IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v21y2018i3d10.1007_s10729-016-9389-8.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-016-9389-8
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10729-016-9389-8?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Massimo Filippini, 2001. "Economies of scale in the Swiss nursing home industry," Applied Economics Letters, Taylor & Francis Journals, vol. 8(1), pages 43-46.
    2. Léopold Simar & Paul Wilson, 2000. "Statistical Inference in Nonparametric Frontier Models: The State of the Art," Journal of Productivity Analysis, Springer, vol. 13(1), pages 49-78, January.
    3. Sajal Chattopadhyay & Dennis Heffley, 1994. "Are For-Profit Nursing Homes More Efficient? Data Envelopment Analysis with a Case-Mix Constraint," Eastern Economic Journal, Eastern Economic Association, vol. 20(2), pages 171-186, Spring.
    4. 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.
    5. Mehdi Farsi & Massimo Filippini & Diego Lunati, 2008. "Economies of Scale and Efficiency Measurement in Switzerland's Nursing Homes," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 359-378, September.
    6. Lars-Erik Borge & Marianne Haraldsvik, 2009. "Efficiency potential and determinants of efficiency: an analysis of the care for the elderly sector in Norway," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 16(4), pages 468-486, August.
    7. Kris Knox & Eric Blankmeyer & J. Stutzman, 2007. "Technical efficiency in texas nursing facilities: A stochastic production frontier approach," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 31(1), pages 75-86, March.
    8. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    9. Shyr-Juh Chang & Mei-Ai Cheng, 2013. "The impact of nursing quality on nursing home efficiency: evidence from Taiwan," Review of Accounting and Finance, Emerald Group Publishing Limited, vol. 12(4), pages 369-386, October.
    10. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    11. Nyman, John A & Bricker, Dennis L, 1989. "Profit Incentives and Technical Efficiency in the Production of Nursing Home Care," The Review of Economics and Statistics, MIT Press, vol. 71(4), pages 586-594, November.
    12. Kleinsorge, Ilene K. & Karney, Dennis F., 1992. "Management of nursing homes using data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 26(1), pages 57-71, January.
    13. Léopold Simar & Paul Wilson, 2011. "Two-stage DEA: caveat emptor," Journal of Productivity Analysis, Springer, vol. 36(2), pages 205-218, October.
    14. Wilson, Paul W., 2008. "FEAR: A software package for frontier efficiency analysis with R," Socio-Economic Planning Sciences, Elsevier, vol. 42(4), pages 247-254, December.
    15. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    16. Vitaliano, Donald F. & Toren, Mark, 1994. "Cost and efficiency in nursing homes: a stochastic frontier approach," Journal of Health Economics, Elsevier, vol. 13(3), pages 281-300, October.
    17. 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.
    18. Hofler, Richard A. & Rungeling, Brian, 1994. "U.S. nursing homes : Are they cost efficient?," Economics Letters, Elsevier, vol. 44(3), pages 301-305.
    19. Fare, R. & Grosskopf, S. & Logan, J., 1985. "The relative performance of publicly-owned and privately-owned electric utilities," Journal of Public Economics, Elsevier, vol. 26(1), pages 89-106, February.
    20. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    21. Giulia Garavaglia & Emanuele Lettieri & Tommaso Agasisti & Silvano Lopez, 2011. "Efficiency and quality of care in nursing homes: an Italian case study," Health Care Management Science, Springer, vol. 14(1), pages 22-35, March.
    22. Fare, Rolf & Grosskopf, Shawna & Logan, James, 1983. "The relative efficiency of Illinois electric utilities," Resources and Energy, Elsevier, vol. 5(4), pages 349-367, December.
    23. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.
    24. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mustafa Jahangoshai Rezaee & Abuzar Karimdadi & Hamidreza Izadbakhsh, 2019. "Road map for progress and attractiveness of Iranian hospitals by integrating self-organizing map and context-dependent DEA," Health Care Management Science, Springer, vol. 22(3), pages 410-436, September.
    2. 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).
    3. 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.
    4. Rozpędowska-Matraszek Danuta J., 2020. "Efficiency Frontiers in Treating Lifestyle Diseases," Folia Oeconomica Stetinensia, Sciendo, vol. 20(1), pages 341-359, June.
    5. 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.
    6. Annika Maren Schneider & Eva-Maria Oppel & Jonas Schreyögg, 2020. "Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market," Health Care Management Science, Springer, vol. 23(4), pages 649-660, December.
    7. Margit Sommersguter-Reichmann, 2022. "Health care quality in nonparametric efficiency studies: a review," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 30(1), pages 67-131, March.
    8. Wang, Song & Yang, Canyu & Hou, Dailing & Dai, Liang, 2023. "How do urban agglomerations drive economic development? A policy implementation and spatial effects perspective," Economic Analysis and Policy, Elsevier, vol. 80(C), pages 1224-1238.
