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Technical Efficiency, Specialization and Ownership Form: Evidences from a Pooling of Italian Hospitals

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Abstract

We evaluate how the productive structure and level of specialization of a hospital affect technical efficiency by analyzing a six-year panel database (2000/2005) drawn from hospital discharge records and Ministry of Health data. We adopt a distance function approach, while measuring the technical efficiency level with stochastic frontier techniques. After controlling for environmental variables and hospital case-mix, inefficiency is negatively associated with specialization and positively associated with capitalization. Capitalization is typical of private structures which, on average, use resources less efficiently with respect to public and not-for-profit hospitals. Finally, by looking at scale elasticities, we find some evidence of unexploited economies of scale, leaving room for centralization.

Suggested Citation

  • Silvio Daidone & Francesco D'Amico, 2009. "Technical Efficiency, Specialization and Ownership Form: Evidences from a Pooling of Italian Hospitals," CEIS Research Paper 143, Tor Vergata University, CEIS, revised 30 Sep 2009.
  • Handle: RePEc:rtv:ceisrp:143
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    1. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    2. Conrad Kobel & Engelbert Theurl, 2013. "Hospital specialisation within a DRG-Framework: The Austrian Case," Working Papers 2013-06, Faculty of Economics and Statistics, University of Innsbruck.
    3. repec:kap:hcarem:v:20:y:2017:i:3:d:10.1007_s10729-016-9359-1 is not listed on IDEAS
    4. Lukas Kwietniewski & Mareike Heimeshoff & Jonas Schreyögg, 2017. "Estimation of a physician practice cost function," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(4), pages 481-494, May.
    5. Adrian Gheorghe & Tracy Roberts & Karla Hemming & Melanie Calvert, 2015. "Evaluating the Generalisability of Trial Results: Introducing a Centre- and Trial-Level Generalisability Index," PharmacoEconomics, Springer, vol. 33(11), pages 1195-1214, November.
    6. Vincenzo Atella & Federico Belotti & Silvio Daidone & Giuseppe Ilardi & Giorgia Marini, 2012. "Cost-containment policies and hospital efficiency: evidence from a panel of Italian hospitals," CEIS Research Paper 228, Tor Vergata University, CEIS, revised 13 Apr 2012.
    7. Federico Belotti & Giuseppe Ilardi, 2012. "Consistent Estimation of the “True” Fixed-effects Stochastic Frontier Model," CEIS Research Paper 231, Tor Vergata University, CEIS, revised 18 Apr 2012.
    8. Jos Blank & Evelien Eggink, 2014. "The impact of policy on hospital productivity: a time series analysis of Dutch hospitals," Health Care Management Science, Springer, vol. 17(2), pages 139-149, June.
    9. Ana Rodríguez-Álvarez & David Roibás-Alonso & Alan Wall, 2013. "The response of decentralized health services to demand uncertainty and the role of political parties in the Spanish public health system," Journal of Productivity Analysis, Springer, vol. 40(3), pages 357-365, December.
    10. Tiemann, Oliver & Schreyögg, Jonas & Busse, Reinhard, 2012. "Hospital ownership and efficiency: A review of studies with particular focus on Germany," Health Policy, Elsevier, vol. 104(2), pages 163-171.
    11. Helmut Herwartz & Christoph Strumann, 2014. "Hospital efficiency under prospective reimbursement schemes: an empirical assessment for the case of Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(2), pages 175-186, March.
    12. Federico Belotti & Giuseppe Ilardi, 2017. "Consistent inference in fixed-effects stochastic frontier models," Temi di discussione (Economic working papers) 1147, Bank of Italy, Economic Research and International Relations Area.
    13. Ogundari, K. & Brümmer, Bernhard, 2011. "Estimating Technical Efficiency, Input substitution and complementary effects using Output Distance Function: A study of Cassava production in Nigeria," Agricultural Economics Review, Greek Association of Agricultural Economists, vol. 12(2), June.
    14. De Nicola, Arianna & Gitto, Simone & Mancuso, Paolo, 2011. "A two-stage DEA model to evaluate the efficiency of the Italian health system," MPRA Paper 39126, University Library of Munich, Germany.
    15. Bettina Campedelli & Andrea Guerrina & Giulia Romano & Chiara Leardini, 2014. "La performance della rete ospedaliera pubblica della regione Veneto. L’impatto delle variabili ambientali e operative sull’efficienza," MECOSAN. Menagement e economia sanitaria, FrancoAngeli Editore, vol. 2014(92), pages 119-142.
    16. Rodríguez-Álvarez, Ana & Roibás, David & Wall, Alan, 2009. "Factors determining the response of hospitals to demand uncertainty," Efficiency Series Papers 2009/04, University of Oviedo, Department of Economics, Oviedo Efficiency Group (OEG).
    17. James Gaughan & Anne Mason & Andrew Street & Padraic Ward, 2012. "English Hospitals Can Improve Their Use of Resources: An Analysis of Costs and Length of Stay for Ten Treatments," Working Papers 078cherp, Centre for Health Economics, University of York.
    18. Cavalieri, M.; Di Caro, P.; Guccio, C.; Lisi, D.;, 2017. "Does neighbour’s grass matter? Exploring spatial dependent heterogeneity in technical efficiency of Italian hospitals," Health, Econometrics and Data Group (HEDG) Working Papers 17/13, HEDG, c/o Department of Economics, University of York.
    19. Ivonne Lindlbauer & Jonas Schreyögg, 2014. "The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?," Health Care Management Science, Springer, vol. 17(4), pages 365-378, December.

    More about this item

    Keywords

    Stochastic frontiers; Hospital Discharge Records; Hospital Specialization; Distance Functions; Technical Efficiency.;

    JEL classification:

    • C16 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Econometric and Statistical Methods; Specific Distributions
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L25 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Firm Performance
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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