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Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

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  • Felder, Stefan
  • Tauchmann, Harald

Abstract

Due to regional competition and patient migration, the efficiency of healthcare provision at the regional level is subject to spatial dependence. We address this issue by applying a spatial autoregressive model to longitudinal data from Germany at the district (`Kreis') level. The empirical model is specified to explain efficiency scores, which we derive through non-parametric order-m efficiency analysis of regional health production. The focus is on the role of health policy of federal states (`Bundesl{\"a}nder') for district efficiency. Regression results reveal significant spatial spillover effects. Notably, accounting for spatial dependence does not decrease but increases the estimated effect of federal states on district efficiency. It appears that genuinely more efficient states are less affected by positive efficiency spillovers, so that taking into account spatial dependence clarifies the importance of health policy at the state level.

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  • Felder, Stefan & Tauchmann, Harald, 2013. "Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 14(1), pages 21-39.
    • Handle: RePEc:zbw:espost:148359
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    3. Klein, Nadja & Herwartz, Helmut & Kneib, Thomas, 2020. "Modelling regional patterns of inefficiency: A Bayesian approach to geoadditive panel stochastic frontier analysis with an application to cereal production in England and Wales," Journal of Econometrics, Elsevier, vol. 214(2), pages 513-539.
    4. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
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    6. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 49, pages 305-320.
    7. Andree Ehlert & Dirk Oberschachtsiek, 2014. "Does managed care reduce health care expenditure? Evidence from spatial panel data," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 207-227, September.
    8. Christoph Pross & Christoph Strumann & Alexander Geissler & Helmut Herwartz & Nadja Klein, 2018. "Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-30, September.
    9. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    10. Katharina Schley, 2018. "Health care service provision in Europe and regional diversity: a stochastic metafrontier approach," Health Economics Review, Springer, vol. 8(1), pages 1-11, December.
    11. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    12. Boris Augurzky & Thomas Kopetsch & Hendrik Schmitz, 2013. "What accounts for the regional differences in the utilisation of hospitals in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 615-627, August.
    13. José Luis Zafra-Gómez & Victor Giménez-García & Cristina María Campos-Alba & Emilio José Higuera-Molina, 2020. "Direct Management or Inter-Municipal Cooperation in Smaller Municipalities? Exploring Cost Efficiency and Installed Capacity in Drinking Water Supply," Water Resources Management: An International Journal, Published for the European Water Resources Association (EWRA), Springer;European Water Resources Association (EWRA), vol. 34(13), pages 4289-4302, October.
    14. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
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    17. Alda, Erik, 2020. "The effects of body-worn cameras on police efficiency: A study of local police agencies in the US," MPRA Paper 103887, University Library of Munich, Germany.
    18. Laia Maynou & Marc Saez & Jordi Bacaria & Guillem Lopez-Casasnovas, 2015. "Health inequalities in the European Union: an empirical analysis of the dynamics of regional differences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 543-559, June.
    19. Chak Hung Jack Cheng & Nopphol Witvorapong, 2021. "Health care policy uncertainty, real health expenditures and health care inflation in the USA," Empirical Economics, Springer, vol. 60(4), pages 2083-2103, April.
    20. Francisco Germano Carvalho Lucio & Jhorland Ayala‐García, 2022. "Public sector efficiency in Brazil," Regional Science Policy & Practice, Wiley Blackwell, vol. 14(6), pages 308-321, December.
    21. Alda, Erik, 2020. "The effects of body-worn cameras on police efficiency: A study of local police agencies in the US," MPRA Paper 103994, University Library of Munich, Germany.

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    More about this item

    Keywords

    Health production; Order-m efficiency; Spatial autoregressive model;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • R10 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - General Regional Economics - - - General

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