Spring 2015 Seminar Series

DATE: 2/26/15
LOCATION: E51-395
TIME: 4:15pm
Reception immediately following

SPEAKER:
Joseph Doyle

TITLE
Paying for Quality in US Healthcare: Where’s the Waste?

ABSTRACT
There is widespread agreement that the US healthcare system wastes as much as 5% of GDP, yet little consensus on what care is actually unproductive in part due to endogeneity concerns. This paper uses the effective random assignment of patients to ambulance companies to generate comparisons across similar patients treated at different hospitals. We find that assignment to hospitals whose patients receive large amounts of care over the three months following a health emergency do not have better survival outcomes compared to hospitals whose patients receive less. Usefully, we find that outcomes are related to different types of treatment intensity: patients assigned to hospitals with high levels of inpatient care are more likely to survive to one year, while those assigned to hospitals with high levels of outpatient care are less likely to do so. Care at skilled nursing facilities (SNF) following hospitalization drive the positive relationship between spending and mortality, offering a new quality measure in addition to the commonly used hospital’s readmission rate: the hospital’s SNF admission rate. When looking for waste in the US healthcare system, downstream care following hospitalization appears to be a good candidate.