scholarly journals Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality

2022 ◽  
Author(s):  
Christoph Strumann ◽  
Alexander Geissler ◽  
Reinhard Busse ◽  
Christoph Pross
Keyword(s):  
Quality Of Care ◽  
Hospital Quality ◽  
Relevant Market ◽  
Difference In Differences ◽  
Non Profit ◽  
Stroke Treatment ◽  
For Profit ◽  
Fair Competition ◽  
Market Shares

AbstractPublic reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl–Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.

scholarly journals MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Larry Polivka
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
The State ◽  
Current Status ◽  
Term Care ◽  
Profit Model ◽  
Non Profit ◽  
For Profit

Abstract Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.

Comparing quality of care in non-profit and for-profit nursing homes: a process perspective

2004 ◽  
Vol 23 (2) ◽  
pp. 229-242 ◽  
Author(s):  
Susan Chesteen ◽  
Berit Helgheim ◽  
Taylor Randall ◽  
Don Wardell
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Non Profit ◽  
For Profit ◽  
Process Perspective

scholarly journals Nurse reported quality of care: A measure of hospital quality

2012 ◽  
Vol 35 (6) ◽  
pp. 566-575 ◽  
Author(s):  
Matthew D. McHugh ◽  
Amy Witkoski Stimpfel
Keyword(s):  
Quality Of Care ◽  
Hospital Quality

Abstract 13776: The Impact of Race on In-hospital Quality of Care Among Young Adults With Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diana Benea ◽  
Valeria Raparelli ◽  
hassan behlouli ◽  
Louise Pilote ◽  
Rachel Dryer
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Clinical Characteristics ◽  
Hospital Quality ◽  
P Value ◽  
White Race

Introduction: The extent to which race influences in-hospital quality of care among young adults with acute myocardial infarction (AMI) is unknown. We examined racial differences in in-hospital quality of AMI care in young adults and described the patient and/or clinical characteristics associated with potential disparities in care. Methods: Data from the GENESIS-PRAXY (Canada) and the VIRGO (U.S.) prospective cohorts of young adults with AMI were analyzed. Among a total of 4,048 adults with AMI (≤55 years) (median=49 years [IQR 44-52], 22% non-white, 58% women), we calculated an in-hospital quality of care score (QCS) for AMI (quality indicators divided by total, with higher scores indicating better care) based on AHA quality of care standards, reporting data disaggregated by race. We categorized race as white versus non-white, which included Black, Asian and North American Indigenous populations. Results: This cohort was comprised of 906 non-white individuals and 3142 white individuals. Non-white adults exhibited a clustering of adverse cardiac risk factors, psychosocial risk factors and comorbidities versus whites; they had higher rates of hypertension, diabetes, alcohol abuse and prior AMI and lower rates of physical activity. They were more likely to have a low SES and receive low social support, and were less likely to be employed, a primary earner, or married/living with a partner. Non-white individuals were also more likely to experience a NSTEMI and less likely to receive cardiac rehabilitation, smoking cessation counseling as well as dual antiplatelet therapy at discharge. Furthermore, non-white individuals had a lower crude QCS than whites (QCS=69.99 vs 73.29, P-value<0.0001). In the multivariable model adjusted for clinical and psychosocial factors, non-white race (LS Mean Difference=-1.49 95%CI -2.87, -0.11, P-value=0.0344) was independently associated with a lower in-hospital QCS. Conclusion: Non-white individuals with AMI exhibited higher rates of adverse psychosocial and clinical characteristics than white individuals yet non-white race was independently associated with lower in-hospital quality of care. Interventions are needed to improve quality of AMI care in non-white young adults.

QUALITY OF CARE IN INVESTOR-OWNED VERSUS NOT-FOR-PROFIT HMOs

2000 ◽  
Vol 1 (2) ◽  
pp. 122-123
Author(s):  
D Himmelstein ◽  
S Woolbandler ◽  
I Hellander ◽  
S Wolfe
Keyword(s):  
Quality Of Care ◽  
For Profit ◽  
Not For Profit

Quality of Care in Profit vs Not-For-Profit Dialysis Centers

JAMA ◽  
2003 ◽  
Vol 289 (23) ◽  
pp. 3088-3088 ◽  
Author(s):  
J. S. Lyons
Keyword(s):  
Quality Of Care ◽  
For Profit ◽  
Not For Profit

scholarly journals How Do Hospitals Respond to Price Changes?

2005 ◽  
Vol 95 (5) ◽  
pp. 1525-1547 ◽  
Author(s):  
Leemore S Dafny
Keyword(s):  
Quality Of Care ◽  
Policy Reform ◽  
Financial Incentive ◽  
Price Changes ◽  
For Profit ◽  
Price Increases ◽  
Diagnosis Codes ◽  
Do So

This paper examines hospital responses to changes in diagnosis-specific prices by exploiting a 1988 policy reform that generated large price changes for 43 percent of Medicare admissions. I find hospitals responded primarily by “upcoding” patients to diagnosis codes with the largest price increases. This response was particularly strong among for-profit hospitals. I find little evidence hospitals increased the volume of admissions differentially for diagnoses subject to the largest price increases, despite the financial incentive to do so. Neither did they increase intensity or quality of care in these diagnoses, suggesting hospitals do not compete for patients at the diagnosis level.

Profits in Medicine: A Context and an Accounting

1978 ◽  
Vol 8 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Gelvin Stevenson
Keyword(s):  
Health Care ◽  
Final Section ◽  
Health Care Expenditures ◽  
Relative Growth ◽  
Non Profit ◽  
Price Controls ◽  
For Profit ◽  
Before And After ◽  
The U.S

The U.S. health care industry is composed of a dynamic mixture of profit and non-profit entities. These sectors sometimes compete in the same activities and may have virtual monopolies over other activities. Estimates of the relative and absolute sizes and growth trends of the profit and non-profit sectors are developed in this article. These estimates show that approximately 39 percent of total health care expenditures in the U.S. in 1975 went to for-profit institutions, generating $3.3 billion in profit. This represented 7 percent of for-profit and 2.8 percent of total expenditures. Some for-profit subsectors grew more rapidly and others less rapidly than total health care expenditures. As a whole, the for-profit sector grew faster than the non-profit sector before and after Medicare and Medicaid were introduced as well as during the period when price controls were in effect. The relative growth of the for-profit sector was greatest right after the introduction of Medicare and Medicaid. The true significance of profit lies not in numbers, but in the effects that the drive for profit have on the nature and quality of health and health care. This is discussed in the final section.

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