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An Empirical Analysis of Cost Efficiency in Non‐profit and Public Nursing Homes


  • Mehdi Farsi
  • Massimo Filippini


***: This paper examines the issue of cost‐efficiency in Switzerland's nursing homes, an issue of concern to policy makers because of the rapid growth of elderly care expenditure and the aging of the population. The fact that nursing homes in Switzerland exist in different institutional forms, private for‐profit, government and non‐profit status, raises the issue of their relative cost efficiency. A panel data of 17 public and 19 nonprofit nursing homes operating over the 9‐year period from 1993 to 2001, in one of the 26 Swiss cantons, Ticino, is studied. Ticino's nursing homes are heavily regulated and monitored by the canton's authorities. However, given that in public firms there are more bureaucratic constraints and agency problems, one can expect a relatively low level of cost‐efficiency. In this paper the effect of institutional form on efficiency is studied using a translog stochastic cost‐frontier model. Several specifications are used to study the robustness of the results. The results suggest that the institutional form influences the efficiency of the studied nursing homes in that non‐profit foundations are likely to be more cost‐efficient than the nursing homes operated by government administration. The results also suggest that a great majority of the nursing homes in the sample do not fully benefit from scale economies. This implies that efficiency gains can be obtained with larger capacities or joint operations.

Suggested Citation

  • Mehdi Farsi & Massimo Filippini, 2004. "An Empirical Analysis of Cost Efficiency in Non‐profit and Public Nursing Homes," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 75(3), pages 339-365, September.
  • Handle: RePEc:bla:annpce:v:75:y:2004:i:3:p:339-365
    DOI: 10.1111/j.1467-8292.2004.00255.x

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    Cited by:

    1. Albalate, Daniel & Rosell, Jordi, 2019. "On the efficiency of toll motorway companies in Spain," Research in Transportation Economics, Elsevier, vol. 76(C).
    2. Mehdi Farsi & Massimo Filippini, 2008. "Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 335-350, March.
    3. Martin, Cécile, 2014. "Concurrence, prix et qualité de la prise en charge en EHPAD en France : Analyses micro-économétriques," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13712 edited by Dormont, Brigitte.
    4. Dewaelheyns, Nico & Eeckloo, Kristof & Van Herck, Gustaaf & Van Hulle, Cynthia & Vleugels, Arthur, 2009. "Do non-profit nursing homes separate governance roles?: The impact of size and ownership characteristics," Health Policy, Elsevier, vol. 90(2-3), pages 188-195, May.
    5. Di Giorgio, Laura & Filippini, Massimo & Masiero, Giuliano, 2014. "Implications of global budget payment system on nursing home costs," Health Policy, Elsevier, vol. 115(2), pages 237-248.
    6. Barron, David N. & West, Elizabeth, 2017. "The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?," Social Science & Medicine, Elsevier, vol. 179(C), pages 137-146.
    7. Pujol, Ferran Espuny & Hancock, Ruth & Hviid, Morten & Morciano, Marcello & Pudney, Stephen, 2019. "Market concentration, supply, quality and prices paid by local authorities in the English care home market," ISER Working Paper Series 2019-10, Institute for Social and Economic Research.
    8. Fusco, Elisa & Allegrini, Veronica, 2020. "The role of spatial interdependence in local government cost efficiency: An application to waste Italian sector," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).
    9. 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, October.
    10. Mehdi Farsi & Massimo Filippini & Michael Kuenzle, 2005. "Unobserved heterogeneity in stochastic cost frontier models: an application to Swiss nursing homes," Applied Economics, Taylor & Francis Journals, vol. 37(18), pages 2127-2141.
    11. Mehdi Farsi & Massimo Filippini & Diego Lunati, 2008. "Economies of Scale and Efficiency Measurement in Switzerland's Nursing Homes," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 359-378, September.
    12. repec:dau:papers:123456789/11700 is not listed on IDEAS
    13. Laura Di Giorgio & Massimo Filippini & Giuliano Masiero, 2012. "The impact of the institutional form on the cost efficiency of nursing homes," Quaderni della facoltà di Scienze economiche dell'Università di Lugano 1203, USI Università della Svizzera italiana.
    14. Marie-Eve Joël & Romain Sibille, 2013. "Education and career path of French nursing home managers : impact on their human resources practices," Post-Print hal-01522519, HAL.
    15. Singleton, John D., 2017. "Putting dollars before scholars? Evidence from for-profit charter schools in Florida," Economics of Education Review, Elsevier, vol. 58(C), pages 43-54.
    16. Medhi Farsi & Massimo Filippini, 2006. "Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland," Quaderni della facoltà di Scienze economiche dell'Università di Lugano 0606, USI Università della Svizzera italiana.
    17. Borisova, Ekaterina I. & Peresetsky, Anatoly & Polishchuk, Leonid, 2010. "Stochastic frontier in non-profit associations’ performance assessment (the case of homeowners’ associations)," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 20(4), pages 75-101.
    18. Di Giorgio, L. & Filippini, M. & Masiero, G., 2015. "Structural and managerial cost differences in nonprofit nursing homes," Economic Modelling, Elsevier, vol. 51(C), pages 289-298.
    19. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.

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