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Internal Markets and Performance in Swedish Health Care

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  • Tambour, Magnus

    (Centre for Health Economics)

  • Rehnberg, Clas

    (Centre for Health Economics)

Abstract

A separation of provider and purchaser roles - together with performance-based reimbursement - were recently introduced in several county councils, which are the local governments that provide and fund almost all health care in Sweden. These changes have been motivated by efficiency and consumer choice arguments. In this paper we analyze the outcome of the former by studying differences in productive performance for county councils with and without new internal organizations. Performance measures are estimated using data envelopment analysis. Using data for the 26 county councils between 1989 and 1994 we find differences in mean efficiency between the two groups, indicating higher technical efficiency in the group with performance based reimbursement (internal markets). Differences in productivity growth are also found, although the differences are significant in one period only.

Suggested Citation

  • Tambour, Magnus & Rehnberg, Clas, 1997. "Internal Markets and Performance in Swedish Health Care," SSE/EFI Working Paper Series in Economics and Finance 161, Stockholm School of Economics.
    • Handle: RePEc:hhs:hastef:0161
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    References listed on IDEAS

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    1. Jeffrey E. Harris, 1977. "The Internal Organization of Hospitals: Some Economic Implications," Bell Journal of Economics, The RAND Corporation, vol. 8(2), pages 467-482, Autumn.
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    3. Borden, James P., 1988. "An assessment of the impact of diagnosis-related group (DRG)-based reimbursement on the technical efficiency of New Jersey hospitals using data envelopment analysis," Journal of Accounting and Public Policy, Elsevier, vol. 7(2), pages 77-96.
    4. Pauly, Mark V & Redisch, Michael, 1973. "The Not-For-Profit Hospital as a Physicians' Cooperative," American Economic Review, American Economic Association, vol. 63(1), pages 87-99, March.
    5. Blomqvist, Ake, 1991. "The doctor as double agent: Information asymmetry, health insurance, and medical care," Journal of Health Economics, Elsevier, vol. 10(4), pages 411-432.
    6. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
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    Cited by:

    1. Mikkola, Hennamari & Keskimaki, Ilmo & Hakkinen, Unto, 2002. "DRG-related prices applied in a public health care system--can Finland learn from Norway and Sweden?," Health Policy, Elsevier, vol. 59(1), pages 37-51, January.
    2. Asandului, Laura & Roman, Monica & Fatulescu, Puiu, 2013. "The Efficiency of Healthcare Systems in Europe: a Data Envelopment Analysis Approach," MPRA Paper 58954, University Library of Munich, Germany, revised Apr 2014.

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    More about this item

    Keywords

    Internal markets; health care; productivity; data envelopment analysis;
    All these keywords.

    JEL classification:

    • D23 - Microeconomics - - Production and Organizations - - - Organizational Behavior; Transaction Costs; Property Rights
    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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