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Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany

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  • Herwartz, Helmut
  • Schley, Katharina

Abstract

The provision of health care in Germany exhibits sizeable geographic variation with a heterogeneous allocation of medical services in rural and urban areas. Furthermore, distinct utilisation patterns and access barriers due to the socio-economic environment might cause inefficiencies in the provision of health care services. Accordingly, an improved understanding of factors governing inefficiencies in health care provision is likely to benefit an efficient spatial allocation of health care infrastructure. We analyse how socio-economic factors influence the regional distribution of (in)efficiencies in the provision of health care services by means of a stochastic frontier analysis. Our results highlight that regional deprivation relates to inefficient provision of health care services. As a consequence, policies should also consider socio-economic conditions to improve the allocation of medical services and overall health.

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  • Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
  • Handle: RePEc:eee:hepoli:v:122:y:2018:i:3:p:293-300
    DOI: 10.1016/j.healthpol.2018.01.004
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    1. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    2. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 215-222, September.
    3. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    4. Wang, Hung-Jen & Ho, Chia-Wen, 2010. "Estimating fixed-effect panel stochastic frontier models by model transformation," Journal of Econometrics, Elsevier, vol. 157(2), pages 286-296, August.
    5. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 617-650.
    6. Hung-jen Wang & Peter Schmidt, 2002. "One-Step and Two-Step Estimation of the Effects of Exogenous Variables on Technical Efficiency Levels," Journal of Productivity Analysis, Springer, vol. 18(2), pages 129-144, September.
    7. repec:bla:devpol:v:23:y:2005:i:2:p:145-163 is not listed on IDEAS
    8. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    9. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
    10. Isabel Correia & Paula Veiga, 2010. "Geographic distribution of physicians in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 383-393, August.
    11. Anselin, Luc, 2002. "Under the hood : Issues in the specification and interpretation of spatial regression models," Agricultural Economics, Blackwell, vol. 27(3), pages 247-267, November.
    12. Cazals, Catherine & Florens, Jean-Pierre & Simar, Leopold, 2002. "Nonparametric frontier estimation: a robust approach," Journal of Econometrics, Elsevier, vol. 106(1), pages 1-25, January.
    13. Ozegowski, Susanne & Sundmacher, Leonie, 2014. "Understanding the gap between need and utilization in outpatient care—The effect of supply-side determinants on regional inequities," Health Policy, Elsevier, vol. 114(1), pages 54-63.
    14. Boris Augurzky & Thomas Kopetsch & Hendrik Schmitz, 2013. "What accounts for the regional differences in the utilisation of hospitals in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 615-627, August.
    15. Mark R Cullen & Clint Cummins & Victor R Fuchs, 2012. "Geographic and Racial Variation in Premature Mortality in the U.S.: Analyzing the Disparities," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-13, April.
    16. Felder, Stefan & Tauchmann, Harald, 2013. "Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 14(1), pages 21-39.
    17. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    18. McDade, Thomas W. & Adair, Linda S., 2001. "Defining the "urban" in urbanization and health: a factor analysis approach," Social Science & Medicine, Elsevier, vol. 53(1), pages 55-70, July.
    19. Gerdtham, Ulf-G. & Johannesson, Magnus, 2003. "A note on the effect of unemployment on mortality," Journal of Health Economics, Elsevier, vol. 22(3), pages 505-518, May.
    20. António Afonso & Miguel St. Aubyn, 2006. "Relative Efficiency of Health Provision: a DEA Approach with Non-discretionary Inputs," Working Papers Department of Economics 2006/33, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
    21. Sundmacher, Leonie, 2013. "Trends and levels of avoidable mortality among districts: “Healthy” benchmarking in Germany," Health Policy, Elsevier, vol. 109(3), pages 281-289.
    22. Brenner, M. Harvey & Mooney, Anne, 1983. "Unemployment and health in the context of economic change," Social Science & Medicine, Elsevier, vol. 17(16), pages 1125-1138, January.
    23. Aka, Bédia F. & Dumont, J.C., 2008. "HEALTH, EDUCATION AND ECONOMIC GROWTH: TESTING FOR LONG-RUN RELATIONSHIPS AND CAUSAL LINKS in the United States," Applied Econometrics and International Development, Euro-American Association of Economic Development, vol. 8(2), pages 101-110.
    24. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442, September.
    25. Omar Fassio & Chiara Rollero & Norma Piccoli, 2013. "Health, Quality of Life and Population Density: A Preliminary Study on “Contextualized” Quality of Life," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 110(2), pages 479-488, January.
    26. Andrew J. Rettenmaier & Zijun Wang, 2012. "Regional variations in medical spending and utilization: a longitudinal analysis of US Medicare population," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 67-82, February.
    27. Parmeter, Christopher F. & Kumbhakar, Subal C., 2014. "Efficiency Analysis: A Primer on Recent Advances," Foundations and Trends(R) in Econometrics, now publishers, vol. 7(3-4), pages 191-385, December.
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