IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v26y2025i2d10.1007_s10198-024-01704-z.html
   My bibliography  Save this article

Economies of scope in the Norwegian public hospital sector

Author

Listed:
  • Nils Arne Lindaas

    (Norwegian University of Science and Technology)

  • Kjartan Sarheim Anthun

    (Norwegian University of Science and Technology
    SINTEF Digital)

  • Sverre A. C. Kittelsen

    (Ragnar Frisch Centre for Economic Research
    University of Oslo)

  • Jon Magnussen

    (Norwegian University of Science and Technology)

Abstract

This study investigates the potential economies of scope in the Norwegian public hospital sector after a major structural and organizational reform. Economies of scope refers to potential cost savings occurring from the scope of production rather than the scale. We use a data driven approach to distinguish between relatively specialized and differentiated hospitals. Using registry data spanning the period 2013–2019, we use non-parametric data envelopment analysis with bootstrapping procedures to investigate the potential presence of economies of scope. This is done separately for three different dimensions of which hospital production can be either specialized or differentiated. The findings suggest that economies of scope are present in the Norwegian hospital sector, meaning that there are cost savings related to the optimal differentiation of the activity. It is difficult to conclude on how these findings relate to the reform.

Suggested Citation

  • Nils Arne Lindaas & Kjartan Sarheim Anthun & Sverre A. C. Kittelsen & Jon Magnussen, 2025. "Economies of scope in the Norwegian public hospital sector," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(2), pages 325-335, March.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:2:d:10.1007_s10198-024-01704-z
    DOI: 10.1007/s10198-024-01704-z
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-024-01704-z
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-024-01704-z?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 search for a different version of it.

    References listed on IDEAS

    as
    1. Sebastian McRae & Jens O. Brunner & Jonathan F. Bard, 2020. "Analyzing economies of scale and scope in hospitals by use of case mix planning," Health Care Management Science, Springer, vol. 23(1), pages 80-101, March.
    2. Carvalho, Pedro & Marques, Rui Cunha, 2014. "Computing economies of vertical integration, economies of scope and economies of scale using partial frontier nonparametric methods," European Journal of Operational Research, Elsevier, vol. 234(1), pages 292-307.
    3. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    4. Christian Growitsch & Heike Wetzel, 2006. "Economies of Scope in European Railways: An Efficiency Analysis," Working Paper Series in Economics 29, University of Lüneburg, Institute of Economics.
    5. 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.
    6. 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.
    7. Annika Maren Schneider & Eva-Maria Oppel & Jonas Schreyögg, 2020. "Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market," Health Care Management Science, Springer, vol. 23(4), pages 649-660, December.
    8. Michael Freeman & Nicos Savva & Stefan Scholtes, 2021. "Economies of Scale and Scope in Hospitals: An Empirical Study of Volume Spillovers," Management Science, INFORMS, vol. 67(2), pages 673-697, February.
    9. 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.
    10. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: How public debt affects hospital performance in Austria," Social Science & Medicine, Elsevier, vol. 249(C).
    11. Weaver, Marcia & Deolalikar, Anil, 2004. "Economies of scale and scope in Vietnamese hospitals," Social Science & Medicine, Elsevier, vol. 59(1), pages 199-208, July.
    12. Hagen, Terje P. & Holom, Geir Hiller & Amayu, Kebebew N., 2018. "Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering," Health Economics, Policy and Law, Cambridge University Press, vol. 13(1), pages 50-67, January.
    13. Diego Prior & Magda Solà, 2000. "Technical efficiency and economies of diversification in health care," Health Care Management Science, Springer, vol. 3(4), pages 299-307, September.
    14. Jonathan R. Clark & Robert S. Huckman, 2012. "Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry," Management Science, INFORMS, vol. 58(4), pages 708-722, April.
    15. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: how public debt affects hospital performance in Austria," LSE Research Online Documents on Economics 116865, London School of Economics and Political Science, LSE Library.
    16. 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)

