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La ineficiencia en costes de los hospitales del Insalud:un estudio detallado / Cost inefficiency in spanish public hospitals: A detailled stydy

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    (Departamento de Fundamentos del Análisis Económico. Universidad de Valladolid.)

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    En este trabajo se mide la ineficiencia técnica y asignativa de los hospitales gestionados por el INSALUD, y se ofrecen los rasgos determinantes del perfil que caracteriza a los centros que resultan ineficientes técnicamente.La principal aportación se refiere al estudio de las causas de la ineficiencia técnica, y al método empleado, que consiste en un análisis econométrico simultáneo de todos los aspectos estudiados. Para ello se estima un sistema compuesto por una frontera de costes y las ecuaciones de participación de los factores. En la frontera, se considera que el componente de ineficiencia técnica es función de una serie de factores explicativos, específicos de cada empresa.Los resultados confirman la existencia de ambos tipos de ineficiencia, pero contrariamente a las conclusiones de trabajos anteriores, con un menor peso de la ineficiencia asignativa frente a la técnica. Los hospitales con mayor grado de ineficiencia técnica se caracterizan por un elevado nivel de actividad pero escasamente diversificada. No poseen un alto equipamiento técnico pero cuentan con al menos un centro de especialidades asociado. This paper measures the technical and allocative efficiency of the Spanish public hospitals, and analyses the characteristics of the centres that are technically inefficient.The main contribution is an econometric study realised in one step of the indexes of both types of efficiency and the determinants of technical efficiency. To do this, a system made up of a cost frontier and the input share equations is estimated. On the frontier, the technical inefficiency component is a function of a set of firm-specific variables.The results confirm the existence of both types of inefficiency, the allocative inefficiency having less importance than the technical. The hospitals with a greater degree of technical inefficiency are characterised by high activity levels accompanied by little diversification of cases. They do not possess highly technical equipment but have at least an outpatient attendance centre for specialities, dependent on them.

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    Article provided by Estudios de Economía Aplicada in its journal Estudios de Economía Aplicada.

    Volume (Year): 21 (2003)
    Issue (Month): (December)
    Pages: 467-484

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    Handle: RePEc:lrk:eeaart:21_3_4
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    1. Morey, RC & Fine, DJ & Loree, SW, 1990. "Comparing the allocative efficiencies of hospitals," Omega, Elsevier, vol. 18(1), pages 71-83.
    2. Guillem López & Marc Sáez, 1998. "Finance versus costs for teaching hospitals in Spain," Economics Working Papers 265, Department of Economics and Business, Universitat Pompeu Fabra.
    3. Beatriz Gonzalez Lopez-Valcarcel & Patricia Barber Perez, 1996. "Changes in the efficiency of spanish public hospitals after the introduction of program-contracts," Investigaciones Economicas, Fundación SEPI, vol. 20(3), pages 377-402, September.
    4. Kumbhakar, Subal C., 1997. "Modeling allocative inefficiency in a translog cost function and cost share equations: An exact relationship," Journal of Econometrics, Elsevier, vol. 76(1-2), pages 351-356.
    5. Forsund, Finn R. & Lovell, C. A. Knox & Schmidt, Peter, 1980. "A survey of frontier production functions and of their relationship to efficiency measurement," Journal of Econometrics, Elsevier, vol. 13(1), pages 5-25, May.
    6. Grannemann, Thomas W. & Brown, Randall S. & Pauly, Mark V., 1986. "Estimating hospital costs : A multiple-output analysis," Journal of Health Economics, Elsevier, vol. 5(2), pages 107-127, June.
    7. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    8. Bauer, Paul W., 1990. "Recent developments in the econometric estimation of frontiers," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 39-56.
    9. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
    10. Adam Wagstaff & Guillem Lopez, 1996. "Hospital costs in Catalonia: a stochastic frontier analysis," Applied Economics Letters, Taylor & Francis Journals, vol. 3(7), pages 471-474.
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