Expense preference behavior and management “outsourcing”: a comparison of adopters and non-adopters of contract management in U.S. hospitals

Carey, Kathleen; Dor, Avi

doi:10.1007/s11123-007-0065-3

Cited by 7 publications

(3 citation statements)

References 36 publications

(39 reference statements)

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“…We adopt this approach to examine the relationship between different nursing staff inputs and patient satisfaction measures in hospitals. We posit a general production function of the form: Y = F ( N 1 , N 1 2 , N 1 3 , N 2 , N 2 2 , N 2 3 , D , W , K : H , S ), where Y , the “output” being produced, here, is the level of patient satisfaction; N is the vector of nursing inputs, measured in hours (e.g., N 1 = NAs, N 2 = RNs); D = physician inputs; W = all other hospital staff (a residual category); K measures the hospital’s capital stock—typically given by number of beds (Carey, 2000; Carey & Dor, 2008; Dor & Farley, 1996). All effects are conditioned on hospital characteristics ( H ), including for-profit/nonprofit status, case mix index (CMI), and teaching status and state-level characteristics ( S ) such as minimum nurse staffing laws and state fixed effects.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach

2020

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Hospitals have increasingly relied on nurse assistants to support nurses in the provision of patient care, yet knowledge about their contributions to the patient experience in U.S. hospitals is limited. We address this issue by exploring the impact of nurse assistants and registered nurses on an array of patient satisfaction measures from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. Using linked data for 2,807 hospitals from 2008 to 2016, we employ a production function approach to estimate and plot marginal impact curves for both nurse assistants and registered nurses. We find that although registered nurses are more impactful, nurse assistants are the more underdeployed staffing category. We also find that after meeting certain thresholds for minimal hours, nurse assistants have a comparative advantage in improving patient satisfaction scores in the housekeeping and patient support domain. Given their lower labor costs, further employment of nurse assistants may be warranted.

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Section: Conceptual Frameworkmentioning

confidence: 99%

The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach

2020

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“…First, we assume that large chain-affiliated and small chain/unaffiliated homes have different production functions for quality. This is plausible, as large chains are characterized by separation of ownership and control, which may make it more difficult to produce at a very high quality level (see Dor et al (1997) and Carey and Dor (2008) for an application of this argument to hospitals). To explore the implications of this, we consider the limiting case where large chains are unable to provide marginal quality beyond a certain threshold whereas small chains and independents are able to provide this higher quality.…”

Section: A Model Of Defensive Behavior By Large Chainsmentioning

confidence: 99%

Are firms with ‘deep pockets’ more responsive to tort liability? Evidence from nursing homes

Brickley

Wedig

2022

Health Economics

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We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic damages for health care services. Small chain and unaffiliated nursing homes enjoyed “judgment proof standing” and were less apt to be sued, prior to reform. We find that the managers of such homes were relatively unresponsive to the implementation of state caps on noneconomic damages. Large “deep‐pocketed” chain‐affiliated homes lacked judgment proof standing and implemented greater reductions in their nursing inputs in the aftermath of tort relief. However, we find little evidence of service quality erosion across four measured dimensions of care outcomes. Our findings are consistent with a “defensive care” model in which large chain homes employ unproductive inputs in an effort to meet a negligence standard of care.

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“…Limited evidence concerning relative hospital performance suggests that contract management may improve hospital efficiency. 1–3 Yet, while the trade literature offers some anecdotal discussion, 4,5 there is a lack of systematic evidence on the possible mechanisms by which contract managers attempt to realize efficiency gains and at what social costs.…”

Section: Introductionmentioning

confidence: 99%

Contract management in USA hospitals: service duplication and access within local markets

Carey

Dor

2008

Health Serv Manage Res

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This paper examines the extent to which hospitals that are under external contract management engage in service duplication, as well as the degree to which the various services they offer contribute to or detract from community access. The study incorporates all USA hospitals using data from the American Hospital Association Annual Survey Database, supplemented by county level measures obtained from the area resource file (ARF). Using data on the 3794 hospitals classified as acute care facilities in 2002, we performed a set of logistic regressions that analyzed whether a hospital offered each of 74 distinct services. For each service (regression), key independent variables measured the number of other hospitals in the local market area that also offered the service. Local area market definitions are the areas circumscribed by the hospital within distances of 10 and 20 miles. Results suggest that contract-managed (CM) hospitals display a more competitive pattern (service duplication) than hospitals in general, but CM hospitals that are the sole provider of services locally are less likely to offer services than traditionally managed sole hospital providers. Contract management does not appear to offer any particular advantages in improving access to hospital services.

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Expense preference behavior and management “outsourcing”: a comparison of adopters and non-adopters of contract management in U.S. hospitals

Abstract: Expense preference, Hospitals, Contract management, D24, L24,

Cited by 7 publications

References 36 publications

The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach

The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach

Are firms with ‘deep pockets’ more responsive to tort liability? Evidence from nursing homes

Contract management in USA hospitals: service duplication and access within local markets

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