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Efficiency and administrative costs in primary care

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  • Giuffrida, Antonio
  • Gravelle, Hugh
  • Sutton, Matthew

Abstract

We construct a simple model of the determinants of administrative managerial effort and apply it explain the doubling of the cost of administering primary care in England in real terms between 1989/90 and 1994/5 following the introduction of the internal market. We find that the main cost driver was the number of GPs, that there are economies of scale but not economies of scope in administration, and that fundholding appeared to increase administrative costs. Most the increase in administrative cost over the period could not be explained by the change in the cost drivers or fundholding, suggesting that the recent abolition of fundholding may do little to reduce primary care administrative costs.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 19 (2000)
Issue (Month): 6 (November)
Pages: 983-1006

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Handle: RePEc:eee:jhecon:v:19:y:2000:i:6:p:983-1006

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Web page: http://www.elsevier.com/locate/inca/505560

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  1. Ai, Chunrong & Norton, Edward C., 2000. "Standard errors for the retransformation problem with heteroscedasticity," Journal of Health Economics, Elsevier, vol. 19(5), pages 697-718, September.
  2. Fournier, Gary M & Mitchell, Jean M, 1992. "Hospital Costs and Competition for Services: A Multiproduct Analysis," The Review of Economics and Statistics, MIT Press, vol. 74(4), pages 627-34, November.
  3. Gaynor, Martin & Pauly, Mark V, 1990. "Compensation and Productive Efficiency of Partnerships: Evidence from Medical Group Practice," Journal of Political Economy, University of Chicago Press, vol. 98(3), pages 544-73, June.
  4. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
  5. Anthony Scott & David Parkin, 1995. "Investigating hospital efficiency in the new NHS: The role of the translog cost function," Health Economics, John Wiley & Sons, Ltd., vol. 4(6), pages 467-478, November.
  6. Hausman, Jerry A, 1978. "Specification Tests in Econometrics," Econometrica, Econometric Society, vol. 46(6), pages 1251-71, November.
  7. Dor, Avi, 1994. "Non-minimum cost functions and the stochastic frontier: On applications to health care providers," Journal of Health Economics, Elsevier, vol. 13(3), pages 329-334, October.
  8. Wholey, Douglas & Feldman, Roger & Christianson, Jon B. & Engberg, John, 1996. "Scale and scope economies among health maintenance organizations," Journal of Health Economics, Elsevier, vol. 15(6), pages 657-684, December.
  9. Skinner, Jonathan, 1994. "What do stochastic frontier cost functions tell us about inefficiency?," Journal of Health Economics, Elsevier, vol. 13(3), pages 323-328, October.
  10. Schmidt, Peter & Sickles, Robin C, 1984. "Production Frontiers and Panel Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(4), pages 367-74, October.
  11. Dor, Avi & Farley, Dean E., 1996. "Payment source and the cost of hospital care: Evidence from a multiproduct cost function with multiple payers," Journal of Health Economics, Elsevier, vol. 15(1), pages 1-21, February.
  12. Caves, Douglas W & Christensen, Laurits R & Tretheway, Michael W, 1980. "Flexible Cost Functions for Multiproduct Firms," The Review of Economics and Statistics, MIT Press, vol. 62(3), pages 477-81, August.
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Cited by:
  1. Roberta Longo & Claire Hulme & Andrew Smith, 2012. "Measures of Performance in Primary Care - a Review of Efficiency Studies," Working Papers 1203, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
  2. Andrew Street, 2003. "How much confidence should we place in efficiency estimates?," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 895-907.
  3. Antonio Giuffrida and & Hugh Gravelle, . "Measuring Performance in Primary Care: Econometric Analysis and DEA," Discussion Papers 99/36, Department of Economics, University of York.
  4. Murillo-Zamorano, Luis R. & Petraglia, C., 2008. "Technical efficiency in primary health care: does quality matter?," MPRA Paper 10725, University Library of Munich, Germany.
  5. Alexandre Marinho, 2004. "Evidências e Modelos Sobre a Coexistência de Hospitais com Fins Lucrativos e Hospitais sem Fins Lucrativos no Sistema Único de Saúde Brasileiro," Discussion Papers 1041, Instituto de Pesquisa Econômica Aplicada - IPEA.
  6. Mann, Stefan, 2001. "Zur Effizienz der deutschen Agrarverwaltung," German Journal of Agricultural Economics, Humboldt-Universitaet zu Berlin, Department for Agricultural Economics, vol. 50(5).

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