IDEAS home Printed from https://ideas.repec.org/a/eee/jpolmo/v35y2013i1p183-195.html
   My bibliography  Save this article

Analyzing cost efficiency of Critical Access Hospitals

Author

Listed:
  • Cristian Nedelea, I.
  • Matthew Fannin, J.

Abstract

The Critical Access Hospital (CAH) program has been created to protect small, financially vulnerable rural hospitals in the U.S. by granting them Medicare cost-based reimbursement. However, there have been concerns that this type of reimbursement might have a negative impact on the cost efficiency of hospitals that converted to CAH status. This study examines the impact of Medicare cost-based reimbursement, length of participation in the CAH program and other environmental variables on the cost efficiency of CAHs using a two-stage approach. In the first stage, data envelopment analysis is used to estimate cost efficiency of CAHs. In the second stage, cost efficiency is regressed on environmental variables using a parametric bootstrap of a truncated regression. The estimated results suggest that Medicare cost-based reimbursement may increase the cost inefficiency of CAHs and that longer participation in the CAH program increases hospital cost inefficiency but the extent of this inefficiency increase is lower than what previous literature showed.

Suggested Citation

  • Cristian Nedelea, I. & Matthew Fannin, J., 2013. "Analyzing cost efficiency of Critical Access Hospitals," Journal of Policy Modeling, Elsevier, vol. 35(1), pages 183-195.
    • Handle: RePEc:eee:jpolmo:v:35:y:2013:i:1:p:183-195
    DOI: 10.1016/j.jpolmod.2012.10.002
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0161893812001123
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.jpolmod.2012.10.002?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Acton, Jan Paul, 1975. "Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence," Journal of Political Economy, University of Chicago Press, vol. 83(3), pages 595-614, June.
    2. Kneip, Alois & Park, Byeong U. & Simar, Léopold, 1998. "A Note On The Convergence Of Nonparametric Dea Estimators For Production Efficiency Scores," Econometric Theory, Cambridge University Press, vol. 14(6), pages 783-793, December.
    3. Sherman T. Folland & Richard A. Hofler, 2001. "How reliable are hospital efficiency estimates? Exploiting the dual to homothetic production," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 683-698, December.
    4. McNamara, Paul E., 2009. "Rural Hospitals, Reimbursement Policy, and Health Care Reform," Choices: The Magazine of Food, Farm, and Resource Issues, Agricultural and Applied Economics Association, vol. 24(4), pages 1-7.
    5. Zuckerman, Stephen & Hadley, Jack & Iezzoni, Lisa, 1994. "Measuring hospital efficiency with frontier cost functions," Journal of Health Economics, Elsevier, vol. 13(3), pages 255-280, October.
    6. 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.
    7. Michael D. Rosko, 2001. "Cost efficiency of US hospitals: a stochastic frontier approach," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 539-551, September.
    8. Anatoly I. Pilyavsky & William E. Aaronson & Patrick M. Bernet & Michael D. Rosko & Vivian G. Valdmanis & Mikhail V. Golubchikov, 2006. "East–west: does it make a difference to hospital efficiencies in Ukraine?," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1173-1186, November.
    9. Paul E. McNamara, 1999. "Welfare Effects of Rural Hospitial Closures: A Nested Logit Analysis of the Demand for Rural Hospital Services," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 81(3), pages 686-691.
    10. Susan M. Capalbo & Christine N. Heggem, 1999. "Valuing Rural Health Care: Issues of Access and Quality," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 81(3), pages 674-679.
    11. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
    12. Valentin Zelenyuk & Vitaliy Zheka, 2006. "Corporate Governance and Firm’s Efficiency: The Case of a Transitional Country, Ukraine," Journal of Productivity Analysis, Springer, vol. 25(1), pages 143-157, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nan Jiang & Antony Andrews, 2020. "Efficiency of New Zealand’s District Health Boards at Providing Hospital Services: A stochastic frontier analysis," Journal of Productivity Analysis, Springer, vol. 53(1), pages 53-68, February.
    2. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    3. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    4. Pınar Kaya Samut & Reyhan Cafrı, 2016. "Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 129(1), pages 113-132, October.
    5. Qian Liu & Bo Li & Muhammad Mohiuddin, 2018. "Prediction and Decomposition of Efficiency Differences in Chinese Provincial Community Health Services," IJERPH, MDPI, vol. 15(10), pages 1-14, October.
