IDEAS home Printed from https://ideas.repec.org/p/pra/mprapa/51926.html
   My bibliography  Save this paper

Efficiency assessment of primary care providers: A conditional nonparametric approach

Author

Listed:
  • Cordero Ferrera, Jose Manuel
  • Alonso Morán, Edurne
  • Nuño Solís, Roberto
  • Orueta, Juan F.
  • Souto Arce, Regina

Abstract

This paper uses a fully nonparametric approach to estimate efficiency measures for primary care units incorporating the effect of (exogenous) environmental factors. This methodology allows us to account for different types of variables (continuous and discrete) describing the main characteristics of patients served by those providers. In addition, we use an extension of this nonparametric approach to deal with the presence of undesirable outputs in data, represented by the rates of hospitalization for ambulatory care sensitive condition (ACSC) and of hospital readmissions. The empirical results show that all the exogenous variables considered have a significant and negative effect on efficiency estimates

Suggested Citation

  • Cordero Ferrera, Jose Manuel & Alonso Morán, Edurne & Nuño Solís, Roberto & Orueta, Juan F. & Souto Arce, Regina, 2013. "Efficiency assessment of primary care providers: A conditional nonparametric approach," MPRA Paper 51926, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:51926
    as

    Download full text from publisher

    File URL: https://mpra.ub.uni-muenchen.de/51926/1/MPRA_paper_51926.pdf
    File Function: original version
    Download Restriction: no

