Cost and technical efficiency of German hospitals: does ownership matter?

Herr, Annika

doi:10.1002/hec.1388

“…This allows distinction to be made between effects caused by an inefficiency and/or statistical errors. Whereas, DEA makes no distinction between effects caused by inefficiency and an outlier or measurement error and attributes all these effects to inefficiency (29,30). Given these methodological concerns (31), the present study relies on SFA.…”

Section: Stochastic Frontier Analysis Vs Data Envelopment Analysismentioning

confidence: 99%

Technical Efficiency of Teaching Hospitals in Iran: The Use of Stochastic Frontier Analysis, 1999–2011

Goudarzi

¹

,

Pourreza

²

,

Shokoohi

³

et al. 2014

Int J Health Policy Manag

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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.

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“…Herr [41] and subsequently applied in empirical applications in the absence of information on Diagnosis-Related Groups (DRG) [42].…”

Section: Datamentioning

confidence: 99%

Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments

Varabyova

¹

,

Blankart

²

,

Schreyögg

³

2016

Health Care Manag Sci

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. In the past decades, hospitals have been facing pressure to increase the efficiency of resource allocation. One way to achieve higher levels of technical efficiency is to treat more patients with the same amount of personnel, which could potentially lead to a trade-off between improving efficiency and maintaining good patient service. The aim of this study is to demonstrate how the nonparametric conditional approach can be used to integrate quality into the analysis of efficiency. The conditional approach allows investigating the mechanism through which quality enters the production process. Generally, an external variable may enter the production process by affecting either the attainable frontier or the distribution of inefficiencies inside the production set. To account for the heterogeneity of hospital services, we focus on a hospital department as the unit of analysis. We use data from 178 departments of interventional cardiology and consider three different measures of quality: patient satisfaction, risk-adjusted mortality, and patient radiation exposure. Our empirical assessment shows that the impact of quality on the production process differs according to the utilized quality measure. Patient satisfaction does not affect the attainable frontier but does have an inverted -shaped effect on the distribution of inefficiencies; risk-adjusted mortality negatively impacts the attainable frontier at high values of mortality but does not impact the distribution of inefficiencies; and patient radiation exposure is not associated with the production process. Our results refute the existence of a clear trade-off between efficiency and quality. The conditional approach can be applied to deal with the complexity of the underlying relationships between efficiency and quality. Terms of use: Documents in

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“…Since economic status and health are frequently found to be positively correlated, we expect a negative coefficient estimate for the former control and a positive coefficient for the latter. We further include hospital ownership as an explanatory variable for efficiency (for recent studies with mixed results, see Herr, 2008, andHerr et al, 2011). Ownership is measured in terms of share in total hospital beds, with public ownership serving as the reference.…”

Section: Model Specifications and Hypothesesmentioning

confidence: 99%

“…Sloan, 2000;Street, 2003;Chen et. al., 2005;Harrison et al, 2004;Staat, 2006;Herr, 2008;Pilyavsky & Staat, 2008;Herr et al, 2011), but also nursing homes (e.g. Anderson et al, 1999;Crivelli et al, 2002Björkgreen et al, 2004), general practitioners and primary care facilities (e.g.…”

Section: Introductionmentioning

confidence: 99%

Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

Felder

¹

,

Tauchmann

²

2011

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Abstract: Due to regional competition and patient migration, the efficiency of health care provision at the regional level is subject to spatial dependence. We address this issue by applying a spatial autoregressive model to longitudinal data from Germany at the district ('Kreis') level. The empirical model is specified to explain efficiency scores, which we derive through non-parametric order-m efficiency analysis of regional health production. The focus is on the role of health policy of federal states ('Bundesländer') for district efficiency. Regression results reveal significant spatial spillover effects. Notably, accounting for spatial dependence does not decrease but increases the estimated effect of federal states on district efficiency. It appears that genuinely more efficient states are less affected by positive efficiency spillovers, so that taking into account spatial dependence clarifies the importance of health policy at the state level. Terms of use: Documents in EconStor may

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Cost and technical efficiency of German hospitals: does ownership matter?

Cited by 134 publications

References 26 publications

Technical Efficiency of Teaching Hospitals in Iran: The Use of Stochastic Frontier Analysis, 1999–2011

Technical Efficiency of Teaching Hospitals in Iran: The Use of Stochastic Frontier Analysis, 1999–2011

Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments

Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

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