Measuring hospital competition.

Specogna, AV; Patten, SB; Hill, MD; University of Calgary, Calgary, AB Background: Previous studies have examined predictors of treatment costs after Spontaneous Intracerebral Hemorrhage (ICH) in various countries and healthcare systems. Currently however, there is no clear understanding of which factors are associated with cost in any Canadian setting and thus no way of understanding how to plan ICH healthcare spending. Methods: We used a retrospective case series study design and adjusted linear regression to investigate if an association existed between the total cost of ICH hospital care in a Canadian health centre and age (years), gender (female vs. male), Charlson Comorbidity Index (0 vs. ≥1), in-hospital mortality (alive vs. dead), and having surgery (no vs. yes). Economic, treatment, and patient data were obtained from administrative sources. Total inflation-adjusted hospital cost per discharge was estimated in Canadian Dollars and log transformed for all analyses. Results: Analyses were performed using 987 consecutive ICH discharges from 1999 to 2008. The total cost of ICH hospital care was highly variable (mean cost per discharge=$25,613.96±$36,116.33; min $446.81 to max $326,275.10). Older age (β=–0.0057; 95% CI: –0.0103 to –0.0011) and death in hospital (β=–0.4859; 95% CI: –0.6357 to –0.3342) were significantly associated with lower total hospital cost per discharge. Whereas Charlson Comorbidity Index of ≥1 (β=0.6489; 95% CI: 0.5063 to 0.7916) and having surgery (β=1.3552; 95% CI: 1.1893 to 1.5210) were significantly associated with higher total hospital cost per discharge. Gender was not significantly associated with cost (β=0.0727; 95% CI: –0.0679 to 0.2134). Conclusions: To our knowledge this is the first study to examine predictors of ICH treatment costs in Canada. In a Canadian health centre, ICH treatment costs were significantly associated with patient age, level of comorbidity, in-hospital mortality, and surgical treatment. This study provides evidence that it may be reasonable to consider …

Adaptive Firm Structure Under Market Competition: Efficiency, Incentives, and Risk Control

Economics of total quality management

Which Matters: Demand of Bond or Supply of Bond?

Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care

Food insecurity and hunger are major challenges in many Ethiopian communities with repercussions on health and nutrition outcomes in vulnerable household members. Depending on the context, a combination of supply and demand factors, community and institutional factors may affect household food insecurity and hunger. Our objective was to determine the degree of household food insecurity and hunger, and examine the contribution of associated contextual factors, in two rural communities of Ethiopia, namely Halaba and Zeway, located in two adjacent regions of the country (SNNPR and Oromiya Regions, respectively). A sample of 630 households were randomly selected from the two districts, and levels of food insecurity and hunger were measured using the Household Food Insecurity Access Scale and Household Hunger Scale developed by Food and Nutrition Technical Assistant project (United States Agency for International Development). Multiple classification analysis was employed to explore the effects of key demand (e.g. household size, livestock) and supply (e.g. land size, wealth) factors and community (geographic location) as well as institutional (participation in food security programs) factors on food insecurity and hunger. Household food insecurity was unacceptably high in both districts (95% in Halaba & 67% in Zeway). Household hunger was 38% in Halaba and 18% in Zeway. Both food insecurity and hunger were significantly greater in Halaba (p<0.001), indicating an effect of geographic location. Both supply and demand factors were significant in determining household food insecurity and hunger ( p <0.01); however, supply factors such as women's access to land, land size and wealth had greater influence than the demand factors. Levels of food insecurity and hunger in both communities were very high and of serious concern. We recommend increasing the food supply, and its subsequent accessibility, for households through enhancing women's access to land, improving income through savings and wealth accumulation, introducing more inclusive programs for women's participation and reducing household work‐burden by significantly enhancing productivity of cultivable land. Support or Funding Information The research was supported by the International Development Research Centre (IDRC) and the Department of Foreign Affairs Trade and Development (DFATD), Government of Canada, through the Canadian International Food Security Research Fund (CIFSRF).

