Do Health Care Providers Quality Discriminate? Empirical Evidence from Primary Care Outpatient Clinics

There has been minimal attention paid to the mechanisms of hospital quality oversight that are currently in place. Accordingly this study will analyze the system of hospital quality regulation in the US. The Social Security Act as amended in 1965 gave the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) "deeming" power for Medicare quality requirements. There are numerous reasons why JCAHO's oversight strategy may be ineffective. The primary reason is the dual role of JCAHO as a regulator and advocate. In conclusion, JCAHO surveys do provide an incentive to hospitals to improve processes of care for the period leading up to an inspection and that incentive gets eliminated after the inspection occurs. JCAHO has announced a change from the scheduled survey to an unannounced strategy. The objective of this change is to provide an incentive to maintain a level of readiness. This may not occur if hospitals are motivated to minimize the overall cost of JCAHO compliance.

Participation in Universal Prevention Programs

We analyze the decision to participate in community-based universal prevention programs through the framework of prospect theory, with family functionality, and related risk status, providing the reference point. We find that participation probability depends on the relative ratios of the weighting and valuation functions. Using data from the Strengthening Families Program and the Washington Healthy Youth Survey, we empirically test the implications of our model. We find that family functionality affects the participation decision in complex and, in some cases, non-linear ways. We discuss the implication of these findings for cost-effectiveness analysis, and suggest directions for further research.Prospect Theory, Treatment Outcomes, Risk Status

Inferring the Latent Incidence of Inefficiency from DEA Estimates and Bayesian Priors

Data envelopment analysis (DEA) is among the most popular empirical tools for measuring cost and productive efficiency. Because DEA is a linear programming technique, establishing formal statistical properties for outcomes is difficult. We show that the incidence of inefficiency within a population of Decision Making Units (DMUs) is a latent variable, with DEA outcomes providing only noisy sample-based categorizations of inefficiency. We then use a Bayesian approach to infer an appropriate posterior distribution for the incidence of inefficient DMUs based on a random sample of DEA outcomes and a prior distribution on the incidence of inefficiency. The methodology applies to both finite and infinite populations, and to sampling DMUs with and without replacement, and accounts for the noise in the DEA characterization of inefficiency within a coherent Bayesian approach to the problem. The result is an appropriately up-scaled, noise-adjusted inference regarding the incidence of inefficiency in a population of DMUs.Data Envelopment Analysis, latent inefficiency, Bayesian inference,Beta priors, posterior incidence of inefficiency

The Costs of a Quiet Disorder: Direct and Indirect Costs of Idiopathic Intracranial Hypertension

Idiopathic Intracranial Hypertension (IIH; pseudotumor cerebri) is a disorder with a reported incidence rate of one to three per 100,000 people in the general population. The rate among obese females of childbearing age is approximately 20 out of every 100,000 (1,9,17,25). As its name suggests, the disorder arises from unknown causes, and manifests itself in the form of elevated cerebrospinal fluid pressure within the skull. Those afflicted with IIH often experience an array of signs and symptoms suggestive of IH, including papilledema, severe headaches, visual disturbances and pulsatile synchronous tinnitus, which can severely limit functional independence and quality of life (8,19,20).idiopathic intracranial hypertension, economic costs, shunts, medical costs, pseudotumor cerebri

The Pot Calling the Kettle Black? A Comparison of Measures of Current Tobacco Use

Researchers often use the discrepancy between self-reported and biochemically assessed active smoking status to argue that self-reported smoking status is not reliable, ignoring the limitations of biochemically assessed measures and treating it as the gold standard in their comparisons. Here, we employ econometric techniques to compare the accuracy of self-reported and biochemically assessed current tobacco use, taking into account measurement errors with both methods. Our approach allows estimating and comparing the sensitivity and specificity of each measure without directly observing true smoking status. The results, robust to several alternative specifications, suggest that there is no clear reason to think that one measure dominates the other in accuracy