    6. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    7. Simar, Léopold & Wilson, Paul W., 2020. "Technical, allocative and overall efficiency: Estimation and inference," European Journal of Operational Research, Elsevier, vol. 282(3), pages 1164-1176.
    8. Gupta, Maansi & Bolia, Nomesh B., 2020. "Efficiency measurement of Indian high courts using DEA: A policy perspective," Journal of Policy Modeling, Elsevier, vol. 42(6), pages 1372-1393.
    9. Gökçe Manavgat & Martine Audibert, 2024. "Healthcare system efficiency and drivers: Re-evaluation of OECD countries for COVID-19," Post-Print hal-04350906, HAL.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    2. Nedelea, I. Cristian & Fannin, James Matthew, 2012. "Efficiency Analysis of Rural Hospitals: Parametric and Semi-parametric Approaches," 2012 Annual Meeting, February 4-7, 2012, Birmingham, Alabama 119725, Southern Agricultural Economics Association.
    3. Mehdi Farsi & Massimo Filippini, 2008. "Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 335-350, March.
    4. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    5. Cyril Chang & Jennifer Troyer, 2009. "The impact of TennCare on hospital efficiency," Health Care Management Science, Springer, vol. 12(3), pages 201-216, September.
    6. Bao Hoang Nguyen & Valentin Zelenyuk, 2021. "Aggregate efficiency of industry and its groups: the case of Queensland public hospitals," Empirical Economics, Springer, vol. 60(6), pages 2795-2836, June.
    7. Stefan Meyer, 2015. "Payment schemes and cost efficiency: evidence from Swiss public hospitals," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 73-97, March.
    8. Niccie L. McKay & Mary E. Deily, 2008. "Cost inefficiency and hospital health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 833-848, July.
    9. Mareike Heimeshoff & Jonas Schreyögg & Lukas Kwietniewski, 2014. "Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data," Health Care Management Science, Springer, vol. 17(2), pages 150-161, June.
    10. Shiu, Alice & Zelenyuk, Valentin, 2009. "Production Efficiency versus Ownership: The Case of China," MPRA Paper 23760, University Library of Munich, Germany, revised 22 Mar 2010.
    11. Sickles, Robin C. & Song, Wonho & Zelenyuk, Valentin, 2018. "Econometric Analysis of Productivity: Theory and Implementation in R," Working Papers 18-008, Rice University, Department of Economics.
    12. Almas Heshmati, 2003. "Productivity Growth, Efficiency and Outsourcing in Manufacturing and Service Industries," Journal of Economic Surveys, Wiley Blackwell, vol. 17(1), pages 79-112, February.
    13. Iustin Nedelea & James Fannin, 2013. "Technical efficiency of Critical Access Hospitals: an application of the two-stage approach with double bootstrap," Health Care Management Science, Springer, vol. 16(1), pages 27-36, March.
    14. Leopold Simar & Valentin Zelenyuk, 2006. "On Testing Equality of Distributions of Technical Efficiency Scores," Econometric Reviews, Taylor & Francis Journals, vol. 25(4), pages 497-522.
    15. Martijn Ludwig & Frits Merode & Wim Groot, 2010. "Principal agent relationships and the efficiency of hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 291-304, June.
    16. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    17. Daniel Friesner & Matthew McPherson & Robert Rosenman, 2006. "Are Hospitals Seasonally Inefficient? Evidence from Washington State Hospitals," Working Papers 2006-3, School of Economic Sciences, Washington State University.
    18. Suthathip Yaisawarng & James F. Burgess, 2006. "Performance‐based budgeting in the public sector: an illustration from the VA health care system," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 295-310, March.
    19. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    20. Carolina Crispin-Fory & Ligia Alba Melo-Becerra & Diego Alexander Restrepo-Tobón & Diego Vásquez-Escobar, 2023. "Eficiencia y solidez financiera de las Instituciones prestadoras de Servicio de Salud (IPS) en Colombia," Borradores de Economia 1248, Banco de la Republica de Colombia.

    More about this item

    Keywords

    Critical Access Hospitals; Two-stage approach; Cost inefficiency; Bootstrap;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    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:eee:jpolmo:v:35:y:2013:i:1:p:183-195. See general information about how to correct material in RePEc.

    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 bibliographic 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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505735 .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.