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Productivity and its Drivers in Finnish Primary Care 1988-2003

  • Maija-Liisa Järviö
  • Juho Aaltonen
  • Tarmo Räty
  • Kalevi Luoma

We measure productivity changes of primary care in Finland between 1988 and 2003 as a ratio of key services produced and real operating costs. In the second stage we estimate a truncated regression model that quantifies the contribution of certain internal and exogenous factors to productivity. We use newly developed techniques to correct asymptotic bias in non-parametric efficiency scores and bootstrap the confidence intervals for the explanatory model parameter estimates. The bias accounts on average 2.8 percent decrease in efficiency level. From 1997 to 2003 the average productivity declined 13.7 percent; the result is insensitive to estimated bias. Even if standard parametric confidence intervals do not generally apply when efficiency scores are regressed, our bootstrapped intervals are almost equal to parametric ones. Of the correlates used the increased income subject to municipal taxation accounted for three percentage points of the productivity decrease. The correlates, that are expected to decrease the need of primary care services, had a negative impact on productivity, implying that health centres have not been able to adjust their resource usage correspondingly. Organisational changes that have taken place within primary care have not resulted in desired productivity improvements.

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Paper provided by Government Institute for Economic Research Finland (VATT) in its series Research Reports with number 118.

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Date of creation: 29 Dec 2005
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Handle: RePEc:fer:resrep:118
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  1. Tsybakov, A.B. & Korostelev, A.P. & Simar, L., 1992. "Efficient Estimation of Monotone Boundaries," Papers 9209, Catholique de Louvain - Institut de statistique.
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  9. Mihály Simai, 2003. "Practical Guide for Active National Policy Makers - what Science and Technology Policy Can and Cannot Do?," Research Reports 103, Government Institute for Economic Research Finland (VATT).
  10. Juha Laine & Miika Linna & Unto Häkkinen & Anja Noro, 2005. "Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly," Health Economics, John Wiley & Sons, Ltd., vol. 14(3), pages 245-256.
  11. Takis Venetoklis & Jaakko Kiander, 2004. "Spending Preferences of Public Sector Officials. Survey Evidence from the Finnish Central Government," Research Reports 114, Government Institute for Economic Research Finland (VATT).
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  13. Kneip, Alois & Park, Byeong U. & Simar, L opold, 1998. "A Note On The Convergence Of Nonparametric Dea Estimators For Production Efficiency Scores," Econometric Theory, Cambridge University Press, vol. 14(06), pages 783-793, December.
  14. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
  15. Unto Häkkinen, 2005. "The impact of changes in Finland's health care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S101-S118.
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