Estimating the quality of care in hospitals using instrumental variables

Gautam Gowrisankaran; Robert J. Town

doi:10.1016/S0167-6296(99)00022-3

Estimating the quality of care in hospitals using instrumental variables

Gautam Gowrisankaran, Robert J. Town

Economics

Research output: Contribution to journal › Article › peer-review

111 Scopus citations

Abstract

Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent. Copyright (C) 1999 Elsevier Science B.V.

Original language	English (US)
Pages (from-to)	747-767
Number of pages	21
Journal	Journal of Health Economics
Volume	18
Issue number	6
DOIs	https://doi.org/10.1016/S0167-6296(99)00022-3
State	Published - Dec 1999

Keywords

Hospital
Instrumental variables
Mortality
Quality

ASJC Scopus subject areas

Health Policy
Public Health, Environmental and Occupational Health

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10.1016/S0167-6296(99)00022-3

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title = "Estimating the quality of care in hospitals using instrumental variables",

abstract = "Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent. Copyright (C) 1999 Elsevier Science B.V.",

keywords = "Hospital, Instrumental variables, Mortality, Quality",

author = "Gautam Gowrisankaran and Town, {Robert J.}",

note = "Funding Information: We would like to thank Dan Ackerberg, Lanier Benkard, Tom Buchmueller, David Cutler, Jon Gruber, Tom Holmes, Emmett Keeler, Yuichi Kitamura, Ariel Pakes, Maureen Smith, Frank Wolak and an anonymous referee for helpful comments. We also received helpful comments from seminar participants at the 1997 American Economics Association Winter Meetings in New Orleans, the University of Illinois, and the Eight Annual Health Economics Meetings in Minneapolis. Gowrisankaran acknowledges financial support from the Office of the Vice President for Research at the University of Minnesota. ",

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T1 - Estimating the quality of care in hospitals using instrumental variables

AU - Gowrisankaran, Gautam

AU - Town, Robert J.

N1 - Funding Information: We would like to thank Dan Ackerberg, Lanier Benkard, Tom Buchmueller, David Cutler, Jon Gruber, Tom Holmes, Emmett Keeler, Yuichi Kitamura, Ariel Pakes, Maureen Smith, Frank Wolak and an anonymous referee for helpful comments. We also received helpful comments from seminar participants at the 1997 American Economics Association Winter Meetings in New Orleans, the University of Illinois, and the Eight Annual Health Economics Meetings in Minneapolis. Gowrisankaran acknowledges financial support from the Office of the Vice President for Research at the University of Minnesota.

PY - 1999/12

Y1 - 1999/12

N2 - Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent. Copyright (C) 1999 Elsevier Science B.V.

AB - Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent. Copyright (C) 1999 Elsevier Science B.V.

KW - Hospital

KW - Instrumental variables

KW - Mortality

KW - Quality

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EP - 767

JO - Journal of Health Economics

JF - Journal of Health Economics

IS - 6

ER -

Estimating the quality of care in hospitals using instrumental variables

Abstract

Keywords

ASJC Scopus subject areas

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