Internal markets and health care efficiency: a multiple-output stochastic frontier analysis.

This paper has two purposes. The first purpose is methodological and aims to extend previous work on efficiency analysis by implementing a multiple-output stochastic ray frontier production function model. This model generalizes the single-output stochastic frontier model to multiple-input, multiple-output technologies and allows simultaneous estimation of technical efficiency and analysis of influential variables on efficiency. The second, empirical, purpose is to test for existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel data set covering the total population of 26 Swedish County Councils from 1989 to 1995. Our empirical results support the frontier model specification and indicate that output-based reimbursement improves technical efficiency. The potential saving in costs due to a switch from budget-based allocation to output-based allocation is estimated to be almost 10%.

[1]  S. Grosskopf.  Statistical inference and nonparametric efficiency: A selective survey , 1996 .

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

[3]  Magnus Tambour,et al.  The Impact of Internal Markets on Health Care Efficiency: Evidence from Health Care Reforms in Sweden , 1999 .

[4]  Paul W. Wilson,et al.  Hospital Ownership and Technical Inefficiency , 1996 .

[5]  Franz C. Palm,et al.  Wald Criteria for Jointly Testing Equality and Inequality , 1986 .

[6]  Rolf Färe,et al.  Fundamentals of production theory , 1988 .

[7]  G. Battese,et al.  A model for technical inefficiency effects in a stochastic frontier production function for panel data , 1995 .

[8]  J. Borden.  An assessment of the impact of diagnosis related group (DRG)-based reimbursement on the technical efficiency of New Jersey hospitals , 1988 .

[9]  Richard C. Morey,et al.  Cost pass-through reimbursement to hospitals and their impacts on operating efficiencies , 1996, Ann. Oper. Res..

[10]  Mickael Löthgren,et al.  Generalized Stochastic Frontier Production Models , 1997 .

[11]  U. Gerdtham,et al.  The impact of aging on health care expenditure in Sweden. , 1993, Health policy.

[12]  D. Jorgenson,et al.  TRANSCENDENTAL LOGARITHMIC PRODUCTION FRONTIERS , 1973 .

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

[14]  L. Iezzoni,et al.  Measuring hospital efficiency with frontier cost functions. , 1994, Journal of health economics.

[15]  W. Meeusen,et al.  Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error , 1977 .

[16]  Gary D. Ferrier,et al.  Rural hospital performance and its correlates , 1996 .

[17]  Shawna Grosskopf,et al.  Budget-Constrained Frontier Measures of Fiscal Equality and Efficiency in Schooling , 1997, Review of Economics and Statistics.

[18]  T. Coelli.  A computer program for frontier production function estimation: Frontier version 2.0 , 1992 .

[19]  T. Coelli.  Estimators and hypothesis tests for a stochastic frontier function: A Monte Carlo analysis , 1995 .

[20]  D. Aigner,et al.  P. Schmidt, 1977,?Formulation and estimation of stochastic frontier production function models,? , 1977 .