Changes in Hospital Efficiency after Privatization
We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped DEA efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 3.2 and 5.4%. We defined four alternative post- privatization periods and found that the increase in efficiency after a conversion to private for- profit status appeared to be permanent. We also observed an increase in efficiency one year after hospitals were converted to private non-profit status, but our estimations suggest that this effect was transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the DRG era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.
|Date of creation:|
|Date of revision:|
|Contact details of provider:|| Web page: https://www.wiso.uni-hamburg.de/repec/hch/|
More information through EDIRC
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- Biørn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2009.
"The effect of activity-based financing on hospital efficiency: A panel data analysis of DEA efficiency scores 1992-2000,"
HERO On line Working Paper Series
2002:8, Oslo University, Health Economics Research Programme.
- Biorn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2002. "The Effect of Activity-Based Financing on Hospital Efficiency: A Panel Data Analysis of DEA Efficiency Scores 1992-2000," MPRA Paper 8099, University Library of Munich, Germany.
- Girma, Sourafel & Gorg, Holger, 2007.
"Evaluating the foreign ownership wage premium using a difference-in-differences matching approach,"
Journal of International Economics,
Elsevier, vol. 72(1), pages 97-112, May.
- Sourafel Girma & Holger Görg, 2006. "Evaluating the foreign ownership wage premium using a difference-indifferences matching approach," The Institute for International Integration Studies Discussion Paper Series iiisdp165, IIIS.
- Girma, Sourafel & Görg, Holger, 2006. "Evaluating the Foreign Ownership Wage Premium Using a Difference-in-Differences Matching Approach," CEPR Discussion Papers 5788, C.E.P.R. Discussion Papers.
- A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2006.
"Robust Inference with Multi-way Clustering,"
NBER Technical Working Papers
0327, National Bureau of Economic Research, Inc.
- A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2011. "Robust Inference With Multiway Clustering," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 29(2), pages 238-249, April.
- Cameron, A. Colin & Gelbach, Jonah B. & Miller, Douglas L., 2011. "Robust Inference With Multiway Clustering," Journal of Business & Economic Statistics, American Statistical Association, vol. 29(2), pages 238-249.
- A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller & Doug Miller, 2009. "Robust Inference with Multi-way Clustering," Working Papers 98, University of California, Davis, Department of Economics.
- Jonah B. Gelbach & Doug Miller, 2009. "Robust Inference with Multi-way Clustering," Working Papers 99, University of California, Davis, Department of Economics.
- B. Hollingsworth & P. Smith, 2003. "Use of ratios in data envelopment analysis," Applied Economics Letters, Taylor & Francis Journals, vol. 10(11), pages 733-735.
- Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
- Pierre Pestieau, 2009.
"Assessing The Performance Of The Public Sector,"
- PESTIEAU, Pierre, . "Assessing the performance of the public sector," CORE Discussion Papers RP 2086, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Pierre Pestieau, 2007. "Assessing the performance of the public sector," CREPP Working Papers 0703, Centre de Recherche en Economie Publique et de la Population (CREPP) (Research Center on Public and Population Economics) HEC-Management School, University of Liège.
- John Vickers & George Yarrow, 1991. "Economic Perspectives on Privatization," Journal of Economic Perspectives, American Economic Association, vol. 5(2), pages 111-132, Spring.
- Dyson, R. G. & Allen, R. & Camanho, A. S. & Podinovski, V. V. & Sarrico, C. S. & Shale, E. A., 2001. "Pitfalls and protocols in DEA," European Journal of Operational Research, Elsevier, vol. 132(2), pages 245-259, July.
- Leopold Simar & Paul Wilson, 2000.
"A general methodology for bootstrapping in non-parametric frontier models,"
Journal of Applied Statistics,
Taylor & Francis Journals, vol. 27(6), pages 779-802.
- Simar, L. & Wilson, P.W., 1998. "A General Methodology for Bootstrapping in Nonparametric Frontier Models," Papers 9811, Catholique de Louvain - Institut de statistique.
- 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.
- David E. M. Sappington & Joseph E. Stiglitz, 1987.
"Privatization, Information and Incentives,"
NBER Working Papers
2196, National Bureau of Economic Research, Inc.
- Mehdi Farsi, 2004. "Changes in Hospital Quality after Conversion in Ownership Status," International Journal of Health Economics and Management, Springer, vol. 4(3), pages 211-230, 09.
- Miika Linna, 1998. "Measuring hospital cost efficiency with panel data models," Health Economics, John Wiley & Sons, Ltd., vol. 7(5), pages 415-427.
- Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128.
- 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.
- Annika Herr & Hendrik Schmitz & Boris Augurzky, 2011. "Profit efficiency and ownership of German hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 660-674, June.
- Kosuke Imai & Gary King & Elizabeth A. Stuart, 2008. "Misunderstandings between experimentalists and observationalists about causal inference," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(2), pages 481-502.
- Fama, Eugene F & Jensen, Michael C, 1983. "Separation of Ownership and Control," Journal of Law and Economics, University of Chicago Press, vol. 26(2), pages 301-25, June.
- Andrei Shleifer, 1985. "A Theory of Yardstick Competition," RAND Journal of Economics, The RAND Corporation, vol. 16(3), pages 319-327, Autumn.
- Heckman, J.J. & Hotz, V.J., 1988.
"Choosing Among Alternative Nonexperimental Methods For Estimating The Impact Of Social Programs: The Case Of Manpower Training,"
University of Chicago - Economics Research Center
88-12, Chicago - Economics Research Center.
