The causal effect of hospital volume on health gains from hip replacement surgery

Laurie Rachet Jacquet; Nils Gutacker; Luigi Siciliani

The causal effect of hospital volume on health gains from hip replacement surgery

Laurie Rachet Jacquet, Nils Gutacker, Luigi Siciliani

Research output: Working paper › Discussion paper

Abstract

This study investigates the causal effect of hospital volume on health gains from hip replacement
surgery in the English National Health Service. We exploit a unique dataset, which links routine
hospital records and patient-reported outcome measures (PROMs) for all public hospitals in England.
PROMs assess patients’ health along key dimensions of pain and mobility shortly before and six
months after the surgery. We investigate whether higher hospital volume increases patient health
six months post-surgery, conditioning on pre-surgery health and other patient medical and
socioeconomic indicators. We address possible reverse-causality bias due to hospital demand being
responsive to quality by constructing a measure of predicted hospital volumes based on a patient
choice model. The results suggest that the observed volume-outcome effect in hip replacement
surgery is clinically small and no longer statistically significant once we account for the endogeneity
of volume.

Original language	English
Place of Publication	York, UK
Publisher	Centre for Health Economics, University of York
Number of pages	32
Publication status	Published - Aug 2019

Publication series

Name	CHE Research Paper
Publisher	Centre for Health Economics, University of York
No.	168

Keywords

quality
hospital
volumes
learning-by-doing
patient reported outcomes

Access to Document

CHERP168_hospital_volume_health_gainsFinal published version, 1.77 MB

https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP168_hospital_volume_health_gains.pdf

Cite this

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title = "The causal effect of hospital volume on health gains from hip replacement surgery",

abstract = "This study investigates the causal effect of hospital volume on health gains from hip replacementsurgery in the English National Health Service. We exploit a unique dataset, which links routinehospital records and patient-reported outcome measures (PROMs) for all public hospitals in England.PROMs assess patients{\textquoteright} health along key dimensions of pain and mobility shortly before and sixmonths after the surgery. We investigate whether higher hospital volume increases patient healthsix months post-surgery, conditioning on pre-surgery health and other patient medical andsocioeconomic indicators. We address possible reverse-causality bias due to hospital demand beingresponsive to quality by constructing a measure of predicted hospital volumes based on a patientchoice model. The results suggest that the observed volume-outcome effect in hip replacementsurgery is clinically small and no longer statistically significant once we account for the endogeneityof volume.",

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AU - Gutacker, Nils

AU - Siciliani, Luigi

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N2 - This study investigates the causal effect of hospital volume on health gains from hip replacementsurgery in the English National Health Service. We exploit a unique dataset, which links routinehospital records and patient-reported outcome measures (PROMs) for all public hospitals in England.PROMs assess patients’ health along key dimensions of pain and mobility shortly before and sixmonths after the surgery. We investigate whether higher hospital volume increases patient healthsix months post-surgery, conditioning on pre-surgery health and other patient medical andsocioeconomic indicators. We address possible reverse-causality bias due to hospital demand beingresponsive to quality by constructing a measure of predicted hospital volumes based on a patientchoice model. The results suggest that the observed volume-outcome effect in hip replacementsurgery is clinically small and no longer statistically significant once we account for the endogeneityof volume.

AB - This study investigates the causal effect of hospital volume on health gains from hip replacementsurgery in the English National Health Service. We exploit a unique dataset, which links routinehospital records and patient-reported outcome measures (PROMs) for all public hospitals in England.PROMs assess patients’ health along key dimensions of pain and mobility shortly before and sixmonths after the surgery. We investigate whether higher hospital volume increases patient healthsix months post-surgery, conditioning on pre-surgery health and other patient medical andsocioeconomic indicators. We address possible reverse-causality bias due to hospital demand beingresponsive to quality by constructing a measure of predicted hospital volumes based on a patientchoice model. The results suggest that the observed volume-outcome effect in hip replacementsurgery is clinically small and no longer statistically significant once we account for the endogeneityof volume.

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