Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals

Abstract

Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.

Efficiency Measurement Using Data Envelopment Analysis (DEA) in Public Healthcare: Research Trends from 2017 to 2022

“…The Metafrontier model, which calculates efficiency by constructing a single efficiency frontier for the entire data composed of groups with different characteristics, was also used [27,32,33]. Studies that analyzed panel data used the techniques of the Malmquist Index [32,[34][35][36] and Window-DEA [5], as well as the Malmquist-Luenberger index, which is a more advanced technique of the Malmquist Index [37]. Besides these techniques, the use of the latest DEA techniques, such as Dynamic DEA [38,39], context-dependent DEA [40,41], and game-cross efficiency model [15,42] were also witnessed.…”

“…Therefore, Tobit regression, or truncated regression, was mostly performed. Besides these, Ordinary Least Squares (OLS) regression [20,29,43], Generalized Linear Mixed Model (GLMM) regression [44], Logistic regression [30], Spatial Durbin Model [45], and multilevel zero-one inflated beta regression [37] were also used to verify the causal relationship between efficiency and independent factors.…”

Efficiency Comparison of Public and Private Hospitals before and after the COVID-19 Pandemic: The Case of Hubei, China

“…Hospitals are the most essential component of the medical and healthcare system, which can be divided into two types based on their nature: public hospitals and private hospitals. The relationship between hospital e ciency and ownership structure has been investigated [13][14][15][16]. Some studies have used data envelopment analysis (DEA) to assess the technical e ciency difference between public and private hospitals, nding con icting empirical results [17][18][19][20][21][22][23][24][25][26].…”