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Market structure and hospital efficiency: Evaluating potential effects of deregulation in a national health service

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  • Eulàlia Dalmau
  • Jaume Puig

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    Abstract

    In this article we examine the potential effect of market structure on hospital technical efficiency as a measure of performance controlled by ownership and regulation. This study is relevant to provide an evaluation of the potential effects of recommended and initiated deregulation policies in order to promote market reforms in the context of a European National Health Service. Our goal was reached through three main empirical stages. Firstly, using patient origin data from hospitals in the region of Catalonia in 1990, we estimated geographic hospital markets through the Elzinga--Hogarty approach, based on patient flows. Then we measured the market level of concentration using the Herfindahl--Hirschman index. Secondly, technical and scale efficiency scores for each hospital was obtained specifying a Data Envelopment Analysis. According to the data nearly two--thirds of the hospitals operate under the production frontier with an average efficiency score of 0.841. Finally, the determinants of the efficiency scores were investigated using a censored regression model. Special attention was paid to test the hypothesis that there is an efficiency improvement in more competitive markets. The results suggest that the number of competitors in the market contributes positively to technical efficiency and there is some evidence that the differences in efficiency scores are attributed to several environmental factors such as ownership, market structure and regulation effects.

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    Bibliographic Info

    Paper provided by Department of Economics and Business, Universitat Pompeu Fabra in its series Working Papers, Research Center on Health and Economics with number 214.

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    Date of creation: Jun 1997
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    Handle: RePEc:upf:upfses:214

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    Web page: http://www.econ.upf.edu/

    Related research

    Keywords: Geographic markets; market concentration; technical efficiency; data envelopment analysis; censored regression model;

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    1. Werden, Gregory J., 1990. "The limited relevance of patient migration data in market delineation for hospital merger cases," Journal of Health Economics, Elsevier, vol. 8(4), pages 363-376, February.
    2. Banker, Rajiv D. & Thrall, R. M., 1992. "Estimation of returns to scale using data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 62(1), pages 74-84, October.
    3. 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.
    4. Noether, Monica, 1988. "Competition among hospitals," Journal of Health Economics, Elsevier, vol. 7(3), pages 259-284, September.
    5. Propper, Carol, 1996. "Market structure and prices: The responses of hospitals in the UK National Health Service to competition," Journal of Public Economics, Elsevier, vol. 61(3), pages 307-335, September.
    6. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
    7. David Dranove & Mark Shanley & Carol Simon, 1992. "Is Hospital Competition Wasteful?," RAND Journal of Economics, The RAND Corporation, vol. 23(2), pages 247-262, Summer.
    8. Chirikos, Thomas N. & Sear, Alan M., 1994. "Technical efficiency and the competitive behavior of hospitals," Socio-Economic Planning Sciences, Elsevier, vol. 28(4), pages 219-227, December.
    9. Abel-Smith, Brian & Mossialos, Elias, 1994. "Cost containment and health care reform: a study of the European Union," Health Policy, Elsevier, vol. 28(2), pages 89-132, May.
    10. Dranove, David & Shanley, Mark & White, William D, 1993. "Price and Concentration in Hospital Markets: The Switch from Patient-Driven to Payer-Driven Competition," Journal of Law and Economics, University of Chicago Press, vol. 36(1), pages 179-204, April.
    11. Maynard, Alan, 1991. "Developing the Health Care Market," Economic Journal, Royal Economic Society, vol. 101(408), pages 1277-86, September.
    12. Zuckerman, Stephen & Hadley, Jack & Iezzoni, Lisa, 1994. "Measuring hospital efficiency with frontier cost functions," Journal of Health Economics, Elsevier, vol. 13(3), pages 255-280, October.
    13. Valdmanis, Vivian, 1992. "Sensitivity analysis for DEA models : An empirical example using public vs. NFP hospitals," Journal of Public Economics, Elsevier, vol. 48(2), pages 185-205, July.
    14. Kooreman, P., 1994. "Nursing home care in the netherlands: A nonparametric efficiency analysis," Open Access publications from Tilburg University urn:nbn:nl:ui:12-377583, Tilburg University.
    15. Kooreman, Peter, 1994. "Nursing home care in The Netherlands: a nonparametric efficiency analysis," Journal of Health Economics, Elsevier, vol. 13(3), pages 301-316, October.
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