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Effect of Teaching on Hospital Productivity


  • S. Grosskopf

    (Southern Illinois Univ.)

  • D. Margaritis

    (Waikato Univ.)

  • V. Valdmanis

    (Univ. of Oklahoma)


In addition to providing direct patient care, some hospitals also are used as training grounds for medical students and physicians-in-training (medical residents). Because of these additional responsibilities, total costs are higher in teaching hospitals than their non-teaching counterparts. In this paper, we use the data envelopment analysis methodology to assess the relative productive efficiency of teaching hospitals in our sample. Outputs will be defined as an array of inpatient and outpatient services and inputs will be characterized as number of physicians, labor, beds, and medical residents. In order to evaluate relative productivity, a reference technology of 'best practice frontier' will be derived from all the observations in our sample under assumptions of both strong and weak disposability of inputs. By analyzing medical residents as weakly disposable inputs, we can estimate how much they detract from the hospital's productive capability.

Suggested Citation

  • S. Grosskopf & D. Margaritis & V. Valdmanis, 1997. "Effect of Teaching on Hospital Productivity," HEW 9702002, University Library of Munich, Germany.
  • Handle: RePEc:wpa:wuwphe:9702002
    Note: Type of Document - WordPerfect 6.1 document and separate title page; prepared on IBM PC; to print on HP; pages: 17; figures: one: request from author. Two binary WordPerfect 6.1 files uploaded with Netscape 3.01 Gold

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    References listed on IDEAS

    1. Rogowski, Jeannette A. & Newhouse, Joseph P., 1992. "Estimating the indirect costs of teaching," Journal of Health Economics, Elsevier, vol. 11(2), pages 153-171, August.
    2. Sloan, Frank A. & Feldman, Roger D. & Steinwald, A. Bruce, 1983. "Effects of teaching on hospital costs," Journal of Health Economics, Elsevier, vol. 2(1), pages 1-28, March.
    3. 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.
    4. Lee, Robert H. & Hadley, Jack, 1985. "The demand for residents," Journal of Health Economics, Elsevier, vol. 4(4), pages 357-371, December.
    5. Brockett, Patrick L. & Cooper, William W. & Wang, Yuying & Shin, Hong-Chul, 1998. "Inefficiency and congestion in Chinese production before and after the 1978 economic reforms," Socio-Economic Planning Sciences, Elsevier, vol. 32(1), pages 1-20, March.
    6. אסתר טולידנו, 1994. "מקבלי דמי אבטלה בשנת 1993," Working Papers 439, National Insurance Institute of Israel.
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    Cited by:

    1. Alexander Karmann & Felix Roesel, 2017. "Hospital Policy and Productivity – Evidence from German States," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1548-1565, December.
    2. Cooper, W. W. & Seiford, Lawrence M. & Thanassoulis, Emmanuel & Zanakis, Stelios H., 2004. "DEA and its uses in different countries," European Journal of Operational Research, Elsevier, vol. 154(2), pages 337-344, April.
    3. Thomas Czypionka & Markus Kraus & Susanne Mayer & Gerald Röhrling, 2014. "Efficiency, ownership, and financing of hospitals: The case of Austria," Health Care Management Science, Springer, vol. 17(4), pages 331-347, December.
    4. Gary D. Ferrier & Hervé Leleu & Vivian G. Valdmanis & Michael Vardanyan, 2018. "A directional distance function approach for identifying the input/output status of medical residents," Applied Economics, Taylor & Francis Journals, vol. 50(9), pages 1006-1021, February.
    5. Yasar Ozcan & Marcos Lins & Maria Lobo & Angela da Silva & Roberto Fiszman & Basilio Pereira, 2010. "Evaluating the performance of Brazilian university hospitals," Annals of Operations Research, Springer, vol. 178(1), pages 247-261, July.
    6. 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.
    7. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    8. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    9. Bo Hsiao & Li-Hsueh Chen, 2019. "Performance Evaluation for Taiwanese Hospitals by Multi-Activity Network Data Envelopment Analysis," International Journal of Information Technology & Decision Making (IJITDM), World Scientific Publishing Co. Pte. Ltd., vol. 18(03), pages 1009-1043, May.
    10. Pedro Simões & Rui Marques, 2011. "Performance and congestion analysis of the portuguese hospital services," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 19(1), pages 39-63, March.
    11. Ni, Huan & Paul, Jomon Aliyas & Bagchi, Aniruddha, 2017. "Effect of Certificate of Need Law on the intensity of competition: The market for emergency care," Socio-Economic Planning Sciences, Elsevier, vol. 60(C), pages 34-48.
    12. Samoilenko, Sergey & Osei-Bryson, Kweku-Muata, 2010. "Determining sources of relative inefficiency in heterogeneous samples: Methodology using Cluster Analysis, DEA and Neural Networks," European Journal of Operational Research, Elsevier, vol. 206(2), pages 479-487, October.
    13. Yongjun Li & Xiyang Lei & Alec Morton, 2019. "Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals," Health Care Management Science, Springer, vol. 22(2), pages 215-228, June.
    14. Pedro Barros & Sara Machado, 2010. "Money for nothing?," Health Care Management Science, Springer, vol. 13(3), pages 234-255, September.

    More about this item


    teaching; hospitals; productivity; DEA;

    JEL classification:

    • I - Health, Education, and Welfare


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