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Hospital cost functions for developing countries

  • Wagstaff, Adam
  • Barnum, Howard

There is extensive literature on hospital cost functions for industrial countries, but very little literature for developing countries. Yet the issues facing policy-makers in all countries are much the same: are hospitals overcapitalized, as is often claimed of U.S. hospitals? Are hospitals inefficient in other respects? Do hospitals vary in efficiency? Are private hospitals more efficient than their public counterparts? Should hospitals specialize or provide a broad range of services? Should costs be reduced by concentrating cases in fewer hospitals? The authors critically survey the techniques available for analyzing hospital costs and review the few hospital cost-function studies undertaken for developing countries. Although the paper is intended primarily for those working in developing countries, the discussion for cost function methodology has broad implications for interpreting econometric cost functions and for examining economies of scale and scope in both developing and industrial countries. The authors survey of econometric techniques is not uncritical. They question, for example, the validity of recent tests of over-capitalization undertaken on American hospitals. They also make general observations about the methods used to investigate economies of scope and economies of scale.

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Paper provided by The World Bank in its series Policy Research Working Paper Series with number 1044.

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Date of creation: 30 Nov 1992
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Handle: RePEc:wbk:wbrwps:1044
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  1. Schmidt, Peter & Knox Lovell, C. A., 1979. "Estimating technical and allocative inefficiency relative to stochastic production and cost frontiers," Journal of Econometrics, Elsevier, vol. 9(3), pages 343-366, February.
  2. Jondrow, James & Knox Lovell, C. A. & Materov, Ivan S. & Schmidt, Peter, 1982. "On the estimation of technical inefficiency in the stochastic frontier production function model," Journal of Econometrics, Elsevier, vol. 19(2-3), pages 233-238, August.
  3. Wagstaff, Adam, 1989. "Econometric studies in health economics : A survey of the British literature," Journal of Health Economics, Elsevier, vol. 8(1), pages 1-51, March.
  4. Greene, William H., 1980. "Maximum likelihood estimation of econometric frontier functions," Journal of Econometrics, Elsevier, vol. 13(1), pages 27-56, May.
  5. Schmidt, Peter & Sickles, Robin C, 1984. "Production Frontiers and Panel Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(4), pages 367-74, October.
  6. Vita, Michael G., 1990. "Exploring hospital production relationships with flexible functional forms," Journal of Health Economics, Elsevier, vol. 9(1), pages 1-21, June.
  7. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
  8. Forsund, Finn R. & Lovell, C. A. Knox & Schmidt, Peter, 1980. "A survey of frontier production functions and of their relationship to efficiency measurement," Journal of Econometrics, Elsevier, vol. 13(1), pages 5-25, May.
  9. Greene, William H., 1982. "Maximum likelihood estimation of stochastic frontier production models," Journal of Econometrics, Elsevier, vol. 18(2), pages 285-289, February.
  10. Grannemann, Thomas W. & Brown, Randall S. & Pauly, Mark V., 1986. "Estimating hospital costs : A multiple-output analysis," Journal of Health Economics, Elsevier, vol. 5(2), pages 107-127, June.
  11. Baumol, William J & Willig, Robert D, 1981. "Fixed Costs, Sunk Costs, Entry Barriers, and Sustainability of Monopoly," The Quarterly Journal of Economics, MIT Press, vol. 96(3), pages 405-31, August.
  12. Wagstaff, Adam, 1989. "The measurement of hospital efficiency: A comment," Social Science & Medicine, Elsevier, vol. 28(1), pages 13-15, January.
  13. Barer, Morris L., 1982. "Case mix adjustment in hospital cost analysis : Information theory revisited," Journal of Health Economics, Elsevier, vol. 1(1), pages 53-80, May.
  14. Robert G. Evans & Hugh D. Walker, 1972. "Information Theory and the Analysis of Hospital Cost Structure," Canadian Journal of Economics, Canadian Economics Association, vol. 5(3), pages 398-418, August.
  15. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
  16. Breyer, Friedrich, 1987. "The specification of a hospital cost function : A comment on the recent literature," Journal of Health Economics, Elsevier, vol. 6(2), pages 147-157, June.
  17. Michael Barrow & Adam Wagstaff, 1989. "Efficiency measurement in the public sector: an appraisal," Fiscal Studies, Institute for Fiscal Studies, vol. 10(1), pages 72-97, February.
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