Economies of scope in Norwegian hospital production - A DEA analysis
AbstractFrom 2002 the Norwegian hospital sector is to be transferred from county to state ownership, organised through regional semiautonomous companies. A major motivation for the reform is to allow for more specialised hospital production. If there are economies or diseconomies of scope, the production of hospital services in a region could become more efficient by exploiting any cost savings that may stem from an optimal division of service production between units. While the theory of economics of scope is well developed, applications have chiefly been concerned with testing for natural monopoly, and few studies of hospital production have been concerned with scope. This paper estimates a multiple output cost function from data on Norwegian hospitals using the non-parametric Data Envelopment Analysis (DEA) method. The cost function is specified with total running costs as the only input, but with seven different outputs to focus on the properties of the output transformation frontier. To overcome the methodological assumption of convexity inherent in DEA, the sample is split into relative specialised and differentiated hospitals, before comparing costs. This partitioning is achieved through grouping as specialised the first and fifth quintiles of the hospitals ranked by the share of the relevant output, since in fact no hospital is fully specialised by producing only one output, or nothing of an output. Exploring scope economies of the best practice cost frontier along three different dimensions, strong economies are found for surgical and medical services, intermediate for inpatient and outpatient production, while elective and emergency care cases have only week economies of scope, which may not be statistically significant. Results for the output mix of individual observations, reveal both economies and diseconomies in the last of these three dimensions. Contrary to these results, average efficiencies are found to be lower for differentiated than specialised hospitals, in all of the dimensions mentioned, although the differences are not very large. Since the DEA method measures hospitals with the largest production of each output as efficient by default, the results for average efficiency may be due to the methods employed.
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Bibliographic InfoPaper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2003:8.
Length: 30 pages
Date of creation: 21 Jun 2009
Date of revision:
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Phone: 2307 5309
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More information through EDIRC
Hospital performance; DEA; Economies of Scope;
Find related papers by JEL classification:
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
- I12 - Health, Education, and Welfare - - Health - - - Health Production
This paper has been announced in the following NEP Reports:
- NEP-ALL-2009-07-03 (All new papers)
- NEP-EFF-2009-07-03 (Efficiency & Productivity)
- NEP-HEA-2009-07-03 (Health Economics)
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- Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
- Diego Prior & Magda Solà, 2000. "Technical efficiency and economies of diversification in health care," Health Care Management Science, Springer, vol. 3(4), pages 299-307, September.
- Christian Growitsch & Heike Wetzel, 2006.
"Economies of Scope in European Railways: An Efficiency Analysis,"
Working Paper Series in Economics
29, University of Lüneburg, Institute of Economics.
- Christian Growitsch & Heike Wetzel, 2006. "Economies of Scope in European Railways: An Efficiency Analysis," IWH Discussion Papers 5, Halle Institute for Economic Research.
- Gary D. Ferrier & Hervé Leleu & James Moises & Vivian Valdmanis, 2009. "The Size and Service Offering Efficiencies of U.S. Hospitals," Working Papers 2009-ECO-09, IESEG School of Management.
- Pablo Arocena, 2005. "The measurement of scope, scale and diversification economies: How (in)efficient is electricity restructuring and unbundling?," Working Papers 2005/1, Institut d'Economia de Barcelona (IEB).
- De Witte, Kristof & Marques, R., 2008.
"Big and beautiful? On non-parametrically measuring scale economies in non-convex technologies,"
Open Access publications from Katholieke Universiteit Leuven
urn:hdl:123456789/197115, Katholieke Universiteit Leuven.
- Kristof Witte & Rui Marques, 2011. "Big and beautiful? On non-parametrically measuring scale economies in non-convex technologies," Journal of Productivity Analysis, Springer, vol. 35(3), pages 213-226, June.
- Kristof De Witte & Rui C. Marcques, 2008. "Big and beautiful? On non-parametrically measuring scale economies in non-convex technologies," Center for Economic Studies - Discussion papers ces0822, Katholieke Universiteit Leuven, Centrum voor Economische Studiën.
- Simões, Pedro & Cunha Marques, Rui, 2009. "Performance and Congestion Analysis of the Portuguese Hospital Services," MPRA Paper 16940, University Library of Munich, Germany.
- Arocena, Pablo, 2008. "Cost and quality gains from diversification and vertical integration in the electricity industry: A DEA approach," Energy Economics, Elsevier, vol. 30(1), pages 39-58, January.
- Kirsi Vitikainen & Miika Linna & Andrew Street, 2010. "Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?," The European Journal of Health Economics, Springer, vol. 11(4), pages 395-404, August.
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