caa a22 4500 445332123 CHVBK 20180317142740.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s10198-010-0268-9 doi (NATIONALLICENCE)springer-10.1007/s10198-010-0268-9 Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments? [Elektronische Daten] [Anne Hvenegaard, Jacob Arendt, Andrew Street, Dorte Gyrd-Hansen] Objective: The purpose is to evaluate the relationship between costs and quality and to assess whether the joint evaluation of costs and quality affects the ranking of hospital departments relative to comparison based on costs alone. Methods: Using patient level data for 3,754 patients in six vascular departments, we estimate fixed effect models for costs (linear) and quality (logistic). We consider two quality measures; mortality and wound complications. To assess whether the joint evaluation of costs and quality affects the ranking of departments, we construct joint confidence regions for each pair of departmental effects for costs and quality using a bootstrap method and rank departments according to their cost-effectiveness ratio. The findings are used to evaluate a theory of a U-shaped cost/quality relationship. Results: The association between cost and quality differs depending on how quality is measured. Lower costs are associated with higher mortality, implying a cost/quality trade-off. In contrast, there is no clear association between costs and wound complications among vascular departments. Conclusions: Compared to benchmarking of departments based solely on their costs, we show that the ranking of departments may be altered considerably when quality is taken into account. Consequently, it is important to have a well-rounded view of departmental objectives when undertaking performance evaluation. The results for mortality may lend some support to the theory of a U-shaped cost/quality relationship. However, the results for wound complications do not support the theory of a U-shaped cost/quality relationship. Springer-Verlag, 2010 Hospital costs nationallicence Efficiency nationallicence Quality nationallicence Cost-effectiveness nationallicence Hvenegaard Anne Danish Institute for Health Services Research, 27-29 Dampfaergevej, 2100, Copenhagen, Denmark aut Arendt Jacob Institute for Public Health—Health Economic Unit, University of Southern Denmark, Odense, Denmark aut Street Andrew Centre for Health Economics, University of York, York, UK aut Gyrd-Hansen Dorte Danish Institute for Health Services Research, 27-29 Dampfaergevej, 2100, Copenhagen, Denmark aut The European Journal of Health Economics Springer-Verlag 12/6(2011-12-01), 541-551 1618-7598 12:6<541 2011 12 10198 https://doi.org/10.1007/s10198-010-0268-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10198-010-0268-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hvenegaard Anne Danish Institute for Health Services Research, 27-29 Dampfaergevej, 2100, Copenhagen, Denmark aut NATIONALLICENCE 700 1- Arendt Jacob Institute for Public Health—Health Economic Unit, University of Southern Denmark, Odense, Denmark aut NATIONALLICENCE 700 1- Street Andrew Centre for Health Economics, University of York, York, UK aut NATIONALLICENCE 700 1- Gyrd-Hansen Dorte Danish Institute for Health Services Research, 27-29 Dampfaergevej, 2100, Copenhagen, Denmark aut NATIONALLICENCE 773 0- The European Journal of Health Economics Springer-Verlag 12/6(2011-12-01), 541-551 1618-7598 12:6<541 2011 12 10198 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer