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Biørn, Erik; Hagen, Terje P.; Iversen, Tor; Magnussen, Jon

doi:10.1023/a:1026212820367

Cited by 155 publications

(22 citation statements)

References 7 publications

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“…There is reason to believe that efficiency gains are larger for privatizations after the introduction of yardstick competition, especially in the case of hospitals converted to private for-profit status [63, 66–68]. We used a dummy variable to model the pre-DRG and the DRG period.…”

Section: Findings and Discussionmentioning

confidence: 99%

Changes in hospital efficiency after privatization

Tiemann

Schreyögg

2012

Health Care Manag Sci

136

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We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped data envelopment analysis (DEA) efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 2.9 and 4.9%. We defined four alternative post-privatization periods and found that the increase in efficiency after a conversion to private for-profit status appeared to be permanent. We also observed an increase in efficiency for the first three years after hospitals were converted to private non-profit status, but our estimations suggest that this effect was rather transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians and administrative staff. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the diagnosis-related groups (DRG) era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.

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Section: Findings and Discussionmentioning

confidence: 99%

Changes in hospital efficiency after privatization

Tiemann

Schreyögg

2012

Health Care Manag Sci

136

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“…Chalkley and Malcomson already delineated a theoretical understanding of changes in the financing system for non-profit hospitals [13,14], and Biørn et al adapted this theory to the Norwegian setting [15,16]. These models often assume a trade-off between efficiency and quality in hospital production that can be shifted by various reimbursement systems.…”

Section: Introductionmentioning

confidence: 99%

The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway

Yin

Lurås

Hagen

et al. 2013

BMC Health Serv Res

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BackgroundWhether activity-based financing of hospitals creates incentives to treat more patients and to reduce the length of each hospital stay is an empirical question that needs investigation. This paper examines how the level of the activity-based component in the financing system of Norwegian hospitals influences the average length of hospital stays for elderly patients suffering from ischemic heart diseases. During the study period, the activity-based component changed several times due to political decisions at the national level.MethodsThe repeated cross-section data were extracted from the Norwegian Patient Register in the period from 2000 to 2007, and included patients with angina pectoris, congestive heart failure, and myocardial infarction. Data were analysed with a log-linear regression model at the individual level.ResultsThe results show a significant, negative association between the level of activity-based financing and length of hospital stays for elderly patients who were suffering from ischemic heart diseases. The effect is small, but an increase of 10 percentage points in the activity-based component reduced the average length of each hospital stay by 1.28%.ConclusionsIn a combined financing system such as the one prevailing in Norway, hospitals appear to respond to economic incentives, but the effect of their responses on inpatient cost is relatively meagre. Our results indicate that hospitals still need to discuss guidelines for reducing hospitalisation costs and for increasing hospital activity in terms of number of patients and efficiency.

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“…Generally, the methods can be divided into those based on financial performance and those based on operational efficiency. Therefore, based on previous studies [23][24][25][26][27] we use the financial performance and operational efficiency to measure departmental performance. A multi-regression model and the Tobit model are used to 1) investigate the relationship between bonuses and departmental performance; and 2) assess the influence of the incentive plan for physicians in the case hospital.…”

Section: Research Design and Variable Measurementmentioning

confidence: 99%

“…The goal of most hospitals is multiple and complex; therefore, DEA model can provide hospital staffs as useful and low cost tool to evaluate health care service performance [41,42] . Previous studies [25,26] used the DEA model to measure hospital efficiency. We use the model to measure departmental efficiency and examine the relationship between physicians' bonuses and departmental efficiency.…”

Section: The Impact Of Physicians' Bonuses On Departments' Operating mentioning

confidence: 99%

The relationship between a physician incentive plan and departmental performance in a Taiwan hospital

Liu

Chu

Liao

2013

JHA

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The objective of this study is to investigate the influence of a physician incentive plan based upon treatment of patients in a large private non-for-profit hospital in Taiwan. We examine the relationship between physicians’ bonuses and departmental performance to assess the impact of the physician incentive plan in the case hospital. The multiple regression models are used to examine the relationship between physicians’ bonuses and departmental profitability. In addition, we use Data Envelopment Analysis (DEA) model to measure the operational efficiency of each department in the case hospital. Then, a multi-factor tobit model is used to examine the relationship between physicians’ bonuses and departmental efficiency. The results indicate that physicians’ bonuses in the case hospital are negatively correlated with departmental profitability and efficiency. That is, the performance measurement of current incentive plan may not be appropriate and it does not induce physicians to increase departmental profitability and improve efficiency. Our results suggest that the incentive plan is flawed and might fail to hold physicians accountable for improving departmental performance in the case hospital.

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Untitled

Cited by 155 publications

References 7 publications

Changes in hospital efficiency after privatization

Changes in hospital efficiency after privatization

The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway

The relationship between a physician incentive plan and departmental performance in a Taiwan hospital

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