Hospital performance in a noncompetitive environment

Bilodeau, Daniel; Crémieux, Pierre‐Yves; Ouellette, Pierre

doi:10.1080/00036840701564384

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…Given these caveats the results are still interesting in terms of potentially pointing towards differences. Bilodeaua et al (2009) find that large hospitals may fail to efficiently use technology, while smaller hospitals, which do not have access to the latest technology, may be more efficient at using the technology they do have access to. This may have been evident if we had been able to assess quality of care, which may be impacted upon by technological developments.…”

Section: Discussionmentioning

confidence: 97%

The scale of hospital production in different settings: one size does not fit all

2013

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This paper analyses the productive efficiency of 141 public hospitals from 1998-2004 in two Canadian provinces; one a small province with a few small cities and a generally more rural population and the other a large province that is more urban in nature, with a population who mainly live in large cities. The relative efficiencies of the hospitals, the changes in productivity during this time period, and the relationship between efficiency and the size or scale of the hospitals are investigated using data envelopment analysis. The models for the production of health care use case mix adjusted hospital discharges as the output, and nursing hours as inputs. We find clear differences between the two provinces. Making use of 'own' and 'meta' technical efficiency frontiers, we demonstrate that efficient units in the larger and more urban province are larger than non-efficient units in that province. However, efficient hospitals in the smaller and more rural province are smaller than non-efficient hospitals in that province. Overall, efficient hospitals in the larger more urban province are larger than efficient hospitals in the smaller more rural province. This has interesting policy implications-different hospitals may have different optimal sizes, or different efficient modes of operation, depending on location, the population they serve, and the policies their respective provincial governments wish to implement. In addition, there are lessons to be learned by comparing the hospitals across the two provinces, since the inefficient hospitals in the small rural province predominantly use hospitals from the large urban province as benchmarks, such that substantially larger improvement potential can be identified by inter-provincial rather than intra-provincial benchmarking analysis.

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Section: Discussionmentioning

confidence: 97%

The scale of hospital production in different settings: one size does not fit all

2013

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“…In this study, we use a nonparametric approach known as DEA to estimate a production frontier and the distance of each hospital to the frontier. DEA is one of the two main methods used to estimate hospital technical or cost efficiency (Bilodeau, Cremiedx, and Quellette ; Varabyova and Schreyögg ; Chowdhury and Zelenyuk ; Ferreira and Marques ). The main advantage of the DEA approach in the present case is that it allows for the estimation of frontiers for multi‐outputs; in the case of inpatient acute care, we want to account for the quality as well as the quantity of stays a hospital produces (see below, subsection “outputs”), because it reflects the dilemma governments face: How can we reduce wait‐times without jeopardizing quality?…”

Section: Methodsmentioning

confidence: 99%

“…Appendix describes the main findings of Canadian studies, which can be summarized as follows: Hospital size, occupancy rate, case mix index, urbanity, and teaching status have significant influences on hospital efficiency (Gruca and Nath ; Bilodeau, Crémieux, and Ouellette ; Bilodeau et al. ; Bilodeau, Cremiedx, and Quellette ; Chowdhury, Wodchis, and Laporte ; Asmild, Hollingsworth, and Birch ; Chowdhury and Zelenyuk ).…”

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confidence: 99%

The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada

Wang

Grignon

Perry

et al. 2018

Health Services Research

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“…For example, Borzekowski (), Bilodeau et al . (), Keeler and Ying (), Vita (), Grannemann et al . () and Conrad and Strauss () all find no evidence or limited evidence of scale economies for hospital care.…”

Section: Previous Literaturementioning

confidence: 99%

Analysis of Hospital Production: An Output Index Approach

Gaynor

Kleiner

Vogt

2013

J of Applied Econometrics

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In this study, we develop and implement an output index approach to the estimation of hospital cost functions that reflects the differentiated nature of hospital care. The approach combines the estimation of an output index within a flexible functional form. We find, in an application to California hospitals, evidence of scope economies across specialties within primary care, and diseconomies of scope within secondary and tertiary care. Minimum efficient scale is reached at larger levels of output than would be estimated by conventional techniques. These results indicate the importance of accounting for firm output heterogeneity when estimating cost functions.

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Hospital performance in a noncompetitive environment

Cited by 6 publications

References 17 publications

The scale of hospital production in different settings: one size does not fit all

The scale of hospital production in different settings: one size does not fit all

The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada

Analysis of Hospital Production: An Output Index Approach

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