IDEAS home Printed from https://ideas.repec.org/p/yor/hectdg/09-26.html
   My bibliography  Save this paper

The costs of new organisational and financial freedom: The case of English NHS trusts

Author

Listed:
  • Marini G
  • Miraldo M

Abstract

In this paper we estimate hospital costs and evaluate economies of scale and scope using a generalised multiproduct cost function and a sample of English NHS trusts with different types of ownership, namely Foundation Trusts and non Foundation Trusts. Evaluating the behaviour of different types of hospitals separately might be particularly helpful for the design, and future developments, of the optimal provider reimbursement tariff. Also it might shed some light on the ability of different types of hospitals to profit from the existence of economies of scale and scope. Results show that, even though these two group of providers do not exhibit differences regarding economies of scale, Foundation Trusts exhibit global diseconomies of scope while non Foundation Trusts exhibit global scope economies.

Suggested Citation

  • Marini G & Miraldo M, 2009. "The costs of new organisational and financial freedom: The case of English NHS trusts," Health, Econometrics and Data Group (HEDG) Working Papers 09/26, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:09/26
    as

    Download full text from publisher

    File URL: https://www.york.ac.uk/media/economics/documents/herc/wp/09_26.pdf
    File Function: Main text
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Caves, Douglas W & Christensen, Laurits R & Tretheway, Michael W, 1980. "Flexible Cost Functions for Multiproduct Firms," The Review of Economics and Statistics, MIT Press, vol. 62(3), pages 477-481, August.
    2. Caves, Douglas W & Christensen, Laurits R & Swanson, Joseph A, 1981. "Productivity Growth, Scale Economies, and Capacity Utilization in U.S. Railroads, 1955-74," American Economic Review, American Economic Association, vol. 71(5), pages 994-1002, December.
    3. Smet, Mike, 2002. "Cost characteristics of hospitals," Social Science & Medicine, Elsevier, vol. 55(6), pages 895-906, September.
    4. Fournier, Gary M & Mitchell, Jean M, 1992. "Hospital Costs and Competition for Services: A Multiproduct Analysis," The Review of Economics and Statistics, MIT Press, vol. 74(4), pages 627-634, November.
    5. Braeutigam, Ronald R. & Daughety, Andrew F., 1983. "On the estimation of returns to scale using variable cost functions," Economics Letters, Elsevier, vol. 11(1-2), pages 25-31.
    6. Giovanni Fraquelli & Massimiliano Piacenza & Davide Vannoni, 2004. "Scope and scale economies in multi-utilities: evidence from gas, water and electricity combinations," Applied Economics, Taylor & Francis Journals, vol. 36(18), pages 2045-2057.
    7. Vitaliano, Donald F., 1987. "On the estimation of hospital cost functions," Journal of Health Economics, Elsevier, vol. 6(4), pages 305-318, December.
    8. Hughes, David & McGuire, Alistair, 2003. "Stochastic demand, production responses and hospital costs," Journal of Health Economics, Elsevier, vol. 22(6), pages 999-1010, November.
    9. Dor, Avi & Farley, Dean E., 1996. "Payment source and the cost of hospital care: Evidence from a multiproduct cost function with multiple payers," Journal of Health Economics, Elsevier, vol. 15(1), pages 1-21, February.
    10. Preyra, Colin & Pink, George, 2006. "Scale and scope efficiencies through hospital consolidations," Journal of Health Economics, Elsevier, vol. 25(6), pages 1049-1068, November.
    11. Berndt, Ernst R. & Christensen, Laurits R., 1973. "The translog function and the substitution of equipment, structures, and labor in U.S. manufacturing 1929-68," Journal of Econometrics, Elsevier, vol. 1(1), pages 81-113, March.
    12. Vita, Michael G., 1990. "Exploring hospital production relationships with flexible functional forms," Journal of Health Economics, Elsevier, vol. 9(1), pages 1-21, June.
    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. Clara Andresciani & Debora Di Gioacchino & Laura Sabani, 2024. "The political economy of the public/private mix in healthcare: assessing the decongestion effect argument," Working Papers - Economics wp2024_23.rdf, Universita' degli Studi di Firenze, Dipartimento di Scienze per l'Economia e l'Impresa.

