Hospital Health Outcomes Research Articles

Merchants of Death: The Effect of Credit Supply Shocks on Hospital Outcomes

This study examines the link between credit supply and hospital health outcomes. We use bank stress tests as exogenous shocks to credit access for hospitals that have lending relationships with tested banks. We find that affected hospitals shift their operations to increase resource utilization following a negative credit shock but reduce the quality of their care to patients across a variety of measures, including a significant increase in risk-adjusted readmission and mortality rates. The results indicate that access to credit can affect the quality of health care hospitals deliver, pointing to important spillover effects of credit market frictions on health outcomes. (JEL G21, G32, I11, I18)

Medical Outcomes of Oncology Inpatients With and Without Chaplain Spiritual Care Visit: The Yale New Haven Hospital Experience.

Although there exists some literature on the psychosocial elements of health between patients with and without spiritual care, less information is available on hospital health outcomes. Hence, we aimed to describe and compare health care utilization and outcomes among medical oncology patients who received and did not receive spiritual care consultation during inpatient admission. We conducted a retrospective chart review of medical oncology patients admitted to Yale New Haven Hospital between January 1, 2018, and December 31, 2020, to compare hospital outcomes between patients with and without spiritual care. Thirty-one thousand six hundred twenty-three patients were included, of whom 11,053 (35%) received a chaplain spiritual care visit and had a spiritual care note. Patients who received spiritual care were older and sicker. Readmission rates within 30 days were greater in the spiritual care group (OR = 1.07; P = .018). In addition, patients receiving spiritual care were at greater odds of increased length of stay (β = 4.92; P < .0001), intensive care unit admission (OR = 2.98; P < .0001), hospital death (OR = 1.46; P < .0001), and emergency department visit within 30 days of discharge (OR = 1.17; P < .0001). Patients who were older and sicker had greater spiritual care utilization than their younger and healthier counterparts. Spiritual care assessment of existential distress, complex grief, and faith-based support may be positively associated not only with patient care and quality of life but also with health care utilization and outcomes.

Merchants of Death: The Effect of Credit Supply Shocks on Hospital Outcomes

This study examines the link between credit supply and hospital health outcomes. Using detailed data on hospitals and the banks that they borrow from, we use bank stress tests as exogenous shocks to credit access for hospitals that have lending relationships with tested banks. We find that affected hospitals shift their operations to enhance their profit margins in response to a negative credit shock, but reduce the quality of their care to patients across a variety of measures. In particular, affected hospitals exhibit significantly lower attentiveness in providing timely and effective treatment and procedures, and are rated substantially lower in patient satisfaction. This decline in care quality is reflected in health outcomes: affected hospitals experience a significant increase in risk-adjusted, unplanned 30-day readmission rates of recently discharged patients and in risk-adjusted 30-day patient mortality rates. Overall, the results indicate that access to credit can affect the quality of healthcare hospitals deliver, pointing to important spillover effects of credit market frictions on health outcomes.

Cost inefficiency and hospital health outcomes

This study explores the association between cost inefficiency and health outcomes in a national sample of acute-care hospitals in the US over the period 1999-2001, with health outcomes being measured by both mortality and complications rates. The empirical analysis examines health outcomes as a function of cost inefficiency and other determinants of outcomes, using stochastic frontier analysis to obtain hospital cost inefficiency scores. The results showed no systematic pattern of association between cost inefficiency and hospital health outcomes; the basic results were unchanged regardless of whether cost inefficiency was measured with or without using instrumental variables. The analysis also indicated, however, that the association between cost inefficiency and health outcomes may vary substantially across geographical regions. The study highlights the importance of distinguishing between 'good' costs that reflect the efficient use of resources and 'bad' costs that stem from waste and other forms of inefficiency. In particular, the study's results suggest that hospital programs focused on reducing cost inefficiency are unlikely to be associated with worsened hospital-level mortality or complications rates, while, on the other hand, across-the-board reductions in cost could well have adverse consequences on health outcomes by reducing efficient as well as inefficient costs.