    9. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
    10. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    11. INUI Tomohiko & KAWASAKI Kazuyasu & ITO Yukiko & MIYAGAWA Tsutomu & MANO Toshiki, 2019. "Management Practices and Labor Productivity in Intensive Care Homes for the Elderly (Japanese)," Discussion Papers (Japanese) 19049, Research Institute of Economy, Trade and Industry (RIETI).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.
    2. Massimo Finocchiaro Castro & Calogero Guccio & Ilde Rizzo, 2014. "An assessment of the waste effects of corruption on infrastructure provision," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 21(4), pages 813-843, August.
    3. Lars-Erik Borge & Marianne Haraldsvik, 2009. "Efficiency potential and determinants of efficiency: an analysis of the care for the elderly sector in Norway," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 16(4), pages 468-486, August.
    4. Valentin Zelenyuk, 2019. "Data Envelopment Analysis and Business Analytics: The Big Data Challenges and Some Solutions," CEPA Working Papers Series WP072019, School of Economics, University of Queensland, Australia.
    5. Cuccia, Tiziana & Guccio, Calogero & Rizzo, Ilde, 2016. "The effects of UNESCO World Heritage List inscription on tourism destinations performance in Italian regions," Economic Modelling, Elsevier, vol. 53(C), pages 494-508.
    6. Bönisch, Peter & Haug, Peter & Illy, Annette & Schreier, Lukas, 2011. "Municipality Size and Efficiency of Local Public Services: Does Size Matter?," IWH Discussion Papers 18/2011, Halle Institute for Economic Research (IWH).
    7. Galina Besstremyannaya, 2013. "The impact of Japanese hospital financing reform on hospital efficiency: A difference-in-difference approach," The Japanese Economic Review, Japanese Economic Association, vol. 64(3), pages 337-362, September.
    8. Thanh Ngo & Kan Wai Hong Tsui, 2022. "Estimating the confidence intervals for DEA efficiency scores of Asia-Pacific airlines," Operational Research, Springer, vol. 22(4), pages 3411-3434, September.
    9. Sickles, Robin C. & Song, Wonho & Zelenyuk, Valentin, 2018. "Econometric Analysis of Productivity: Theory and Implementation in R," Working Papers 18-008, Rice University, Department of Economics.
    10. Michael Zschille & Matthias Walter, 2012. "The performance of German water utilities: a (semi)-parametric analysis," Applied Economics, Taylor & Francis Journals, vol. 44(29), pages 3749-3764, October.
    11. Yauheniya Varabyova & Jonas Schreyögg, 2018. "Integrating quality into the nonparametric analysis of efficiency: a simulation comparison of popular methods," Annals of Operations Research, Springer, vol. 261(1), pages 365-392, February.
    12. Amir Moradi-Motlagh & Ali Emrouznejad, 2022. "The origins and development of statistical approaches in non-parametric frontier models: a survey of the first two decades of scholarly literature (1998–2020)," Annals of Operations Research, Springer, vol. 318(1), pages 713-741, November.
    13. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    14. Léopold Simar & Paul W. Wilson, 2015. "Statistical Approaches for Non-parametric Frontier Models: A Guided Tour," International Statistical Review, International Statistical Institute, vol. 83(1), pages 77-110, April.
    15. Luis R. Murillo‐Zamorano, 2004. "Economic Efficiency and Frontier Techniques," Journal of Economic Surveys, Wiley Blackwell, vol. 18(1), pages 33-77, February.
    16. Calogero Guccio & Marco Ferdinando Martorana & Luisa Monaco, 2016. "Evaluating the impact of the Bologna Process on the efficiency convergence of Italian universities: a non-parametric frontier approach," Journal of Productivity Analysis, Springer, vol. 45(3), pages 275-298, June.
    17. Gounopoulos, Dimitrios & Kallias, Konstantinos & Newton, David & Tzeremes, Nickolaos, 2016. "Political connections and IPO underpricing: An efficiency problem," MPRA Paper 69427, University Library of Munich, Germany.
    18. Thilakaweera, Bolanda Hewa & Harvie, Charles & Arjomandi, Amir, 2016. "Branch expansion and banking efficiency in Sri Lanka’s post‐conflict era," Journal of Asian Economics, Elsevier, vol. 47(C), pages 45-57.
    19. Lampe, Hannes W. & Hilgers, Dennis, 2015. "Trajectories of efficiency measurement: A bibliometric analysis of DEA and SFA," European Journal of Operational Research, Elsevier, vol. 240(1), pages 1-21.
    20. Yauheniya Varabyova & Carl Rudolf Blankart & Jonas Schreyögg, 2017. "Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments," Health Care Management Science, Springer, vol. 20(4), pages 565-576, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:21:y:2018:i:3:d:10.1007_s10729-016-9389-8. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.