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Accounting for quality in the measurement of hospital performance: evidence from Costa Rica


  • Pablo Arocena

    (Universidad Pública de Navarra, Spain)

  • Ariadna García-Prado

    (World Bank, Washington, DC, USA)


This paper provides insights into how Costa Rican public hospitals responded to the pressure for increased efficiency and quality introduced by the reforms carried out over the period 1997-2001. To that purpose we compute a generalized output distance function by means of non-parametric mathematical programming to construct a productivity index, which accounts for productivity changes while controlling for quality of care. Our results show an improvement in hospital performance mainly driven by quality increases. The adoption of management contracts seems to have contributed to such enhancement, more notably for small hospitals. Further, productivity growth is primarily due to technical and scale efficiency change rather than technological change. A number of policy implications are drawn from these results. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • Pablo Arocena & Ariadna García-Prado, 2007. "Accounting for quality in the measurement of hospital performance: evidence from Costa Rica," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 667-685.
  • Handle: RePEc:wly:hlthec:v:16:y:2007:i:7:p:667-685 DOI: 10.1002/hec.1204

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    References listed on IDEAS

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    Cited by:

    1. Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2013. "Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals," GIAM Working Papers 13-7, Galatasaray University Economic Research Center.
    2. Karmann, Alexander & Roesel, Felix, 2016. "Hospital policy and productivity: Evidence from German states," CEPIE Working Papers 07/16, Technische Universität Dresden, Center of Public and International Economics (CEPIE).
    3. 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.
    4. Cheng, Gang & Zervopoulos, Panagiotis D., 2014. "Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function," European Journal of Operational Research, Elsevier, vol. 238(3), pages 899-910.
    5. Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2012. "Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals," MPRA Paper 37437, University Library of Munich, Germany.
    6. Davis, Peter & Milne, Barry & Parker, Karl & Hider, Phil & Lay-Yee, Roy & Cumming, Jackie & Graham, Patrick, 2013. "Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions," Health Policy, Elsevier, vol. 112(1), pages 19-27.
    7. Iablonskii, K. & Fedotov, Y., 2015. "Organizational performance measurement of healthcare organizations," Working Papers 6422, Graduate School of Management, St. Petersburg State University.
    8. Alonso, José M. & Clifton, Judith & Díaz-Fuentes, Daniel, 2015. "The impact of New Public Management on efficiency: An analysis of Madrid's hospitals," Health Policy, Elsevier, vol. 119(3), pages 333-340.
    9. Simon Eckermann & Tim Coelli, 2008. "Including quality attributes in a model of health care efficiency: A net benefit approach," CEPA Working Papers Series WP032008, School of Economics, University of Queensland, Australia.
    10. Eckermann, Simon & Coelli, Tim, 2013. "Including quality attributes in efficiency measures consistent with net benefit: Creating incentives for evidence based medicine in practice," Social Science & Medicine, Elsevier, vol. 76(C), pages 159-168.
    11. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, vol. 28(4), pages 771-780, July.
    12. Yang, Jinqiu & Zeng, Wu, 2014. "The trade-offs between efficiency and quality in the hospital production: Some evidence from Shenzhen, China," China Economic Review, Elsevier, vol. 31(C), pages 166-184.
    13. Cruz-Cázares, Claudio & Bayona-Sáez, Cristina & García-Marco, Teresa, 2013. "You can’t manage right what you can’t measure well: Technological innovation efficiency," Research Policy, Elsevier, vol. 42(6), pages 1239-1250.

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