measuring the output of health in the united states workshop on measurement of non-market output in...
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Measuring the Output of Health in the United StatesWorkshop on Measurement of Non-Market Output in Education and Health
Michael S. ChristianU.S. Bureau of Economic Analysis
October 4, 2006
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Two Projects in Health Economics
Home and volunteer production
Direct volume measurement
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Direct Volume Measurement
Real health care services measured in U.S. GDP accounts by price deflation CPI, PPI, input price indexes Based on prices of procedures
Direct volume measurement is an interesting alternative
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Inpatient Hospital Services (1)
Volume of inpatient hospital services Simple count of discharges Fisher index of discharges by condition Fisher index adjusted by survival rate
Measuring by condition measures some cost savings as price decreases Substitution to less expensive
procedures
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Inpatient Hospital Services (2)
Survival rate adjustment adapted from Dawson et al (2006)
Two sources on volume, survival rates Nationwide Inpatient Sample (NIS)
National Hospital Discharge Survey (NHDS)
Fisher weights are mean charges by condition from NIS
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Inpatient Hospital Services (3)
Annual volume growth, 1993-2003
NIS NHDS
Simple count 1.1% 1.2%
Fisher index 1.3% 1.6%
Survival adjustment 2.1% 2.5%
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NIS Inpatient Discharges
95
100
105
110
115
120
125
130
1993 1995 1997 1999 2001 2003
Survival adjusted
Fisher index
Simple count
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NHDS Inpatient Discharges
95
100
105
110
115
120
125
130
1993 1995 1997 1999 2001 2003
Survival adjusted
Fisher index
Simple count
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Aggregate Survival Adjustment
95
100
105
110
115
1993 1995 1997 1999 2001 2003
NIS
NHDS
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Inpatient Hospital Services (4)
Large effects from survival adjustment
Indexes only account for cost-saving substitutions within inpatient services Ignores potentially important
substitutions across service categories Aizcorbe and Nestoriak (2006)
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