Certificate of Need Laws and Cardiac Surgery

Certificate of Need (CON) were enacted in order to try to stem the wave of increasing health care costs. In order for hospitals or other providers to expand or build a new facility, CON requires these organizations to get prior government approval. The logic was that when providers expanded medical facilities, supplier-induced demand would increase…

Health Care Efficiency: Academic vs. Vendor Measures

Measuring efficiency in health care is extremely difficult.  If there was an accurate scientific measure of patient health (e.g., a 1-100 scale) before and after treatment.  That way, one could measure changes in health before and after treatment per every dollar spent.  However, measuring health outcomes is very difficult.  In the academic literature, hospital efficiency most commonly…

Medical procedures: What proportion met quality standards?

According the a 2008 Leapfrog Hospital Survey, below are the proportion of each type of medical procedure that met quality standards: Coronary artery bypass graft: 43% Percutaneous coronary interventions: 35% High-risk deliveries: 32% Pancreatic resection: 23% Bariatric surgery: 16% Esophagectomy: 15% Aortic valve replacement: 7% Aortic abdominal aneurysm repair: 5% Source: Binder and Rudolph (HSR…

Front-Line Staff Perspectives

As an economist, I conduct most of my analysis based on the quantitative data.  However, qualitative data should not be overlooked.  A paper by Tucker et al. (2008) looks at how the front-line hospital staff evaluates quality issues.  Some examples of their findings are: The largest number of operational failures occurred in the equipment/supply category.…

Does competition improve health care quality?

If economists decided to re-write the Ten Commandments, “Thou shalt love Competition” may make the list.  However, does competition always improve quality?  Even in the case of health care? A paper by Scanlon et al. (2008) “…found no evidence of a strong and consistent relationship between HMO competition (measured either by the HHI or the…

APGAR Score

P4P.  Evidence-based medicine.  Insurers and policymakers want to be sure that patient insurance premiums are being used towards high quality medical care. One example of quality evaluation in practice is the Apgar Score.  In 1952, Dr. Virginia Apgar developed this metric to evaluate the health of newborns.  Newborns receive a 0, 1, or 2 score on 5…