An Alternative Model for Analyzing the Physician-Hospital Relationship in Rural Areas

We introduce a modeling framework called Transaction Cost Economics to help decision makers in rural health care markets choose among alternative organizational relationships in order to more cost-effectively deliver healthcare services. In particular, the hospital-physician relationship is analyzed and the transactional attributes, institutional environment, and market characteristics are identified as key variables influencing the organizational relationship between hospital and physician. As asset specfic investments are made by either the hospital or physician, vertically integrated relationships are more likely to occur. The degree of remoteness of rural areas is also considered to affect the impact of these asset-specific investments.Community/Rural/Urban Development, Health Economics and Policy,

Estimating Labor and Fiscal Impacts using Louisiana Community Impact Model: Comparing Panel Model and Three Stage Least Squares (3SLS)

Labor market, COMPAS model, Forecasting performance, 3sls, panel, Community/Rural/Urban Development, R1,

Incorporating State Elementary and Secondary School Funding Formulas in Community Impact Models

COMPAS modeling, public school finance, labor markets, revenue capacity, Community/Rural/Urban Development, Public Economics, I22,

New Estimation Strategies for Demand Threshold Models in the Southern United States

This paper estimates demand threshold models using both first generation log-log models and second generation Tobit models to zip code areas in the Southern US. Results of own-place demographic and economic variables were consistent with previous studies but impacts of neighboring zip codes contrasted previous studies.Demand Threshold Analysis, Central Place Theory, Demand and Price Analysis, R120,

Efficiency Analysis of Rural Hospitals: Parametric and Semi-parametric Approaches

This paper examined cost efficiency differences between rural hospitals participating in the Critical Access Hospital (CAH) Program and a group of non-converting, prospectively paid rural hospitals using both a two-stage semi-parametric approach as well as stochastic frontier analysis (SFA). CAHs receive Medicare cost-based reimbursement, in contrast with the rest of the hospitals reimbursed under Medicare prospective payment system (PPS). However, cost-based reimbursement has been associated with inefficiency in hospital operations and, consequently, concerns have been raised about the efficiency of CAHs. Results showed a positive and significant effect of CAH status on cost inefficiency under both model specifications suggesting that CAHs were less cost efficient than non-converting rural hospitals.rural hospitals, efficiency, SFA, two-stage approach, Community/Rural/Urban Development, Health Economics and Policy, Production Economics, Productivity Analysis, Public Economics, Research Methods/ Statistical Methods, I18,

Determinants of Cost Inefficiency of Critical Access Hospitals: A Two-stage, Semi-parametric Approach

This study examines, post-conversion, cost inefficiency of Critical Access Hospitals (CAH) using a two-stage approach. While the results suggest that Medicare cost-based reimbursement and longer participation in the CAH program may increase the cost inefficiency of CAHs, the extent of this inefficiency increase is lower than what previous literature showed.Critical Access Hospitals, cost inefficiency, two-stage approach, bootstrap, Community/Rural/Urban Development, Health Economics and Policy, Production Economics, I18,

Measuring the Relative Profitability of Mid-South Cotton Production from an Alternative Gin Seed Rebate Model

The purpose of this paper is to assess the opportunity returns forgone to cotton producers in the lower Mid-South region of the United States for growing cotton, compared to alternative commodities. We calculate the actual net returns per acre for selected cotton-producing counties in Arkansas, Louisiana, and Mississippi. In addition, we calculate the opportunity returns per acre if the acres planted in cotton were planted in the highest net return commodity per acre between corn and soybeans during the period 1997 through 2008. Our results find that producers in these cotton producing-counties faced sizeable opportunity revenues foregone averaging 43% between 2003 and 2008. Most observers of the cotton industry would argue that these foregone revenues are a function of historical cotton producers not planting a higher proportion of their acreage in the more-profitable corn enterprise in 2007 and 2008. However, opportunity revenues per acre foregone averaged 37% in the 2007-08 period. This finding suggests that cotton producers recognized a few years prior to the corn price spike in 2007 that alternative commodities, such as corn and soybeans, would generate greater returns on their land. Our research suggests that the higher corn price helped push cotton producers over the edge into planting a greater percentage of their acreage in alternative commodities.cotton ginning, returns above variable costs, cotton, corn, soybeans, Production Economics, Q10,

An application of the two-stage, semi-parametric approach with double bootstrap to analyze technical efficiency of Critical Access Hospitals

This study examines technical efficiency of Critical Access Hospitals (CAH) using a two-stage approach and bootstrap procedures for making valid inference about the impact of environmental variables on CAH efficiency. In the first stage, a data envelopment analysis (DEA) efficiency estimator is used to estimate technical efficiency of each hospital in the sample. In the second stage, efficiency scores are regressed on environmental variables using a truncated regression with bootstrap. Alternatively, a double bootstrap procedure is used, where bias-corrected DEA efficiency scores, obtained by means of bootstrap in the first stage, are used in the second stage bootstrapped truncated regression. While both procedures provide valid inference in the second stage analysis, the double bootstrap procedure has also been shown to improve statistical efficiency in the second stage truncated regression. Our results indicate that, while the two procedures yield in general similar and consistent results, only the double bootstrap procedure unveiled the direct association between Medicare cost-based reimbursement and CAH inefficiency.Critical Access Hospitals, efficiency, two-stage approach, bootstrap, Health Economics and Policy,

Analyzing Differences in Rural Hospital Efficiency: A Data Envelopment Analysis Approach

This study analyzes difference in efficiency among the U.S. rural hospitals using a two-stage, semi-parametric approach. Data Envelopment Analysis is used in the first stage to calculate cost, technical and allocative efficiencies of Critical Access Hospitals (CAH) and non-CAH rural hospitals. Following Simar and Wilson (2007), bootstrapped truncated regressions are used in the second stage to infer on relationship between the cost, technical and allocative inefficiencies of hospitals and some environmental variables. The estimated results show that CAHs are less cost, technical and allocative efficient than non-CAH rural hospitals. The results also show that Medicare cost-based reimbursement for CAHs has a negative effect on the efficiency of these hospitals while Medicare prospective payment system for non-CAH rural hospitals has a positive effect on hospital efficiency.efficiency, two-stage, semi-parametric, bootstrap, data envelopment analysis, Health Economics and Policy, I12, I18,

Factors Affecting Outsourcing for Information Technology Services in Rural Hospitals: Theory and Evidence

As health information technology becomes more prevalent for most healthcare facilities, hospitals across the nation are choosing between performing this service in-house and outsourcing to a technology firm in the health industry. This paper examines factors affecting the information technology (IT) outsource decision for various hospitals. Using 2004 data from the American Hospital Association, logistic regression models find that governmental ownership and a proxy variable for hospitals that treat more severe injuries positively impact the probability of outsourcing for IT services.Health Information Technology, Outsourcing, Hospital, Health Economics and Policy, Labor and Human Capital, Research and Development/Tech Change/Emerging Technologies, I12, C140,