Econometrics Hospitals Quality

Is Quality of Care within a Hosptial Homogeneous?

According to a paper by Zhang, Hauck and Zhao (2013), the answer is ‘no‘.   Using a Bayesian approach (i.e., three-level random intercept probit mode) the authors find that different specialties within the same hospital can provide very different quality of care to the patients.  The authors summarize their findings as follows:

Of the variation in complication propensity unexplained by observable patient characteristics, we find that a larger proportion is attributable to the lower specialty or departmental level, in particular for emergency patients. This suggests to policy makers that although efforts to implement patient safety initiatives should ideally involve both executive hospital management and medical teams on specialty level, action on the lower level is of prime importance. Variation in complications rates at hospital level as measured by the posterior densities for the hospital level effects confirms this result. These variations are greater for elective than for emergency patients, suggesting that hospital management at higher executive level has greater scope for improving performance in elective than emergency episodes.


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