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Economies of Scale and Hospital Productivity: An empirical analysis of medical area level panel data

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  • MORIKAWA Masayuki

Abstract

This paper estimates the total factor productivity (TFP) of hospitals by using panel data drawn from prefectures and secondary medical areas. The study focuses on the economies of scale at the medical area and hospital levels. It uses the average length of stay as a measure of medical quality. We avoid case-mix bias by using data from medical areas instead of those from the hospital level. We control unobservable regional characteristics by employing panel data estimation. We eliminate price disparities among regions by using quantity data. Our results show that hospital size affects productivity: the larger the hospital, the higher the productivity. The hospital-size effect is economically significant: hospital productivity increases by more than 10% when the size of the hospital doubles. The size effects are null when we do not control the average length of stay. The main policy implication is the clear fact that consolidating hospitals improves productivity.

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Bibliographic Info

Paper provided by Research Institute of Economy, Trade and Industry (RIETI) in its series Discussion papers with number 10050.

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Length: 19 pages
Date of creation: Oct 2010
Date of revision:
Handle: RePEc:eti:dpaper:10050

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  1. MORIKAWA Masayuki, 2008. "Economies of Density and Productivity in Service Industries: An Analysis of Personal-Service Industries Based on Establishment-Level Data," Discussion papers 08023, Research Institute of Economy, Trade and Industry (RIETI).
  2. Gobillon, Laurent & Milcent, Carine, 2012. "Spatial Disparities in Hospital Performance," IZA Discussion Papers 6936, Institute for the Study of Labor (IZA).
  3. Emma Hall & Carol Propper & John Van Reenen, 2008. "Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance," NBER Working Papers 13776, National Bureau of Economic Research, Inc.
  4. Preyra, Colin & Pink, George, 2006. "Scale and scope efficiencies through hospital consolidations," Journal of Health Economics, Elsevier, vol. 25(6), pages 1049-1068, November.
  5. Vitaliano, Donald F., 1987. "On the estimation of hospital cost functions," Journal of Health Economics, Elsevier, vol. 6(4), pages 305-318, December.
  6. Martin Gaynor & Harald Seider & William B. Vogt, 2005. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, American Economic Association, vol. 95(2), pages 243-247, May.
  7. Gabriel A. Picone & Frank A. Sloan & Shin-Yi Chou & Donald H. Taylor, 2003. "Does Higher Hospital Cost Imply Higher Quality of Care?," The Review of Economics and Statistics, MIT Press, vol. 85(1), pages 51-62, February.
  8. Martin, Stephen & Smith, Peter, 1996. "Explaining variations in inpatient length of stay in the National Health Service," Journal of Health Economics, Elsevier, vol. 15(3), pages 279-304, June.
  9. Fenn, Paul & Davies, Philip, 1990. "Variations in length of stay : A conditional likelihood approach," Journal of Health Economics, Elsevier, vol. 9(2), pages 223-234, September.
  10. Nawata, Kazumitsu & Nitta, Ayako & Watanabe, Sonoko & Kawabuchi, Koichi, 2006. "An analysis of the length of stay and effectiveness of treatment for hip fracture patients in Japan: Evaluation of the 2002 revision of the medical service fee schedule," Journal of Health Economics, Elsevier, vol. 25(4), pages 722-739, July.
  11. Tong Li & Robert Rosenman, 2001. "Estimating hospital costs with a generalized Leontief function," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 523-538.
  12. Mehdi Farsi, 2008. "The temporal variation of cost-efficiency in Switzerland’s hospitals: an application of mixed models," Journal of Productivity Analysis, Springer, vol. 30(2), pages 155-168, October.
  13. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
  14. 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.
  15. Berndt, Ernst R. & Cutler, David M. & Frank, Richard G. & Griliches, Zvi & Newhouse, Joseph P. & Triplett, Jack E., 2000. "Medical care prices and output," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 3, pages 119-180 Elsevier.
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