Assessing the Estimands and Estimates of Hospitalization Rates in Health Economics and Clinical Medicine
Aditya Jain,
Gil Peled,
Filip Obradovic,
Federico Crippa,
Yeshaya Nussbaum,
Michael Gmeiner,
Daniela Ladner and
Charles Manski
No 33768, NBER Working Papers from National Bureau of Economic Research, Inc
Abstract:
Even though data on hospital admissions are widely used in health research, hospitalization-related quantities 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 quantities that are of interest in health economics and clinical medicine subspecialities. Using the Grossman human capital model, we motivate the importance of measuring healthy time. We show that an upper bound on healthy time can be calculated using lengths of hospital stay without assumptions about health status outside the hospital. 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 evaluate the Centers for Medicare and Medicaid Services (CMS) use of risk-standardized readmission rates to penalize hospitals under the Hospital Readmissions Reduction Program (HRRP) and find that it may inadvertently conflict with disease-specific care aimed at reducing mortality risk. We show that risk-standardized rates can be sensitive to patient case mix, potentially leading to hospital rankings that do not reflect hospital quality. We also summarize debates regarding the effectiveness of risk-standardized readmission rates in reducing readmissions.
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2025-05
New Economics Papers: this item is included in nep-hea
Note: EH
References: View references in EconPapers View complete reference list from CitEc
Citations:
Downloads: (external link)
http://www.nber.org/papers/w33768.pdf (application/pdf)
Access to the full text is generally limited to series subscribers, however if the top level domain of the client browser is in a developing country or transition economy free access is provided. More information about subscriptions and free access is available at http://www.nber.org/wwphelp.html. Free access is also available to older working papers.
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:nbr:nberwo:33768
Ordering information: This working paper can be ordered from
http://www.nber.org/papers/w33768
The price is Paper copy available by mail.
Access Statistics for this paper
More papers in NBER Working Papers from National Bureau of Economic Research, Inc National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.. Contact information at EDIRC.
Bibliographic data for series maintained by ().