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Health Economics Review

, 3:22

First Online: 21 October 2013Received: 07 March 2013Accepted: 09 October 2013DOI: 10.1186-2191-1991-3-22

Cite this article as: Kruse, M. & Christensen, J. Health Econ Rev 2013 3: 22. doi:10.1186-2191-1991-3-22


An increasing focus on hospital productivity has rendered a need for more thorough knowledge of cost drivers in hospitals, including a need for quantification of the impact of age, case-mix and other characteristics of patients, as well as establishment of the cost-quality relationship.

The aim of this study is to identify cost drivers for vascular surgery in Danish hospitals with a specific view to quality of the treatment: Is higher quality associated with increased costs, when all other cost drivers are accounted for?

We analyse cost drivers in a register-based study, using patient level data from three sources: The Vascular Register, the hospital cost database, and the National Patient Register with added DRG-information. The analysis follows a multilevel set-up, where cost drivers at patient level are analysed in a set of general linear regression models including complications and mortality as quality measures. At the hospital level of the analysis, we analyse deviations of observed costs from risk-adjusted costs and compare these to deviations of observed quality from risk-adjusted quality.

We find, not surprisingly, that a number of patient characteristics, including case-mix and severity, have a major impact on treatment costs. At patient level, both complications and mortality are associated with increased costs. At hospital department level, results are not straightforward, but could indicate a U-shaped association.

We conclude that the relation between costs and quality is not straightforward, at least not at department level. Our results indicate, albeit vaguely, a U-shaped relation between quality, in terms of fewer surgical complications than expected, and costs at department level, since our results suggest that increasing costs for vascular departments are associated with increased quality when costs are high and decreased quality when costs are low. For mortality however, we have not been able to establish a clear relation to costs.

JEL codes: I12- health production; C33 - Models with Panel Data; Longitudinal Data; Spatial Time Series; D24 - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity

KeywordsHospital costs Treatment quality Cost drivers Vascular surgery Electronic supplementary materialThe online version of this article doi:10.1186-2191-1991-3-22 contains supplementary material, which is available to authorized users.

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Autor: Marie Kruse - Jan Christensen


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