Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns
Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns
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DOI：
10.1162/rest_a_00804
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发表时间：
2019-12-01
影响因子：
8
通讯作者：
Gruber, Jonathan
中科院分区：
文献类型：
--
作者：
Doyle, Joseph;Graves, John;Gruber, Jonathan
医院质量衡量标准对于医疗支付改革背后的一个关键理念至关重要：“按质量付费”，而不是按数量付费。然而，这些措施在很大程度上面临着重大批评，因为在对医院进行排名时，潜在的风险调整未能克服内生性担忧。在这篇文章中，我们测试了在常用质量指标得分较高的医院接受治疗的患者在再住院和死亡率方面是否有更好的健康结果。为了比较同一市场中不同医院的相似患者，我们利用救护车公司的偏好作为选择医院的工具。我们发现，保险公司用来衡量提供者质量的各种指标都是成功的：与低质量的医院相比，选择高质量的医院会产生10%到15%的更好的结果。
Hospital quality measures are crucial to a key idea behind health care payment reforms: "paying for quality" instead of quantity. Nevertheless, such measures face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns when ranking hospitals. In this paper, we test whether patients treated at hospitals that score higher on commonly used quality measures have better health outcomes in terms of rehospitalization and mortality. To compare similar patients across hospitals in the same market, we exploit ambulance company preferences as an instrument for hospital choice. We find that a variety of measures that insurers use to measure provider quality are successful: choosing a high-quality hospital compared to a low-quality hospital results in 10% to 15% better outcomes.