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Decomposing the productivity differences between hospitals in the Nordic countries

  • Kittelsen, Sverre A.C.

    ()

    (Frisch Centre)

  • Persson, Benny Adam

    (Frisch Centre)

  • Rehnberg, Clas

    (Karolinska Institutet, Stockholm)

  • Anthun, Kjartan S.

    (SINTEF)

  • Goude, Fanny

    (Karolinska Institutet)

  • Rättö, Hanna

    (National Institute for Health and Welfare – THL, Helsinki)

  • Hope, Øyvind

    (SINTEF)

  • Häkkinen, Unto

    (National Institute for Health and Welfare – THL, Helsinki)

  • Medin, Emma

    (Karolinska Institutet, Stockholm)

  • Kalseth, Birgitte

    (SINTEF)

  • Kilsmark, Jannie

    (Danish Institute of health research, Copenhagen)

Previous studies indicate that Finnish hospitals have significantly higher productivity than in the other Nordic countries. We decompose the productivity levels into technical efficiency, scale efficiency and country specific possibility sets (technical frontiers). Data have been collected on operating costs and patient discharges in each DRG group for all hospitals in the Nordic countries. We find that there are small differences in scale and technical efficiency between countries, but large differences in production possibilities (frontier position). The results are robust to the choice of bootstrapped Data Envelopment Analysis (DEA) or Stochastic Frontier Analysis (SFA) as frontier estimation methodology.

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File URL: http://www.med.uio.no/helsam/forskning/nettverk/hero/publikasjoner/skriftserie/2013/hero2013-4.pdf
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Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2013:4.

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Length: 29 pages
Date of creation: 23 Jan 2014
Date of revision:
Handle: RePEc:hhs:oslohe:2013_004
Contact details of provider: Postal: HERO / Institute of Health Management and Health Economics P.O. Box 1089 Blindern, N-0317 Oslo, Norway
Phone: 2307 5309
Fax: 2307 5310
Web page: http://www.hero.uio.no/eng.html
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  1. Kittelsen, Sverre A.C. & Magnussen, Jon & Sarheim Anthun, Kjartan & Häkkinen, Unto & Linna, Miika & Medin, Emma & Olsen, Kim Rose & Rehnberg, Clas, 2009. "Hospital productivity and the Norwegian ownership reform – A Nordic comparative study," HERO On line Working Paper Series 2008:10, Oslo University, Health Economics Research Programme.
  2. Caves, Douglas W & Christensen, Laurits R & Diewert, W Erwin, 1982. "The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity," Econometrica, Econometric Society, vol. 50(6), pages 1393-1414, November.
  3. Linna, Miika & Hakkinen, Unto & Magnussen, Jon, 2006. "Comparing hospital cost efficiency between Norway and Finland," Health Policy, Elsevier, vol. 77(3), pages 268-278, August.
  4. Léopold Simar & Paul Wilson, 2000. "Statistical Inference in Nonparametric Frontier Models: The State of the Art," Journal of Productivity Analysis, Springer, vol. 13(1), pages 49-78, January.
  5. Førsund, Finn R & Edvardsen, Dag F., 2001. "International Benchmarking of Electricity Distribution Utilities," Memorandum 35/2001, Oslo University, Department of Economics.
  6. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
  7. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-32.
  8. Salvanes, K.G. & Tjotta, S., 1998. "A NOte on the Importance of Testing for Regularities for Estimated Flexible Functional Forms," Norway; Department of Economics, University of Bergen 177, Department of Economics, University of Bergen.
  9. Benoit Dervaux & Gary Ferrier & Herve Leleu & Vivian Valdmanis, 2004. "Comparing French and US hospital technologies: a directional input distance function approach," Applied Economics, Taylor & Francis Journals, vol. 36(10), pages 1065-1081.
  10. Lukas Steinmann & Gunnar Dittrich & Alexander Karmann & Peter Zweifel, 2004. "Measuring and comparing the (in)efficiency of German and Swiss hospitals," The European Journal of Health Economics, Springer, vol. 5(3), pages 216-226, September.
  11. Berg, Sigbjorn Atle & Forsund, Finn R & Jansen, Eilev S, 1992. " Malmquist Indices of Productivity Growth during the Deregulation of Norwegian Banking, 1980-89," Scandinavian Journal of Economics, Wiley Blackwell, vol. 94(0), pages S211-28, Supplemen.
  12. Miika Linna & Unto Häkkinen & Mikko Peltola & Jon Magnussen & Kjartan Anthun & Sverre Kittelsen & Annette Roed & Kim Olsen & Emma Medin & Clas Rehnberg, 2010. "Measuring cost efficiency in the Nordic Hospitals—a cross-sectional comparison of public hospitals in 2002," Health Care Management Science, Springer, vol. 13(4), pages 346-357, December.
  13. Halsteinli, Vidar & Kittelsen, Sverre A. & Magnussen, Jon, 2010. "Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment," Social Science & Medicine, Elsevier, vol. 70(3), pages 439-446, February.
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