Abstract
ABSTRACTThis study investigates whether highly skilled health care providers are at a disadvantage because they attract difficult cases, by examining all publicly funded patient discharges in New Zealand over 1999–2011. Using a patient's transfer status and the complication and co-morbidity level as the measures of task difficulty, the effects of task difficulty on three performance indicators commonly used in practice, the length of hospital stay and the probabilities of 30-day mortality and readmission, are calculated. The results confirm that the disadvantage does exist, but certain providers do better in the presence of such disadvantage. Even among highly skilled providers, the variance in performance is large. The results also suggest that specialisation may be beneficial, as transferred cases treated by highly skilled providers have better outcomes. In particular, the provider treating the most complex cases in the country achieves the best outcomes for transferred patients.
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