Measuring efficiency in health care: analytic techniques and health policy
Gespeichert in:
Hauptverfasser: | , , |
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Format: | Buch |
Sprache: | English |
Veröffentlicht: |
Cambridge
Cambridge Univ. Press
2006
|
Ausgabe: | 1. publ. |
Schlagworte: | |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | XVII, 243 S. graph. Darst. |
ISBN: | 0521851440 9780521851442 |
Internformat
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245 | 1 | 0 | |a Measuring efficiency in health care |b analytic techniques and health policy |c Rowena Jacobs, Peter C. Smith and Andrew Street |
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650 | 4 | |a Gesundheitsversorgung / Technische Effizienz / Data-Envelopment-Analyse / Gesundheitswesen / Krankenhaus / Großbritannien | |
650 | 4 | |a Gesundheitswesen - Stochastische Analysis - Effizienzmessung - Data Envelopment Analysis | |
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Datensatz im Suchindex
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Contents
List of figures page viii
List of tables x
Preface xiii
Acknowledgements xv
List of abbreviations xvi
1 Efficiency in health care 1
1.1 Introduction 1
1.2 The demand for efficiency analysis in health care 2
1.3 Organisational efficiency 4
1.4 Analytic efficiency measurement techniques 10
1.5 Experience with efficiency analysis in health care 12
1.6 This book 13
2 The components of an efficiency model 17
2.1 Introduction 17
2.2 Unit of analysis 19
2.3 What are outputs in health care? 21
2.3.2 Heaftfc outcomes 22
2.3.2 Health care activities 1TI
1.A Valuing health care outputs 28
2.5 Specifying inputs 29
2.5.1 Labour inputs 30
2.5.2 Capital inputs 31
2.5.3 Summary 33
2.6 Environmental constraints 33
2.7 Practical challenges 37
2.8 Conclusions 39
3 Stochastic frontier analysis of cross sectional data 41
3.1 Introduction 41
3.2 Considerations in stochastic frontier analysis 42
3.2.1 Whether to estimate a production or a cost function 42
3.2.2 Whether to transform variables 43
V
vi Contents
3.2.3 Whether to estimate a total or an average function 44
3.2.4 Which explanatory variables to include 47
3.2.5 How to model the residual 50
3.2.6 How to extract the efficiency estimates 57
3.3 Application to acute hospitals in England 58
3.4 Conclusions 65
4 Stochastic frontier analysis of panel data 69
4.1 Introduction 69
4.2 Time invariant efficiency 70
4.2.1 Empirical application 73
4.3 Time varying efficiency 79
4.3.1 Empirical application 81
4.4 Unobserved heterogeneity 82
4.4.1 Empirical application 84
4.5 Summary and sensitivity analysis 86
4.6 Conclusions 89
5 Data envelopment analysis 91
5.1 Introduction 91
5.2 The DEA methodology 91
5.2.1 Input oriented efficiency 92.
5.2.2 Output oriented efficiency 94
5.2.3 DEA formulation 96
5.3 Considerations in data envelopment analysis 100
5.3.1 Whether to assume constant or variable returns to scale 101
5.3.2 Whether to assume an input or an output orientation 105
5.3.3 Whether to apply weight restrictions 106
5.3.4 Dealing with'slacks' 109
5.3.5 Model specification and judging the quality of a DEA model 111
5.3.6 How to adjust for environmental factors 115
5.4 Application to acute hospitals in England 117
5.4.1 The methods and data 117
5.4.2 Model specifications 118
5.4.3 Results 118
5.5 Conclusions 127
6 The Malmquist index 129
6.1 Introduction 129
6.2 The Malmquist methodology 130
6.2.1 A graphical illustration 130
6.2.2 The general form of the Malmquist index 133
6.3 Considerations in using the Malmquist index 137
6.4 Previous literature on the Malmquist index in health care 138
6.5 Application to acute hospitals in England 139
6.5.1 The methods and data 139
Contents vn
6.5.2 Model specifications 139
6.5.3 Results 139
6.6 Conclusions 149
7 A comparison of SFA and DEA 151
7.1 Introduction 151
7.2 Why SFA and DEA produce different efficiency estimates 151
7.3 Other differences between SFA and DEA 154
7.4 Comparison of different methodologies 156
7.4.1 The methods and data 156
7.4.2 Model specifications 156
7.4.3 Results 159
7.5 Conclusions 164
8 Unresolved issues and challenges in efficiency measurement 167
8.1 Introduction 167
8.2 Output weights 167
8.3 Modelling the production process 171
8.4 Environmental constraints 174
8.5 Dynamic effects 177
8.6 Conclusions 178
9 Some alternative approaches to measuring performance 179
9.1 Introduction 179
9.2 Multilevel modelling 180
9.3 Generalised statistical modelling 187
9.3.1 Illustrative example 192
9.4 Seemingly unrelated regression (SUR) in a multilevel context 197
9.4.1 Illustrative example 199
9.5 Conclusions 204
10 Conclusions 207
10.1 Introduction 207
10.2 Output weights 208
10.3 Partitioning unexplained variation 209
10.4 Unresolved technical issues 211
10.5 For policy makers and regulators 213
Appendix: Data description 215
References 219
Author index 233
Subject index 237
Figures
1.1 Efficiency measurement under constant returns to scale page 5
1.2 The case of two outputs 6
1.3 The case of two inputs 6
1.4 Allocative efficiency with two inputs 8
1.5 Allocative efficiency with two outputs 8
1.6 Technical and allocative inefficiency 9
1.7 Economies of scale 10
2.1 The naive model of organisational performance 18