    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. Ricardo Gonçalves & Pedro Pita Barros, 2013. "Economies of scale and scope in the provision of diagnostic techniques and therapeutic services in Portuguese hospitals," Applied Economics, Taylor & Francis Journals, vol. 45(4), pages 415-433, February.
    2. Alvaro Almeida & Joana Cima, 2015. "Demand uncertainty and hospital costs: an application to Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 35-45, January.
    3. Kristensen, Troels & Olsen, Kim Rose & Kilsmark, Jannie & Lauridsen, Jørgen T. & Pedersen, Kjeld Møller, 2012. "Economies of scale and scope in the Danish hospital sector prior to radical restructuring plans," Health Policy, Elsevier, vol. 106(2), pages 120-126.
    4. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, vol. 28(4), pages 771-780, July.
    5. Kathleen Carey & Jean M. Mitchell, 2018. "Specialization and production cost efficiency: evidence from ambulatory surgery centers," International Journal of Health Economics and Management, Springer, vol. 18(1), pages 83-98, March.
    6. Vassilis H. Aletras, 1999. "A comparison of hospital scale effects in short‐run and long‐run cost functions," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 521-530, September.
    7. Engberg, John & Wholey, Douglas & Feldman, Roger & Christianson, Jon B., 2004. "The effect of mergers on firms' costs: evidence from the HMO industry," The Quarterly Review of Economics and Finance, Elsevier, vol. 44(4), pages 574-600, September.
    8. Jennifer L. Troyer, 2002. "Cross‐Subsidization in Nursing Homes: Explaining Rate Differentials Among Payer Types," Southern Economic Journal, John Wiley & Sons, vol. 68(4), pages 750-773, April.
    9. Alvaro Almeida & Joana Cima, 2013. "Demand Uncertainty and Hospital Costs: an Application to Portuguese NHS Hospitals," FEP Working Papers 499, Universidade do Porto, Faculdade de Economia do Porto.
    10. Farsi, Mehdi & Filippini, Massimo, 2009. "An analysis of cost efficiency in Swiss multi-utilities," Energy Economics, Elsevier, vol. 31(2), pages 306-315, March.
    11. Dor, Avi & Farley, Dean E., 1996. "Payment source and the cost of hospital care: Evidence from a multiproduct cost function with multiple payers," Journal of Health Economics, Elsevier, vol. 15(1), pages 1-21, February.
    12. Ajayi, Victor & Weyman-Jones, Thomas & Glass, Anthony, 2017. "Cost efficiency and electricity market structure: A case study of OECD countries," Energy Economics, Elsevier, vol. 65(C), pages 283-291.
    13. F. Patrick Hallagan, 1996. "Are Big Hospitals the Best Medicine," The American Economist, Sage Publications, vol. 40(1), pages 31-39, March.
    14. Calem, Paul S. & Dor, Avi & Rizzo, John A., 1999. "The welfare effects of mergers in the hospital industry," Journal of Economics and Business, Elsevier, vol. 51(3), pages 197-213, May.
    15. Paul W. Wilson & Kathleen Carey, 2004. "Nonparametric analysis of returns to scale in the US hospital industry," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 505-524.
    16. John Romley & Erin Trish & Dana Goldman & Melinda Beeuwkes Buntin & Yulei He & Paul Ginsburg, 2019. "Geographic variation in the delivery of high-value inpatient care," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-11, March.
    17. Avi Dor & Sarah Duffy & Herbert Wong, 1997. "Expense Preference Behavior and Contract‐Management: Evidence from U.S. Hospitals," Southern Economic Journal, John Wiley & Sons, vol. 64(2), pages 542-554, October.
    18. Helda Azevedo & Céu Mateus, 2014. "Cost effects of hospital mergers in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 999-1010, December.
    19. Kurup, Hari K K, 2010. "On the estimation of hospital cost: the approach," MPRA Paper 22767, University Library of Munich, Germany.
    20. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.

    More about this item

    Keywords

    Economies of Scale; Economies of Scope; Foundation Trusts; Payment by Results;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • O33 - Economic Development, Innovation, Technological Change, and Growth - - Innovation; Research and Development; Technological Change; Intellectual Property Rights - - - Technological Change: Choices and Consequences; Diffusion Processes

    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:yor:hectdg:09/26. 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: Jane Rawlings (email available below). General contact details of provider: https://edirc.repec.org/data/deyoruk.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.