Limited Intragenerational Mobility of Surgical Caseload of Iowa Hospitals

  • Liam O’Neill
  • Franklin DexterEmail author
  • Richard H. Epstein
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


We previously calculated the Gini index for 121 Iowa hospitals over the ten-year period 2007-2016. The Gini index is a statistic used in economics to assess difference in the distribution of wealth among groups. We reported a high degree of “inequality” among hospitals. In this paper, we extend this work by calculating the intragenerational mobility for the hospitals present in 2007-2008 and 2015-2016. Whereas in economics intragenerational mobility often is measured as changes in income over time within a group, we study changes in hospitals’ surgical caseloads. Intragenerational mobility was quantified using the Spearman rank correlation, the slope of the ordinary least squares (OLS) regression line in the log scale, and the Shorrocks trace index. The results were consistent across the three measures. There was a low degree of mobility for the surgical caseloads of the hospitals during the 10-year period under study. For example, based on the slope of the OLS regression, intragenerational mobility was not significantly different from zero (P > 0.05). None (0%) of the 113 hospitals with at least 10 cases both periods increased from the 1st to 5th quintile, 1st to 4th quintile, 2nd to 5th quintile, 2nd to 4th quintile, or even from 3rd to 5th quintile. The results show the importance of hospitals not investing irrationally based on false hope of surgical growth.


Intergenerational mobility Intragenerational mobility Gini index Shorrocks trace Surgical caseload Surgical services Operating room management 



Availability of data and materials: The data that support the findings of this study are available from the Iowa Hospital Association, Restrictions apply to the availability and distribution of these data, which were used under agreement with the University of Iowa Hospitals and Clinics.

Author’s contributions

LO helped analyze the data and write the manuscript.

FD helped design the study, obtain the data, analyze the data, and write the manuscript.

RHE helped design the study and write the manuscript.


Funding for this project was provided solely from departmental sources.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Health Behavior and Health SystemsUniversity of North Texas – Health Science CenterFort WorthUSA
  2. 2.Division of Management Consulting, Department of AnesthesiaUniversity of IowaIowaUSA
  3. 3.Anesthesiology, Perioperative Medicine and Pain ManagementUniversity of MiamiMiamiUSA

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