Technical efficiency of Critical Access Hospitals: an application of the two-stage approach with double bootstrap

Abstract

The Critical Access Hospital (CAH) Program has offered Medicare cost-based reimbursement to small hospitals that meet certain eligibility criteria to improve their financial viability and quality of care. However, cost-based reimbursement has been associated with inefficiency in hospital operations. This study uses a two-stage approach and bootstrap procedures to examine the effects of environmental variables on the technical efficiency of CAHs. The two-stage approach with quality controls significantly improved statistical efficiency of parameter estimates in the second stage bootstrapped truncated regression relative to a similar model without quality controls. Overall, our results suggest that enhanced Medicare reimbursement may not have had detrimental effects on the technical efficiency of CAHs.

Monte‐Carlo Comparison of Conditional Nonparametric Methods and Traditional Approaches to Include Exogenous Variables

“…Furthermore, they advocate the use of the truncated regression model that explicitly takes into account the bounded domain of the DEA efficiency estimates. Since then, this method has been mostly used in the literature for identifying the influential determinants of efficiencies in multiple contexts such as education (Alexander et al ., ; Miningou and Vierstraete, ; Santín and Sicilia, ), health care (Blank and Valdmanis, ; Afonso and St Aubyn, ; Nedelea and Fannin, ), tourism (Barros et al ., ) or regional analysis (Demchuk and Zelenyuk, ).…”

The Performance of Double Bootstrap Method for Large Sampling Sequence

“…Having a complete information needed to estimate one-step-ahead of Equation (1), further steps is to find the replication size of single and double bootstrap using the respective b τ and bb τ . Even though the sample size of sukuk Ijarah has found to be greater compare to basic bootstrap conditional sample size, the bootstrap procedure could still be proceed because the method can helps to increase the efficiency of estimation [18]- [20]. Considering this advantage, thus, the tested replication size starts from 50 replications until the converged estimation value is obtained.…”

“…Despite of its great advantage in improving the first bootstrap accuracy estimation, the procedure seems to demand a high computer processing and eventually provide a range of time to complete the whole algorithm of iteration [2] [7]- [9]. Motivated by these problems, this paper proposes an alternative procedure of double bootstrap method which aims to increase the accuracy estimation by constructing the interval and reduce the computer processing.…”

The accuracy of two-sided confidence interval algorithm: an alternative of double bootstrap approach

“…The aim for this discussion is to find a better result on solving the uncertainty estimation and provide more accuracy estimation when involving the used of either small or finite sample data. In terms of accuracy, the double bootstrap is widely used to estimate the one-sided and two-sided confidence interval, see for example [1], [2], [3] and [4]. These previous researches successfully increased the accuracy of interval estimation, where implementing the double bootstrap statistically proven to decrease the error from a factor of order n -2 to order n -1 .…”

“…Even though the previous discussion on double bootstrap gave a high impact, it seems that the procedure of implementing this method required a difficult and excessive calculation. The conventional double bootstrap procedure is used the iteration method where generally the second bootstrap replication is made at each replication sets of first, more likely, single bootstrap [4], [7] and [8]. This procedure is quite easy to perform if the single bootstrap replication number is small but the major problem happen if the replication is a greater value.…”