Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals

Abstract

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, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals

“…The regional average annual income per household increased the odds of reaching the efficiency frontier 6.43-fold for every one standard deviation increase in the average annual income per household. This result is in line with previous results [ 47 ], and confirms the importance of a region’s income level in improving the possibility of its hospitals’ reaching the efficiency frontier.…”

“…The number of private beds per thousand inhabitants decreased by 63% the odds of being positioned on the efficiency frontier. Previous work did not find this relationship significant [ 47 ], although the divergence of results is probably due to the different estimation method used. In this sense, the results of this study are more robust when using an econometric specification in line with the DEA technical efficiency density function.…”

Efficiency in chronic illness care coordination: public-private collaboration models vs. traditional management

“…This result suggests that the efficiency of the new management models would be even better if primary care units were included. This is the case of the Valencian concession model, which has recently been found to achieve better results than the traditional public management [10]. For all the management models, we find important divergences across different units.…”

“…The results obtained are mixed. For instance, the most recent study [10] concluded that PPP formulas favored hospital efficiency, while in other study the findings were inconclusive [11]. Likewise, in a previous empirical analysis focused on hospitals belonging to the Madrid Regional Health Service, the results suggest that there are no significant differences in terms of technical efficiency between public hospitals and those adopting new management formulas [12].…”

“…The use of these methods is very common in the literature as shown recently in a comprehensive systematic review focused on hospitals [9]. Among them, the most frequent option is the Data Envelopment Analysis (DEA), which has been previously used in the Spanish context to analyze different models of hospital ownership and management [10][11][12]. The results obtained are mixed.…”