Essays on hospital efficiency measurement
The overall objective of this thesis is to contribute to the existing knowledge of efficiency measurements through the exploration of efficiency modelling issues and practical applications of different efficiency analysis frameworks. More specifically, this objective will be achieved through a collection of three essays, each of which deals with a distinctive topic. However, the umbrella theme uniting them is measuring productivity and efficiency of hospitals. Quantifying the effects of modelling choices on hospital efficiency measures using meta-regression analysis Motivation and objective: This study recognises the sensitivity of efficiency estimates discussed in the literature and attempts to quantity the effects of modelling choices on estimated efficiencies using the meta-regression technique. Methodology and data: The meta-regression technique is used to quantify the degree to which modelling factors influence efficiency estimates. Modelling factors included in the regression are: sample size; dimension (number of variables); parametric versus non-parametric method; returns to scale (RTS) assumption; functional form; error distributional form; input versus output orientation; cost versus technical efficiency measure; and cross-sectional versus panel data. The data set is derived from 253 estimated models reported in 95 empirical analyses of hospital efficiency in the 22-year period from 1987 to 2008. Results and contributions: Sample size, dimension and RTS are found to have statistically significant effects at the 1% level. Sample size has a negative (and diminishing) effect on mean estimated efficiency; dimension has a positive (and diminishing) effect; while the imposition of constant returns to scale has a negative effect. This study is valuable contribution in that it quantifies the potential variation of efficiency estimates as a result of different model specifications and estimation approaches. The results can be used in improving the policy relevance of the empirical results produced by hospital efficiency studies. Measuring labour efficiency in Queensland public hospitals Motivation and objectives: This chapter attempts to measure efficiencies of public hospitals in Queensland with respect to medical labour usage for the period 1996-2003. It is motivated by the fact that the hospital sector is a labour intensive industry; therefore the improvements in productivity and efficiency are likely to come from the better use of human resources. Methodology and data: A labour input requirement frontier is estimated under the "true" random effect framework with the inclusion of selected control variables to capture the observed heterogeneity. Sensitivity analysis is performed on alternative model specification and estimation strategies. The data consists of 84 public hospitals in Queensland, and cover the period of 8 financial years. Results and contributions: The results suggest that inpatient outputs (represented by weighted episodes of surgical and medical care) greatly influence the labour requirement. The paper finds evidence to support the hypothesis that Queensland Health public hospitals are on average operating at a sub-optimal scale, and that teaching and principal referral hospitals tend to consume more labour resources. Labour requirements in city and town hospitals were also higher than shire and island ones. Hospitals located in the areas with large Indigenous population do not appear to require more medical labour resources. Apart from the policy implications of scale-inefficiencies and the evolution of labout efficiency during the studied period, the study contributes to the literature in being the first study examining labour efficiency in hospital sector under the latest generation of frontier model in a panel data framework. Funding reforms and public hospital efficiency in Vietnam Motivation and objectives: Financing and provision of health services in Vietnam has been gradually privatised in the last two decades or so under the belief that a market-based allocation of health resources would deliver more efficient outcomes. However, market failure is a prominent characteristic of the health care market and there remain questions about the benefit of reforms, especially on efficiency improvement. This chapter attempts to evaluate the impact of financial autonomisation - one of the most recent reform initiatives that turns public service units into quasi-corporates - on productive efficiency of public hospitals in Vietnam between the two periods 1998-2000 (pre-reform) and 2005-2007 (post-reform). Methodology and data: The meta-frontier framework is used to investigate the evolution of technical efficiencies and meta-technology ratios of different geographic and economic regions. The estimation is conducted using the Data Envelopment Analysis method on a dataset of 62 hospitals over 6 years, covering the two periods of pre-reform (1998-2000) and post-reform (2005-2007). Results and contributions: It is evident that the reform has created a more favourable operating environment for public hospitals in some regions of low poverty rates while the poorest regions appear to miss out on the reform benefits. Furthermore, a reduction in technical efficiency is observed overall, which implies that the gain from reform is not sufficient to outweigh the loss. Its contribution lies in the novel application of the recently developed meta-frontier framework to investigate effects of reform. This study also carries important policy implications for future reforms. It suggests that the reform has failed to improve productive efficiency of the public hospital sector while evidently sacrificing the objective of equity in health care.
Year of publication: |
2010-09-01
|
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Authors: | Kim Huong Nguyen |
Subject: | health economics | econometrics | hospital | Productivity analysis | efficiency measurement | stochastic frontier analysis | data envelopment analysis | Queensland | Vietnam |
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