Supply-side healthcare factors may contribute to the rise from 2001 to 2003 in ADHD medication prescriptions. This finding warrants attention because it implies that the relative capacity of the healthcare system may influence population prescription rates. We encourage further exploration of the contribution of the supply-side of the healthcare market to secular changes in ADHD medication prescriptions.
Objective: To test whether hospital closures hurt or help surrounding hospitals financially. Do hospital closures improve market efficiency or do they merely shift the least profitable patients to hospitals that can better cross-subsidize them? Methods: Using California hospital data from 2000 to 2011, the analysis employed random-effect and fixed-effect models to test for a change in operating margin before and after a series of 2004, 2007 and 2009 hospital closures (the highest volume years for closures). The main independent variable was each hospital's predicted percent increase in patient volume due to absorption from closing hospitals. We used 5-digit zip code and DRG patient flow data to predict the number of patients each open hospital would absorb from nearby hospital closures. Results: Hospitals experiencing the biggest increase in patient volume due to nearby hospital closings saw a drop in operating margin following those closures. This drop could not be explained by changes in payer mix or reimbursement type for those patients. Conclusions: Our results suggest that hospital closures are shifting high cost patients to open hospitals, not necessarily improving efficiency in the market.
Despite the Affordable Care Act's push to improve the coordination of care for patients with multiple chronic conditions, most measures of coordination quality focus on a specific moment in the care process (e.g., medication errors or transfer between facilities), rather than patient outcomes. One possible supplementary way of measuring the care coordination quality of a facility would be to identify the patients needing the most coordination, and to look at outcomes for that group. This paper lays the groundwork for a new measure of care coordination quality by outlining a conceptual framework that considers the interaction between a patient's interdisciplinarity, biological susceptibility, and procedural intensity. Interdisciplinarity captures the degree of specialized medical expertise needed for a patient's care and will be an important measure to estimate the number of specialists a patient might see. We then develop a preliminary measure of interdisciplinarity and run tests linking interdisciplinarity to medical mistakes, as defined by Agency for Healthcare Research and Quality's Patient Safety Indicators. Finally, we use our preliminary measure to verify that interdisciplinarity is likely to be statistically different from existing measures of comorbidity, like the Charlson score. Future research will need to build upon our findings by developing a more statistically validated measure of interdisciplinarity.
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