A comparative inpatient care efficiency analysis of safety-net vs. non-safety-net hospitals: an analysis using Massachusetts inpatient claims data from 2015 to 2019
- PMID: 40278982
- DOI: 10.1007/s10729-025-09704-y
A comparative inpatient care efficiency analysis of safety-net vs. non-safety-net hospitals: an analysis using Massachusetts inpatient claims data from 2015 to 2019
Abstract
This study examines the inpatient service efficiency of safety-net and non-safety-net hospitals using a two-stage approach at both the hospital and physician levels. For the hospital-level analysis, we conducted 430 Data Envelopment Analysis (DEA) models at the first stage to measure efficiency at the Diagnosis-Related Groups (DRG) level. In the second stage, Tobit and logistic regression models were applied to compare safety-net hospitals to non-safety-net hospitals. For the physician-level analysis, we conducted 386 DEA models to measure individual physician efficiency within specific DRGs. In the second stage, we compared the performance of the same physicians working in safety-net versus non-safety-net hospitals. The findings reveal that non-safety-net hospitals demonstrate significantly higher efficiency than safety-net hospitals. However, comparisons of the same physicians across settings show no significant differences in individual efficiency. This suggests that the efficiency gap arises not from the support or motivation provided by hospitals but from differences in the quality of physicians employed. These results underscore the need for policies that help safety-net hospitals attract and retain high-quality physicians to bridge the efficiency gap and better serve vulnerable populations.
Keywords: Data envelopment Analysis; Hospital efficiency; Physician efficiency; Safety-net hospitals.
© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Conflict of interest statement
Declarations. Conflict of interest: The authors declare that there is no conflict of interest associated with this research paper. We have no financial or personal relationships with any individuals, organizations, or entities that could potentially influence or bias our work. This includes, but is not limited to, financial interests, employment, consultancies, patent applications/registrations, and funding sources that may have a direct or indirect impact on the research presented in this paper. Statement of data use: In accordance with the guidelines and policies established by our institution and the Data Use Agreement (DUA) governing the use of data from the Center for Health Information and Analysis (CHIA), we hereby provide a statement regarding the use of data in our original research article. Our research article, titled “The relationship between Safety-net status and hospital and physician”, represents original research conducted to advance the understanding of the efficiency of safety-net hospitals This research involved the use of data obtained from CHIA, which has been made available to us as approved data users. We wish to clarify that CHIA does not require pre-publication approval for research conducted using their data, and they do not routinely review publications. Instead, they place a strong emphasis on the responsibility of the organization that received the data to adhere to the DUA restrictions, particularly those related to aggregation and cell size limits. We acknowledge and respect this approach. In preparing this article for publication, we have diligently examined our findings and methods in consultation with oversight within our organization. Our primary objective has been to ensure that the publication of aggregate and cell-suppressed data from CHIA is in full compliance with the requirements outlined in the DUA. We have taken all necessary precautions to maintain the privacy and confidentiality of the data, as well as to prevent any potential re-identification of individuals or organizations mentioned within the dataset. Furthermore, we are committed to upholding the highest ethical standards in our research and publication practices. We believe that our study, which adheres to the principles and guidelines set forth in the DUA, provides valuable insights and contributes to the broader understanding of hospitals serve vulnerable population. In conclusion, this statement affirms our commitment to responsible and ethical data use and publication practices as outlined in the DUA governing our use of CHIA data. We are confident that our research will provide valuable contributions to the field and serve the interests of both the scientific community and the broader public.
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