- James J. Heckman, 1989. "Choosing Among Alternative Nonexperimental Methods for Estimating the Impact of Social Programs: The Case of Manpower Training," NBER Working Papers 2861, National Bureau of Economic Research, Inc.
- Haskel, Jonathan & Szymanski, Stefan, 1993. "Privatization, Liberalization, Wages and Employment: Theory and Evidence for the UK," Economica, London School of Economics and Political Science, vol. 60(238), pages 161-81, May.
- Léopold Simar & Paul W. Wilson, 1998.
"Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models,"
INFORMS, vol. 44(1), pages 49-61, January.
- SIMAR, Léopold & WILSON, Paul, 1995. "Sensitivity Analysis to Efficiency Scores : How to Bootstrap in Nonparametric Frontier Models," CORE Discussion Papers 1995043, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Simar, L. & Wilson, P.W., . "Sensitivity analysis of efficiency scores: how to bootstrap in nonparametric frontier models," CORE Discussion Papers RP 1304, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
- Jeffrey Smith & Petra Todd, 2003.
"Does Matching Overcome Lalonde's Critique of Nonexperimental Estimators?,"
University of Western Ontario, Centre for Human Capital and Productivity (CHCP) Working Papers
20035, University of Western Ontario, Centre for Human Capital and Productivity (CHCP).
- A. Smith, Jeffrey & E. Todd, Petra, 2005. "Does matching overcome LaLonde's critique of nonexperimental estimators?," Journal of Econometrics, Elsevier, vol. 125(1-2), pages 305-353.
- Anatoly I. Pilyavsky & William E. Aaronson & Patrick M. Bernet & Michael D. Rosko & Vivian G. Valdmanis & Mikhail V. Golubchikov, 2006. "East-west: does it make a difference to hospital efficiencies in Ukraine?," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1173-1186.
- Schmidt, Klaus M., 1996.
"The costs and benefits of privatization: An incomplete contracts approach,"
Munich Reprints in Economics
19773, University of Munich, Department of Economics.
- Schmidt, Klaus M, 1996. "The Costs and Benefits of Privatization: An Incomplete Contracts Approach," Journal of Law, Economics and Organization, Oxford University Press, vol. 12(1), pages 1-24, April.
- H. Sherman & Joe Zhu, 2006. "Benchmarking with quality-adjusted DEA (Q-DEA) to seek lower-cost high-quality service: Evidence from a U.S.bank application," Annals of Operations Research, Springer, vol. 145(1), pages 301-319, July.
- Michael D. Rosko, 2001. "Cost efficiency of US hospitals: a stochastic frontier approach," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 539-551.
- Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
- Jeffry M. Netter & William L. Megginson, 2001. "From State to Market: A Survey of Empirical Studies on Privatization," Journal of Economic Literature, American Economic Association, vol. 39(2), pages 321-389, June.
- Andrei Shleifer & Robert W. Vishny, 1994. "Politicians and Firms," The Quarterly Journal of Economics, Oxford University Press, vol. 109(4), pages 995-1025.
- Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442, September.
- Eytan Sheshinski & Luis F. López-Calva, 2003. "Privatization and Its Benefits: Theory and Evidence," CESifo Economic Studies, CESifo, vol. 49(3), pages 429-459.
- Annika Herr, 2008. "Cost and technical efficiency of German hospitals: does ownership matter?," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1057-1071.
- Megginson, William L & Nash, Robert C & van Randenborgh, Matthias, 1994. " The Financial and Operating Performance of Newly Privatized Firms: An International Empirical Analysis," Journal of Finance, American Finance Association, vol. 49(2), pages 403-52, June.
- Chang, Hsihui & Chang, Wen-Jing & Das, Somnath & Li, Shu-Hsing, 2004. "Health care regulation and the operating efficiency of hospitals: Evidence from Taiwan," Journal of Accounting and Public Policy, Elsevier, vol. 23(6), pages 483-510.
- Boycko, Maxim & Shleifer, Andrei & Vishny, Robert W, 1996. "A Theory of Privatisation," Economic Journal, Royal Economic Society, vol. 106(435), pages 309-19, March.
- Kathleen Carey, 2000. "A multilevel modelling approach to analysis of patient costs under managed care," Health Economics, John Wiley & Sons, Ltd., vol. 9(5), pages 435-446.
- Richard Blundell & Monica Costa Dias, 2000. "Evaluation methods for non-experimental data," Fiscal Studies, Institute for Fiscal Studies, vol. 21(4), pages 427-468, January.
- Parker, David & Martin, Stephen, 1995. "The Impact of UK Privatisation on Labour and Total Factor Productivity," Scottish Journal of Political Economy, Scottish Economic Society, vol. 42(2), pages 201-20, May.
- Syrjanen, Mikko J., 2004. "Non-discretionary and discretionary factors and scale in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 158(1), pages 20-33, October.
- James J. Heckman & Hidehiko Ichimura & Petra E. Todd, 1997. "Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," Review of Economic Studies, Oxford University Press, vol. 64(4), pages 605-654.
- Gabriel Picone & Shin-Yi Chou & Frank Sloan, 2002. "Are For-Profit Hospital Conversions Harmful to Patients and to Medicare?," RAND Journal of Economics, The RAND Corporation, vol. 33(3), pages 507-523, Autumn.
- Villalonga, Belen, 2000. "Privatization and efficiency: differentiating ownership effects from political, organizational, and dynamic effects," Journal of Economic Behavior & Organization, Elsevier, vol. 42(1), pages 43-74, May.
When requesting a correction, please mention this item's handle: RePEc:hch:wpaper:201102. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Katja Sudmann)
If references are entirely missing, you can add them using this form.