Evaluating Hospital Performance
Date
Authors
Pruckner, Gerald
Schober, Thomas
Supervisor
Item type
Journal Article
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Science and Business Media LLC
Abstract
Patient selection remains a major challenge in evaluating hospital performance. We exploit the quasi-random assignment of patients to hospitals, based on a rotation schedule between hospitals in the Upper Austrian capital of Linz. In an instrumental variable (IV) framework, we use high-quality administrative data and estimate hospital performance with respect to in-hospital mortality, 30-day mortality, and 30-day readmission. We contrast these results with those of traditional risk adjustment models based on patient observables. We find that the assessment of hospital performance is sensitive to the inclusion of patient observables and that increasing the number of socio-economic covariates to better control for patient risk profiles does not always help bring risk-adjusted estimates closer to IV estimates. The divergence between methods is most pronounced for readmissions, where risk-adjustment models imply large and statistically significant differences between hospitals, whereas IV estimates are substantially smaller and not statistically significant. Our results suggest that common risk adjustment does not adequately control for patient differences between hospitals and that hospital quality indicators based on common administrative data should be interpreted with caution. The trend toward personalized medicine may support the process of collecting more clinical information at the individual level, thus allowing for better quality comparisons between hospitals.Description
Keywords
Admission schedule, Health risk adjustment, Hospital performance, Hospitalization, 38 Economics, 3801 Applied Economics, 42 Health Sciences, Precision Medicine, Patient Safety, Generic health relevance, 3 Good Health and Well Being, 1117 Public Health and Health Services, 1402 Applied Economics, Health Policy & Services, 3801 Applied economics, 4206 Public health, 4407 Policy and administration
Source
European Journal of Health Economics, ISSN: 1618-7598 (Print); 1618-7601 (Online), Springer Science and Business Media LLC, 1-17. doi: 10.1007/s10198-026-01936-1
Publisher's version
Rights statement
Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.