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Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter?

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  • Chowdhury, Hedayet
  • Zelenyuk, Valentin
  • Laporte, Audrey
  • Wodchis, Walter P.

Abstract

In this paper we compare productivity, efficiency and technological changes with and without case-mix as output categories using panel data on Ontario hospitals for the period 2002–2006. We use the Malmquist Productivity Index (MPI), Data Envelopment Analysis (DEA), and non-parametric density estimation and related statistical tests. We also decompose MPI into efficiency change (ECH) and technological change (TCH). We found that productivity, efficiency and technological changes were significantly different between two alternative models, with case-mix (as a weighting device, Model 2) and without case-mix (Model 1). On the other hand, adding case-mix as a separate output (Model 3) did not have any significant impact on the distribution of efficiency estimates compared to the model without case-mix. We also found that in Model 2, productivity growth was driven mainly by improvements in technology rather than increases in efficiency while in Model 1 and Model 3, the two effects (ECH and TCH) almost balanced each other leading to no productivity change.

Suggested Citation

  • Chowdhury, Hedayet & Zelenyuk, Valentin & Laporte, Audrey & Wodchis, Walter P., 2014. "Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter?," International Journal of Production Economics, Elsevier, vol. 150(C), pages 74-82.
    • Handle: RePEc:eee:proeco:v:150:y:2014:i:c:p:74-82
    DOI: 10.1016/j.ijpe.2013.12.003
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    References listed on IDEAS

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    1. Leopold Simar & Valentin Zelenyuk, 2006. "On Testing Equality of Distributions of Technical Efficiency Scores," Econometric Reviews, Taylor & Francis Journals, vol. 25(4), pages 497-522.
    2. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    3. Leleu, Hervé & Moises, James & Valdmanis, Vivian, 2012. "Optimal productive size of hospital's intensive care units," International Journal of Production Economics, Elsevier, vol. 136(2), pages 297-305.
    4. Aletras, Vassilios & Kontodimopoulos, Nick & Zagouldoudis, Athanasios & Niakas, Dimitris, 2007. "The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals," Health Policy, Elsevier, vol. 83(2-3), pages 236-245, October.
    5. Vitikainen, Kirsi & Street, Andrew & Linna, Miika, 2009. "Estimation of hospital efficiency--Do different definitions and casemix measures for hospital output affect the results?," Health Policy, Elsevier, vol. 89(2), pages 149-159, February.
    6. Miika Linna, 1998. "Measuring hospital cost efficiency with panel data models," Health Economics, John Wiley & Sons, Ltd., vol. 7(5), pages 415-427, August.
    7. Halsteinli, Vidar & Kittelsen, Sverre A. & Magnussen, Jon, 2010. "Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment," Social Science & Medicine, Elsevier, vol. 70(3), pages 439-446, February.
    8. James F. Burgess, Jr. & Paul W. Wilson, 1996. "Hospital Ownership and Technical Inefficiency," Management Science, INFORMS, vol. 42(1), pages 110-123, January.
    9. Caves, Douglas W & Christensen, Laurits R & Diewert, W Erwin, 1982. "The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity," Econometrica, Econometric Society, vol. 50(6), pages 1393-1414, November.
    10. Kostas Kounetas & Fotis Papathanassopoulos, 2013. "How efficient are Greek hospitals? A case study using a double bootstrap DEA approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 979-994, December.
    11. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
    12. Magnussen, Jon & Nyland, Kari, 2008. "Measuring efficiency in clinical departments," Health Policy, Elsevier, vol. 87(1), pages 1-7, July.
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