Productivity changes in Taiwanese hospitals and the national health insurance

In 1995 Taiwan launched the National Health Insurance (NHI) programme, which changed the method payment for hospital finances. This article examines the impact of this financial reform on hospital productivity during this period. Using the Malmquist productivity index approach, a hospital's change in productivity is decomposed into quality, efficiency, and technological change components. Factors affecting efficiency and productivity are also assessed. Results indicate that most hospitals experienced a significant productivity slowdown due to declines in technology and quality of service, but efficiency did significantly improve. The inception of the NHI programme does greatly improve a hospital's productivity and quality of service, but decreases efficiency. Public hospitals' efficiency improvements are significant.

[1]  R. Färe,et al.  Productivity and quality changes in Swedish pharmacies , 1995 .

[2]  Sanjay Kallapur,et al.  Changes in hospital service mix and cost allocations in response to changes in Medicare reimbursement schemes , 1997 .

[3]  L. R. Christensen,et al.  THE ECONOMIC THEORY OF INDEX NUMBERS AND THE MEASUREMENT OF INPUT, OUTPUT, AND PRODUCTIVITY , 1982 .

[4]  S. Eastaugh Health Economics: Efficiency, Quality, and Equity , 1992 .

[5]  R. Färe,et al.  Productivity Developments in Swedish Hospitals: A Malmquist Output Index Approach , 1994 .

[6]  D M Nadzam,et al.  Development of medication-use indicators by the Joint Commission on Accreditation of Healthcare Organizations. , 1991, American journal of hospital pharmacy.

[7]  Rolf Färe,et al.  Malmquist Productivity Indexes: A Survey of Theory and Practice , 1998 .

[8]  C. Tn Further evidence that hospital production is inefficient. , 1998 .

[9]  Paul W. Wilson,et al.  Decomposing hospital productivity changes, 1985–1988: A nonparametric Malmquist approach , 1995 .

[10]  J. Newhouse Toward a Theory of Nonprofit Institutions: An Economic Model of a Hospital , 1970 .

[11]  Y A Ozcan,et al.  Church ownership and hospital efficiency. , 1996, Hospital & health services administration.

[12]  Léopold Simar,et al.  Estimating and bootstrapping Malmquist indices , 1999, Eur. J. Oper. Res..

[13]  V. Valdmanis Ownership and technical efficiency of hospitals. , 1990, Medical care.

[14]  Rikard Althin,et al.  Measurement of Productivity Changes: Two Malmquist Index Approaches , 2001 .

[15]  Thomas G. Cowing,et al.  Multiproduct Short-Run Hospital Cost Functions: Empirical Evidence and Policy Implications from Cross-Section Data , 1983 .

[16]  M. Kenward,et al.  An Introduction to the Bootstrap , 2007 .

[17]  P. Roos Measuring Output of Hospital Services , 2002 .

[18]  M. Linna,et al.  Measuring hospital cost efficiency with panel data models. , 1998, Health economics.

[19]  J. Clement,et al.  A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals. , 1997, Hospital & health services administration.

[20]  M Linna Health care financing reform and the productivity change in Finnish hospitals. , 2000, Journal of health care finance.

[21]  R. Clark Does the nonprofit form fit the hospital industry? , 1980, Harvard law review.

[22]  R. Shepherd Theory of cost and production functions , 1970 .

[23]  P. Kooreman Nursing home care in The Netherlands: a nonparametric efficiency analysis. , 1994, Journal of health economics.

[24]  P. Joskow Reimbursement policy, cost containment and non-price competition. , 1983, Journal of health economics.

[25]  Paul W. Wilson,et al.  TECHNICAL EFFICIENCY IN THE DECENTRALIZED CARE OF THE DEVELOPMENTALLY DISABLED , 1994 .

[26]  M. Noether,et al.  Competition among hospitals. , 1988, Journal of health economics.

[27]  W. Schwartz,et al.  Eliminating waste and inefficiency can do little to contain costs. , 1994, Health affairs.

[28]  J. Magnussen,et al.  Efficiency measurement and the operationalization of hospital production. , 1996, Health services research.

[29]  R. Färe,et al.  Productivity changes in Swedish pharamacies 1980–1989: A non-parametric Malmquist approach , 1992 .

[30]  P. W. Wilson,et al.  Comparing mean efficiency and productivity scores from small samples: A bootstrap methodology , 1995 .

[31]  S. Grosskopf,et al.  Measuring hospital performance. A non-parametric approach. , 1987, Journal of health economics.

[32]  F A Sloan,et al.  Hospital ownership and performance. , 1985, Economic inquiry.

[33]  M. Tambour,et al.  Bootstrapping the data envelopment analysis Malmquist productivity index , 1999 .

[34]  Vivian Valdmanis,et al.  Sensitivity analysis for DEA models: An empirical example using public vs. NFP hospitals , 1992 .

[35]  S. Malmquist Index numbers and indifference surfaces , 1953 .

[36]  L. McMahon,et al.  The Risk-Adjusted Mortality Index: A New Measure of Hospital Performance , 1988, Medical care.