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    <title>EconStor Collection: hche Research Papers, Hamburg Center for Health Economics, Universität Hamburg</title>
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    <title>EconStor</title>
    <url>http://www.econstor.eu/retrieve/100009</url>
    <link>http://hdl.handle.net/10419/65668</link>
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    <title>Changes in hospital efficiency after privatization</title>
    <link>http://hdl.handle.net/10419/65673</link>
    <description>Title: Changes in hospital efficiency after privatization
&lt;br/&gt;
&lt;br/&gt;Authors: Tiemann, Oliver; Schreyögg, Jonas
&lt;br/&gt;
&lt;br/&gt;Abstract: We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped DEA efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 3.2 and 5.4%. We defined four alternative post-privatization periods and found that the increase in efficiency after a conversion to private for-profit status appeared to be permanent. We also observed an increase in efficiency one year after hospitals were converted to private non-profit status, but our estimations suggest that this effect was transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the DRG era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.</description>
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  <item rdf:about="http://hdl.handle.net/10419/65672">
    <title>Measuring the relationship between costs and outcomes: The example of Acute Myocardial Infarction in German hospitals</title>
    <link>http://hdl.handle.net/10419/65672</link>
    <description>Title: Measuring the relationship between costs and outcomes: The example of Acute Myocardial Infarction in German hospitals
&lt;br/&gt;
&lt;br/&gt;Authors: Stargardt, Tom; Schreyögg, Jonas; Kondofersky, Ivan
&lt;br/&gt;
&lt;br/&gt;Abstract: In this paper, we propose a methodological approach to measure the relationship between hospital costs and health outcomes. We propose to investigate the relationship for each condition or disease area using patient-level data. We suggest to examine health outcomes as a function of costs and other patientlevel variables: (1) using two-stage residual inclusion with Murphy-Topel adjustment to address costs being endogenous to health outcomes, (2) using random-effects models in both stages to correct for correlation between observation, and (3) using Cox proportional hazard models in the second stage to ensure the available information is exploited. To demonstrate its application, data on mortality following hospital treatment for acute myocardial infarction (AMI) from a large German sickness was used. Provider reimbursement was used as a proxy for treatment costs. We relied on the Ontario Acute Myocardial Infarction Mortality Prediction Rules as a disease-specific risk-adjustment instrument. 12,284 patients with a treatment for AMI in 2004-2006 were included. Results showed a reduction in hospital costs by 100 to increase the hazard of dying, i.e. mortality, by 0.43%. The negative association between costs and mortality confirms that increased resource input leads to better outcomes for treatment after AMI.</description>
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  <item rdf:about="http://hdl.handle.net/10419/65671">
    <title>Electronic word of mouth about medical services</title>
    <link>http://hdl.handle.net/10419/65671</link>
    <description>Title: Electronic word of mouth about medical services
&lt;br/&gt;
&lt;br/&gt;Authors: Hinz, Vera; Drevs, Florian; Wehner, Jürgen
&lt;br/&gt;
&lt;br/&gt;Abstract: Electronic word of mouth (eWOM) about medical services gains growing popularity from the part of health care users, accompanied with a high reluctance of health care providers towards existing platforms, fearing unqualified, negative reviews driven by motives of vengeance. Purpose of this research is to shed light on the characteristics, content, and motives of eWOM about medical services. Using primary and secondary data of 822 reviews, this study shows that reviews about medical services are positive more often than negative, and that altruistic motives override egoistic motives. Furthermore, why a review is written significantly relates to the review's valence (positive, negative), degree of affectivity, and degree of differentiation. Motives and characteristics also affect the review's content, differentiated in four aspects (medical care, relationships, comfort, and processes). Hence this study counters the arguments of many health care providers and offers new insights in an underresearched field, providing implications for both management and future research.</description>
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  <item rdf:about="http://hdl.handle.net/10419/65670">
    <title>Effect of type of insurance and income on waiting time for outpatient care</title>
    <link>http://hdl.handle.net/10419/65670</link>
    <description>Title: Effect of type of insurance and income on waiting time for outpatient care
&lt;br/&gt;
&lt;br/&gt;Authors: Roll, Kathrin; Stargardt, Tom; Schreyögg, Jonas
&lt;br/&gt;
&lt;br/&gt;Abstract: This paper analyzes the impact of type of insurance, income, and reason for appointment on waiting time for an appointment and waiting time in the physician's practice in the outpatient sector. Data were obtained from a German patient survey conducted between 2007 and 2009. We differentiated between GP and specialist and controlled for socioeconomic, structural, and institutional characteristics as well as interactions between type of insurance and control variables. Our results reveal that private health insurance plays a significant role in faster access to care at GP and specialist practices. Access to care is also highly influenced by the reason for an appointment. We also found that increased income had a negative effect on waiting time in practices and on waiting time for an appointment in GP practices. Whether inequalities in access to health care also impact overall quality of treatment needs to be investigated in future research.</description>
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