Variation in quality and risk: Effects on evaluation and budgeting.
Item
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Title
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Variation in quality and risk: Effects on evaluation and budgeting.
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Identifier
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AAI3047197
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identifier
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3047197
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Creator
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Bridges, John Francis Patrick.
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Contributor
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Adviser: Michael Grossman
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Date
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2002
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Language
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English
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Publisher
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City University of New York.
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Subject
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Economics, General | Health Sciences, Health Care Management
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Abstract
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This thesis contains three chapters that discuss various aspects of evaluation and hospital budgeting for health care. Chapter one focuses on an optimal hospital funding formula, from a hospital's perspective, and uses hedonic regression technique to estimate variation in price using various measures of product heterogeneity. Unlike traditional pricing models, cost is used as the dependent variable, where costs are estimated using a clinical costing system. Analysis was performed on 1996/97 patient level cost data from the New Children's Hospital (NCH), Sydney, Australia. The results illustrate that payment systems that use all available information of product heterogeneity dominated traditional case mix based payments, but both are superior to those reliant on bed days only.;Chapter two examines the use of portfolio theory as a theoretical foundation for Cost Effectiveness Analysis (CEA) in the evaluation of health care interventions. Here a general formula for the evaluation of a portfolio of health care interventions is derived that allows for synergies between interventions where the population effects are aggregated from individual effects. A number of special cases are presented to illustrate the nature of the formulation of modified portfolio theory. The chapter raises some important issues in CEA, especially with regard to the importance of correlations between interventions and the role of uncertainty.;Chapter three again uses hedonic regression to explain the variation of prices for coronary artery bypass graft (CABG) for individuals who are privately insured by self-insured firms. The primary data is from the inpatient component of MarketScan for 1995 and 1996 provided by the MEDSTAT group. Additional data on product heterogeneity is derived from the American Hospital Association's hospital survey and from the Area Resource File. A quality index, based upon the epidemiological literature's work on z-scores, is also estimated from Medicare data for the period 1990--93. The results indicate that there may be a potential market failure with price being responsive to uncertainty but not adverse quality. The study also finds that insurer and hospital type, a proxy for their respective bargaining powers, are significant predictors of prices.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
