On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study

Helmig, Bernd; Lapsley, Irvine

doi:10.1258/0951484011912762

Cited by 52 publications

(43 citation statements)

References 20 publications

(34 reference statements)

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“…However, even with their excess inputs, inefficient hospitals produce fewer outputs than their counterparts. In Germany, public hospitals are more efficient than private ones because they use fewer resources (Helmig and Lapsley, 2001), compared with the significant investments in improving the quality of medical services in private hospitals.…”

Section: Methodsmentioning

confidence: 99%

Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country

Nistor

Ştefănescu

Crișan

2017

Studia Universitatis Babes-Bolyai Oeconomica

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Abstract. Aiming to analyze the efficiency of the public sector, this paper enriches the literature by providing insights of the healthcare system for an emergent countryRomania. The empirical findings reached by applying the input orientated-variable return to scale (VRS) model of Data Envelopment Analysis (DEA) and Tobit regression method are determined on two key levels of the study. The Data Envelopment Analysis technique quantifies the efficiency within 20 representative hospitals located in the four administrative macro-regions, highlighting the ways of increasing efficiency, while the Tobit regression identifies the factors that influence the efficiency level. The results of the investigation allow for comparisons with other emerging countries, as efficiency has become an increasingly significant factor for public sector evolution. JEL classification: H41, I18, M40

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Section: Methodsmentioning

confidence: 99%

Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country

Nistor

Ştefănescu

Crișan

2017

Studia Universitatis Babes-Bolyai Oeconomica

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“…But from the available data in 2011, it is evident that Ireland (Connolly and Hyndman, 2011), France, Germany, Romania, Sweden, Portugal, Spain, Greece, Italy and Cyprus have also made considerable efforts to introduce the accrual accounting basis at the national level (FEE, 2011). It is also necessary to mention Australia and Canada, which are considered to be the most developed countries in the usage of the accrual accounting basis not only for financial reporting but also for budgeting purposes at all levels of government (Mehrolhassani and Emami, 2013 have introduced the DRG methodology at the sectoral level for paying public health services provided by public hospitals (Polyzos et al, 2013;Christensen, Laegreid and Stigen, 2004;Pettersen, 2001;Helmig and Lapsley, 2001;SanchezMartinez et al, 2006). But in some countries like Ireland, Germany, France, Finland and UK, it was also introduced at the institutional level (O'Reilly et al, 2012).…”

Section: Ivana Dražić Lutilsky Berislav žMuk and Martina Dragijamentioning

confidence: 99%

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

Lutilsky

Žmuk

Dragija

2016

CES

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The purpose of this paper is to present the current usage of cost accounting methodology in Croatian public hospitals through conducted empirical research and to provide opinions of accountants and financial officers regarding possible implementation of cost accounting methodology in public hospitals.In the paper, the authors analyze the accounting system in Croatian public hospitals, identifying the flaws of the current accounting system with regard to the recording and allocation of costs. National healthcare systems of different European countries provide a theoretical background for the usage of accrual accounting basis and cost accounting methodologies, showing better governance and financial sustainability of public hospitals which have introduced cost accounting methodology. The conducted empirical research shows that accountants and financial officers believe that the healthcare system in Croatia is ready for a change in the current accounting system based on the modified accrual Croatian Economic Survey : Vol. 18 : No. 2 : December 2016 : pp. 5-38 basis through the implementation of accrual accounting basis and full costing approach to cost allocation. Full costing approach is also known as activity-based accounting method for cost allocation. The authors also recommend some initial steps for implementation of the new cost accounting system in Croatian public hospitals. Ivana Dražić Lutilsky

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“…271 ] Nevertheless, public-and third-sector hospitals were no less -perhaps more -efficient than private ones. 272,273 Attempts to control the health system by regulation and tariffs pushed provider competition into the marginal 'windows'…”

Section: Provider Competitionmentioning

confidence: 99%

NHS commissioning practice and health system governance: a mixed-methods realistic evaluation

Sheaff

Charles

Mahon

et al. 2015

Health Services and Delivery Research

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BackgroundBy 2010 English health policy-makers had concluded that the main NHS commissioners [primary care trusts (PCTs)] did not sufficiently control provider costs and performance. After the 2010 general election, they decided to replace PCTs with general practitioner (GP)-controlled Clinical Commissioning Groups (CCGs). Health-care commissioners have six main media of power for exercising control over providers, which can be used in different combinations (‘modes of commissioning’).ObjectivesTo: elicit the programme theory of NHS commissioning policy and empirically test its assumptions; explain what shaped NHS commissioning structures; examine how far current commissioning practice allowed commissioners to exercise governance over providers; examine how commissioning practices differ in different types of commissioning organisation and for specific care groups; and explain what factors influenced commissioning practice and the relationships between commissioners and providers.DesignMixed-methods realistic evaluation, comprising: Leximancer and cognitive frame analyses of policy statements to elicit the programme theory of NHS commissioning policy; exploratory cross-sectional analysis of publicly available managerial data about PCTs; systematic comparison of case studies of commissioning in four English sites – including commissioning for older people at risk of unplanned hospital admission; mental health; public health; and planned orthopaedic surgery – and of English NHS commissioning practice with that of a German sick-fund and an Italian region (Lombardy); action learning sets, to validate the findings and draw out practical implications; and two framework analyses synthesising the findings and testing the programme theory empirically.ResultsIn the four English case study sites, CCGs were formed by recycling former commissioning structures, relying on and maintaining the existing GP commissioning leaderships. The stability of distributed commissioning depended on the convergence of commissioners’ interests. Joint NHS and local government commissioning was more co-ordinated at strategic than operational level. NHS providers’ responsiveness to commissioners reflected how far their interests converged, but also providers’ own internal ability to implement agreements. Commissioning for mental health services and to prevent recurrent unplanned hospital readmissions relied more on local ‘micro-commissioning’ (collaborative care pathway design) than on competition. Service commissioning was irrelevant to intersectoral health promotion, but not clinical prevention work. On balance, the possibility of competition did not affect service outcomes in the ways that English NHS commissioning policies assumed. ‘Commodified’ planned orthopaedic surgery most lent itself to provider competition. In all three countries, tariff payments increased provider activity and commissioners’ costs. To contain costs, commissioners bundled tariff payments into blocks, agreed prospective case loads with providers and paid below-tariff rates for additional cases. Managerial performance, negotiated order and discursive control were the predominant media of power used by English, German and Italian commissioners.ConclusionsCommissioning practice worked in certain respects differently from what NHS commissioning policy assumed. It was often laborious and uncertain. In the four English case study sites financial and ‘real-side’ contract negotiations were partly decoupled, clinician involvement being least on the financial side. Tariff systems weakened commissioners’ capacity to choose providers and control costs. Commissioners adapted the systems to solve this problem. Our findings suggest a need for further research into whether or not differently owned providers (corporate, third sector, public, professional partnership, etc.) respond differently to health-care commissioners and, if so, what specific implications for commissioning practice follow. They also suggest that further work is needed to assess how commissioning practices impact on health system integration when care pathways have to be constructed across multiple providers that must tender competitively for work, perhaps against each other.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study

Cited by 52 publications

References 20 publications

Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country

Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

NHS commissioning practice and health system governance: a mixed-methods realistic evaluation

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