IDEAS home Printed from https://ideas.repec.org/a/kap/jproda/v40y2013i2p197-206.html
   My bibliography  Save this article

The scale of hospital production in different settings: one size does not fit all

Author

Listed:
  • Mette Asmild
  • Bruce Hollingsworth
  • Stephen Birch

Abstract

This paper analyses the productive efficiency of 141 public hospitals from 1998 to 2004 in two Canadian provinces; one a small province with a few small cities and a generally more rural population and the other a large province that is more urban in nature, with a population who mainly live in large cities. The relative efficiencies of the hospitals, the changes in productivity during this time period, and the relationship between efficiency and the size or scale of the hospitals are investigated using data envelopment analysis. The models for the production of health care use case mix adjusted hospital discharges as the output, and nursing hours as inputs. We find clear differences between the two provinces. Making use of ‘own’ and ‘meta’ technical efficiency frontiers, we demonstrate that efficient units in the larger and more urban province are larger than non-efficient units in that province. However, efficient hospitals in the smaller and more rural province are smaller than non-efficient hospitals in that province. Overall, efficient hospitals in the larger more urban province are larger than efficient hospitals in the smaller more rural province. This has interesting policy implications—different hospitals may have different optimal sizes, or different efficient modes of operation, depending on location, the population they serve, and the policies their respective provincial governments wish to implement. In addition, there are lessons to be learned by comparing the hospitals across the two provinces, since the inefficient hospitals in the small rural province predominantly use hospitals from the large urban province as benchmarks, such that substantially larger improvement potential can be identified by inter-provincial rather than intra-provincial benchmarking analysis. Copyright Springer Science+Business Media New York 2013

Suggested Citation

  • Mette Asmild & Bruce Hollingsworth & Stephen Birch, 2013. "The scale of hospital production in different settings: one size does not fit all," Journal of Productivity Analysis, Springer, vol. 40(2), pages 197-206, October.
  • Handle: RePEc:kap:jproda:v:40:y:2013:i:2:p:197-206
    DOI: 10.1007/s11123-012-0332-9
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1007/s11123-012-0332-9
    Download Restriction: Access to full text is restricted to subscribers.

