Advanced Search
MyIDEAS: Login to save this paper or follow this series

Towards panel data specifications of efficiency measures for English acute hospitals


Author Info

  • Neil Soderlund
  • Rowena Jacobs

    (Centre for Health Economics, The University of York)

Registered author(s):


    This paper reports work undertaken for the Department of Health to explore different approaches of measuring hospital efficiency. The emphasis throughout is on developing adjusted cost-efficiency measures in line with NHS Trusts performance objectives. Previous work described the derivation of three residual-based cost indices (CCI, 2CCI and 3CCI), each with increasing adjustment in terms of case mix, factor prices and environmental factors for a single year’s data (1995/6) (Söderlund & van der Merwe, 1999). This study explores further options based on the previous work by: (1) supplementing hospital level with specialty level data; (2) studying a 4-year panel from 1994/5 to 1997/8; (3) estimating models with non-symmetric error terms and including Trust-specific effects when measuring inefficiency. Although the paper argues that panel data models may have certain advantages over cross-sectional ones, the results suggest that data pooling across years provide robust parameter estimates. Longitudinal fixed effect models may however be useful to construct efficiency indices while stochastic frontier models have the advantage of taking account of random noise. Specialty level models proved inferior to whole hospital estimations. The paper argues that the degree of variation between hospitals in terms of efficiency is not that great and scope for efficiency enhancement is primarily attainable by optimising capacity and activity levels in the long run. Increased activity levels may however have adverse consequences such as increased hospital infection rates, poorer quality of care and a lack of capacity to deal with emergency demand. The paper argues that the Department of Health might consider a shift from the adjusted cost index approach used in this normative benchmarking framework to the more conventional efficiency analysis approach using a total cost function, and more flexible functional forms, allowing for a more defensible interpretation of the residuals as inefficiency.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL:
    File Function: First version, 2001
    Download Restriction: no

    Bibliographic Info

    Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 185chedp.

    as in new window
    Length: 35 pages
    Date of creation: Jun 2001
    Date of revision:
    Handle: RePEc:chy:respap:185chedp

    Contact details of provider:
    Postal: York Y010 5DD
    Phone: (01904) 321401
    Fax: (0)1904 323759
    Web page:
    More information through EDIRC

    Related research

    Keywords: efficiency;


    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
    as in new window
    1. Robinson, James C. & Luft, Harold S., 1985. "The impact of hospital market structure on patient volume, average length of stay, and the cost of care," Journal of Health Economics, Elsevier, vol. 4(4), pages 333-356, December.
    2. Hausman, Jerry A, 1978. "Specification Tests in Econometrics," Econometrica, Econometric Society, vol. 46(6), pages 1251-71, November.
    3. Vita, Michael G., 1990. "Exploring hospital production relationships with flexible functional forms," Journal of Health Economics, Elsevier, vol. 9(1), pages 1-21, June.
    4. White, Halbert, 1980. "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity," Econometrica, Econometric Society, vol. 48(4), pages 817-38, May.
    5. Uwe Jensen, 2000. "Is it efficient to analyse efficiency rankings?," Empirical Economics, Springer, vol. 25(2), pages 189-208.
    6. Breyer, Friedrich, 1987. "The specification of a hospital cost function : A comment on the recent literature," Journal of Health Economics, Elsevier, vol. 6(2), pages 147-157, June.
    7. Vitaliano, Donald F., 1987. "On the estimation of hospital cost functions," Journal of Health Economics, Elsevier, vol. 6(4), pages 305-318, December.
    8. Neil Soderlund & Rowena van der Merwe, 1999. "Hospital benchmarking analysis and the derivation of cost indices," Working Papers 174chedp, Centre for Health Economics, University of York.
    9. Melnick, Glenn A. & Zwanziger, Jack & Bamezai, Anil & Pattison, Robert, 1992. "The effects of market structure and bargaining position on hospital prices," Journal of Health Economics, Elsevier, vol. 11(3), pages 217-233, October.
    10. Krishnan, Ranjani, 2001. "Market restructuring and pricing in the hospital industry," Journal of Health Economics, Elsevier, vol. 20(2), pages 213-237, March.
    11. Farley, Dean E., 1989. "Measuring casemix specialization and the concentration of diagnoses in hospitals using information theory," Journal of Health Economics, Elsevier, vol. 8(2), pages 185-207, June.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as in new window

    Cited by:
    1. Rowena Jacobs & Diane Dawson, 2003. "Hospital efficiency targets," Health Economics, John Wiley & Sons, Ltd., vol. 12(8), pages 669-684.


    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.


    Access and download statistics


    When requesting a correction, please mention this item's handle: RePEc:chy:respap:185chedp. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Frances Sharp).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.