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. 1988 Feb;22(6):821–836.

Why are urban hospital costs so high? The relative importance of patient source of admission, teaching, competition, and case mix.

K E Thorpe 1
PMCID: PMC1065477  PMID: 3126164

Abstract

This article examines factors accounting for higher costs in urban hospitals as well as their relative contribution to those costs. The costs of urban hospitals are influenced by case mix, wages, competition, the ratio of forecasted to actual admissions, teaching, and the percentage of patients admitted through the emergency room. The bulk of the higher costs in urban hospitals are linked to graduate medical education. Treatment of poor patients and the admission of patients through the emergency room also contribute to the higher costs. Higher inpatient costs stemming from outpatient activities pose distributional problems for hospitals when these costs are not accounted for in prospective (inpatient) rate-setting programs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson G. F., Lave J. R. Financing graduate medical education using multiple regression to set payment rates. Inquiry. 1986 Summer;23(2):191–199. [PubMed] [Google Scholar]
  2. Chamberlain M. A., Care G., Harfield B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehabil Med. 1982;4(2):101–106. doi: 10.3109/09638288209166889. [DOI] [PubMed] [Google Scholar]
  3. Feder J., Hadley J., Mullner R. Falling through the cracks: poverty, insurance coverage, and hospital care for the poor, 1980 and 1982. Milbank Mem Fund Q Health Soc. 1984 Fall;62(4):544–566. [PubMed] [Google Scholar]
  4. Grannemann T. W., Brown R. S., Pauly M. V. Estimating hospital costs. A multiple-output analysis. J Health Econ. 1986 Jun;5(2):107–127. doi: 10.1016/0167-6296(86)90001-9. [DOI] [PubMed] [Google Scholar]
  5. Knickman J. R., Foltz A. M. A statistical analysis of reasons for East-West differences in hospital use. Inquiry. 1985 Spring;22(1):45–58. [PubMed] [Google Scholar]
  6. Pauly M. V., Wilson P. Hospital output forecasts and the cost of empty hospital beds. Health Serv Res. 1986 Aug;21(3):403–428. [PMC free article] [PubMed] [Google Scholar]
  7. Robinson J. C., Luft H. S. The impact of hospital market structure on patient volume, average length of stay, and the cost of care. J Health Econ. 1985 Dec;4(4):333–356. doi: 10.1016/0167-6296(85)90012-8. [DOI] [PubMed] [Google Scholar]
  8. Roemer M. I., Hopkins C. E., Carr L., Gartside F. Copayments for ambulatory care: penny-wise and pound-foolish. Med Care. 1975 Jun;13(6):457–466. doi: 10.1097/00005650-197506000-00002. [DOI] [PubMed] [Google Scholar]
  9. Sloan F. A., Valvona J. Uncovering the high costs of teaching hospitals. Health Aff (Millwood) 1986 Fall;5(3):68–85. doi: 10.1377/hlthaff.5.3.68. [DOI] [PubMed] [Google Scholar]
  10. Thorpe K. E. The distributional implications of using relative prices in DRG payment systems. Inquiry. 1987 Spring;24(1):85–95. [PubMed] [Google Scholar]

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