    File URL: https://libkey.io/10.1007/s11123-012-0332-9?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Dranove, David, 1998. "Economies of scale in non-revenue producing cost centers: Implications for hospital mergers," Journal of Health Economics, Elsevier, vol. 17(1), pages 69-83, January.
    2. 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.
    3. Fried, Harold O. & Lovell, C. A. Knox & Schmidt, Shelton S. (ed.), 2008. "The Measurement of Productive Efficiency and Productivity Growth," OUP Catalogue, Oxford University Press, number 9780195183528.
    4. Wheelock, David C & Wilson, Paul W, 1999. "Technical Progress, Inefficiency, and Productivity Change in U.S. Banking, 1984-1993," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 31(2), pages 212-234, May.
    5. Daniel Bilodeau & Pierre-Yves Cremieux & Pierre Ouellette, 2009. "Hospital performance in a noncompetitive environment," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 459-468.
    6. Vitaliano, Donald F., 1987. "On the estimation of hospital cost functions," Journal of Health Economics, Elsevier, vol. 6(4), pages 305-318, December.
    7. Daniel Bilodeau & Pierre-Yves Crémieux & Pierre Ouellette, 2002. "Hospital Technology in a Nonmarket Health Care System," Southern Economic Journal, John Wiley & Sons, vol. 68(3), pages 511-529, January.
    8. Daniel Bilodeau & Pierre-Yves Crémieux & Brigitte Jaumard & Pierre Ouellette & Tsévi Vovor, 2004. "Measuring Hospital Performance in the Presence of Quasi-Fixed Inputs: An Analysis of Québec Hospitals," Journal of Productivity Analysis, Springer, vol. 21(2), pages 183-199, March.
    9. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    10. Preyra, Colin & Pink, George, 2006. "Scale and scope efficiencies through hospital consolidations," Journal of Health Economics, Elsevier, vol. 25(6), pages 1049-1068, November.
    11. Mette Asmild & Fai Tam, 2007. "Estimating global frontier shifts and global Malmquist indices," Journal of Productivity Analysis, Springer, vol. 27(2), pages 137-148, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mitropoulos, Panagiotis & Talias, Μichael A. & Mitropoulos, Ioannis, 2015. "Combining stochastic DEA with Bayesian analysis to obtain statistical properties of the efficiency scores: An application to Greek public hospitals," European Journal of Operational Research, Elsevier, vol. 243(1), pages 302-311.
    2. Antony Andrews & Omphile Temoso & Sean Kimpton, 2021. "Persistent and Transient Inefficiency of Australian States and Territories in Providing Public Hospital Services: An Application of Bayesian Stochastic Finite Mixture Frontier Analysis," Economic Papers, The Economic Society of Australia, vol. 40(2), pages 104-115, June.
    3. Panagiotis Mitropoulos & Panagiotis D. Zervopoulos & Ioannis Mitropoulos, 2020. "Measuring performance in the presence of noisy data with targeted desirable levels: evidence from healthcare units," Annals of Operations Research, Springer, vol. 294(1), pages 537-566, November.
    4. Sverre Kittelsen & Benny Winsnes & Kjartan Anthun & Fanny Goude & Øyvind Hope & Unto Häkkinen & Birgitte Kalseth & Jannie Kilsmark & Emma Medin & Clas Rehnberg & Hanna Rättö, 2015. "Decomposing the productivity differences between hospitals in the Nordic countries," Journal of Productivity Analysis, Springer, vol. 43(3), pages 281-293, June.
    5. Monica Giancotti & Annamaria Guglielmo & Marianna Mauro, 2017. "Efficiency and optimal size of hospitals: Results of a systematic search," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-40, March.
    6. Ashraf Mahate & Samer Hamidi & Fevzi Akinci, 2017. "Measuring the Effect of Size on Technical Efficiency of the United Arab Emirates Hospitals," Global Journal of Health Science, Canadian Center of Science and Education, vol. 9(3), pages 116-116, March.
    7. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    8. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    9. See, Kok Fong & Ng, Ying Chu, 2021. "Do hospital reform and ownership matter to Shenzhen hospitals in China? A productivity analysis," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 145-155.
    10. Cheng, Xiaomei & Bjørndal, Endre & Bjørndal, Mette, 2015. "Optimal Scale in Different Environments – The Case of Norwegian Electricity Distribution Companies," Discussion Papers 2015/22, Norwegian School of Economics, Department of Business and Management Science.
    11. Víctor Giménez & Jorge R. Keith & Diego Prior, 2019. "Do healthcare financing systems influence hospital efficiency? A metafrontier approach for the case of Mexico," Health Care Management Science, Springer, vol. 22(3), pages 549-559, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Monica Giancotti & Annamaria Guglielmo & Marianna Mauro, 2017. "Efficiency and optimal size of hospitals: Results of a systematic search," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-40, March.
    2. Leleu, Hervé & Moises, James & Valdmanis, Vivian, 2012. "Optimal productive size of hospital's intensive care units," International Journal of Production Economics, Elsevier, vol. 136(2), pages 297-305.
    3. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    4. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    5. Gary Ferrier & Hervé Leleu & James Moises & Vivian Valdmanis, 2013. "The Focus Efficiency of U.S. Hospitals," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 41(3), pages 241-263, September.
    6. Troels Kristensen & Peter Bogetoft & Kjeld Pedersen, 2010. "Potential gains from hospital mergers in Denmark," Health Care Management Science, Springer, vol. 13(4), pages 334-345, December.
    7. Jeong Hoon Choi & Imsu Park & Ilyoung Jung & Asoke Dey, 2017. "Complementary effect of patient volume and quality of care on hospital cost efficiency," Health Care Management Science, Springer, vol. 20(2), pages 221-231, June.
    8. Cordero Ferrera, Jose Manuel & Alonso Morán, Edurne & Nuño Solís, Roberto & Orueta, Juan F. & Souto Arce, Regina, 2013. "Efficiency assessment of primary care providers: A conditional nonparametric approach," MPRA Paper 51926, University Library of Munich, Germany.
    9. MORIKAWA Masayuki, 2010. "Economies of Scale and Hospital Productivity: An empirical analysis of medical area level panel data," Discussion papers 10050, Research Institute of Economy, Trade and Industry (RIETI).
    10. Kostas Kounetas & Fotis Papathanassopoulos, 2013. "How efficient are Greek hospitals? A case study using a double bootstrap DEA approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 979-994, December.
    11. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    12. Galina Besstremyannaya, 2015. "Heterogeneous effect of residency matching and prospective payment on labor returns and hospital scale economies," Discussion Papers 15-001, Stanford Institute for Economic Policy Research.
    13. Valentin Zelenyuk, 2023. "Productivity analysis: roots, foundations, trends and perspectives," Journal of Productivity Analysis, Springer, vol. 60(3), pages 229-247, December.
    14. 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.
    15. Emrouznejad, Ali & De Witte, Kristof, 2010. "COOPER-framework: A unified process for non-parametric projects," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1573-1586, December.
    16. Daraio, Cinzia & Kerstens, Kristiaan & Nepomuceno, Thyago & Sickles, Robin C., 2019. "Empirical Surveys of Frontier Applications: A Meta-Review," Working Papers 19-005, Rice University, Department of Economics.
    17. Aparicio, Juan & Santín, Daniel, 2022. "A New Malmquist Index Based on a Standard Technology for Measuring Total Factor Productivity Changes," MPRA Paper 114467, University Library of Munich, Germany.
    18. Mohsen Afsharian & Heinz Ahn, 2015. "The overall Malmquist index: a new approach for measuring productivity changes over time," Annals of Operations Research, Springer, vol. 226(1), pages 1-27, March.
    19. Alvaro Almeida & Joana Cima, 2015. "Demand uncertainty and hospital costs: an application to Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 35-45, January.
    20. Cordero, José Manuel & Alonso-Morán, Edurne & Nuño-Solinis, Roberto & Orueta, Juan F. & Arce, Regina Sauto, 2015. "Efficiency assessment of primary care providers: A conditional nonparametric approach," European Journal of Operational Research, Elsevier, vol. 240(1), pages 235-244.

    More about this item

    Keywords

    Data envelopment analysis (DEA); Scale; Efficiency; Hospitals; Provinces; D24; C61; I18;
    All these keywords.

    JEL classification:

    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:jproda:v:40:y:2013:i:2:p:197-206. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.