Measuring Efficiency in Health Care: Analytic Techniques and Health Policy

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Figures......Page 10
Tables......Page 12
Preface......Page 15
Acknowledgements......Page 17
Abbreviations......Page 18
1.1 Introduction......Page 21
1.2 The demand for efficiency analysis in health care......Page 22
1.3 Organisational efficiency......Page 24
1.4 Analytic efficiency measurement techniques......Page 30
1.5 Experience with efficiency analysis in health care......Page 32
1.6 This book......Page 33
2.1 Introduction......Page 37
2.2 Unit of analysis......Page 39
2.3 What are outputs in health care?......Page 41
2.3.1 Health outcomes......Page 42
2.3.2 Health care activities......Page 47
2.4 Valuing health care outputs......Page 48
2.5 Specifying inputs......Page 49
2.5.1 Labour inputs......Page 50
2.5.2 Capital inputs......Page 51
2.6 Environmental constraints......Page 53
2.7 Practical challenges......Page 57
2.8 Conclusions......Page 59
3.1 Introduction......Page 61
3.2.1 Whether to estimate a production or a cost function......Page 62
3.2.2 Whether to transform variables......Page 63
3.2.3 Whether to estimate a total or an average function......Page 64
3.2.4 Which explanatory variables to include......Page 67
3.2.5 How to model the residual......Page 70
3.2.6 How to extract the efficiency estimates......Page 77
3.3 Application to acute hospitals in England......Page 78
3.4 Conclusions......Page 85
4.1 Introduction......Page 89
4.2 Time-invariant efficiency......Page 90
4.2.1 Empirical application......Page 93
4.3 Time-varying efficiency......Page 99
4.3.1 Empirical application......Page 101
4.4 Unobserved heterogeneity......Page 102
4.4.1 Empirical application......Page 104
4.5 Summary and sensitivity analysis......Page 106
4.6 Conclusions......Page 109
5.2 The DEA methodology......Page 111
5.2.1 Input-oriented efficiency......Page 112
5.2.2 Output-oriented efficiency......Page 114
5.2.3 DEA formulation......Page 116
5.3 Considerations in data envelopment analysis......Page 120
5.3.1 Whether to assume constant or variable returns to scale......Page 121
5.3.2 Whether to assume an input or an output orientation......Page 125
5.3.3 Whether to apply weight restrictions......Page 126
5.3.4 Dealing with ‘slacks’......Page 129
5.3.5 Model specification and judging the quality of a DEA model......Page 131
5.3.6 How to adjust for environmental factors......Page 135
5.4.1 The methods and data......Page 137
5.4.3 Results......Page 138
5.5 Conclusions......Page 147
6.1 Introduction......Page 149
6.2.1 A graphical illustration......Page 150
6.2.2 The general form of the Malmquist index......Page 153
6.3 Considerations in using the Malmquist index......Page 157
6.4 Previous literature on the Malmquist index in health care......Page 158
6.5.3 Results......Page 159
6.6 Conclusions......Page 169
7.2 Why SFA and DEA produce different efficiency estimates......Page 171
7.3 Other differences between SFA and DEA......Page 174
7.4.2 Model specifications......Page 176
7.4.3 Results......Page 179
7.5 Conclusions......Page 184
8.2 Output weights......Page 187
8.3 Modelling the production process......Page 191
8.4 Environmental constraints......Page 194
8.5 Dynamic effects......Page 197
8.6 Conclusions......Page 198
9.1 Introduction......Page 199
9.2 Multilevel modelling......Page 200
9.3 Generalised statistical modelling......Page 207
9.3.1 Illustrative example......Page 212
9.4 Seemingly unrelated regression (SUR) in a multilevel context......Page 217
9.4.1 Illustrative example......Page 219
9.5 Conclusions......Page 224
10.1 Introduction......Page 227
10.2 Output weights......Page 228
10.3 Partitioning unexplained variation......Page 229
10.4 Unresolved technical issues......Page 231
10.5 For policy makers and regulators......Page 233
Appendix Data description......Page 235
References......Page 239
Author index......Page 253
Subject index......Page 257