A methodology for measuring the relative effectiveness of healthcare services

^** Email: giorgio.vittadini{at}unimib.it^*** Email: simona.minotti{at}unicatt.it In this paper we propose a methodology for measuring the ‘relativeeffectiveness’ of healthcare services (i.e. the effectof hospital care on patients) under general conditions, in which:) a healthcare outcome underlies qualitative and quantitativeobservable indicators; ß) we are interested in studyingthe simultaneous dependency of multiple outcomes on covariates(where the outcomes can also be correlated to each other); )the relative effectiveness is adjusted for hospital-specificcovariates; ) we hypothesise a general distribution for randomdisturbances and the random parameters of relative effectiveness.For this topic, a generalisation of the SURE (seemingly unrelatedregression equations) multilevel model is proposed. The solutionsare obtained by means of Bayesian inference methods. Since thereis currently no software available to estimate this model, anSAS procedure based on Markov Chain Monte Carlo methods hasbeen developed by the authors, in line with Goldstein &Spiegelhalter (1996, J. R. Stat. Soc. Ser. A, 159, 385–443),Spiegelhalter et al. (1996, Bayesian Using Gibbs Sampling Manual.Cambridge: MRC Biostatistic Unit, Institute of Public Health)and Albert & Chib (1997, J. Am. Stat. Assoc., 92, 916–925).In addition, a new theoretical result regarding the joint posteriordistribution for the parameters is provided. The model proposedhas been implemented for an effectiveness study of a selectionof Lombard hospitals.