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Accounting for quality in the measurement of hospital performance: evidence from Costa Rica

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  • Pablo Arocena

    (Universidad P�blica de Navarra, Spain)

  • Ariadna Garc�a-Prado

    (World Bank, Washington, DC, USA)

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    Abstract

    This paper provides insights into how Costa Rican public hospitals responded to the pressure for increased efficiency and quality introduced by the reforms carried out over the period 1997-2001. To that purpose we compute a generalized output distance function by means of non-parametric mathematical programming to construct a productivity index, which accounts for productivity changes while controlling for quality of care. Our results show an improvement in hospital performance mainly driven by quality increases. The adoption of management contracts seems to have contributed to such enhancement, more notably for small hospitals. Further, productivity growth is primarily due to technical and scale efficiency change rather than technological change. A number of policy implications are drawn from these results. Copyright © 2006 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1204
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 16 (2007)
    Issue (Month): 7 ()
    Pages: 667-685

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    Handle: RePEc:wly:hlthec:v:16:y:2007:i:7:p:667-685

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Miika Linna & Unto Häkkinen & Eero Linnakko, 1998. "An econometric study of costs of teaching and research in Finnish hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 291-305.
    2. Fare, R. & Grosskopf, S. & Hernandez-Sancho, F., 2004. "Environmental performance: an index number approach," Resource and Energy Economics, Elsevier, vol. 26(4), pages 343-352, December.
    3. Jean-Paul Chavas & Thomas L. Cox, 1999. "A Generalized Distance Function and the Analysis of Production Efficiency," Wisconsin-Madison Agricultural and Applied Economics Staff Papers 422, Wisconsin-Madison Agricultural and Applied Economics Department.
    4. Filmer, Deon & Hammer, Jeffrey S & Pritchett, Lant H, 2000. "Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries," World Bank Research Observer, World Bank Group, vol. 15(2), pages 199-224, August.
    5. Juan Ventura & Eduardo GonzáLez & Ana Cárcaba, 2004. "Efficiency and Program-Contract Bargaining in Spanish Public Hospitals," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 75(4), pages 549-573, December.
    6. Rodriguez-Alvarez, Ana & Fernandez-Blanco, Victor & Lovell, C. A. Knox, 2004. "Allocative inefficiency and its cost:: The case of Spanish public hospitals," International Journal of Production Economics, Elsevier, vol. 92(2), pages 99-111, November.
    7. Jose Zofio & C. A. Knox Lovell, 2001. "Graph efficiency and productivity measures: an application to US agriculture," Applied Economics, Taylor & Francis Journals, vol. 33(11), pages 1433-1442.
    8. Arocena, Pablo & Waddams Price, Catherine, 2002. "Generating efficiency: economic and environmental regulation of public and private electricity generators in Spain," International Journal of Industrial Organization, Elsevier, vol. 20(1), pages 41-69, January.
    9. repec:ccp:journl:v:20:y:2002:i:1:p:41-69 is not listed on IDEAS
    10. Fare, Rolf, et al, 1989. "Multilateral Productivity Comparisons When Some Outputs Are Undesirable: A Nonparametric Approach," The Review of Economics and Statistics, MIT Press, vol. 71(1), pages 90-98, February.
    11. Dranove, David & Satterthwaite, Mark A., 2000. "The industrial organization of health care markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 20, pages 1093-1139 Elsevier.
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    Cited by:
    1. Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2012. "Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals," MPRA Paper 37437, University Library of Munich, Germany.
    2. Simon Eckermann & Tim Coelli, 2008. "Including quality attributes in a model of health care efficiency: A net benefit approach," CEPA Working Papers Series WP032008, School of Economics, University of Queensland, Australia.
    3. Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2013. "Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals," GIAM Working Papers 13-7, Galatasaray University Economic Research Center.
    4. Luigi Siciliani & Anderson Stanciole & Rowena Jacobs, 2008. "Do waiting times reduce hospital costs?," Discussion Papers 08/02, Department of Economics, University of York.
    5. Cruz-Cázares, Claudio & Bayona-Sáez, Cristina & García-Marco, Teresa, 2013. "You can’t manage right what you can’t measure well: Technological innovation efficiency," Research Policy, Elsevier, vol. 42(6), pages 1239-1250.

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