A non-parametric investigation of supply side factors and healthcare efficiency in the U.S

Springer Science and Business Media LLC - Tập 54 - Trang 59-74 - 2020
Richard Gearhart1, Nyakundi Michieka1
1California State University Bakersfield, Bakersfield, USA

Tóm tắt

In this study, the supply-side factors affecting healthcare efficiency in the U.S are studied using data between 2010 and 2017. The recently developed non-parametric order-m estimator is used for the analysis. Results suggest that the U.S. has output production that is 87.6-percent of the expected maximum amount, with life expectancy being 3 years too short given healthcare spending and education levels. However, conditioning efficiency estimates on supply-side secondary environmental variables explains 34 to 85-percent of inefficiency found in the average county. This suggests that hospital expenditures are an inefficient mechanism to improve healthcare efficiency, while focus should be placed on the number and composition of healthcare personnel. Our results suggest that lack of access to care due to provider availability is the biggest impediment to timely and successful care, and that increasing the number of primary care providers or nurse practitioners will improve poor health outcomes in many counties. This suggests that healthcare providers are the main avenues to improve healthcare inefficiency on the supply side.

Tài liệu tham khảo

Badin L, Daraio C, Simar L (2012) How to measure the impact of environmental factors in a nonparametric production model. Eur J Operational Res 223:818–833 Baicker K, Chandra A (2004) Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff 23:W184–W197 Bazzoli GJ, Chen HF, Zhao M, Lindrooth RC (2008) Hospital financial condition and the quality of patient care. Health Econ 17(8):977–995 Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A (1995) Preventable hospitalizations and access to health care. JAMA 274(4):305–311 Cazals C, Florens J-P, Simar L (2002) Nonparametric frontier estimation: a robust approach. J Econ 106:1–25 Chowdhury H, Zelenyuk V (2016) Performance of hospital services in Ontario: DEA with truncated regression approach. Omega 63:111–122 British Medical Journal Evidence Centre (2011) Clinical Evidence Handbook. BMJ Publishing Group, London Courtemanche C, Soneji S, Tchernis R (2015) Modeling area-level health rankings. Health Serv Res 50(5):1413–1431 Coyne CA, Demian-Popescu C, Friend D (2006) Social and cultural factors influencing health in southern West Virginia: a qualitative study. Preventing Chronic Dis 3(4):1–8 Daouia A, Gijbels I (2011) Robustness and inference in nonparametric partial frontier modeling. J Econ 161(2):147–165 Daraio C, Simar L (2005) Introducing environmental variables in nonparametric frontier models: a probabilistic approach. J Product Anal 24:93–121 Daraio C, Simar L (2007b) Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach. J Product Anal 28:13–32 Daraio C, Simar L (2007a) Advanced robust and nonparametric methods in efficiency analysis. Springer Science and Business Media, LLC, New York Delamater PL, Messina JP, Grady SC, WinklerPrins V, Shortridge AM (2013) Do more hospital beds lead to higher hospitalization rates? A spatial examination of Roemer’s Law. PLoS ONE 8(2):e54900 Dotson JW, Roll JM, Packer RR, Lewis JM, McPherson S, Howell D (2014) Urban and rural utilization of evidence-based practices for substance use and mental health disorders. J Rural Health 30(3):292–299 Evans D, Tandon A, Murray C, Lauer J (2000). The comparative efficiency of national health systems in producing health: an analysis of 191 countries. GPE Discussion Paper Series No. 29. World Health Organization: Geneva Ferreira D, Marques RC (2016) Should inpatients be adjusted by their complexity and severity for efficiency assessment? Evidence from Portugal. Health Care Manag Sci 19(1):43–57 Ferreira D, Marques R (2019) Do quality and access to hospital services impact on their technical efficiency? Omega 86:218–236 Ferreira D, Nunes A, Marques RC (2018) Economies of scope in the health