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Estimation of hospital efficiency--Do different definitions and casemix measures for hospital output affect the results?

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  • Vitikainen, Kirsi
  • Street, Andrew
  • Linna, Miika

Abstract

Objectives Hospital efficiency has been the subject of numerous health economics studies, but there is little evidence on how the chosen output and casemix measures affect the efficiency results. The aim of this study is to examine the robustness of efficiency results due to these factors. Comparison is made between activities and episode output measures, and two different output grouping systems (Classic and FullDRG).Methods Non-parametric data envelopment analysis is used as an analysis technique. The data consist of all public acute care hospitals in Finland in 2005 (n = 40).Results Efficiency estimates were not found to be highly sensitive to the choice between episode and activity descriptions of output, but more so to the choice of DRG grouping system. Estimates are most sensitive to scale assumptions, with evidence of decreasing returns to scale in larger hospitals.Conclusions Episode measures are generally to be preferred to activity measures because these better capture the patient pathway, while FullDRGs are preferred to Classic DRGs particularly because of the better description of outpatient output in the former grouping system. Attention should be paid to reducing the extent of scale inefficiency in Finland.

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  • Vitikainen, Kirsi & Street, Andrew & Linna, Miika, 2009. "Estimation of hospital efficiency--Do different definitions and casemix measures for hospital output affect the results?," Health Policy, Elsevier, vol. 89(2), pages 149-159, February.
    • Handle: RePEc:eee:hepoli:v:89:y:2009:i:2:p:149-159
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    2. Nabila Asghar & Hafeez-ur-Rehman & Hafiz Ghulam Mujaddid, 2018. "Efficiency Analysis Of Hospitals In Punjab Districts: An Application Of Dea Bootstrap," IBT Journal of Business Studies (JBS), Ilma University, Faculty of Management Science, vol. 14(1), pages 120-128.
    3. Anthun, Kjartan Sarheim & Kittelsen, Sverre Andreas Campbell & Magnussen, Jon, 2017. "Productivity growth, case mix and optimal size of hospitals. A 16-year study of the Norwegian hospital sector," Health Policy, Elsevier, vol. 121(4), pages 418-425.
    4. Medin, Emma & Häkkinen, Unto & Linna, Miika & Anthun, Kjartan S. & Kittelsen, Sverre A.C. & Rehnberg, Clas, 2013. "International hospital productivity comparison: Experiences from the Nordic countries," Health Policy, Elsevier, vol. 112(1), pages 80-87.
    5. 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;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 395-404, August.
    6. Chowdhury, Hedayet & Zelenyuk, Valentin & Laporte, Audrey & Wodchis, Walter P., 2014. "Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter?," International Journal of Production Economics, Elsevier, vol. 150(C), pages 74-82.
    7. Miryam Daoud Marrakchi & Hédi Essid, 2019. "Efficiency Assessment of Tunisian Public hospitals Using Data Envelopment Analysis (DEA)," Working Papers 1291, Economic Research Forum, revised 2019.
    8. Emma Medin & Kjartan Anthun & Unto Häkkinen & Sverre Kittelsen & Miika Linna & Jon Magnussen & Kim Olsen & Clas Rehnberg, 2011. "Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 509-519, December.
    9. Halsteinli, Vidar & Kittelsen, Sverre A. & Magnussen, Jon, 2010. "Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment," Social Science & Medicine, Elsevier, vol. 70(3), pages 439-446, February.
    10. Halkos, George E. & Tzeremes, Nickolaos G., 2011. "A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures," Health Policy, Elsevier, vol. 103(1), pages 73-82.
    11. Nabila Asghar & Hafeez-ur-Rehman & Hafiz Ghulam Mujaddid, 2018. "Efficiency Analysis Of Hospitals In Punjab Districts: An Application Of Dea Bootstrap," IBT Journal of Business Studies (JBS), Ilma University, Faculty of Management Science, vol. 14(1), pages 14-10.
    12. José Luis Franco Miguel & Carmen Fullana Belda & Antonio Rúa Vieites, 2019. "Analysis of the technical efficiency of the forms of hospital management based on public‐private collaboration of the Madrid Health Service, as compared with traditional management," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 414-442, January.
    13. Garcia-Lacalle, Javier & Martin, Emilio, 2010. "Rural vs urban hospital performance in a 'competitive' public health service," Social Science & Medicine, Elsevier, vol. 71(6), pages 1131-1140, September.
    14. Fu-bao Zhou & Xin-xin Wang & Ying-ke Liu, 2014. "Gas drainage efficiency: an input–output model for evaluating gas drainage projects," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 74(2), pages 989-1005, November.
    15. Productivity Commission, 2009. "Public and Private Hospitals," Research Reports, Productivity Commission, Government of Australia, number 37.

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