Different modes of hospital-physician relationships ▣Modes: a“Physicians'workbench”(Majority in US) Physicians not directly employed by hospital ▣Direct employees(UK NHS;US“hospitalists”) Physician-owned hospitals(Japan;US) Tradeoffs between the different modes: o Physician loyalty to hospital or the patient? o Doctors without connection to the hospital may overuse hospital resources Bhattacharya,Hyde and Tu-HealthEconomics
Bhattacharya, Hyde and Tu – Health Economics Different modes of hospital-physician relationships Modes: “Physicians’workbench” (Majority in US) ◼ Physicians not directly employed by hospital Direct employees (UK NHS; US “hospitalists”) Physician-owned hospitals (Japan; US) Tradeoffs between the different modes: o Physician loyalty to hospital or the patient? o Doctors without connection to the hospital may overuse hospital resources
Positive volume-outcome correlation Surgical mortality rates decrease with increased hospital volume Table 6.1.Surgical mortality rates for various Medicare procedures,by hospital volume. Hospital volume Procedure Lowest 20% Middle 20% Highest 20% Coronary-artery bypass grafting" 6.1 5.3* 4.8 Aortic-valve replacement 9.9 9.1* 7.6 Carotid endarterectomy 2.0 1.8* 1.7* Pancreatic resectiond 17.6 11.6* 3.8* Nepherectomy 3.6 2.7* 2.6 Learning-by-doing hypothesis High volume leads to good outcomes Selective-referral hypothesis Good outcomes leads to high volume Bhattacharya,Hyde and Tu-HealthEconomics
Bhattacharya, Hyde and Tu – Health Economics Surgical mortality rates decrease with increased hospital volume Learning-by-doing hypothesis High volume leads to good outcomes Selective-referral hypothesis Good outcomes leads to high volume Positive volume-outcome correlation