Determinants of transient and persistent hospital efficiency: The case of Italy

Colombi, Roberto; Martini, Gianmaria; Vittadini, Giorgio

doi:10.1002/hec.3557

Cited by 56 publications

(62 citation statements)

References 84 publications

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“…In their study of 133 Italian hospitals, Colombi et.al. found that hospitals specialized in single treatments have higher transient inefficiency than general hospitals, indicating economies of scope [15]. In the same vein, a study in three States of the USA using stochastic frontier cost function presented some evidence that general hospitals are more efficient than specialized ones [34].…”

Section: Specialization Vs Economies Of Scopementioning

confidence: 96%

“…The teaching status of a hospital often requires conducting additional clinical tests and diagnostics for the benefit of the residents this imply that teaching hospitals are likely to use higher level of resources than nonteaching hospitals for producing the same level of output [40]. An empirical study of the determinants of hospital efficiency in Italy using four-randomcomponent stochastic frontier model did not find statistically significant effect of teaching hospitals on transient (short-term) and permanent (long-term) inefficiency [15].…”

Section: Teaching Statusmentioning

confidence: 96%

“…The evidence regarding the effect of hospital ownership on efficiency is mixed, and depends on a number of factors including the country and geographical location of the hospital under investigation, the hospital structure and its financing schemes, in addition to the methods and the comparative data sets used in measuring efficiency [15][16][17]. While some studies indicate that private FP hospitals are more efficient than private NFP hospitals [18][19][20], others, to the contrary, show that private NFP hospitals are more efficient than private FP ones [21][22][23].…”

Section: Ownershipmentioning

confidence: 99%

“…The preceding discussion revealed that various factors determine the level of hospital efficiency including hospital size, patient case-mix, ownership, location, teaching status, reimbursement system used and others [8,33,63]. These factors can be classified broadly as factors that are internal and/or external to the hospital [15]. Furthermore, understanding the determinants of hospital efficiency entails a proper examination of hospital production function, which portrays the relationship between factor inputs (such as human resources, beds, medicines and technologies, etc.)…”

Section: Developing a Hospital Efficiency Frameworkmentioning

confidence: 99%

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Determinants of Hospital Efficiency: insights from the literature

Asbu

Masri

Naboulsi³

2020

Preprint

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BackgroundAchieving Universal Health Coverage and other health and health-related targets of the sustainable development goals entails curbing waste in health spending due to inefficiency. Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies. MethodsThe study is based on survey of the literature on hospital efficiency and its determinants. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed. ResultsHospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others.

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Section: Specialization Vs Economies Of Scopementioning

confidence: 96%

Section: Teaching Statusmentioning

confidence: 96%

Section: Ownershipmentioning

confidence: 99%

Section: Developing a Hospital Efficiency Frameworkmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of Hospital Efficiency: insights from the literature

Asbu

Masri

Naboulsi³

2020

Preprint

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show abstract

“…Therefore, each healthcare provider should only be benchmarked against their equilibrium level of inefficiency to obtain an unbiased measure of efficiency. To date, in the healthcare literature, only the study by Colombi et al [11] incorporated the persistent nature of inefficiency for 133 Italian hospitals. Nevertheless, this analysis excluded the concept of rigidities in altering inputs, and linked persistence to technical shortcomings and ineffective organisational structure.…”

mentioning

confidence: 99%

Want to Improve Public Health Access? Let’s Start with the Basics: Measuring Efficiency Correctly

Andrews

2020

PharmacoEconomics Open

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Across developed countries, rising healthcare costs are a significant challenge for government budgets and a motivation for persuading policymakers to consider ways of reducing inefficiency and increasing productivity. Government expenditures in the healthcare system face severe consequences due to inefficiency, including lower health outcomes and larger unmet population needs [1]. Since the early application of the efficiency measurement technique by Nunamaker [2], which measured the technical efficiency of hospitals in Wisconsin, the analysis of hospital efficiencies has gained considerable momentum. Currently, a vast array of studies uses varying sophistication of econometric methodologies to determine levels of healthcare efficiency. Comprehensive reviews of health care efficiency studies by Hussey et al.[3], Hollingsworth and Peacock [1], and Jacobs et al. [4] identify data envelopment analysis (DEA) and stochastic frontier analysis (SFA) as the dominant methodologies in the literature.DEA and SFA belong to a class of methodologies using the economic theory of production to measure the performance of a healthcare provider against the so-called 'efficient frontier', determined by the most efficient healthcare providers. In other words, healthcare services are products generated in a production process that uses healthcare inputs in the form of labour, capital, and other intermediaries. The most efficient healthcare provider will use the least amount of inputs to provide a given number of healthcare services. The efficient frontiers are constructed based on the fundamental assumption that healthcare providers, like other manufacturing agents, can reduce or increase their inputs depending on their particular demand for healthcare services. However, this assumption in healthcare production function may not hold, for two reasons. First, the demand for healthcare services cannot always be predicted with enough accuracy, and, as a result, healthcare providers are bound to operate with excess capacity. Second, the presence of excess capacity suggests that healthcare providers cannot readily alter their level of inputs in the pursuit of greater efficiency, leading to rigidities in the adjustment of healthcare inputs. Several studies [5][6][7][8] show that there is a substantial excess inpatient capacity among hospitals, with one study by the American Hospital Association [9] approximating the occupancy rates to be as low as 63% in American hospitals. Moreover, given the highly regulated operating environment and the prevalence of public finances as a key source of healthcare services in most developed countries [4], healthcare providers are often required to maintain a reserve or standby capacity to meet unforeseen health needs [5, 10]; for example, the recent COVID-19 pandemic.The existence of rigidity in healthcare inputs suggests that inefficiency among healthcare providers will persist through time, and, as a result, healthcare providers will always have a level of inefficiency with them. Therefore, each healthca...

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Estimation and determinants of transient and persistent efficiency of rice production in Spain

Monje,

Sepulveda,

Guesmi

et al. 2024

Agribusiness

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Rice is a basic component in the diet of more than half of the world's population, with 95% of its production destined for human consumption. Spain is the second rice producer in the European Union (EU), geographically located in four autonomous communities contributing to the local economy. This study aims at assessing the productive efficiency of rice farms in this country. To our knowledge, no previous work has dealt with the performance of rice framers in the EU in general and in Spain in particular. We used the Generalized True Ramdom‐effects model to estimate the persistent and transient efficiency levels of farms and identifying the production risk factors using a sample of 158 rice farms over the period 2014–2017. Empirical findings reveal an overall efficiency level of 0.81 on average, mainly explained by the long‐term efficiency component. Moreover, results show an important room for efficiency improvement at the short‐term to enhance productive management skills of farmers. Finally, labor, fertilizer, water and insurance spending are likely to be risk‐decreasing factors. [EconLit Citations: C13, D22, Q12].

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Determinants of transient and persistent hospital efficiency: The case of Italy

Cited by 56 publications

References 84 publications

Determinants of Hospital Efficiency: insights from the literature

Determinants of Hospital Efficiency: insights from the literature

Want to Improve Public Health Access? Let’s Start with the Basics: Measuring Efficiency Correctly

Estimation and determinants of transient and persistent efficiency of rice production in Spain

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