    References listed on IDEAS

    as
    1. De Witte, Kristof & Geys, Benny, 2013. "Citizen coproduction and efficient public good provision: Theory and evidence from local public libraries," European Journal of Operational Research, Elsevier, pages 592-602.
    2. De Witte, Kristof & Rogge, Nicky, 2011. "Accounting for exogenous influences in performance evaluations of teachers," Economics of Education Review, Elsevier, vol. 30(4), pages 641-653, August.
    3. De Witte, Kristof & Rogge, Nicky & Cherchye, Laurens & Van Puyenbroeck, Tom, 2013. "Economies of scope in research and teaching: A non-parametric investigation," Omega, Elsevier, vol. 41(2), pages 305-314.
    4. Halkos, George E. & Tzeremes, Nickolaos G., 2011. "A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures," Health Policy, Elsevier, vol. 103(1), pages 73-82.
    5. Peter Hall & Jeff Racine & Qi Li, 2004. "Cross-Validation and the Estimation of Conditional Probability Densities," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 1015-1026, December.
    6. Vidoli, Francesco, 2011. "Evaluating the water sector in Italy through a two stage method using the conditional robust nonparametric frontier and multivariate adaptive regression splines," European Journal of Operational Research, Elsevier, vol. 212(3), pages 583-595, August.
    7. Filipe Amado, Carla Alexandra & Dyson, Robert G., 2008. "On comparing the performance of primary care providers," European Journal of Operational Research, Elsevier, vol. 185(3), pages 915-932, March.
    8. Amado, Carla Alexandra da Encarnação Filipe & Santos, Sérgio Pereira dos, 2009. "Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres," Health Policy, Elsevier, vol. 91(1), pages 43-56, June.
    9. George EMM. Halkos & Nickolaos G. Tzeremes, 2011. "Modelling Regional Welfare Efficiency Applying Conditional Full Frontiers," Spatial Economic Analysis, Taylor & Francis Journals, vol. 6(4), pages 451-471, July.
    10. Kristof De Witte & Mika Kortelainen, 2013. "What explains the performance of students in a heterogeneous environment? Conditional efficiency estimation with continuous and discrete environmental variables," Applied Economics, Taylor & Francis Journals, vol. 45(17), pages 2401-2412, June.
    11. Lu, Wen-Min & Lo, Shih-Fang, 2007. "A closer look at the economic-environmental disparities for regional development in China," European Journal of Operational Research, Elsevier, vol. 183(2), pages 882-894, December.
    12. 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.
    13. Haelermans, Carla & De Witte, Kristof, 2012. "The role of innovations in secondary school performance – Evidence from a conditional efficiency model," European Journal of Operational Research, Elsevier, vol. 223(2), pages 541-549.
    14. repec:pal:jorsoc:v:55:y:2004:i:10:d:10.1057_palgrave.jors.2601768 is not listed on IDEAS
    15. Witte, Kristof De & Geys, Benny, 2011. "Evaluating efficient public good provision: Theory and evidence from a generalised conditional efficiency model for public libraries," Journal of Urban Economics, Elsevier, pages 319-327.
    16. Dyckhoff, H. & Allen, K., 2001. "Measuring ecological efficiency with data envelopment analysis (DEA)," European Journal of Operational Research, Elsevier, vol. 132(2), pages 312-325, July.
    17. Badin, Luiza & Daraio, Cinzia & Simar, Léopold, 2010. "Optimal bandwidth selection for conditional efficiency measures: A data-driven approach," European Journal of Operational Research, Elsevier, vol. 201(2), pages 633-640, March.
    18. Racine, Jeff & Li, Qi, 2004. "Nonparametric estimation of regression functions with both categorical and continuous data," Journal of Econometrics, Elsevier, vol. 119(1), pages 99-130, March.
    19. Cinzia Daraio & Léopold Simar, 2005. "Introducing Environmental Variables in Nonparametric Frontier Models: a Probabilistic Approach," Journal of Productivity Analysis, Springer, vol. 24(1), pages 93-121, September.
    20. Laurens Cherchye & Kristof De Witte & Erwin Ooghe, 2008. "Equity and efficiency in private and public education: a nonparametric comparison," Working Papers Department of Economics ces0725, KU Leuven, Faculty of Economics and Business, Department of Economics.
    21. Cheng, Gang & Zervopoulos, Panagiotis & Qian, Zhenhua, 2013. "A variant of radial measure capable of dealing with negative inputs and outputs in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 225(1), pages 100-105.
    22. Sahoo, Biresh K. & Luptacik, Mikulas & Mahlberg, Bernhard, 2011. "Alternative measures of environmental technology structure in DEA: An application," European Journal of Operational Research, Elsevier, vol. 215(3), pages 750-762, December.
    23. Knox Lovell, C. A. & Pastor, Jesus T. & Turner, Judi A., 1995. "Measuring macroeconomic performance in the OECD: A comparison of European and non-European countries," European Journal of Operational Research, Elsevier, vol. 87(3), pages 507-518, December.
    24. Racine, Jeff, 1997. "Consistent Significance Testing for Nonparametric Regression," Journal of Business & Economic Statistics, American Statistical Association, vol. 15(3), pages 369-378, July.
    25. Léopold Simar & Paul Wilson, 2011. "Two-stage DEA: caveat emptor," Journal of Productivity Analysis, Springer, vol. 36(2), pages 205-218, October.
    26. Hua, Zhongsheng & Bian, Yiwen & Liang, Liang, 2007. "Eco-efficiency analysis of paper mills along the Huai River: An extended DEA approach," Omega, Elsevier, vol. 35(5), pages 578-587, October.
    27. Campbell, S. M. & Roland, M. O. & Buetow, S. A., 2000. "Defining quality of care," Social Science & Medicine, Elsevier, vol. 51(11), pages 1611-1625, December.
    28. Robert Rosenman & Daniel Friesner, 2004. "Scope and scale inefficiencies in physician practices," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1091-1116.
    29. Cherchye, Laurens & De Witte, Kristof & Ooghe, Erwin & Nicaise, Ides, 2010. "Efficiency and equity in private and public education: A nonparametric comparison," European Journal of Operational Research, Elsevier, vol. 202(2), pages 563-573, April.