The purpose of this study is to indicate how the change in a package of patient care services is related to changes in hospital costs. Based on the empirical results performed, one can argue that the inflation in hospital costs on both a per day and per treated case basis is in part explained by a set of patient care service intensity variables. Results of many studies of hospital cost behavior implicitly support the notion that changes in quality of services are related to changes in hospital costs. Although these studies did not explicitly consider variables for quality, the variables in these other studies embody factors for quality of hospital patient care services [6, 7, 9, 10, 12, 14,17, 20]. In this study, the purpose is to indicate explicitly how the change in a package of patient care services is related to changes in hospital costs. This study stems from observations made in several empirical studies funded by the Social Security Administration. The purpose of those studies was to examine the impact of a particular method for hospital cost containment called prospective reimbursement (PR), on the rise in costs of hospital care [ 1, 2, 5, 11, 15, 24]. One general conclusion of the studies was that the use of hospital services was related to actions taken by hospital decision makers, i.e., administrators, nurses and doctors, to contain the rise in hospital costs. Although the evidence varied, some observations justify the notion that costs and the use of certain quality enhancing patient care services are related. For example, Dowling et. all. [1 1] found that some indicators of ancillary service use were lower in the PR hospitals than in a set of control hospitals. Specifically, they found that the number of laboratory tests per case increased more slowly in PR hospitals than in control hospitals, while the number of X-ray films per case increased faster in the PR hospitals than in control Jeffrey E. Jarrett is a professor in the Department of Management Science at the University of Rhode Island. He has a Ph.D. from New York University and has published articles in several professional journals including Management Science, Decision Sciences, The Journal of Accounting Research, The Journal of Finance, The Accounting Review, The Journal of Business Finance and Accounting, and The Review of Economic and Business Research. Note: The author gratefully acknowledges the comments of Ernest Kurnow and several anonymous referees in earlier drafts of this manuscript. Thanks is also given to Sherry Allison-Cooke and Harvey Zimmerman for permitting the author to gather the appropriate data for the study.

A Total Knee Arthroplasty Preoperative Optimization Program Managed by an Advanced Practice Provider (Physician Assistant) Decreases Complications and Cost: A Pilot Study

The goal of this study was to examine the impact of research activities on hospital costs and lengths of stay in French public hospitals. Our data consist of a random sample of 30000 inpatient stays in 38 hospitals that were extracted from the French Hospital Cost Survey database. Hospital characteristics were added using data from a French national survey and performing a bibliometric study. This is a retrospective study of hospitalizations. We used multilevel modelling. We considered separate models to explain the cost per day and the length of hospital stay (LOS). Research output was defined based on the quartiles of the distribution of the number of impact-weighted scientific publications produced in our sample of hospitals over a 6-year period. Research production was associated with a higher cost of care. The cost per day was 19% higher in hospitals in the 3rd quartile and 42% higher in hospitals in the 4th quartile compared to that in hospitals that were not involved in research activities. This result was sensitive to the type of care under consideration. The effect was stronger in oncology but not significant in routine care. Scientific production did not impact the LOS.

For decades, the prevailing assumption regarding the diffusion of high-cost medical technologies has been that competitive markets favor more aggressive adoption of new treatments by health care providers (ie, the "Medical Arms Race"). However, novel regulations governing the adoption of transcatheter aortic valve replacement (TAVR) may have disrupted this paradigm when TAVR was introduced. The objective of this study was to assess the relationship between the market concentration of physician group practices and the adoption of TAVR in its first years of use. This was a retrospective cohort study. Physician group practices (n=5116) providing interventional cardiology services in the United States from May 1, 2012, to December 31, 2014. The first use of TAVR as indicated by a fee-for-service Medicare claim. Covariates including characteristics of the physician groups (ie, case volume, hospital affiliation, mean patient risk) as well as county-level and market-level characteristics. By the close of 2014, 9.3% of practices had adopted TAVR. Cox proportional hazards models revealed a hazard ratio of 1.26 (95% confidence interval: 1.16-1.37, P<0.001) per 1000 point increase in the physician group practice Herfindahl-Hirschman Index, indicating each 1000 point increase in group practice Herfindahl-Hirschman Index was associated with a 26% relative increase in the rate of TAVR adoption. Adoption of TAVR by physician groups in concentrated markets was potentially a consequence of the unique regulations governing TAVR reimbursement, which favored the adoption of TAVR by physician groups with greater market power. These findings have important implications for how future regulations may shape patterns of technology adoption.

Hospital competition and patient-perceived quality of care: Evidence from a single-payer system in Taiwan

The Influence of Supply and Demand Factors on Aggregate Health Care Expenditure with a Specific Focus on Age Composition

In this paper using historical monthly data on the US oil stocks (Crude Oil and Petroleum Products Ending Stock-coppes), industrial production, energy use for transportation, oil production, and oil imports, we examine whether supply and demand shocks explain the apparent decline in the volatility of the growth of COPPES since about the mid-1980s. We find that nearly 70% of the variation in the US COPPES growth is explained by its supply and demand factors, each sharing about half of this variation. This is on account of sharp decline in the contribution of persistence to the US COPPES growth variation from about 47% in the pre-break period to about 17% in the post-break period. This reduction is taken up by increased contribution of demand and supply factors since mid 1980s, of which growth variances have declined on net since then. This in turn contributes to the stability of the US COPPES growth fluctuations.

Do demand and supply shocks explain USA’s oil stock fluctuations?

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