Three Essays on Entry, Volume and Outcomes in Hospital Markets

详细信息   

• 作者：Li ; Suhui
• 学历：Doctor
• 年：2012
• 关键词：Social sciences ; Health and environmental sciences
• 导师：Chou,Shin-Yi
• 毕业院校：Lehigh University
• Department：Economics
• 专业：Economics;Public health;Public policy;Health care management;Clinical outcomes;Hospitals;Surgery;Medical procedures
• ISBN：9781267373250
• CBH：3510107
• Country：USA
• 语种：English
• FileSize：3839905
• Pages：108

文摘

This dissertation studies the hospital markets in Pennsylvania from three different perspectives. The first chapter examines the consequences of hospital entry in the Pennsylvania cardiac surgery market,which experienced substantial entry after the Certificate of Need (CON) state regulation was repealed in 1996. Results suggest that hospital entry was associated with increased surgery rates. The consequent increase in total costs,however,was offset by the fact that entry led to significantly lower cost per surgery and slightly improved patient outcomes. A welfare analysis implies that free entry in the Pennsylvania cardiac surgery market was welfare improving. The second chapter investigates the influence of local medical resources on racial disparities in surgery use. The study documents the incidence of the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures among Medicare patients who were initially diagnosed with acute myocardial infarction (AMI) from 1995 through 2006. A multilevel statistical analysis reveals that,conditional on individual characteristics,black patients were more likely to live in counties with lower CABG rates and higher PCI rates for both black and white populations. Consequences of inadequate medical resources may be particularly exacerbated for blacks,compared with whites. The third chapter explores the reasons for an observed positive relationship between hospital procedure volume and surgical outcomes. Results from multivariate logistic regressions show that patients being treated by high-volume surgeons have lower risk-adjusted in-hospital mortality than those treated by low-volume surgeons,regardless of the procedure volume of admission hospital. These results imply that under the national trend of decreasing hospital CABG volumes,more attention should be paid to build the volume of operating surgeons with the goal of ensuring surgical quality in low-volume CABG hospitals.