Does Higher Cost Inefficiency Imply Higher Profit Inefficiency? Evidence on Inefficiency and Ownership of German Hospitals (original) (raw)
Public vs. Private in Hospital Efficiency: Exploring Determinants in a Competitive Environment
International Journal of Public Administration, 2017
This study investigates the determinants of efficiency in an Italian regional health system and estimates the effect exerted by ownership on hospitals' performance. To achieve this aim, the Veneto region was considered as a case study and a full dataset (2011-2012) containing nonpublicly available technical data and cost and income items was analyzed. Efficiencies are measured applying a three-stage data envelopment analysis (DEA). Our results suggest that private hospitals perform better than public hospitals in productivity and cost saving, not considering the effect of other environmental and operational variables such as length of stay and beds per capita.
The European Journal of Health Economics, 2014
The introduction of prospective hospital reimbursement based on diagnosis-related groups (DRG) has been a conspicuous attempt to decelerate the steady increase of hospital expenditures in the German health sector. In this work, the effect of the financial reform on hospital efficiency is subjected to empirical testing by means of two complementary testing approaches. On the one hand, we apply a two-stage procedure based on nonparametric efficiency measurement. On the other hand, a stochastic frontier model is employed that allows a onestep estimation of both production frontier parameters and inefficiency effects. To identify efficiency gains as a consequence of changes in the hospital incentive structure, we account for technological progress, spatial dependence and hospital heterogeneity. The results of both approaches do not reveal any increase in overall efficiency after the DRG reform. In contrast, a significant decline in overall hospital efficiency over time is observed.
On the impact of ownership structure and hospital efficiency in Italy
In the paper we evaluate the technical efficiency of Italian hospitals for the years 1995 to1998. We adopt parametric and non-parametric approaches to evaluate the impact of different ownership structures on the hospital technical efficiency. We use Data Envelopment Analysis with an output oriented model (more appropriate within a PPS system) for the non-parametric approach. We also adopt a parametric approach using COLS technique to estimate a translog output distance function, to accommodate multiple inputs and outputs. Our findings suggest that public owned hospitals are more efficient than their not-for-profit counterpart when the number of discharged patients is considered as one of the outputs (together with the number. of day hospital treatments and that of emergency room treatments); this result is robust to the two different approach. On the contrary, the two t echniques of estimation produce different results when the number of in-patient days is considered as output.
Electronic physician, 2016
Introduction: Hospitals are the most expensive health services provider in the world. Therefore, the evaluation of their performance can be used to reduce costs. The aim of this study was to determine the efficiency of the hospitals at the Kurdistan University of Medical Sciences using stochastic frontier analysis (SFA). Methods: This was a cross-sectional and retrospective study that assessed the performance of Kurdistan teaching hospitals (n = 12) between 2007 and 2013. The Stochastic Frontier Analysis method was used to achieve this aim. The numbers of active beds, nurses, physicians, and other staff members were considered as input variables, while the inpatient admission was considered as the output. The data were analyzed using Frontier 4.1 software. Results: The mean technical efficiency of the hospitals we studied was 0.67. The results of the Cobb-Douglas production function showed that the maximum elasticity was related to the active beds and the elasticity of nurses was negative. Also, the return to scale was increasing. Conclusion: The results of this study indicated that the performances of the hospitals were not appropriate in terms of technical efficiency. In addition, there was a capacity enhancement of the output of the hospitals, compared with the most efficient hospitals studied, of about33%. It is suggested that the effect of various factors, such as the quality of health care and the patients' satisfaction, be considered in the future studies to assess hospitals' performances.
Measuring Technical Inefficiency in Private and Public Hospitals Using Initial Treatment Methods
Journal of Economics Studies and Research, 2015
The debate over how to solve the problem of rising health care costs has produced a vast amount of literature in many different fields. In particular, economists have developed a method known as stochastic frontier analysis which can be used to estimate how inefficiencies within the health care industry can contribute to rising health care costs. Most studies of this nature estimate a best practice frontier focusing only on the long-run outcomes of hospitals, using variables such as patient days and mortality rates as proxies. In this study we approach the issue of hospital efficiency differently by estimating the best practice production frontier for the initial treatment of patients admitted for heart attack, heart failure, or pneumonia. We are particularly interested in analyzing what role (if any) hospital ownership plays in determining technical inefficiency. According to bureaucracy theory, it is hypothesized that non-profit and for-profit hospitals will exhibit greater efficiency relative to public hospitals. Our results reveal some evidence that private hospitals are in fact more efficient than public hospitals in two out of the three medical conditions analyzed.
Internal markets and health care efficiency: a multiple-output stochastic frontier analysis
Health Economics, 1999
This paper has two purposes. The first purpose is methodological and aims to extend previous work on efficiency analysis by implementing a multiple-output stochastic ray frontier production function model. This model generalizes the single-output stochastic frontier model to multiple-input, multiple-output technologies and allows simultaneous estimation of technical efficiency and analysis of influential variables on efficiency. The second, empirical, purpose is to test for existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel data set covering the total population of 26 Swedish County Councils from 1989 to 1995. Our empirical results support the frontier model specification and indicate that output-based reimbursement improves technical efficiency. The potential saving in costs due to a switch from budget-based allocation to output-based allocation is estimated to be almost 10%.
2014
Background Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. Methods The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. Results The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Conclusion Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals.
How reliable are hospital efficiency estimates? Exploiting the dual to homothetic production
Health Economics, 2001
For scientific use, stochastic frontier estimates of hospital efficiency must be robust to plausible departures from the assumptions made by the investigator. Comparisons of alternative study designs, each well within the 'accepted' range according to current practice, generate similar mean inefficiencies but substantially different hospital rankings. The three alternative study contrasts feature (1) pooling vs partitioned estimates, (2) a cost function dual to a homothetic production process vs the translog, and (3) two conceptually valid but empirically different cost-of-capital measures. The results suggest caution regarding the use of frontier methods to rank individual hospitals, a use that seems to be required for reimbursement incentives, but they are robust when generating comparisons of hospital group mean inefficiencies, such as testing models that compare non-profits and for-profits by economic inefficiency. Demonstrations find little or no efficiency differences between these paired groups: non-profit vs for-profit; teaching vs non-teaching; urban vs rural; high percent of Medicare reliant vs low percent; and chain vs independent hospitals.
Accounting for Heterogeneity in the Measurement of Hospital Performance
SSRN Electronic Journal, 2000
With prospective payment of hospitals becoming more common, measuring their performance is gaining in importance. However, the standard cost frontier model yields biased efficiency scores because it ignores technological heterogeneity between hospitals. In this paper, efficiency scores are derived from a random intercept and an extended random parameter frontier model, designed to overcome the problem of unobserved heterogeneity in stochastic frontier analysis. Using a sample of 100 Swiss hospitals covering the years 2004 to 2007 and applying Bayesian inference, significant heterogeneity is found, suggesting rejection of the standard cost frontier model. Estimated inefficiency decreases even below the 14 percent reported by Hollingsworth (2008) for European countries. Accounting for unobserved heterogeneity would make hospitals rated below 85 percent efficiency according to the standard model gain up to 12 percentage points, serving to highlight the importance of heterogeneity correction in the estimation of hospital performance.
International Journal of Environmental Research and Public Health
Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public,...