    30. Zhou, P. & Ang, B.W. & Poh, K.L., 2008. "A survey of data envelopment analysis in energy and environmental studies," European Journal of Operational Research, Elsevier, vol. 189(1), pages 1-18, August.
    31. H. Fried & C. Lovell & S. Schmidt & S. Yaisawarng, 2002. "Accounting for Environmental Effects and Statistical Noise in Data Envelopment Analysis," Journal of Productivity Analysis, Springer, vol. 17(1), pages 157-174, January.
    32. 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.
    33. Cinzia Daraio & Léopold Simar, 2007. "Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach," Journal of Productivity Analysis, Springer, vol. 28(1), pages 13-32, October.
    34. Verschelde, Marijn & Rogge, Nicky, 2012. "An environment-adjusted evaluation of citizen satisfaction with local police effectiveness: Evidence from a conditional Data Envelopment Analysis approach," European Journal of Operational Research, Elsevier, vol. 223(1), pages 214-225.
    35. Qi Li & Jeffrey Scott Racine, 2006. "Nonparametric Econometrics: Theory and Practice," Economics Books, Princeton University Press, edition 1, number 8355, June.
    36. Yang, Hongliang & Pollitt, Michael, 2009. "Incorporating both undesirable outputs and uncontrollable variables into DEA: The performance of Chinese coal-fired power plants," European Journal of Operational Research, Elsevier, vol. 197(3), pages 1095-1105, September.
    37. Fare, Rolf & Grosskopf, Shawna, 2004. "Modeling undesirable factors in efficiency evaluation: Comment," European Journal of Operational Research, Elsevier, vol. 157(1), pages 242-245, August.
    38. Chilingerian, Jon A., 1995. "Evaluating physician efficiency in hospitals: A multivariate analysis of best practices," European Journal of Operational Research, Elsevier, vol. 80(3), pages 548-574, February.
    39. Fare, Rolf, et al, 1989. "Multilateral Productivity Comparisons When Some Outputs Are Undesirable: A Nonparametric Approach," The Review of Economics and Statistics, MIT Press, vol. 71(1), pages 90-98, February.
    40. 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.
    41. 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.
    42. Cazals Catherine & Dudley Paul & Florens Jean-Pierre & Patel Shital & Rodriguez Frank, 2008. "Delivery Offices Cost Frontier: A Robust Non Parametric Approach with Exogenous Variables," Review of Network Economics, De Gruyter, pages 1-15.
    43. Seiford, Lawrence M. & Zhu, Joe, 2002. "Modeling undesirable factors in efficiency evaluation," European Journal of Operational Research, Elsevier, vol. 142(1), pages 16-20, October.
    44. Podinovski, Victor V. & Kuosmanen, Timo, 2011. "Modelling weak disposability in data envelopment analysis under relaxed convexity assumptions," European Journal of Operational Research, Elsevier, vol. 211(3), pages 577-585, June.
    45. Daraio, Cinzia & Simar, Leopold, 2006. "A robust nonparametric approach to evaluate and explain the performance of mutual funds," European Journal of Operational Research, Elsevier, vol. 175(1), pages 516-542, November.
    46. Bădin, Luiza & Daraio, Cinzia & Simar, Léopold, 2012. "How to measure the impact of environmental factors in a nonparametric production model," European Journal of Operational Research, Elsevier, vol. 223(3), pages 818-833.
    47. Jose Manuel Cordero-Ferrera & Francisco Pedraja-Chaparro & Javier Salinas-Jimenez, 2008. "Measuring efficiency in education: an analysis of different approaches for incorporating non-discretionary inputs," Applied Economics, Taylor & Francis Journals, vol. 40(10), pages 1323-1339.
    48. Daouia, Abdelaati & Simar, Leopold, 2007. "Nonparametric efficiency analysis: A multivariate conditional quantile approach," Journal of Econometrics, Elsevier, vol. 140(2), pages 375-400, October.
    49. Muniz, M. A., 2002. "Separating managerial inefficiency and external conditions in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 143(3), pages 625-643, December.
    50. Cazals, Catherine & Florens, Jean-Pierre & Simar, Leopold, 2002. "Nonparametric frontier estimation: a robust approach," Journal of Econometrics, Elsevier, vol. 106(1), pages 1-25, January.
    51. Halkos, George E. & Tzeremes, Nickolaos G., 2013. "A conditional directional distance function approach for measuring regional environmental efficiency: Evidence from UK regions," European Journal of Operational Research, Elsevier, vol. 227(1), pages 182-189.
    52. 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;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(3), pages 216-226, September.
    53. 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.
    54. Emrouznejad, Ali & Parker, Barnett R. & Tavares, Gabriel, 2008. "Evaluation of research in efficiency and productivity: A survey and analysis of the first 30 years of scholarly literature in DEA," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 151-157, September.
    55. Korhonen, Pekka J. & Luptacik, Mikulas, 2004. "Eco-efficiency analysis of power plants: An extension of data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 154(2), pages 437-446, April.
    56. Chih-Ching Yang & Ching-Kai Hsiao & Ming-Miin Yu, 2008. "Technical efficiency and impact of environmental regulations in farrow-to-finish swine production in Taiwan," Agricultural Economics, International Association of Agricultural Economists, vol. 39(1), pages 51-61, July.
    57. Jeffery Racine & Jeffrey Hart & Qi Li, 2006. "Testing the Significance of Categorical Predictor Variables in Nonparametric Regression Models," Econometric Reviews, Taylor & Francis Journals, vol. 25(4), pages 523-544.
    58. Scheel, Holger, 2001. "Undesirable outputs in efficiency valuations," European Journal of Operational Research, Elsevier, vol. 132(2), pages 400-410, July.
    Full references (including those not matched with items on IDEAS)

    More about this item

    Keywords

    OR in health services; Efficiency; Data Envelopment Analysis; Environmental factors; Nonparametric analysis;

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pra:mprapa:51926. 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: (Joachim Winter). General contact details of provider: http://edirc.repec.org/data/vfmunde.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.