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Hospital Cost and Efficiency in a Regime of Stringent Regulation

Author

Listed:
  • Donald F. Vitaliano

    (Rensselaer Polytechnic Institute)

  • Mark Toren

    (New York State Department of Health)

Abstract

A stochastic frontier cost function is fitted to data for 219 New York hospitals (1991). Economic inefficiency is estimated to be about 18 percent, comparable to published estimates for hospitals nationwide. Hospitals with over 300 beds are notably more efficient, and those with more Medicare patients are also more efficient. A reduction in excess bed capacity to control costs appears warranted. Rochester area hospitals, where a system of monopsony reimbursement exists, are more efficient. Unionized hospitals are less efficient. The stringent regulatory system in New York does not appear to effectively control costs or to affect efficiency.

Suggested Citation

  • Donald F. Vitaliano & Mark Toren, 1996. "Hospital Cost and Efficiency in a Regime of Stringent Regulation," Eastern Economic Journal, Eastern Economic Association, vol. 22(2), pages 161-175, Spring.
    • Handle: RePEc:eej:eeconj:v:22:y:1996:i:2:p:161-175
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    File URL: http://web.holycross.edu/RePEc/eej/Archive/Volume22/V22N2P161_175.pdf
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    2. Jana Votápková & Lenka Šťastná, 2013. "Efficiency of Hospitals in the Czech Republic," Prague Economic Papers, Prague University of Economics and Business, vol. 2013(4), pages 524-541.
    3. C. O’Donnell & K. Nguyen, 2013. "An econometric approach to estimating support prices and measures of productivity change in public hospitals," Journal of Productivity Analysis, Springer, vol. 40(3), pages 323-335, December.
    4. Gian Paolo Barbetta & Gilberto Turati & Angelo M. Zago, 2007. "Behavioral differences between public and private not‐for‐profit hospitals in the Italian national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 75-96, January.
    5. Mehdi Farsi, 2008. "The temporal variation of cost-efficiency in Switzerland’s hospitals: an application of mixed models," Journal of Productivity Analysis, Springer, vol. 30(2), pages 155-168, October.
    6. Cyril Chang & Jennifer Troyer, 2009. "The impact of TennCare on hospital efficiency," Health Care Management Science, Springer, vol. 12(3), pages 201-216, September.
    7. Sujoy Chakravarty & Martin Gaynor & Steven Klepper & William B. Vogt, 2006. "Does the profit motive make Jack nimble? Ownership form and the evolution of the US hospital industry," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 345-361, April.
    8. Michael D. Rosko, 2001. "Cost efficiency of US hospitals: a stochastic frontier approach," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 539-551, September.
    9. J.L.T. Blank & A.H.Q.M. Merkies, 2004. "Empirical assessment of the economic behaviour of Dutch general hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 265-280, March.
    10. Mehdi Farsi & Massimo Filippini, 2008. "Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 335-350, March.
    11. Berta, Paolo & Callea, Giuditta & Martini, Gianmaria & Vittadini, Giorgio, 2010. "The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation," Economic Modelling, Elsevier, vol. 27(4), pages 812-821, July.
    12. Molem Christopher S. & Beri Parfait B. & Ntangsi Max M., 2017. "Determinants of the Inefficiency of Public Hospitals in Cameroon," International Journal of Academic Research in Business and Social Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Business and Social Sciences, vol. 7(6), pages 404-419, June.
    13. John Ruggiero & Donald F. Vitaliano, 1999. "Assessing The Efficiency Of Public Schools Using Data Envelopment Analysis And Frontier Regression," Contemporary Economic Policy, Western Economic Association International, vol. 17(3), pages 321-331, July.
    14. Alejandro Arvelo-Martín & Juan José Díaz-Hernández & Ignacio Abásolo-Alessón, 2019. "Hospital productivity bias when not adjusting for cost heterogeneity: The case of Spain," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-17, June.
    15. Elenka Brenna & Federico Spandonaro, 2014. "Does federalism induce patients’ mobility across regions? Evidence from the Italian experience," DISCE - Working Papers del Dipartimento di Economia e Finanza def009, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    16. Kim-Huong Nguyen & Tim Coelli, 2009. "Quantifying the effects of modelling choices on hospital efficiency measures: A meta-regression analysis," CEPA Working Papers Series WP072009, School of Economics, University of Queensland, Australia.
    17. Gillian Currie & Cam Donaldson & Mingshan Lu, 2003. "What Does Canada Profit from the For-Profit Debate on Health Care?," Canadian Public Policy, University of Toronto Press, vol. 29(2), pages 227-251, June.
    18. Camilla Mastromarco & Lenka Stastna & Jana Votapkova, 2019. "Efficiency of hospitals in the Czech Republic: Conditional efficiency approach," Journal of Productivity Analysis, Springer, vol. 51(1), pages 73-89, February.
    19. Donald F. Vitaliano, 2020. "On the efficient location of hospitals," Letters in Spatial and Resource Sciences, Springer, vol. 13(1), pages 1-10, April.
    20. Brachmann, Matthias, 2009. "Trägerschaft und Governance – Auswirkungen auf den organisationalen Wandel im Krankenhaussektor," ZögU - Zeitschrift für öffentliche und gemeinwirtschaftliche Unternehmen, Nomos Verlagsgesellschaft mbH & Co. KG, vol. 32(4), pages 370-391.
    21. Matranga, Domenica & Sapienza, Francesca, 2015. "Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily," Health Policy, Elsevier, vol. 119(3), pages 324-332.
    22. Jeong Hoon Choi & Imsu Park & Ilyoung Jung & Asoke Dey, 2017. "Complementary effect of patient volume and quality of care on hospital cost efficiency," Health Care Management Science, Springer, vol. 20(2), pages 221-231, June.
    23. Germà Bel & Marc Esteve, 2018. "“Is Private Production of Hospital Services Cheaper than Public Production? A Meta-Regression of Public vs Private Costs and Efficiency for Hospitals”," IREA Working Papers 201824, University of Barcelona, Research Institute of Applied Economics, revised Oct 2018.
    24. Ryan Mutter & William Greene & William Spector & Michael Rosko & Dana Mukamel, 2013. "Investigating the impact of endogeneity on inefficiency estimates in the application of stochastic frontier analysis to nursing homes," Journal of Productivity Analysis, Springer, vol. 39(2), pages 101-110, April.

    More about this item

    Keywords

    Hospital; Hospitals; Medicare;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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