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Hospital Ownership and Technical Inefficiency


  • James F. Burgess, Jr.

    (Management Science Group (515/MSG), US Department of Veterans Affairs, Bedford, Massachusetts 01730)

  • Paul W. Wilson

    (Department of Economics, University of Texas, Austin, Texas 78712)


The theoretical industrial organization literature cites varying factors which might influence the degree of technical efficiency achieved under different ownership structures in the US hospital industry. Unfortunately, this literature offers no consensus regarding the net direction and magnitude of these various effects. This study analyzes the four types of ownership structure in the US hospital industry---private nonprofit, private for-profit, federal, and state and local government. Distance functions are used to measure technical efficiency of hospitals producing multiple outputs relative to other hospitals in the sample, allowing comparisons among the different ownership types.

Suggested Citation

  • James F. Burgess, Jr. & Paul W. Wilson, 1996. "Hospital Ownership and Technical Inefficiency," Management Science, INFORMS, vol. 42(1), pages 110-123, January.
  • Handle: RePEc:inm:ormnsc:v:42:y:1996:i:1:p:110-123

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    References listed on IDEAS

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    1. Thomas Czypionka & Markus Kraus & Susanne Mayer & Gerald Röhrling, 2014. "Efficiency, ownership, and financing of hospitals: The case of Austria," Health Care Management Science, Springer, vol. 17(4), pages 331-347, December.
    2. N. Maniadakis & N. Kotsopoulos & P. Prezerakos & J. Yfantopoulos, 2009. "Health Care Services Performance Measurement: Theory, Methods and Empirical Evidence," European Research Studies Journal, European Research Studies Journal, vol. 0(3), pages 151-170.
    3. 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.
    4. repec:ces:ifodre:v:12:y:2005:i:02:p:s.9-18 is not listed on IDEAS
    5. Obure, Carol Dayo & Jacobs, Rowena & Guinness, Lorna & Mayhew, Susannah & Vassall, Anna, 2016. "Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality me," Social Science & Medicine, Elsevier, vol. 151(C), pages 147-156.
    6. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    7. Chang, Hsihui & Cheng, Mei-Ai & Das, Somnath, 2004. "Hospital ownership and operating efficiency: Evidence from Taiwan," European Journal of Operational Research, Elsevier, vol. 159(2), pages 513-527, December.
    8. Burgess, James Jr. & Carey, Kathleen & Young, Gary J., 2005. "The effect of network arrangements on hospital pricing behavior," Journal of Health Economics, Elsevier, vol. 24(2), pages 391-405, March.
    9. Athanassopoulos, Antreas & Gounaris, Chrysostomos, 2001. "Assessing the technical and allocative efficiency of hospital operations in Greece and its resource allocation implications," European Journal of Operational Research, Elsevier, vol. 133(2), pages 416-431, January.
    10. Roberto Cellini & Giacomo Pignataro & Ilde Rizzo, 2000. "Competition and Efficiency in Health Care: An Analysis of the Italian Case," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 7(4), pages 503-519, August.
    11. Brigitte Dormont & Carine Milcent, 2012. "Comment évaluer la productivité et l'efficacité des hôpitaux publics et privés ? Les enjeux de la convergence tarifaire," Économie et Statistique, Programme National Persée, vol. 455(1), pages 143-173.
    12. Hu, Hsin-Hui & Qi, Qinghui & Yang, Chih-Hai, 2012. "Analysis of hospital technical efficiency in China: Effect of health insurance reform," China Economic Review, Elsevier, vol. 23(4), pages 865-877.
    13. Suthathip Yaisawarng & James F. Burgess, 2006. "Performance-based budgeting in the public sector: an illustration from the VA health care system," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 295-310.
    14. Piet Verheyen, 1998. "The Missing Link in Budget Models of Nonprofit Institutions: Two Practical Dutch Applications," Management Science, INFORMS, vol. 44(6), pages 787-800, June.
    15. Tambour, Magnus & Rehnberg, Clas, 1997. "Internal Markets and Performance in Swedish Health Care," SSE/EFI Working Paper Series in Economics and Finance 161, Stockholm School of Economics.
    16. Tiemann, Oliver & Schreyögg, Jonas & Busse, Reinhard, 2012. "Hospital ownership and efficiency: A review of studies with particular focus on Germany," Health Policy, Elsevier, vol. 104(2), pages 163-171.
    17. Cláudia Araújo & Carlos Barros & Peter Wanke, 2014. "Efficiency determinants and capacity issues in Brazilian for-profit hospitals," Health Care Management Science, Springer, vol. 17(2), pages 126-138, June.
    18. Fuh-Hwa Liu & Ying-Hock Teng & Ching-Hsiang Lai, 2011. "The disaster response performance of hospitals in Taiwan: evaluation and classification," Quality & Quantity: International Journal of Methodology, Springer, vol. 45(3), pages 495-511, April.
    19. 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.
    20. Brigitte Dormont & Carine Milcent, 2004. "The sources of hospital cost variability," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 927-939.
    21. repec:dau:papers:123456789/7738 is not listed on IDEAS
    22. repec:kap:hcarem:v:20:y:2017:i:2:d:10.1007_s10729-015-9348-9 is not listed on IDEAS


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