmerkrankungen (CED) in deutschen Krankenhäusern. Wir befassen uns insbesondere mit den Auswirkungen der Komplexität auf die Rentabilität und möglichen Unterschieden zwischen verschiedenen Krankenhaustypen. Methoden Wir haben anonymisierte Falldaten, einschließlich Kostendaten, vom Institut für Krankenhausvergütung (InEK) verwendet, um Berechnungen gemäß §21-4 des Krankenhausvergütungsgesetzes (KHEntgG) der Diagnosis Related Groups (DRG) des Deutschen Gesellschaft für Gastroenterologie, Stoffwechsel- und Verdauungskrankheiten (DGVS) von 2019 durchzuführen. Es wurden 3385 Fälle mit CED als Hauptdiagnose, 1876 Fälle mit Morbus Crohn und 1509 Fälle mit Colitis ulcerosa analysiert, die sich auf 49 Krankenhäuser verteilen. Um den Einfluss der Komplexität eines Falls auf die Vergütungssituation zu untersuchen, haben wir verschiedene Variablen untersucht, darunter gastroenterologische Komplikationen, Infektionen, spezifische Prozeduren, Aufnahmegrunde und Zusatzentgelte. Um mögliche Zentrumseffekte zu untersuchen, haben wir die Krankenhäuser nach Versorgungstyp gruppiert. Um die Rentabilität zwischen verschiedenen Diagnosegruppen vergleichbar zu machen, wurde der standardisierte Metrik der relativen Rentabilität pro Fall bestimmt. Ergebnisse Es wurde gezeigt, dass alle Versorgungstypen CED nicht kostendeckend behandeln. Folglich sind die durchschnittlichen Einnahmen pro Fall niedriger als die zugeordneten Kosten. Der finanzielle Verlust liegt im Durchschnitt bei 10% (296€ absoluter finanzieller Verlust) und variiert je nach Art des Krankenhauses (Grund- und Regelversorger: 3%, Schwerpunktversorger: 10%, Maximalversorger: 13%, Universitätskliniken: 13%). Die Kosten pro Fall unterscheiden sich zwischen den Versorgungstypen; Krankenhäuser mit mehr Betten tragen höhere Kosten. Im Durchschnitt liegen die Kosten der Universitätskliniken um 2296€ über denen der Primärversorger, wobei 902€ auf die Personalkosten entfallen. Fälle mit höherer Komplexität weisen höhere finanzielle Verluste auf als Fälle mit geringerer Komplexität. Diskussion Diese Analyse zeigt, dass die Kosten für die Behandlung von CED in deutschen Krankenhäusern nicht gedeckt werden. Eine Verringerung des finanziellen Verlustes kann z.B. durch eine Anpassung der Vergütung für gastroenterologische Komplikationen und Infektionen und einen entsprechenden Zuschlag für den Aufnahmegrund (z.B., Verlegung) erreicht werden. Darüber hinaus könnte ein Zuschlag für Universitätskliniken eingeführt werden, um die erhöhten Komplexitäts- und Vorhaltekosten zu berücksichtigen