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Hospital efficiency under global budgeting: evidence from Taiwan

Author

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  • Hung-pin Lai

    (National Chung Cheng University)

  • Meng-Chi Tang

    (National Chung Cheng University)

Abstract

Global budgeting sets a predetermined cap to restrain health expenditure, but the fixed budget for medical providers could result in less efficient services. This paper measures hospital efficiency under global budgeting using simultaneous stochastic frontier analysis, stressing that physicians and dentists within a hospital were under separate budgets in Taiwan. Empirical results show that hospital efficiency was not improved after global budgeting, and physicians were found to be less efficient than dentists. The physicians and dentists within the same hospital were also found to be less integrated after global budgeting. Empirical results show that a joint analysis improves the estimation efficiency from separate analysis and suggest that the aggregate inefficiency came mostly from physicians in hospitals that were small, public, non-teaching, located in small markets and had a low market share. Except for public hospitals, physicians and dentists in the above hospitals were also found to be less integrated.

Suggested Citation

  • Hung-pin Lai & Meng-Chi Tang, 2018. "Hospital efficiency under global budgeting: evidence from Taiwan," Empirical Economics, Springer, vol. 55(3), pages 937-963, November.
    • Handle: RePEc:spr:empeco:v:55:y:2018:i:3:d:10.1007_s00181-017-1317-3
    DOI: 10.1007/s00181-017-1317-3
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    References listed on IDEAS

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    1. Mougeot, Michel & Naegelen, Florence, 2005. "Hospital price regulation and expenditure cap policy," Journal of Health Economics, Elsevier, vol. 24(1), pages 55-72, January.
    2. Fan, Chinn-Ping & Chen, Kong-Pin & Kan, Kamhon, 1998. "The design of payment systems for physicians under global budget - an experimental study," Journal of Economic Behavior & Organization, Elsevier, vol. 34(2), pages 295-311, February.
    3. Bradley Chen & Victoria Y. Fan, 2015. "Strategic Provider Behavior Under Global Budget Payment with Price Adjustment in Taiwan," Health Economics, John Wiley & Sons, Ltd., vol. 24(11), pages 1422-1436, November.
    4. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    5. Hauck, Katharina & Street, Andrew, 2006. "Performance assessment in the context of multiple objectives: A multivariate multilevel analysis," Journal of Health Economics, Elsevier, vol. 25(6), pages 1029-1048, November.
    6. Hung-pin Lai & Cliff Huang, 2013. "Maximum likelihood estimation of seemingly unrelated stochastic frontier regressions," Journal of Productivity Analysis, Springer, vol. 40(1), pages 1-14, August.
    7. Kumbhakar,Subal C. & Wang,Hung-Jen & Horncastle,Alan P., 2015. "A Practitioner's Guide to Stochastic Frontier Analysis Using Stata," Cambridge Books, Cambridge University Press, number 9781107029514.
    8. James M. Poterba, 1994. "A Skeptic's View of Global Budget Caps," Journal of Economic Perspectives, American Economic Association, vol. 8(3), pages 67-73, Summer.
    9. Cheng, Shou-Hsia & Chen, Chi-Chen & Chang, Wei-Ling, 2009. "Hospital response to a global budget program under universal health insurance in Taiwan," Health Policy, Elsevier, vol. 92(2-3), pages 158-164, October.
    10. Miaw-Chwen Lee & Andrew M. Jones, 2004. "How did Dentists Respond to the Introduction of Global Budgets in Taiwan? An Evaluation Using Individual Panel Data," International Journal of Health Economics and Management, Springer, vol. 4(4), pages 307-326, December.
    11. Yan, Yu-Hua & Hsu, Shuofen & Yang, Chen-Wei & Fang, Shih-Chieh, 2010. "Agency problems in hospitals participating in self-management project under global budget system in Taiwan," Health Policy, Elsevier, vol. 94(2), pages 135-143, February.
    12. Chang, Ray-E. & Hsieh, Chi-Jeng & Myrtle, Robert C., 2011. "The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients," Social Science & Medicine, Elsevier, vol. 73(1), pages 153-159, July.
    13. U.‐G. Gerdtham & M. Löthgren & M. Tambour & C. Rehnberg, 1999. "Internal markets and health care efficiency: a multiple‐output stochastic frontier analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(2), pages 151-164, March.
    14. Chia-Hsuan Wu & Ching-Cheng Chang & Po-Chi Chen & Ken-Nan Kuo, 2013. "Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 21(2), pages 431-453, March.
    15. Benstetter, Franz & Wambach, Achim, 2006. "The treadmill effect in a fixed budget system," Journal of Health Economics, Elsevier, vol. 25(1), pages 146-169, January.
    16. Kamhon Kan & Shu-Fen Li & Wei-Der Tsai, 2014. "The impact of global budgeting on treatment intensity and outcomes," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 311-337, December.
    17. Roger Feldman & Felix Lobo, 1997. "Global Budgets and Excess Demand for Hospital Care," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 187-196, March.
    18. Mougeot, Michel & Naegelen, Florence, 2005. "Hospital price regulation and expenditure cap policy," Journal of Health Economics, Elsevier, vol. 24(1), pages 55-72, January.
    19. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
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    Cited by:

    1. Meng-Chi Tang & Yi-Nong Wu, 2020. "Medical providers as double agents in a universal health care system: evidence from generic pharmaceutical adoption in Taiwan," Empirical Economics, Springer, vol. 59(1), pages 169-203, July.
    2. Lin, Lee-Kai, 2022. "Effects of a global budget payment scheme on medical specialty workforces," Social Science & Medicine, Elsevier, vol. 309(C).
    3. Li Xiang & Zhengdong Zhong & Junnan Jiang, 2022. "The Response of Different-Levels Public Hospitals to Regional Global Budget with a Floating Payment System: Evidence from China," IJERPH, MDPI, vol. 19(23), pages 1-11, November.

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    More about this item

    Keywords

    Hospital efficiency; Global budgeting; Stochastic frontier analysis; Universal health care;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • C3 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables
    • R3 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Real Estate Markets, Spatial Production Analysis, and Firm Location

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