Romley John A, Goldman Dana P
University of Southern California, Los Angeles, and the RAND Corporation.
J Ind Econ. 2011;59(4):578-608. doi: 10.1111/j.1467-6451.2011.00468.x.
We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate ‘revealed quality’ into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs.
我们分析了医院质量改进的成本，应对两个挑战。医院质量是多维度的且难以衡量，而未观测到的生产率可能会影响质量供给。我们从患者选择中推断洛杉矶医院的质量。然后，我们将“显示质量”纳入成本函数，以医院需求作为工具变量。我们发现，显示质量能够区分不同医院，但与临床质量的相关性并不强。显示质量成本颇高，且往往会随着医院生产率的提高而增加。因此，医院体验的非临床方面（可能包括患者便利设施）在医院需求、竞争和成本方面发挥着重要作用。
