Assessing the estimands and estimates of hospitalization artes in health economics and clinical medicine

Aditya Jain, Gil Peled, Filip Obradović, Federico Crippa, Yeshaya Nussbaum, Michael Gmeiner, Daniela P. Ladner and Charles F. Manski

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: Even though data on hospital admissions are widely used in health research, hospitalization‐related estimands measured using these data are not always clearly conceptualized. Consequently, estimators of these quantities can have unclear rationales and undesirable properties. We evaluate three “rate” estimators for measuring hospitalization‐related estimands. Using the Gross-man human capital model, we motivate the importance of measuring healthy time. We show that an upper bound on healthytime can be calculated using lengths of hospital stay without assumptions about health status outside the hospital. We illustratethe empirical value of these bounds. Next, we find that an admission rate conventionally used in clinical research is a patient follow‐up time weighted average that lacks a clear basis for the weights. We propose an alternative estimator with more desirable properties and weaker assumptions. We assess its performance using a model of hospital admissions and death. Finally, we evaluate the Centers for Medicare and Medicaid Services (CMS) use of risk‐standardized readmission rates to penalize hospitals by showing that risk‐standardized rates can be sensitive to patient case mix, potentially leading to hospital rankings that do not reflect hospital quality. We propose treating hospital specific intercepts in the CMS risk‐standardization model as a measure of quality.

Keywords: healthcare; health data; hospitalization; household production; medicare (search for similar items in EconPapers)
JEL-codes: D13 I10 (search for similar items in EconPapers)
Date: 2026-06-18
References: Add references at CitEc
Citations:

Published in Health Economics, 18, June, 2026. ISSN: 1057-9230

Downloads: (external link)
https://researchonline.lse.ac.uk/id/eprint/138904/ Open access version. (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:ehl:lserod:138904

Access Statistics for this paper

More papers in LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library LSE Library Portugal Street London, WC2A 2HD, U.K.. Contact information at EDIRC.
Bibliographic data for series maintained by LSERO Manager ().