Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals

Abstract

We evaluate how the productive structure and level of specialization of a hospital affect technical efficiency by analyzing a six-year panel database (2000/2005) drawn from hospital discharge records and Ministry of Health data. We adopt a distance function approach, while measuring the technical efficiency level with stochastic frontier techniques. After controlling for environmental variables and hospital case-mix, inefficiency is negatively associated with specialization and positively associated with capitalization. Capitalization is typical of private structures which, on average, use resources less efficiently with respect to public and not-for-profit hospitals. Finally, by looking at scale elasticities, we find some evidence of unexploited economies of scale, leaving room for centralization.JEL Codes: C16, I12, I18, L25, L33

Evaluating the Generalisability of Trial Results: Introducing a Centre- and Trial-Level Generalisability Index

“…Given that the real-world RCT case study was a UK surgical trial, we searched for factors relevant to hospital care. The following characteristics were included in the Gix: bed capacity [15,[21][22][23], teaching function [21,[24][25][26][27], market environment [28,29], cost performance and the degree of specialisation [30,31] (Table 1). Market environment was operationalised using the UK Department of Health Market Forces Factor (MFF), a metric that accounts for three main categories of capital costs: labour (nonmedical staff and medical staff), land and buildings [32].…”

Hospital ownership and efficiency: A review of studies with particular focus on Germany

“…Among the 12 studies, only 4 had the explicit objective of estimating the impact of hospital ownership on efficiency [26][27][28][29], while the other 8 studies [30][31][32][33][34][35][36][37] merely included ownership as a control variable and primarily explored the impact of market factors (e.g., competition) and other determinants of hospital performance (e.g., managerial issues) or compared statistical methods.…”

“…Out of the 12 included studies, 7 applied SFA [26,27,[30][31][32]35,37], while 4 studies conducted DEA [28,29,34,36], and 1 study compared both methodological approaches [33]. Among the five DEA studies, only two studies [34,36] have used a two-stage analysis (i.e., DEA followed by some form of regression analysis), despite the fact that in recent years it has become the state-of-the-art approach when applying DEA [38].…”

“…Out of these three studies, the two conducted in Florida found public hospitals to be more efficient than private non-profit hospitals [32,33]. Daidone and D'Amico [26] conducted the fourth study that was based on a subregion in Italy (i.e., Lazio Region) and their results indicated that inefficiency was highest for private for-profit hospitals and lowest for public hospitals, with private non-profit hospitals being in between. In addition, five out of eight nation-wide studies showed private for-profit hospitals to be less efficient than their public [28,29,32,35,37] and private non-profit counterparts [29][30][31]35,37].…”

Do Geographical Locations Affect in Hospitals Performance? A Multi-group Data Envelopment Analysis

“…For instance, Daidone and D'Amico [4] applied stochastic frontier analysis (SFA) on 6-year panel database (2000/2005) and examined the impact of productive structure and level of specialization of a hospital on cost/technical efficiency. They found the situation of hospital's efficiency is positively associated with specialization and negatively associated with capitalization (capitalization is typical of private structures).…”