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Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

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  • Stefan Felder
  • Harald Tauchmann

Abstract

Due to regional competition and patient migration, the efficiency of healthcare provision at the regional level is subject to spatial dependence. We address this issue by applying a spatial autoregressive model to longitudinal data from Germany at the district (‘Kreis’) level. The empirical model is specified to explain efficiency scores, which we derive through non-parametric order-m efficiency analysis of regional health production. The focus is on the role of health policy of federal states (‘Bundesländer’) for district efficiency. Regression results reveal significant spatial spillover effects. Notably, accounting for spatial dependence does not decrease but increases the estimated effect of federal states on district efficiency. It appears that genuinely more efficient states are less affected by positive efficiency spillovers, so that taking into account spatial dependence clarifies the importance of health policy at the state level. Copyright Springer-Verlag 2013

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  • Stefan Felder & Harald Tauchmann, 2013. "Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 21-39, February.
    • Handle: RePEc:spr:eujhec:v:14:y:2013:i:1:p:21-39
    DOI: 10.1007/s10198-011-0345-8
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    2. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 49, pages 305-320.
    3. Katharina Schley, 2018. "Health care service provision in Europe and regional diversity: a stochastic metafrontier approach," Health Economics Review, Springer, vol. 8(1), pages 1-11, December.
    4. 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.
    5. José Luis Zafra-Gómez & Victor Giménez-García & Cristina María Campos-Alba & Emilio José Higuera-Molina, 2020. "Direct Management or Inter-Municipal Cooperation in Smaller Municipalities? Exploring Cost Efficiency and Installed Capacity in Drinking Water Supply," Water Resources Management: An International Journal, Published for the European Water Resources Association (EWRA), Springer;European Water Resources Association (EWRA), vol. 34(13), pages 4289-4302, October.
    6. Helmut Herwartz & Christoph Strumann, 2024. "Too many cooks could spoil the broth: choice overload and the provision of ambulatory health care," International Journal of Health Economics and Management, Springer, vol. 24(3), pages 357-373, September.
    7. Peipei Chai & Quan Wan & Yohannes Kinfu, 2021. "Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008–2015," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(2), pages 267-279, March.
    8. Luciana Aimone Gigio & Demetrio Alampi & Enza Maltese & Elena Sceresini, 2024. "The Italian Primary Healthcare System: a macro area comparison," Questioni di Economia e Finanza (Occasional Papers) 867, Bank of Italy, Economic Research and International Relations Area.
    9. Laia Maynou & Marc Saez & Jordi Bacaria & Guillem Lopez-Casasnovas, 2015. "Health inequalities in the European Union: an empirical analysis of the dynamics of regional differences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 543-559, June.
    10. Francisco Germano Carvalho Lucio & Jhorland Ayala‐García, 2022. "Public sector efficiency in Brazil," Regional Science Policy & Practice, Wiley Blackwell, vol. 14(6), pages 308-321, December.
    11. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    12. Klein, Nadja & Herwartz, Helmut & Kneib, Thomas, 2020. "Modelling regional patterns of inefficiency: A Bayesian approach to geoadditive panel stochastic frontier analysis with an application to cereal production in England and Wales," Journal of Econometrics, Elsevier, vol. 214(2), pages 513-539.
    13. 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.
    14. Danny Wende, 2019. "Spatial risk adjustment between health insurances: using GWR in risk adjustment models to conserve incentives for service optimisation and reduce MAUP," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 1079-1091, September.
    15. Andree Ehlert & Dirk Oberschachtsiek, 2014. "Does managed care reduce health care expenditure? Evidence from spatial panel data," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 207-227, September.
    16. Christoph Pross & Christoph Strumann & Alexander Geissler & Helmut Herwartz & Nadja Klein, 2018. "Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-30, September.
    17. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    18. 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.
    19. 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.
    20. Guy Dabi GAB-LEYBA & Claire MAINGUY, 2020. "Efficiency of public spending on primary education in developing countries: the case of resource-rich countries," Working Papers of BETA 2020-40, Bureau d'Economie Théorique et Appliquée, UDS, Strasbourg.
    21. Alda, Erik, 2020. "The effects of body-worn cameras on police efficiency: A study of local police agencies in the US," MPRA Paper 103887, University Library of Munich, Germany.
    22. Chak Hung Jack Cheng & Nopphol Witvorapong, 2021. "Health care policy uncertainty, real health expenditures and health care inflation in the USA," Empirical Economics, Springer, vol. 60(4), pages 2083-2103, April.
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    More about this item

    Keywords

    Health production; Order-m efficiency; Spatial autoregressive model; I12; R10;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • R10 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - General Regional Economics - - - General

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