Patients' Perceptions and Treatment Effectiveness

An extensive literature relating patients’ expectations to treatment outcomes has not addressed the determinants of these expectations. We argue that treatment history is part of a reference point that influences patients’ expectations of how effective further treatment might be, thus influencing whether to proceed with additional treatment or not. We hypothesize that those patients with unsuccessful prior treatments have diminished expected improvement from subsequent treatments. Prospect theory provides a theoretical foundation for reference frame effects, and the model is tested with data on patients diagnosed with idiopathic intracranial hypertension. Our results support the reference frame hypothesis.Prospect Theory, Treatment Outcomes, Treatment History, Misclassification, Monotone Rank Estimator

Detecting Selection Bias in Community Disseminations of Universal Family-Based Prevention Programs

The goals of the present study were to demonstrate a method for examining selection bias in large-scale implementations of community-based family skills programs, and to explore the nature of selection bias in one such implementation. We used evaluation data from a statewide dissemination of a popular substance abuse prevention program (N programs = 42; N youth = 294). The program’s evaluation measures were designed to match publicly available data on risk and protective factor scales collected in the state’s schools, which enabled us to construct a comparison sample of non-participants (N = 20,608). We then examined the risk status of adolescents in both groups to determine whether risk and protective factor scores were related to the probability of program participation. Participation was predicted by both demographics and risk and protective factor scores. Among families with younger adolescents, program attendance was associated with lower risk; among families with older adolescents, participation was associated with both higher risk (on parental management skills) and lower risk (on substance use). Selection effects must be identified and corrected for in order to calculate valid estimates of program benefits, but in community-based disseminations, the necessary supplemental comparison sample is difficult to obtain. The evaluation design and analytic approach described here can be used in program evaluations of real-world, “bottom-up” dissemination efforts to identify who attends a program, which in turn can help to inform recruitment strategies, to pinpoint possible selection influences on measured program outcomes, and to refine estimates of program costs and benefits.repeated auction; selectivity; prevention program; community-based implementation; program evaluation

Are Hospital Pharmacies More Efficient if They Employ Nurses?

This paper assesses the efficiency of utilizing nurses in Washington State hospital pharmacies. We take the perspective of a pharmacy department manager and model an input oriented hospital pharmacy production process. Data envelopment analysis (DEA) is used to examine both scale efficiency and technical efficiency, and differences across hospital pharmacies that use and do not use nurse staffing are analyzed using cross-tabulations and nonparametric hypothesis tests. The results indicate that the use of nurse staffing does not significantly impact either scale or technical efficiency. Thus, permitting nurses to play a greater role in hospital pharmacies does not adversely affect efficiency. This paper has important policy implications for hospital administrators and pharmacists.

Estimating treatment effectiveness with sample selection

We consider a situation where treatment outcome is observed after two stages of selection; first of participation into the treatment, then in completion of the treatment. Estimates were obtained using two methods. First, three different binary response selection models were estimated sequentially in multiple steps. Second, all three equations were estimated jointly. All methods produce similar parameter estimates. We find evidence of selection effects from completion to outcome that could bias parameter estimates of the outcome equation, but not from participation to outcome, indicating that correcting only for participation may be insufficient to avoid biased estimates in the outcome equation.selection bias, trivariate probit, bivariate probit, treatment effects

Productivity Growth and Convergence in U.S. Agriculture: New Cointegration Panel Data Results

Dynamic effects of health and inter-state and inter-industry knowledge spillovers, total factor productivity (TFP) growth and convergence in U.S. agriculture are examined using recently developed procedures for panel data and a growth accounting model. Strong evidence is found to support the hypothesis that TFP converges to a steady-state. Health care supply in rural areas and research spillovers from other states and from nonagricultural sectors are found to have significant impacts on the productivity growth rate both in the short-run and long-run. These results suggest richer opportunities for policymakers to enhance productivity growth.convergence, growth, pooled mean group estimator, total factor productivity