Advances in Health Economics and Health Services Research

Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days, and perhaps outpatient visits or numbers of surgeries performed. This simplicity represents an extreme of aggregation, focuses the attention of the analysis entirely on the structure of the organization at the highest levels, and provides no insight into the specific services that might be provided to each patient as well as the characteristics of those patients, which might lead to specialization of their care. This process is fundamentally complex, which makes it especially difficult to model. This table-setting chapter will characterize some of the key contextual choices that must be made by researchers in this field which are then applied in subsequent chapters. The key point of this chapter will be to argue that there are very few “one size fits all” decisions in this process and thus the context of particular research objectives and questions will determine how modeling choices are made in practice. Some intuition about how these decisions have substantial implications for outcomes of measurement for hospital productivity will be provided; however, no attempt will be made to conduct a literature review of all the choices that have been made. Instead, we will suggest that new careful attention to the choices made can make future studies more effective in communicating to the communities implementing the research.