HOSPITAL STAFFING ADJUSTMENTS UNDER GLOBAL BUDGETING

The U.S. Department of Veterans Affairs operates a hospital system tha t distributes a national global budget to 159 hospital units. Over rec ent years, cost containment and downward budgetary pressures have affe cted hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential per formance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous a nalyses by employing better data on physicians and by evaluating the b ehavior of hospitals in consecutive years. Our findings provide manage rs of hospital systems with promising new approaches for comparing hos pital production processes and move information on the effects of glob al budgeting on individual hospital staffing within systems.