NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH
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John Romley

Schaeffer Center for Health Policy and Economics
University of Southern California
3335 S. Figueroa St, Unit A
Los Angeles, CA 90089-7273

E-Mail: EmailAddress: hidden: you can email any NBER-related person as first underscore last at nber dot org
Institutional Affiliation: University of Southern California

NBER Working Papers and Publications

April 2019Quantifying Productivity Growth in Health Care Using Insurance Claims and Administrative Data
with Abe Dunn, Dana Goldman, Neeraj Sood
in Big Data for 21st Century Economic Statistics, Katharine G. Abraham, Ron S. Jarmin, Brian Moyer, and Matthew D. Shapiro
We assess changes in multifactor productivity (MFP) in delivering episodes of care (including that received after initial discharge from a hospital) for elderly Medicare beneficiaries with three important conditions over 2002-2014. Across the conditions, we find that MFP declined during the 2000s and then stabilized. For heart attack, for example, MFP decreased by 15.9% over the study period. While heart-attack patients experienced better health outcomes over time, growth in the cost of care for these episodes dominated. The cost of hospital readmissions among heart-attack patients appears to have increased substantially.
October 2013Identifying the Health Production Function: The Case of Hospitals
with Neeraj Sood: w19490
Estimates of the returns to medical care may reflect not only the efficacy of more intensive care, but also unmeasured differences in patient severity or the productivity of health-care providers. We use a variety of instruments that are plausibly orthogonal to heterogeneity among providers as well as patients to analyze the intensity of care and 30-day survival among Medicare patients hospitalized for heart attack, congestive heart failure and pneumonia. We find that the intensity of care is endogenous for two out of three conditions. The elasticity of 30-day mortality with respect to care intensity increases in magnitude from -0.27 to -0.71 for pneumonia and from -0.16 to -0.33 for congestive heart failure, when we address the identification problem. This finding is consistent with t...
December 2008Hospitals As Hotels: The Role of Patient Amenities in Hospital Demand
with Dana Goldman: w14619
Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital's demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications ...
January 2008How Costly Is Hospital Quality? A Revealed-Preference Approach
with Dana Goldman: w13730
One of the most important and vexing issues in health care concerns the cost to improve quality. Unfortunately, quality is difficult to measure and potentially confounded with productivity. Rather than relying on clinical or process measures, we infer quality at hospitals in greater Los Angeles from the revealed preference of pneumonia patients. We then decompose the joint contribution of quality and unobserved productivity to hospital costs, relying on heterogeneous tastes among patients for plausibly exogenous quality variation. We find that more productive hospitals provide higher quality, demonstrating that the cost of quality improvement is substantially understated by methods that do not take into account productivity differences. After accounting for these differences, we find that ...

Published: Romley, J. A. and Goldman, D. P. (2011), How Costly is Hospital Quality? A Revealed-Preference Approach. The Journal of Industrial Economics, 59: 578–608. doi: 10.1111/j.1467-6451.2011.00468.x citation courtesy of

 
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