Calls for Papers

Hospital Organization and Productivity

October 4-5, 2013

The NBER is organizing a conference on how organizational structure, management practices, and related innovations affect the costs and cost-effectiveness of health care, focusing on the hospital industry and health systems that have hospitals at their core. The hospital sector represents the single largest sector within the healthcare industry; accounts for 31 percent of national health expenditures; and is the locus of many managerial and technological innovations. It is also marked by substantial heterogeneity in organizational forms - most notably the presence of both for-profit and not-for-profit entities - and substantial variation in management practices and the relationship between measured inputs and outputs. The sector is consolidating and increasingly under financial pressure, as cost-containment efforts seek to drive out unnecessary hospital utilization and Medicare and Medicaid payments fall.

The NBER will host a two-day conference that will bring together economists, physicians, and policymakers to discuss the available evidence on how organizational form, practices, and procedures affect health outcomes and costs, and to better understand cost-saving potential within the hospital sector. The organizers are Amitabh Chandra, David Cutler, Robert Huckman and Elizabeth Martinez.

The conference will emphasize empirical research on specific organizational structures, interventions, and practices. In keeping with the NBER's prohibition on making policy recommendations, papers may describe the consequences of policies, and their potential costs or benefits, but they may not offer policy recommendations or make normative statements about particular policies.

Examples of questions about organizational structures, practices and trends that might be addressed in conference papers include, but are not limited to:

    * How are innovations in health care delivery affecting hospital utilization, and what are the implications for total costs of care?
    * How are changes in payments, either in the form of payment reforms like bundled payments or value-based reimbursement, affecting the delivery of hospital care?
    * How are trends in hospital consolidation or regulation affecting hospital pricing?
    * How do operational changes such as lean production techniques and standardized care protocols affect healthcare costs, the patient experience, and outcomes?
    * What is the evidence that providing information on hospital performance and prices has impacted providers and patients?
    * How does the structure of physician compensation, or the hiring of particular physicians with a particular practice style, affect the value of care?
    * What is the evidence, if any, that for-profit and not-for-profit health care organizations respond differently to incentives to improve the value of care?

Preference will be given to research papers that are grounded in the study of a specific organizational feature or practice that has the potential to reduce costs and improve hospital productivity. Studies using data from a single organization are welcome, although authors should provide some discussion of the extent to which their findings are likely to apply to a broader set of organizations and in other contexts.

All papers will have discussants, many of whom will come from clinical or practitioner backgrounds, and will be invited for submission to a special issue of Health Affairs. If the authors choose to submit their papers to this journal, their manuscripts will be subject to the standard review process at Health Affairs. Presenting a paper at the conference does not guarantee publication in the special issue, for which the four conference organizers will serve as guest editors.

The conference, which will include approximately eight papers, will be held on Cape Cod, Massachusetts. The NBER will cover the economy-class airfare and associated travel expenses as well as lodging costs for up to two presenters per paper. It will also provide an honorarium of $3000 per paper, and with the understanding that presenters stay for the entire conference.

Completed papers or detailed outlines and abstracts for potential presentation at the conference may be uploaded at If a submitted manuscript is under review at, or scheduled for publication in, another journal, that should be clearly noted. Such papers may be appropriate for the conference but inappropriate for the special issue.

Papers, outlines, or abstracts must be submitted by February 28, 2013; authors will be notified about whether their paper has been included on the program by March 15, 2013. Questions should be directed to

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