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On the (in)efficiency of Swiss hospitals

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  • L. Steinmann
  • P. Zweifel

Abstract

The efficiency of hospitals is of interest to health insurers, government authorities and hospital management itself. However, econometric methods for determining (in)efficiency have severe drawbacks since hospitals are multiproduct firms and because the duality between production and cost functions cannot be assumed. In this work, non-parametric, deterministic data envelopment analysis (DEA) is used to measure the relative inefficiency of 89 Swiss hospitals covering the years 1993-1996 (310 observations). Special attention is given to the role of patient days in the production of health. The findings depend on whether patient days are viewed as an input of patient time or as an output, as in previous studies. While the probability of a unit being inefficient cannot be explained using the available data, the degree of overall inefficiency is shown to significantly depend on the financial incentives faced by management, in particular due to subsidization. Private hospitals do not seem to be less inefficient than public ones; however, this may be caused by their 'overusing' inputs that in fact are valued as amenities by patients. This consideration points to an important limitation in applying the purely quantitative criteria of DEA to hospitals.

Suggested Citation

  • L. Steinmann & P. Zweifel, 2003. "On the (in)efficiency of Swiss hospitals," Applied Economics, Taylor & Francis Journals, vol. 35(3), pages 361-370.
  • Handle: RePEc:taf:applec:v:35:y:2003:i:3:p:361-370
    DOI: 10.1080/00036840210167183
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    References listed on IDEAS

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    1. Charnes, A. & Cooper, W. W. & Huang, Z. M. & Sun, D. B., 1990. "Polyhedral Cone-Ratio DEA Models with an illustrative application to large commercial banks," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 73-91.
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    4. 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.
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    Citations

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    Cited by:

    1. Carlos Pestana Barros & António Gomes de Menezes & José Cabral Vieira, 2013. "Measurement of hospital efficiency, using a latent class stochastic frontier model," Applied Economics, Taylor & Francis Journals, vol. 45(1), pages 47-54, January.
    2. Philippe Widmer, 2015. "Does prospective payment increase hospital (in)efficiency? Evidence from the Swiss hospital sector," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 407-419, May.
    3. Ancarani, A. & Di Mauro, C. & Giammanco, M.D., 2009. "The impact of managerial and organizational aspects on hospital wards' efficiency: Evidence from a case study," European Journal of Operational Research, Elsevier, vol. 194(1), pages 280-293, April.
    4. Steinmann, Lukas & Dittrich, Gunnar & Karmann, Alexander & Zweifel, Peter, 2003. "Measuring and comparing the (in)efficiency of German and Swiss hospitals," Dresden Discussion Paper Series in Economics 16/03, Technische Universität Dresden, Faculty of Business and Economics, Department of Economics.
    5. Dino Rizzi & Vincenzo Rebba, 2006. "Measuring Hospital Efficiency through Data Envelopment Analysis when Policy-makers� Preferences Matter. An Application to a sample of Italian NHS hospitals," Working Papers 2006_13, Department of Economics, University of Venice "Ca' Foscari".
    6. repec:ces:ifodre:v:12:y:2005:i:02:p:s.9-18 is not listed on IDEAS
    7. Esso-hanam Atake, 2015. "Technical efficiency of public hospitals in Togo: A directional distance function approach," Economics Bulletin, AccessEcon, vol. 35(3), pages 1752-1764.
    8. Teresa Curristine & Zsuzsanna Lonti & Isabelle Joumard, 2007. "Improving Public Sector Efficiency: Challenges and Opportunities," OECD Journal on Budgeting, OECD Publishing, vol. 7(1), pages 1-41.
    9. Po-Chin Wu & Chiung-Wen Fan & Sheng-Chieh Pan, 2014. "Does Human Development Index Provide Rational Development Rankings? Evidence from Efficiency Rankings in Super Efficiency Model," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 116(2), pages 647-658, April.
    10. R. Amy Puenpatom & Robert Rosenman, 2006. "Efficiency of Thai provincial public hospitals after the introduction of National Health Insurance Program," Working Papers 2006-2, School of Economic Sciences, Washington State University.
    11. Björn A. Kuchinke & Ansgar Wübker, 2009. "Defizite von öffentlichen Allgemeinkrankenhäusern in Deutschland: Empirische Befunde von 1998 bis 2004 und wirtschaftspolitische Implikationen," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 10(3), pages 290-308, August.
    12. Po-Chin Wu & Tzu-Hsien Huang & Sheng-Chieh Pan, 2014. "Country Performance Evaluation: The DEA Model Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 118(2), pages 835-849, September.
    13. Reto Schleiniger, 2008. "Regional Quantity, Productivity and Efficiency Measures of the Swiss Health Care System," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 459-476, September.
    14. Ng, Ying Chu, 2011. "The productive efficiency of Chinese hospitals," China Economic Review, Elsevier, vol. 22(3), pages 428-439, September.
    15. Fatima S. Al Shamsi & Hassan Aly & Mohamed El-Bassiouni, 2009. "Measuring and explaining the efficiencies of the United Arab Emirates banking system," Applied Economics, Taylor & Francis Journals, vol. 41(27), pages 3505-3519.

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