Hospital Cost Analysis

Přední strana obálky
Springer Science & Business Media, 31. 1. 1995 - Počet stran: 393
Hospital Cost Analysis provides an overview of theoretical developments in the economic analysis of production and costs in the multiproduct firm, and discusses these developments. Following a lucid explanation of the concepts of jointness, input/output separability and returns to scale, a detailed discussion of the concept measurement and classification of hospital output is provided. A fundamental dilemma confronting economists interested in estimating hospital cost functions is highlighted, viz. the trade-off between flexibility in functional form and homogeneity within hospital output categories. Empirical results on the effects of case mix, scale and utilisation, public/private ownership, and the centralised administration of hospital systems on hospital costs are presented. The implications of hospital cost analysis for public policy with respect to hospital payment schemes, including schemes based on Diagnosis Related Groups (DRGs), are also considered. This book brings together the literature on hospital cost analysis with theoretical developments in the analysis of the multiproduct cost functions. It will be of considerable interest to teachers and students of health economics and health policy advisers interested in the determinants of hospital costs and the design of hospital payment schemes.
 

Obsah

Introduction
xxiii
THEORETICAL CONSIDERATIONS
5
The Economic Theory of Production and Cost in the Multiproduct Firm
7
22 Multiproduct Production Functions
9
222 InputOutput Separability
13
223 Returns to Scale
14
23 Multiproduct Cost Functions
15
232 InputOutput Separability
19
72 Theory and Specification
216
722 Teaching Output and the Specification of the Cost Function
221
73 Differences Between Teaching and Non Teaching Hospitals
222
732 CostVolume Differences
223
733 Case Mix Differences18 and 47 Diagnostic Categories
226
734 Case Mix DifferencesOther Case Mix Dimensions
232
74 Empirical Results on the Effects of Teaching on Hospital Costs
233
75 Summary and Conclusions
245

234 NonJointness and InputOutput Separability
22
235 InputOutput Separability and Overall Constant Returns to Scale
24
237 NonJointness InputOutput Separability and Overall Constant Returns to Scale
27
24 Joint and Common Costs
28
25 Specific Functional Forms
31
251 The Generalised LinearGeneralised Leontief Cost Function
32
252 The Translog Cost Function
34
26 Selected Empirical Examples
35
27 Summary and Conclusions
39
NonJointness Overall and ProductSpecific Returns to Scale
41
The Concept Measurement and Classification of Hospital Output
43
32 Conceptual Issues
44
322 The Concept of Output
46
33 The Unit of Measurement
53
332 Cases vs Days
57
34 The Classification of Output
66
341 Case Mix Classification Schemes
67
342 Scalar Case Mix Indexes
74
35 Summary and Conclusions
80
EMPIRICAL RESULTS
83
The Queensland Public Hospital SystemAn Overview
85
43 Interstate Differences
88
44 Summary and Conclusions
95
The Effect of Case Mix on Hospital CostsEvidence from Queensland
99
53 The Data
107
532 Hospital Finance Data
108
54 Descriptive Statistics
109
55 Empirical Results
115
552 The Multicollinearity Problem
127
553 Principal Components Analysis
133
554 Information Theory Indexes
142
56 Summary and Conclusions
153
Characteristic Roots Characteristic Vectors and Multicollinearity
156
The Derivation of Principal Components
163
The Effects of Scale Utilisation and Input Prices on Hospital CostsEvidence from Queensland
169
62 Definition and Measurement Issues
171
622 Measuring Scale and Utilisation
173
623 Measuring Input Price Differences
176
Specification
177
64 Descriptive Statistics
185
65 Empirical Results
188
652 Scale and Utilisation with Disaggregated Case Mix Classifications197879 to 198081
204
653 Scale and Utilisation with Information Theory Case Mix Indexes197778
206
654 Input Price Differences
211
66 Summary and Conclusions
212
A Comparison of the Costs of Teaching and NonTeaching Public Hospitals in Queensland
215
A Comparison of Public and Private Hospital Costs in Queensland
247
82 Theoretical Background
248
83 Differences between Public and Private Hospitals in Queensland
253
832 Private Hospital Data
254
833 CostVolume Differences
255
834 Case Mix Differences
256
84 Empirical Analysis of Cost Differences
260
841 Specification
261
843 Results with Public Hospital Medical Salaries and Private Hospital Outpatient Costs Excluded
265
85 Summary and Conclusions
268
A Comparison of Public Hospital Costs in Queensland and New South Wales
271
92 The Grants Commission Procedures
273
93 Descriptive Statistics
275
932 CostVolume Characteristics
276
Case Mix Differences
278
94 Empirical Results on the Causes of Interstate Cost Differences
279
941 Separate State Estimates
282
Pooled Results
286
943 Effects of Other Adjustments
290
95 Summary and Conclusions
293
HOSPITAL COST ANALYSIS AND HOSPITAL PAYMENT SCHEMES
295
A Hospital Performances Appraisal and Payment Scheme based on Estimated Cost Functions
297
1022 The Cost per CaseCost per DayLength of Stay Relationship
302
1023 Cost per Day Predictions
303
1024 Length of Stay Predictions
304
1025 Disaggregating Cost per Case by Input Components
306
1031 The Estimated Cost per Day Equations
307
1032 Costliness Ratios and the Relative Stay Index
311
1033 Prediction Intervals and Costliness Ratios for Input Components
316
104 Some Problems
321
1042 Multicollinearity and Prediction
322
1043 Replication with other Methods of Estimation
323
105 Summary and Conclusions
324
Proof that the Sum of Predicted Input Component Costs per Case Equals Predicted Average Cost per Case
326
The DRG Hospital Payment Scheme Some Economic Aspects
329
112 The DRO Hospital Payment Scheme
331
113 Hospital Costs and the DRG Payment Scheme
333
1132 Application to the DRG Payment Scheme
336
114 Predicting Hospital Case Mix
342
115 Summary and Conclusions
350
Conclusion
353
References
361
Index of Names
378
Index of Subjects
384
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