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Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach

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  • Shiovan Ni Luasa

    (University of Limerick)

  • Declan Dineen

    (University of Limerick)

  • Marta Zieba

    (University of Limerick)

Abstract

This article provides methodological and empirical insights into the estimation of technical efficiency in the nursing home sector. Focusing on long-stay care and using primary data, we examine technical and scale efficiency in 39 public and 73 private Irish nursing homes by applying an input-oriented data envelopment analysis (DEA). We employ robust bootstrap methods to validate our nonparametric DEA scores and to integrate the effects of potential determinants in estimating the efficiencies. Both the homogenous and two-stage double bootstrap procedures are used to obtain confidence intervals for the bias-corrected DEA scores. Importantly, the application of the double bootstrap approach affords true DEA technical efficiency scores after adjusting for the effects of ownership, size, case-mix, and other determinants such as location, and quality. Based on our DEA results for variable returns to scale technology, the average technical efficiency score is 62 %, and the mean scale efficiency is 88 %, with nearly all units operating on the increasing returns to scale part of the production frontier. Moreover, based on the double bootstrap results, Irish nursing homes are less technically efficient, and more scale efficient than the conventional DEA estimates suggest. Regarding the efficiency determinants, in terms of ownership, we find that private facilities are less efficient than the public units. Furthermore, the size of the nursing home has a positive effect, and this reinforces our finding that Irish homes produce at increasing returns to scale. Also, notably, we find that a tendency towards quality improvements can lead to poorer technical efficiency performance.

Suggested Citation

  • Shiovan Ni Luasa & Declan Dineen & Marta Zieba, 2018. "Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach," Health Care Management Science, Springer, vol. 21(3), pages 326-347, September.
    • Handle: RePEc:kap:hcarem:v:21:y:2018:i:3:d:10.1007_s10729-016-9389-8
    DOI: 10.1007/s10729-016-9389-8
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    5. Castiglione, Concetta & Infante, Davide & Zieba, Marta, 2023. "Public support for performing arts. Efficiency and productivity gains in eleven European countries," Socio-Economic Planning Sciences, Elsevier, vol. 85(C).
    6. Izabela Ertingerová, 2018. "Assessment of efficiency and productivity of the residential social facilities [Posouzení efektivity a produktivity pobytových sociálních zařízení]," Český finanční a účetní časopis, Prague University of Economics and Business, vol. 2018(2), pages 25-41.
    7. Rozpędowska-Matraszek Danuta J., 2020. "Efficiency Frontiers in Treating Lifestyle Diseases," Folia Oeconomica Stetinensia, Sciendo, vol. 20(1), pages 341-359, June.
    8. Alice Tran & Kim-Huong Nguyen & Len Gray & Tracy Comans, 2019. "A Systematic Literature Review of Efficiency Measurement in Nursing Homes," IJERPH, MDPI, vol. 16(12), pages 1-18, June.
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