sector: the case of Portuguese hospitals. Eur J Oper Res 266(2):716–735 Ferreira DC, Nunes AM, Marques RC (2020) Optimizing payments based on efficiency, quality, complexity, and heterogeneity: the case of hospital funding. Int Trans Oper Res 27(4):1930–1961 Ferreira, DC, Marques, RC, & Nunes, AM (2019). Pay for performance in health care: a new best practice tariff-based tool using a log-linear piecewise frontier function and a dual–primal approach for unique solutions. Oper Res 1–46. https://doi.org/10.1007/s12351-019-00502-3 Fisher E (2003) Medical care: is more always better? N. Engl J Med 349:1665–1667 Fisher ES, Wennberg JE, Stukel TA, Sharp SM (1994) Hospital readmission rates for cohorts of Medicare beneficiaries in Boston and New Haven. N. Engl J Med 331:989–995 Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL (2003b) The impliactions of regional variations in Medicare spending: Part 2, health outcomes, and satisfaction with care. Ann Intern Med 138(4):288–298 Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL (2003a) The implications of regional variations in Medicare spending: Part 1, the content, quality, and accessibility of care. Ann Intern Med 138(4):273–287 Fisher ES, Wennberg JE, Stukel TA, Skinner JS, Sharp SM, Freeman JL, Gittelsohn AM (2000) Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res 34(6):1351–1362 Gaynor M, Anderson GF (1995) Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds. J Health Econ 14(3):291–317 Gearhart RS (2016) Non-robustness of cross-country health care rankings among OECD countries. J Appl Econ 19(1):113–144 Gearhart RS, Michieka NM (2018) A comparison of the robust conditional order-m estimation and two stage DEA in measuring healthcare efficiency among California counties. Econ Model 73:395–406 Gearhart RS, Michieka NM (2019) Natural resource abundance and healthcare efficiency in appalachia: a robust conditional approach. Energy Policy 129:985–996 Gearhart RS, Michieka NM (2020) Efficiency of American states after implementation of the Patient Protection and Affordable Care Act (PPACA) From 2014 to 2017. Appl Econ 52(18):1959–1972 Ginsburg PB, Koretz DM (1983) Bed availability and hospital utilization: estimates of the “Roemer effect”. Health Care Financ Rev 5:87–92 Glickman SW, Ou FS, DeLong ER, Roe MT, Lytle BL, Mulgund J, Rumfield JS, Gibler WB, Ohman EM, Schulman KA, Peterson ED (2007) Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA 297(21):2373–2380 Goodman DC, Grumbach K (2008) Does having more physicians lead to better health system performance. JAMA 299(3):335–337 Goodman DC, Fisher E, Little G, Stukel T, Chang C, Schoendorf K (2002) The relation between the availability of neonatal intensive care and neonatal mortality. N Engl J Med 346(20):1538–1544 Health Affairs Ahead of Print: National Health Spending in 2017 (2018). Health Affairs Blog. https://doi.org/10.1377/hblog20181206.671046 Jha AK, Joynt KE, Orav EJ, Epstein AM (2012) The long-term effect of premier pay for performance on patient outcomes. N Engl J Med 366:1606–1615 Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ (2007) The Association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 45(12):1195–1204 Kneip A, Park B, Simar L (1998) A note on the convergence of non-parametric DEA efficiency measures. Econom Theory 14:783–793 Kocher R, Sahni NR (2011) Rethinking health care labor. N Engl J Med 365:1370–1372 Kohl S, Schoenfelder J, Fugener A, Brunner JO (2019) The use of data envelopment analysis (DEA) in healthcare with a focus on hospitals. Health Care Manag Sci 22:245–286 Krakauer H, Jacoby I, Millman M, Lukomnki J (1996) Physician impact on hospital admission and mortality rates in the Medicare population. Health Serv Res 31(2):191–211 Kroneman M, Siegers JJ (2004) The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries. Soc Sci Med 59:1731–1740 Lenz ER, Mundinger MO, Kane RL, Hopkins SC, Lin SX (2014) Primary care outcomes in patients treated by nurse practitioners or physicians: two year follow-up. Med Care Res Rev 61(3):332.351 Litvak E, Bisognano M (2011). More patients, less payment: increasing hospital efficiency in the aftermath of health reform. Health Affairs 30(1): https://doi.org/10.1377/hlthaff.2010.1114 Mastromarco C, Simar L (2018) Globalization and productivity: a robust nonparametric world frontier analysis. Econ Model 69:134–149 Maynard A (2012) The powers and pitfalls of payment for performance. Health Econ 21:3–12 Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY, Cleary PD, Friedewald WT, Siu AL, Shelanski ML (2000) Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA 283(1):59–68 Nayar P, Ozcan YA (2008) Data envelopment analysis comparison of hospital efficiency and quality. J Med Syst 32:193–199 Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M (2011) Nurse staffing and inpatient hospital mortality. N Engl J Med 346:1037–1045 Pasley BH, Lagoe RJ, Marshall NO (1995) Excess acute care bed capacity and its causes: the experience of New York state. Health Serv Res 30:115–131 Remington P, Catlin B, Gennuso K (2015) The county health rankings: rationale and methods. Popul Health Metr 13:11 Ryan AM (2009) The effects of the premier hospital quality incentive demonstration on mortality and hospital costs in medicare. Health Serv Res 44(3):821–842 Shekelle PG (2013) Nurse-patient ratios as a patient safety strategy: a systematic review. Ann Intern Med 158(2):404–409 Shi L (1994) Primary care, specialty care, and life chances. Int J Health Serv 24(3):431–458 Shwartz M, Pekz EA, Labonte A, Heineke J, Restuccia JD (2011) Bringing responsibility for small area variations in hospitalization rates back to the hospital: the propensity to hospitalize index and a test of the Roemer’s Law. Med Care 49:1062–1067 Silow-Carroll S, Alteras T, Meyer JA (2007) Hospital quality improvement: strategies and lessons from US hospitals. Commonwealth Fund Simar L, Wilson PW (2007) Estimation and inference in two-stage, semi-parametric models of production processes. J Econ 136:31–64 Simar L, Wilson PW (2008) Statistical inference in non-parametric frontier models: recent developments and perspectives. In: Ho Fried, Cak Lovell, Ss Schmidt (Eds) The measurement of productive efficiency and productivity growth. Oxford University Press, Oxford, p 421–521 Simar L, Wilson PW (2011) Two-stage DEA: caveat emptor. J Product Anal 36:205–218 Starfield B, Shi L, Macinko J (2005b) Contribution of primary care to health systems and health. Milbank Q 83(3):457–502 Starfield B, Shi L, Grover A, Macinko J (2005a) The effects of specialist supply on populations’ health: assessing the evidence. Health Aff 24:W597–W5107 Sutton M, Nikolova S, Boaden R, Lester H, McDonald R, Roland M (2012) Reduced mortality with hospital pay for performance in England. N Engl J Med 367:1821–1828 Varabyova Y, Muller JM (2016) The efficiency of health care production in OECD countries: a systematic review and meta-analysis of cross-country comparisons. Health Policy 120(3):252–263 Venning P, Durie A, Roland M, Roberts C, Leese B (2000) Randomized controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ 320:1048 Wennberg JE (2010) Tracking medicine: a researcher’s quest to understand health care. Oxford University Press, New York Wennberg, J (2005) Variation in use of Medicare services among regions and selected academic medical centers: Is more better? Technical Report 874, The Commonwealth Fund Werner RM, Kolstad JT, Stuart EA, Polsky D (2011a) The effect of pay-for-performance in hospitals: lessons for quality improvement. Health Aff 30(4):690–698 Werner RM, Kolstad JT, Stuart EA, Polsky D (2011b) The effect of pay-for-performance in hospitals: lessons for quality improvement. Health Aff 30(4):XXXX Wheelock D, Wilson PW (2008) Non-parametric, unconditional quantile estimation for efficiency analysis with an application to Federal Reserve check processing operations. J Econ 145:209–225 De Witte K, Kortelainen M (2013) What explains the performance of students in a heterogeneous environment? Conditional efficiency estimation with continuous and discrete environmental variables. Appl Econ 45:2401–2412