    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. Dinesh R. Pai & Fatma Pakdil & Nasibeh Azadeh-Fard, 2024. "Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984–2022," Health Care Management Science, Springer, vol. 27(2), pages 284-312, June.
    2. Kao, Chiang & Pang, Rui-Zhi & Liu, Shiang-Tai & Bai, Xue-Jie, 2021. "Optimal expansion paths for hospitals of different types: Viewpoint of scope economies and evidence from Chinese hospitals," European Journal of Operational Research, Elsevier, vol. 289(2), pages 628-638.
    3. Ricardo Ocaña-Riola & Carmen Pérez-Romero & Mª Isabel Ortega-Díaz & José Jesús Martín-Martín, 2021. "Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals," IJERPH, MDPI, vol. 18(19), pages 1-18, September.
    4. 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.
    5. Kao, Chiang & Pang, Rui-Zhi & Liu, Shiang-Tai & Bai, Xue-Jie, 2021. "Most productive types of hospitals: An empirical analysis," Omega, Elsevier, vol. 99(C).
    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. Kao, Chiang, 2016. "Efficiency decomposition and aggregation in network data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 255(3), pages 778-786.
    8. Pérez-López, Gemma & Prior, Diego & Zafra-Gómez, José L., 2018. "Temporal scale efficiency in DEA panel data estimations. An application to the solid waste disposal service in Spain," Omega, Elsevier, vol. 76(C), pages 18-27.
    9. Guerrini, Andrea & Romano, Giulia & Leardini, Chiara, 2018. "Economies of scale and density in the Italian water industry: A stochastic frontier approach," Utilities Policy, Elsevier, vol. 52(C), pages 103-111.
    10. Dakpo, K Hervé & Desjeux, Yann & Jeanneaux, Philippe & Latruffe, Laure, 2016. "Productivity, efficiency and technological change in French agriculture during 2002-2014: A Färe-Primont index decomposition," 149th Seminar, October 27-28, 2016, Rennes, France 244793, European Association of Agricultural Economists.
    11. Mette Asmild & Tomas Baležentis & Jens Leth Hougaard, 2019. "Industry Competitiveness Indicators," IFRO Working Paper 2019/01, University of Copenhagen, Department of Food and Resource Economics.
    12. Aparicio, Juan & Santín, Daniel, 2024. "Global and local technical changes: A new decomposition of the Malmquist productivity index using virtual units," Economic Modelling, Elsevier, vol. 134(C).
    13. Amaral, António L. & Martins, Rita & Dias, Luís C., 2023. "Operational drivers of water reuse efficiency in Portuguese wastewater service providers," Utilities Policy, Elsevier, vol. 83(C).
    14. Sebastian McRae & Jens O. Brunner & Jonathan F. Bard, 2020. "Analyzing economies of scale and scope in hospitals by use of case mix planning," Health Care Management Science, Springer, vol. 23(1), pages 80-101, March.
    15. Maria Balaguer-Coll & Diego Prior & Emili Tortosa-Ausina, 2010. "Decentralization and efficiency of local government," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 45(3), pages 571-601, December.
    16. Iveta Vrabková & Sabrina Lee, 2023. "Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany," Health Economics Review, Springer, vol. 13(1), pages 1-14, December.
    17. Diwas Singh KC & Stefan Scholtes & Christian Terwiesch, 2020. "Empirical Research in Healthcare Operations: Past Research, Present Understanding, and Future Opportunities," Manufacturing & Service Operations Management, INFORMS, vol. 22(1), pages 73-83, January.
    18. Peipei Chai & Quan Wan & Yohannes Kinfu, 2021. "Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008–2015," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(2), pages 267-279, March.
    19. 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.
    20. Nicky Rogge, 2017. "Measuring the impact of the economic crisis on the level of change in EU social inclusion: period 2005–2012," Journal of Productivity Analysis, Springer, vol. 47(2), pages 103-116, April.

    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:spr:eujhec:v:26:y:2025:i:2:d:10.1007_s10198-024-01704-z. 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.