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Internal markets and health care efficiency: a multiple‐output stochastic frontier analysis

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  • U.‐G. Gerdtham
  • M. Löthgren
  • M. Tambour
  • C. Rehnberg

Abstract

This paper has two purposes. The first purpose is methodological and aims to extend previous work on efficiency analysis by implementing a multiple‐output stochastic ray frontier production function model. This model generalizes the single‐output stochastic frontier model to multiple‐input, multiple‐output technologies and allows simultaneous estimation of technical efficiency and analysis of influential variables on efficiency. The second, empirical, purpose is to test for existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel data set covering the total population of 26 Swedish County Councils from 1989 to 1995. Our empirical results support the frontier model specification and indicate that output‐based reimbursement improves technical efficiency. The potential saving in costs due to a switch from budget‐based allocation to output‐based allocation is estimated to be almost 10%. Copyright © 1999 John Wiley & Sons, Ltd.

Suggested Citation

  • U.‐G. Gerdtham & M. Löthgren & M. Tambour & C. Rehnberg, 1999. "Internal markets and health care efficiency: a multiple‐output stochastic frontier analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(2), pages 151-164, March.
    • Handle: RePEc:wly:hlthec:v:8:y:1999:i:2:p:151-164
    DOI: 10.1002/(SICI)1099-1050(199903)8:2<151::AID-HEC411>3.0.CO;2-Q
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    References listed on IDEAS

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    1. Zuckerman, Stephen & Hadley, Jack & Iezzoni, Lisa, 1994. "Measuring hospital efficiency with frontier cost functions," Journal of Health Economics, Elsevier, vol. 13(3), pages 255-280, October.
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    3. James F. Burgess, Jr. & Paul W. Wilson, 1996. "Hospital Ownership and Technical Inefficiency," Management Science, INFORMS, vol. 42(1), pages 110-123, January.
    4. Meeusen, Wim & van den Broeck, Julien, 1977. "Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 18(2), pages 435-444, June.
    5. Lothgren, Mickael, 1997. "Generalized stochastic frontier production models," Economics Letters, Elsevier, vol. 57(3), pages 255-259, December.
    6. Kodde, David A & Palm, Franz C, 1986. "Wald Criteria for Jointly Testing Equality and Inequality Restriction s," Econometrica, Econometric Society, vol. 54(5), pages 1243-1248, September.
    7. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    8. Christensen, Laurits R & Jorgenson, Dale W & Lau, Lawrence J, 1973. "Transcendental Logarithmic Production Frontiers," The Review of Economics and Statistics, MIT Press, vol. 55(1), pages 28-45, February.
    9. Kooreman, Peter, 1994. "Nursing home care in The Netherlands: a nonparametric efficiency analysis," Journal of Health Economics, Elsevier, vol. 13(3), pages 301-316, October.
    10. Gerdtham, Ulf-G., 1993. "The impact of aging on health care expenditure in Sweden," Health Policy, Elsevier, vol. 24(1), pages 1-8, April.
    11. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
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    More about this item

    JEL classification:

    • C12 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Hypothesis Testing: General
    • C13 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Estimation: General
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • I10 - Health, Education, and Welfare - - Health - - - General

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