IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v13y2004i1p21-35.html
   My bibliography  Save this article

Cost‐effectiveness analysis and health care resource allocation: decision rules under variable returns to scale

Author

Listed:
  • Elamin H. Elbasha
  • Mark L. Messonnier

Abstract

We argue that health programs are administered in settings that often violate the frequently stated assumption of constant returns to scale in the provision of health services. Three types of returns to scale are identified from the general economic literature: returns to scale with respect to population, effectiveness, and quality. We show that decision rules based on incremental cost‐effectiveness ratios or cost–benefit tests are not optimal if returns to scale are not constant. We derive the optimal decision rules under variable returns to scale using optimization techniques, and employ several examples to illustrate the concepts and methods. Published in 2003 by John Wiley & Sons, Ltd.

Suggested Citation

  • Elamin H. Elbasha & Mark L. Messonnier, 2004. "Cost‐effectiveness analysis and health care resource allocation: decision rules under variable returns to scale," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 21-35, January.
    • Handle: RePEc:wly:hlthec:v:13:y:2004:i:1:p:21-35
    DOI: 10.1002/hec.793
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.793
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.793?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
    ---><---

    References listed on IDEAS

    as
    1. Dor, Avi, 1989. "The costs of Medicare patients in nursing homes in the United States : A multiple output analysis," Journal of Health Economics, Elsevier, vol. 8(3), pages 253-270, December.
    2. Gaynor, Martin & Vogt, William B., 2000. "Antitrust and competition in health care markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 27, pages 1405-1487, Elsevier.
    3. Bailey, Elizabeth E & Friedlaender, Ann F, 1982. "Market Structure and Multiproduct Industries," Journal of Economic Literature, American Economic Association, vol. 20(3), pages 1024-1048, September.
    4. Baumol, William J, 1982. "Contestable Markets: An Uprising in the Theory of Industry Structure," American Economic Review, American Economic Association, vol. 72(1), pages 1-15, March.
    5. Eugene M. Laska & Morris Meisner & Carole Siegel & Aaron A. Stinnett, 1999. "Ratio‐based and net benefit‐based approaches to health care resource allocation: proofs of optimality and equivalence," Health Economics, John Wiley & Sons, Ltd., vol. 8(2), pages 171-174, March.
    6. Escarce, Jose J. & Pauly, Mark V., 1998. "Physician opportunity costs in physician practice cost functions," Journal of Health Economics, Elsevier, vol. 17(2), pages 129-151, April.
    7. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February.
    8. Dreze, Jean & Stern, Nicholas, 1987. "The theory of cost-benefit analysis," Handbook of Public Economics, in: A. J. Auerbach & M. Feldstein (ed.), Handbook of Public Economics, edition 1, volume 2, chapter 14, pages 909-989, Elsevier.
    9. Weinstein, Milton & Zeckhauser, Richard, 1973. "Critical ratios and efficient allocation," Journal of Public Economics, Elsevier, vol. 2(2), pages 147-157, April.
    10. Taylor, Jim & Bradley, Steve, 2000. "Resource Utilization and Economies of Size in Secondary Schools," Bulletin of Economic Research, Wiley Blackwell, vol. 52(2), pages 123-150, April.
    11. Ahern, Melissa, 1993. "The softness of medical production and implications for specifying hospital outputs," Journal of Economic Behavior & Organization, Elsevier, vol. 20(3), pages 281-294, April.
    12. Duncombe, William & Yinger, John, 1993. "An analysis of returns to scale in public production, with an application to fire protection," Journal of Public Economics, Elsevier, vol. 52(1), pages 49-72, August.
    13. Sintonen, Harri & Linnosmaa, Ismo, 2000. "Economics of dental services," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 24, pages 1251-1296, Elsevier.
    14. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    15. Stinnett, Aaron A. & Paltiel, A. David, 1996. "Mathematical programming for the efficient allocation of health care resources," Journal of Health Economics, Elsevier, vol. 15(5), pages 641-653, October.
    16. Koshal, Rajindar K. & Koshal, Manjulika, 1999. "Economies of scale and scope in higher education: a case of comprehensive universities," Economics of Education Review, Elsevier, vol. 18(2), pages 269-277, April.
    17. 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.
    18. Gertler, Paul J & Waldman, Donald M, 1992. "Quality-Adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry," Journal of Political Economy, University of Chicago Press, vol. 100(6), pages 1232-1256, December.
    19. Johannesson, Magnus & Weinstein, Milton C., 1993. "On the decision rules of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 12(4), pages 459-467, December.
    20. Scott B. Cantor, 1994. "Cost - Effectiveness Analysis, Extended Dominance, and Ethics," Medical Decision Making, , vol. 14(3), pages 259-265, August.
    21. Okunade, Albert Ade, 1993. "Production Cost Structure of U.S. Hospital Pharmacies: Time-Series, Cross-Sectional Bed Size Evidence," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 8(3), pages 277-294, July-Sept.
    22. Vita, Michael G., 1990. "Exploring hospital production relationships with flexible functional forms," Journal of Health Economics, Elsevier, vol. 9(1), pages 1-21, June.
    23. Birch, Stephen & Gafni, Amiram, 1993. "Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems," Journal of Health Economics, Elsevier, vol. 12(4), pages 469-476, December.
    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. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost–utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433, April.
    2. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    3. Joanne Lord & George Laking & Alastair Fischer, 2006. "Non‐linearity in the cost‐effectiveness frontier," Health Economics, John Wiley & Sons, Ltd., vol. 15(6), pages 565-577, June.
    4. repec:ebl:ecbull:v:9:y:2005:i:7:p:1-8 is not listed on IDEAS
    5. Laia Cirera & Beatriz Galatas & Sergi Alonso & Krijn Paaijmans & Miler Mamuquele & Helena Martí-Soler & Caterina Guinovart & Humberto Munguambe & Fabião Luis & Hoticha Nhantumbo & Júlia Montañà & Quiq, 2020. "Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-17, July.
    6. Sun-Young Kim & Sue Goldie, 2008. "Cost-Effectiveness Analyses of Vaccination Programmes," PharmacoEconomics, Springer, vol. 26(3), pages 191-215, March.
    7. Kirwin, Erin & Meacock, Rachel & Round, Jeff & Sutton, Matt, 2022. "The diagonal approach: A theoretic framework for the economic evaluation of vertical and horizontal interventions in healthcare," Social Science & Medicine, Elsevier, vol. 301(C).
    8. Manuela Runge & Robert W Snow & Fabrizio Molteni & Sumaiyya Thawer & Ally Mohamed & Renata Mandike & Emanuele Giorgi & Peter M Macharia & Thomas A Smith & Christian Lengeler & Emilie Pothin, 2020. "Simulating the council-specific impact of anti-malaria interventions: A tool to support malaria strategic planning in Tanzania," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-25, February.
    9. Eddy Adang, 2008. "Economic evaluation of innovative technologies in health care should include a short-run perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 381-384, November.

