The Department of Public Policy and Administration, Ben-Gurion University of the Negev, POB 653, Beer-Sheva 84105, Israel.
Faculty of Management, Lev College of Technology, Havaad Haleumi 21 St., Givat Mordechai, Jerusalem 9116001, Israel.
Int J Environ Res Public Health. 2019 Mar 2;16(5):761. doi: 10.3390/ijerph16050761.
We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures of clinical scores, as well as a rich set of covariates, we found that the relationship was indeed hump-shaped. At the two extremes, departments with an insufficient (excessive) number of physicians may gain a substantial increase in healthcare quality by the addition (dismissal) of a single physician. The marginal elasticity of healthcare quality with respect to the number of physicians, although positive and significant, was much smaller than the marginal contribution of other factors. Moreover, research quality conducted at the ward level was shown to be an important moderator. Our results suggest that studying the relationship between the number of physicians per bed and the quality of healthcare at an aggregate level may lead to bias. Framing the problem at the ward-level may facilitate a better allocation of physicians.
我们通过关注病房层面的医师队伍规模与医疗保健结果之间的联系，为关于更多医疗保健支出是否与更好的结果相关的争论增添了一个新视角。根据标准的组织理论，我们提出由于组织限制，医师队伍规模与医疗绩效之间的关系呈驼峰形。我们使用了一个涵盖三个专业的 150 个美国大学系的样本，记录了临床评分的衡量标准以及一系列丰富的协变量，结果发现这种关系确实呈驼峰形。在两个极端，医师人数不足（过多）的系通过增加（解雇）一名医师，可以显著提高医疗质量。尽管医疗质量对医师人数的边际弹性是正的且显著的，但它远小于其他因素的边际贡献。此外，在病房层面进行的研究质量被证明是一个重要的调节因素。我们的研究结果表明，在总体水平上研究每床医师人数与医疗保健质量之间的关系可能会导致偏差。在病房层面上提出问题可以促进医师更好地分配。
