Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. A nonparametric Data Envelopment Analysis (DEA) is performed on hospitals in the federal state of Saxony (Germany) and in Switzerland. This study is of interest from three points of view. First, contrary to most existing work, patient days are not treated as an output but as an input. Second, the usual DEA assumption of a homogeneous sample is tested and rejected for a large part of the observations. The proposed solution is to restrict DEA to comparable observations in the two countries. Finally, hospital beds are treated as a discretionary input in one DEA and as a fixed input in the other, and the effect on efficiency is related to differences in hospital planning in Germany and Switzerland. Based on the comparable observations, hospitals of Saxony have higher efficiency scores than their Swiss counterparts. Terms of use: Documents inJEL-Classification: I11, I18, C61

The Sisyphus syndrome in health revisited Zweifel, P; Steinmann, L; Eugster, P Zweifel, P; Steinmann, L; Eugster, P. The Sisyphus syndrome in health revisited. The Sisyphus syndrome in health revisited Abstract Health care may be similar to Sisyphus work: When the task is about to be completed, work has to start all over again. To see the analogy, consider an initial decision to allocate more resources to health. The likely consequence is an increased number of survivors, who will exert additional demand for health care. With more resources allocated to health, the cycle starts over again. The objective of this paper is to improve on earlier research that failed to find evidence of a Sisyphus syndrome in industrialized countries. This time, there are signs of such a cycle, which however seems to have faded away recently. The Sisyphus Syndrome in Health Revisited AbstractHealth care may be similar to Sisyphus work: When the task is about to be completed, work has to start all over again. To see the analogy, consider an initial decision to allocate more resources to health. The likely consequence is an increased number of survivors, who will exert additional demand for health care. With more resources allocated to health, the cycle starts over again. The objective of this paper is to improve on earlier research that failed to find evidence of a Sisyphus syndrome in industrialized countries. This time, there are signs of such a cycle, which however seems to have faded away recently.

The efficiency of hospitals is of interest to health insurers, government authorities and hospital management itself. However, econometric methods for determining (in)efficiency have severe drawbacks since hospitals are multiproduct firms and because the duality between production and cost functions cannot be assumed. In this work, non-parametric, deterministic data envelopment analysis (DEA) is used to measure the relative inefficiency of 89 Swiss hospitals covering the years 1993-1996 (310 observations). Special attention is given to the role of patient days in the production of health. The findings depend on whether patient days are viewed as an input of patient time or as an output, as in previous studies. While the probability of a unit being inefficient cannot be explained using the available data, the degree of overall inefficiency is shown to significantly depend on the financial incentives faced by management, in particular due to subsidization. Private hospitals do not seem to be less inefficient than public ones; however, this may be caused by their 'overusing' inputs that in fact are valued as amenities by patients. This consideration points to an important limitation in applying the purely quantitative criteria of DEA to hospitals.

The impact of aging on healthcare expenditure (HCE) has been at the center of a prolonged debate. This paper purports to shed light on several issues of this debate by presenting new evidence on the "red herring" hypothesis advanced by Zweifel, Felder and Meier (1999). This hypothesis amounts to distinguishing a mortality from a morbidity component in healthcare expenditure (HCE) and claiming that failure to make this distinction results in excessive estimates of future growth of HCE. A re-estimation based on a much larger data set is performed, using the refined econometric methodology. The main contribution is consistency, however. Rather than treating the mortality component as a residual in forecasting, its dynamics are analyzed in the same detail as that of the morbidity component when predicting the impact of population aging on the future growth of HCE. For the case of Switzerland, it finds this impact to be relatively small regardless of whether or not the mortality component is accounted for, thus qualifying the "red herring" hypothesis.

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