    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. Elamin H. Elbasha, 2005. "Risk aversion and uncertainty in cost‐effectiveness analysis: the expected‐utility, moment‐generating function approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 457-470, May.
    2. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    3. Morton, Alec, 2014. "Aversion to health inequalities in healthcare prioritisation: A multicriteria optimisation perspective," Journal of Health Economics, Elsevier, vol. 36(C), pages 164-173.
    4. Kirwin, Erin & Meacock, Rachel & Round, Jeff & Sutton, Matt, 2022. "The diagonal approach: A theoretic framework for the economic evaluation of vertical and horizontal interventions in healthcare," Social Science & Medicine, Elsevier, vol. 301(C).
    5. Pedram Sendi, 2008. "Bridging the gap between health and non-health investments: moving from cost-effectiveness analysis to a return on investment approach across sectors of economy," International Journal of Health Economics and Management, Springer, vol. 8(2), pages 113-121, June.
    6. Morton, Alec & Thomas, Ranjeeta & Smith, Peter C., 2016. "Decision rules for allocation of finances to health systems strengthening," Journal of Health Economics, Elsevier, vol. 49(C), pages 97-108.
    7. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    8. Stinnett, Aaron A. & Paltiel, A. David, 1996. "Mathematical programming for the efficient allocation of health care resources," Journal of Health Economics, Elsevier, vol. 15(5), pages 641-653, October.
    9. Al, Maiwenn J. & Feenstra, Talitha & Brouwer, Werner B. F., 2004. "Decision makers' views on health care objectives and budget constraints: results from a pilot study," Health Policy, Elsevier, vol. 70(1), pages 33-48, October.
    10. Martin, Cécile, 2014. "Concurrence, prix et qualité de la prise en charge en EHPAD en France : Analyses micro-économétriques," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13712 edited by Dormont, Brigitte.
    11. P. Sendi & A. Gafni & S. Birch, 2002. "Opportunity costs and uncertainty in the economic evaluation of health care interventions," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 23-31, January.
    12. Birch, Stephen & Gafni, Amiram, 2003. "Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results," Health Policy, Elsevier, vol. 64(2), pages 207-219, May.
    13. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    14. Karl Claxton & Simon Walker & Steven Palmer & Mark Sculpher, 2010. "Appropriate Perspectives for Health Care Decisions," Working Papers 054cherp, Centre for Health Economics, University of York.
    15. Stephen Birch & Amiram Gafni, 2012. "Decision Rules in Economic Evaluation Revisited," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 49, Edward Elgar Publishing.
    16. A. Gafni & S. D. Walter & S. Birch & P. Sendi, 2008. "An opportunity cost approach to sample size calculation in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 99-107, January.
    17. Amiram Gafni & Stephen Walter & Stephen Birch, 2013. "Uncertainty And The Decision Maker: Assessing And Managing The Risk Of Undesirable Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(11), pages 1287-1294, November.
    18. Mark Sculpher & David Torgerson & Ron Goeree & Bernie O'Brien, 1999. "A critical structured review of economic evaluations of interventions for the prevention and treatment of osteoporosis," Working Papers 169chedp, Centre for Health Economics, University of York.
    19. Liang-Cheng Zhang & Andrew C. Worthington, 2018. "Explaining Estimated Economies of Scale and Scope in Higher Education: A Meta-Regression Analysis," Research in Higher Education, Springer;Association for Institutional Research, vol. 59(2), pages 156-173, March.
    20. Hoel, Michael, 2009. "Efficient use of health care resources: The interaction between improved health and reduced health related income loss," HERO Online Working Paper Series 2001:9, University of Oslo, Health Economics Research Programme.

    More about this item

    Statistics

    Access and download statistics

    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:wly:hlthec:v:13:y:2004:i:1:p:21-35. 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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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.