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The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?

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  • Ivonne Lindlbauer
  • Jonas Schreyögg

Abstract

This study investigated the relationship between hospital specialization and technical efficiency using different measures of specialization, including two novel approaches based on patient volumes rather than patient proportions. It was motivated by the observation that most studies to date have quantified hospital specialization using information about hospital patients grouped into different categories based on their diagnosis, and in doing so have used proportions—thus indirectly assuming that these categories are dependent on one other. In order to account for the diversification of organizations and the idea that hospitals can be specialized in terms of professional expertise or technical equipment within a given diagnosis category, we developed our two specialization measures based on patient volume in each category. Using a one-step stochastic frontier approach on randomly selected data from the annual reports of 1,239 acute care German hospitals for the years 2000 through 2010, we estimated the relationship of inefficiency to exogenous variables, such as specialization. The results show that specialization as quantified by our novel measures has effects on efficiency that are the opposite of those obtained using earlier measures of specialization. These results underscore the importance of always providing an exact definition of specialization when studying its effects. Additionally, a Monte Carlo simulation based on three scenarios is provided to facilitate the choice of a specialization measure for further analysis. Copyright Springer Science+Business Media New York 2014

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  • Ivonne Lindlbauer & Jonas Schreyögg, 2014. "The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?," Health Care Management Science, Springer, vol. 17(4), pages 365-378, December.
    • Handle: RePEc:kap:hcarem:v:17:y:2014:i:4:p:365-378
    DOI: 10.1007/s10729-014-9275-1
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    6. Diogo Cunha Ferreira & Alexandre Morais Nunes & Rui Cunha Marques, 2020. "Operational efficiency vs clinical safety, care appropriateness, timeliness, and access to health care," Journal of Productivity Analysis, Springer, vol. 53(3), pages 355-375, June.
    7. Vomhof, Markus, 2016. "Hospital competition with heterogeneous patient groups: Incentives and regulation," Ruhr Economic Papers 624, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    8. Mª Isabel Ortega-Díaz & Ricardo Ocaña-Riola & Carmen Pérez-Romero & José Jesús Martín-Martín, 2020. "Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals," IJERPH, MDPI, vol. 17(16), pages 1-19, August.
    9. Diogo Cunha Ferreira & Rui Cunha Marques, 2020. "A step forward on order-α robust nonparametric method: inclusion of weight restrictions, convexity and non-variable returns to scale," Operational Research, Springer, vol. 20(2), pages 1011-1046, June.
    10. Sommersguter-Reichmann, Margit & Stepan, Adolf, 2015. "The interplay between regulation and efficiency: Evidence from the Austrian hospital inpatient sector," Socio-Economic Planning Sciences, Elsevier, vol. 52(C), pages 10-21.
    11. José M. Cordero & Agustín García-García & Enrique Lau-Cortés & Cristina Polo, 2021. "Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter?," IJERPH, MDPI, vol. 18(16), pages 1-21, August.
    12. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
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    14. Annika Maren Schneider & Eva-Maria Oppel & Jonas Schreyögg, 2020. "Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market," Health Care Management Science, Springer, vol. 23(4), pages 649-660, December.
    15. Diogo Cunha Ferreira & Rui Cunha Marques & Alexandre Morais Nunes, 2021. "Pay for performance in health care: a new best practice tariff-based tool using a log-linear piecewise frontier function and a dual–primal approach for unique solutions," Operational Research, Springer, vol. 21(3), pages 2101-2146, September.
    16. Ricardo Ocaña-Riola & Carmen Pérez-Romero & Mª Isabel Ortega-Díaz & José Jesús Martín-Martín, 2021. "Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals," IJERPH, MDPI, vol. 18(19), pages 1-18, September.

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