Gail A. Jensen

The Role of Physicians in Hospital Production

We use a translog production function approach to examine the effects of medical staff physicians on hospital production, and how their effects differ in teaching and nonteaching hospitals. In teaching hospitals, we also focus on the special role of medical residents. We find that physicians have a strong positive influence on the productivity of other inputs, and that they are substitutes for other resources. Controlling for patient casemix causes significant changes in estimated marginal products; those of labor inputs increase and that of capital declines. The implications of our findings for policy are explored.

Employer-Sponsored Health Insurance and Mandated Benefit Laws

Regulations for the content of private health plans, called mandated benefit laws, are widespread and growing in the United States, at both state and federal levels. Three aspects of these laws are examined: their current scope; some economic reasons for their existence; and the theory and empirical evidence for their effects in health insurance markets. A growing body of literature suggests that society is paying a high price for enhanced coverage via mandated benefits. These laws increase insurance premiums, cause declines in wages and other fringe benefits, and lead some employers and their workers to forgo health benefits altogether. The cost of mandated benefit laws falls disproportionately on workers in small firms.

Medical staff specialty mix and hospital production.

This paper analyzes the role of medical staff characteristics in determining different dimensions of hospital output. Using a set of flexible functional form production functions, and adjusting for hospital case mix, we examine the output contribution of physicians and other inputs, and the influence that physicians in different specialties have on the productivity of other physicians, as well as on other labor and capital. We also examine the input substitution possibilities available to hospitals, and where possible, we compare our estimates to those obtained by other researchers. We find that physicians have numerous significant effects of production and conclude that physicians are an important input that should not be ignored in empirical cost and production function studies for hospitals.

Clinical and Economic Effectiveness of an Inpatient Anticoagulation Service

We conducted a prospective cohort study to evaluate clinical and economic end points achieved by a pharmacist‐managed anticoagulation service compared with usual care (50 patients/group). The primary therapeutic end point was the time between starting heparin therapy and surpassing the activated partial thromboplastin time therapeutic threshold. The primary economic end point was the direct variable cost of hospitalization from admission to discharge. No significant differences between groups were noted for the primary therapeutic end point. Total hospital costs were significantly lower for patients receiving pharmacist‐managed care than for those receiving usual care (

Why Do Nursing Home Costs Vary? The Determinants of Nursing Home Costs

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Diverging racial and ethnic disparities in access to physician care: comparing 2000 and 2007.

2014, respectively, 1997 dollars, p=0.04). Earlier start of warfarin (p=0.05) and shorter hospital stay (5 and 7 days, p=0.05) were associated with the pharmacist‐managed group.

Cost Sharing and the Changing Pattern of Employer-Sponsored Health Benefits

Since the costs of nursing home care are a major component of the rapidly rising costs of health care, it is appropriate to base public policy discussions about cost containment on the determinants of nursing home costs. This article investigates the determinants of nursing home operating costs and reviews the results of 11 related econometric cost analyses conducted by the authors. Single-equation cost analyses are developed for nursing homes in three states and in the nation. The cost results of a multi-equation model of nursing home behavior are also reviewed. The analyses indicate that facility size and occupancy rate are minimally important in determing cost variation. Facility characteristics, particularly type of facility and ownership, are important variables. Nonprofit facilities consistently had higher costs than for-profit facilities, after controlling for patient mix and service differences, and, in one analysis, for a measure of quality.

Medical malpractice among physicians: Who will be sued and who will pay?

Objective:To examine recent changes in racial and ethnic disparities in access to physician services in the United States, and investigate the economic factors driving the changes observed. Methods:Using nationally representative data on adults aged 25–64 from the 2000 and 2007 Medical Expenditure Panel Survey, we examine changes in two measures of access: whether the individual reported having a usual source of care, and whether he/she had any doctor visits during the past year. In each year, we calculate disparities in access between African Americans and Whites, and between Hispanics and Whites, applying the Institute of Medicine’s definition of a disparity. Nonlinear regression decomposition techniques are then used to quantify how changes in personal characteristics, comparing 2000 and 2007, helped shape the changes observed. Results:Large disparities in access to physician care were evident for both minority groups in 2000 and 2007. Disparities in no doctor visits during the past year diminished for African Americans, but disparities in both measures worsened sharply for Hispanics. Conclusions:Disparities in access to physician care are improving for African Americans in one dimension, but eroding for Hispanics in multiple dimensions. The most important contributing factors to the growing disparities between Hispanics and Whites are health insurance, education, and income differences.

Endogenous Fringe Benefits, Compensating Wage Differentials and Older Workers

The perception that employers have been redesigning group health benefits to encourage more cost-effective use is distorted by limited study methods. New estimates of initiatives undertaken by larger private-sector employers--based on nationally representative data from the U.S. Bureau of Labor Statistics--reveal a more uncertain picture of cost containment. Cost sharing for initial hospital stays was broadened between 1981 and 1985, but coverage in most other areas--categories of care, lifetime benefit limits, etc.--was actually increased. Real health care expenditures will continue to grow absent more significant employee cost sharing.

The dynamics of health insurance among the near elderly.

This paper examines whether a physicians future claims of medical malpractice are predictable from information on the physicians recent claims history, training credentials, practice characteristics, and demographics. Data on the medical malpractice experience of 8,733 Michigan physicians between 1980 and 1989 is analyzed. We find strong evidence of repetition over time regarding who was sued and who paid claims. The worse a physicians malpractice litigation record during 1980–1984, the worse was his record during 1985–1989. Training credentials were also highly predictive of future malpractice experience. Physicians trained at lower ranked medical schools or who went through lower-ranked residency programs faced higher odds of developing adverse malpractice records, even after controlling for their previous litigation record. Growing internet access to information on these characteristics will help inform prospective patients if they wish to avoid physicians likely to be sued and likely to make payments in the future for malpractice.