John A. Romley Copyright (c) 2011 All rights reserved. http://works.bepress.com/john_romley Recent documents in John A. Romley en-us Tue, 20 Dec 2011 14:19:48 PST 3600 Racial and Ethnic Disparities in Hospital Care Resulting from Air Pollution in Excess of Federal Standards http://works.bepress.com/john_romley/15 http://works.bepress.com/john_romley/15 Sat, 27 Aug 2011 13:37:48 PDT Andrew Hackbarth et al. Hospitals Hospital Spending and Inpatient Mortality: Evidence from California http://works.bepress.com/john_romley/14 http://works.bepress.com/john_romley/14 Mon, 31 Jan 2011 15:13:26 PST John Romley et al. Hospitals The Benefits from Giving Makers of Conventional ‘Small Molecule’ Drugs Longer Exclusivity Over Clinical Trial Data http://works.bepress.com/john_romley/13 http://works.bepress.com/john_romley/13 Wed, 05 Jan 2011 19:47:09 PST Pharmaceutical companies and generic drug manufacturers have long been at odds over “data exclusivity” regulations. These rules require a waiting period of at least five years before generic drug companies can access valuable clinical trial data necessary to bring less expensive forms of innovative drugs to market. Pharmaceutical companies want the data exclusivity period lengthened to protect their investment. Generic manufacturers want the period shortened so that they can bring less expensive versions of drugs to patients sooner. We examine the long-term effect of extending the data exclusivity period for conventional “small-molecule” drugs to twelve years—the same exclusivity period already extended to large-molecule biologic drugs under the Affordable Care Act. We conclude that Americans would benefit from a longer period of data exclusivity.

]]> Dana Goldman et al. Other health care The Emerging Importance of Patient Amenities in Hospital Care http://works.bepress.com/john_romley/12 http://works.bepress.com/john_romley/12 Wed, 01 Dec 2010 14:21:48 PST Dana Goldman et al. Hospitals The Impact of Air Quality on Hospital Spending http://works.bepress.com/john_romley/9 http://works.bepress.com/john_romley/9 Thu, 11 Mar 2010 20:02:45 PST John Romley et al. Hospitals Efficiency and Its Measurement: What Practitioners Need To Know http://works.bepress.com/john_romley/8 http://works.bepress.com/john_romley/8 Tue, 07 Jul 2009 20:35:04 PDT John Romley et al. Other health care Do the Owners of Small Law Firms Benefit from Limited Liability? http://works.bepress.com/john_romley/7 http://works.bepress.com/john_romley/7 Thu, 08 Jan 2009 14:09:46 PST John Romley et al. Legal services How Costly Is Hospital Quality? A Revealed-Preference Approach http://works.bepress.com/john_romley/6 http://works.bepress.com/john_romley/6 Tue, 06 Jan 2009 18:49:42 PST We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate `revealed quality' into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs.

]]> John A. Romley et al. Hospitals Hospitals As Hotels: The Role of Patient Amenities in Hospital Demand http://works.bepress.com/john_romley/5 http://works.bepress.com/john_romley/5 Tue, 06 Jan 2009 18:47:11 PST Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital's demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.

]]> Dana Goldman et al. Hospitals A Systematic Review of Health Care Efficiency Measures http://works.bepress.com/john_romley/4 http://works.bepress.com/john_romley/4 Tue, 06 Jan 2009 18:44:12 PST Objective: To review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods.

Data Sources: Review of the MedLine and EconLit databases for articles published from 1990-2008, as well as search of the “gray” literature for additional measures developed by private organizations.

Study Design: We performed a systematic review for existing efficiency measures. We classified the efficiency measures by perspective, outputs, inputs, methods used, and reporting of scientific soundness.

Principal Findings: We identified 265 measures in the peer-reviewed literature and 8 measures in the gray literature, with little overlap between the two sets of measures. Almost all of the measures did not explicitly consider the quality of care. Thus, unless quality is assumed to be equivalent across groups, the measures may reflect the costs of care only, not efficiency. Evidence on the measures’ scientific soundness was mostly lacking: evidence on reliability or validity was reported for 6 measures (2.3%) and sensitivity analyses were reported for 67 measures (25.3%).

Conclusions: Efficiency measures have been subjected to few rigorous evaluations of reliability and validity, and methods of accounting for quality of care in efficiency measurement are not well-developed at this time. Use of these measures without greater understanding of these issues is likely to engender resistance from providers and could lead to unintended consequences.

]]> Peter Hussey et al. Other health care What Can We Learn about Hospitals from the Revealed Preferences of Patients? http://works.bepress.com/john_romley/3 http://works.bepress.com/john_romley/3 Tue, 06 Jan 2009 18:38:46 PST In choosing their hospital, patients are concerned with both quality of care and amenities such as comfortable rooms. This column summarises recent research showing that patients value amenities and more productive hospitals compete for patients by supplying higher quality. We need to assess the value of amenities in relation to other hospital benefits, since improving amenities is more costly than improving care.

]]> Dana Goldman et al. Hospitals Alcohol and Environmental Justice: The Density of Liquor Stores and Bars in Urban Neighborhoods in the United States http://works.bepress.com/john_romley/2 http://works.bepress.com/john_romley/2 Tue, 06 Jan 2009 18:35:15 PST Objective: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. Method: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. Results: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas and nonwhites in higher-income areas. Nonwhite youths face higher densities of liquor stores than white youths. The density of liquor stores and bars is lower in higher-income areas, especially for nonwhites. Conclusions: Mismatches between alcohol demand and the supply of liquor stores within urban neighborhoods constitute an environmental injustice for minorities and lower-income persons, with potential adverse consequences for drinking behavior and other social ills. Our results for bars are sensitive to the measure of outlet density as well as population density. Although neither measure is clearly superior, a measure that accounts for roadway miles may reflect proximity to alcohol retailers and thus serve as a useful refinement to the per-capita measure. If so, alcohol policy might also focus on density per roadway mile. Further research on the existence, causes, and consequences of environmental injustice in alcohol retailing is warranted.

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