IDEAS home Printed from https://ideas.repec.org/p/hhs/oslohe/2001_012.html
   My bibliography  Save this paper

Errors in Survey Based Quality Evaluation Variables in Efficiency Models of Primary Care Physicians

Author

Listed:
  • Kittelsen, Sverre A.C.

    (Frisch Centre)

  • Kjæserud, Guri Galtung

    (Frisch Centre)

  • Kvamme, Odd Jarle

    (Department of General Practice)

Abstract

Efficiency analyses in the health care sector are often criticised for not incorporating quality variables. The definition of quality of primary health care has many aspects, and it is inevitably also a question of the patients’ perception of the services received. This paper uses variables derived from patient evaluation surveys as measures of the quality of the production of health care services. It uses statistical tests to judge if such measures have a significant impact on the use of resources in various Data Envelopment Analysis (DEA) models. As the use of survey data implies that the quality variables are measured with error, the assumptions underlying a DEA model are not strictly fulfilled. This paper focuses on ways of correcting for biases that might result from the violation of selected assumptions. Firstly, any selection bias in the patient mix of each physician is controlled for by regressing the patient evaluation responses on the patient characteristics. The corrected quality evaluation variables are entered as outputs in the DEA model, and model specification tests indicate that out of 25 different quality variables, only waiting time has a systematic impact on the efficiency results. Secondly, the effect on the efficiency estimates of the remaining sampling error in the patient sample for each physician is accounted for by constructing confidence intervals based on resampling. Finally, as an alternative approach to including the quality variables in the DEA model, a regression model finds different variables significant, but not always with a trade-of between quality and quantity.

Suggested Citation

  • Kittelsen, Sverre A.C. & Kjæserud, Guri Galtung & Kvamme, Odd Jarle, 2009. "Errors in Survey Based Quality Evaluation Variables in Efficiency Models of Primary Care Physicians," HERO Online Working Paper Series 2001:12, University of Oslo, Health Economics Research Programme.
  • Handle: RePEc:hhs:oslohe:2001_012
    as

    Download full text from publisher

    File URL: http://www.hero.uio.no/publicat/2001/HERO2001_12.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. A. Charnes & W. W. Cooper & E. Rhodes, 1981. "Evaluating Program and Managerial Efficiency: An Application of Data Envelopment Analysis to Program Follow Through," Management Science, INFORMS, vol. 27(6), pages 668-697, June.
    3. Kittelsen,S.A.C., 1999. "Monte Carlo simulations of DEA efficiency measures and hypothesis tests," Memorandum 09/1999, Oslo University, Department of Economics.
    4. Kneip, A & Park, B-U & Simar, L, 1996. "A Note on the Convergence of Nonparametric DEA Efficiency Measures," Papers 9603, Catholique de Louvain - Institut de statistique.
    5. Olesen, O. B. & Petersen, N. C., 1995. "Incorporating quality into data envelopment analysis: a stochastic dominance approach," International Journal of Production Economics, Elsevier, vol. 39(1-2), pages 117-135, April.
    6. Banker, Rajiv D., 1984. "Estimating most productive scale size using data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 17(1), pages 35-44, July.
    7. 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.
    8. SIMAR , Léopold, 1995. "Aspects of Statistical Analysis in DEA-Type Frontier Models," LIDAM Discussion Papers CORE 1995061, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    9. Rajiv D. Banker, 1993. "Maximum Likelihood, Consistency and Data Envelopment Analysis: A Statistical Foundation," Management Science, INFORMS, vol. 39(10), pages 1265-1273, October.
    Full references (including those not matched with items on IDEAS)

