Journal article

Cream skimming and hospital transfers in a mixed public-private system

Terence C Cheng, John P Haisken-DeNew, Jongsay Yong



The increasing prominence of the private sector in health care provision has generated considerable interest in understanding its implications on quality and cost. This paper investigates the phenomenon of cream skimming in a mixed public-private hospital setting using the novel approach of analysing hospital transfers. We analyse hospital administrative data of patients with ischemic heart disease from the state of Victoria, Australia. The data set contains approximately 1.77 million admission episodes in 309 hospitals, of which 132 are public hospitals, and 177 private hospitals. We ask if patients transferred between public and private hospitals differ systematically in the severity and c..

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Awarded by Australian Research Council

Awarded by National Health and Medical Research Council

Funding Acknowledgements

We are extremely grateful for the helpful comments and suggestions from the two anonymous reviewers. Funding supports from the Australian Research Council Linkage Grant LP0455325 and National Health and Medical Research Council Partnership Grant 567217 are gratefully acknowledged. We thank the Victorian Department of Health (formerly the Victorian Department of Human Services) for providing the data.