    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. Kittelsen, Sverre A.C. & Magnussen, Jon, 2009. "Testing DEA Models of Efficiency in Norwegian Psychiatric Outpatient Clinics," HERO Online Working Paper Series 1999:4, University of Oslo, Health Economics Research Programme.
    2. 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.
    3. Cook, Wade D. & Seiford, Larry M., 2009. "Data envelopment analysis (DEA) - Thirty years on," European Journal of Operational Research, Elsevier, vol. 192(1), pages 1-17, January.
    4. Léopold Simar & Paul Wilson, 2011. "Inference by the m out of n bootstrap in nonparametric frontier models," Journal of Productivity Analysis, Springer, vol. 36(1), pages 33-53, August.
    5. Hallsteinli, Vidar & Kittelsen, Sverre AC & Magnussen, Jon, 2009. "Scale, efficiency and organization in Norwegian psychiatric outpatient clinics for children," HERO Online Working Paper Series 2001:8, University of Oslo, Health Economics Research Programme.
    6. 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.
    7. Leopold Simar & Paul Wilson, 2000. "A general methodology for bootstrapping in non-parametric frontier models," Journal of Applied Statistics, Taylor & Francis Journals, vol. 27(6), pages 779-802.
    8. Forsund, Finn R. & Sarafoglou, Nikias, 2005. "The tale of two research communities: The diffusion of research on productive efficiency," International Journal of Production Economics, Elsevier, vol. 98(1), pages 17-40, October.
    9. Alois Kneip & Léopold Simar & Paul Wilson, 2011. "A Computationally Efficient, Consistent Bootstrap for Inference with Non-parametric DEA Estimators," Computational Economics, Springer;Society for Computational Economics, vol. 38(4), pages 483-515, November.
    10. Jesús T. Pastor & JosÉ L. Ruiz & Inmaculada Sirvent, 2002. "A Statistical Test for Nested Radial Dea Models," Operations Research, INFORMS, vol. 50(4), pages 728-735, August.
    11. Kittelsen,S.A.C., 1999. "Monte Carlo simulations of DEA efficiency measures and hypothesis tests," Memorandum 09/1999, Oslo University, Department of Economics.
    12. Olesen, Ole B. & Petersen, Niels Christian, 2016. "Stochastic Data Envelopment Analysis—A review," European Journal of Operational Research, Elsevier, vol. 251(1), pages 2-21.
    13. Nasrabadi, Nasim & Dehnokhalaji, Akram & Korhonen, Pekka & Lokman, Banu & Wallenius, Jyrki, 2022. "Robustness of efficiency scores in data envelopment analysis with interval scale data," European Journal of Operational Research, Elsevier, vol. 297(3), pages 1151-1161.
    14. Emrouznejad, Ali & De Witte, Kristof, 2010. "COOPER-framework: A unified process for non-parametric projects," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1573-1586, December.
    15. Pastor, Jesus T. & Ruiz, Jose L. & Sirvent, Inmaculada, 1999. "A statistical test for detecting influential observations in DEA," European Journal of Operational Research, Elsevier, vol. 115(3), pages 542-554, June.
    16. Simar, Léopold & Vanhems, Anne & Wilson, Paul W., 2012. "Statistical inference for DEA estimators of directional distances," European Journal of Operational Research, Elsevier, vol. 220(3), pages 853-864.
    17. Subhash C. Ray, 2022. "Choice of Inputs and Outputs for Production Analysis," Springer Books, in: Subhash C. Ray & Robert G. Chambers & Subal C. Kumbhakar (ed.), Handbook of Production Economics, chapter 26, pages 1083-1116, Springer.
    18. P. Brockett & B. Golany & Shan Li, 1999. "Analysis of Intertemporal Efficiency Trends Using Rank Statistics With an Application Evaluating the Macro Economic Performance of OECD Nations," Journal of Productivity Analysis, Springer, vol. 11(2), pages 169-182, April.
    19. Reuben Elan & Verma Bharat Bhushan & Bhat Ramesh, 2001. "Hospital Efficiency: An Empirical Analysis of District and Grant-in-Aid Hospitals in Gujarat," IIMA Working Papers WP2001-07-05, Indian Institute of Management Ahmedabad, Research and Publication Department.
    20. Vincent Charles & Ioannis E. Tsolas & Tatiana Gherman, 2018. "Satisficing data envelopment analysis: a Bayesian approach for peer mining in the banking sector," Annals of Operations Research, Springer, vol. 269(1), pages 81-102, October.

    More about this item

    Keywords

    DEA; Health economics; Quality; Patient evaluation; Efficiency; Errors in variables; Resampling; Bootstrap; Selection bias; Sampling error;
    All these keywords.

    JEL classification:

    • C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:hhs:oslohe:2001_012. 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: Kristi Brinkmann Lenander (email available below). General contact details of provider: https://edirc.repec.org/data/heuiono.html .

    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.