2.2 Change in health status: before and after intervention 25
2.3 Change in health status: with and without intervention 25
2.4 The dynamic nature of organisational performance 32
2.5 The broader context of efficiency analysis 38
3.1 Linear and logarithmic functional forms 44
3.2 Illustration of heteroscedastic data 46
3.3 Illustration of an OLS regression and COLS frontier 52
3.4 Illustration of a stochastic frontier 54
3.5 Histograms showing (a) the residual from the
OLS model; (b) the inefficiency term from the
half normal model; (c) the inefficiency term from the
truncated model; (d) the inefficiency term from the
exponential model 56
4.1 Mean changes in costs and activity over time 77
5.1 Technical and allocative efficiency under an
input orientation 93
5.2 Technical and allocative efficiency under an
output orientation 95
5.3 Constant and variable returns to scale 102
5.4 Input and output orientation 106
5.5 Efficiency measurement and input slacks 110
5.6 Efficiency measurement and output slacks 110
viii
List of figures ix
5.7 Distribution of efficiency scores for five DEA models 123
6.1 Illustration of productivity change with one input
and one output 131
6.2 Mean expenditure and activity, 1994/95 1997/98 142
6.3 Malmquist TFP indices 145
6.4 Decomposition of Malmquist index for Model 2 146
8.1 The production possibility frontier: different
preferences lead to different weights 168
8.2 Composite scores indicated by the lines
QQ and C2C2 169
8.3 Observed performance of five systems with
identical expenditure and environment 170
9.1 Performance ranking using aggregate
organisational data 181
9.2 Changes in performance ranking based on
hierarchical structure 182
9.3 Hierarchical data structure 183
9.4 The production possibility frontier with two
performance indicators 188
9.5 Multivariate hierarchical data structure 201
9.6 Waiting time for routine surgery sensitivity
analysis of health authority effects 204
Tables
3.1 Calculating individual efficiency estimates for each
organisation page 57
3.2 Descriptive statistics 60
3.3 Regression results for average cost function 63
3.4 Correlations across average cost specifications 65
3.5 Regression results for total cost function 66
3.6 Correlations across total cost specifications 68
3.7 Correlations across average and total cost
specifications 68
4.1 Summary of time invariant SF panel data models 74
4.2 Descriptive statistics 75
4.3 Estimates from time invariant SF models 78
4.4 Estimates from time varying SF models 82
4.5 Estimates from 'true' SF models 85
4.6 Comparison of estimates from different models 87
4.7 Sensitivity analysis of mean efficiency 88
5.1 DEA model variables, 1997/98 119
5.2 DEA model specifications 121
5.3 DEA model specifications and efficiency results 122
5.4 Correlations between efficiency scores 123
5.5 Correlations between efficiency ranks 124
5.6 Individual hospital scores and rankings under various
specifications 125
5.7 Data for Models 1 and 2 of DEA specifications for
ten hospitals 126
5.8 Tobit Model of DEA efficiency scores regressed against
a single environmental factor 127
6.1 Mean values for Malmquist model variables 140
6.2 Malmquist model specifications 143
6.3 Malmquist TFP results 144
6.4 Correlations between Malmquist TFP scores 145
x
List of tables xi
6.5 Individual hospital scores and rankings for each year
for Model 2 147
6.6 Data for Model 2 of Malmquist specification for
hospital I 148
7.1 Comparison of SFA and DEA 154
7.2 Model variables, 1997/98 157
7.3 Model specifications 159
7.4 Model 1 efficiency scores 160
7.5 Correlations of SFA and DEA efficiency scores
for Model 1 160
7.6 Individual hospital scores and rankings for Model 1 161
7.7 Descriptive statistics for SFA and DEA efficiency scores 162
7.8 Individual hospital scores and rankings under various
specifications 163
9.1 Socio deraographic data used in needs index 184
9.2 Three level random intercept model to explain
proportion of variability in performance indicators
attributable to regional and district health authorities 186
9.3 OLS and SUR results for three performance indicators 194
9.4 Correlations of OLS residuals 197
9.5 Performance indicators and socio economic variables 200
9.6 Correlation of health authority effects from the
multivariate multilevel model 202 |
adam_txt |
Contents
List of figures page viii
List of tables x
Preface xiii
Acknowledgements xv
List of abbreviations xvi
1 Efficiency in health care 1
1.1 Introduction 1
1.2 The demand for efficiency analysis in health care 2
1.3 Organisational efficiency 4
1.4 Analytic efficiency measurement techniques 10
1.5 Experience with efficiency analysis in health care 12
1.6 This book 13
2 The components of an efficiency model 17
2.1 Introduction 17
2.2 Unit of analysis 19
2.3 What are outputs in health care? 21
2.3.2 Heaftfc outcomes 22
2.3.2 Health care activities 1TI
1.A Valuing health care outputs 28
2.5 Specifying inputs 29
2.5.1 Labour inputs 30
2.5.2 Capital inputs 31
2.5.3 Summary 33
2.6 Environmental constraints 33
2.7 Practical challenges 37
2.8 Conclusions 39
3 Stochastic frontier analysis of cross sectional data 41
3.1 Introduction 41
3.2 Considerations in stochastic frontier analysis 42
3.2.1 Whether to estimate a production or a cost function 42
3.2.2 Whether to transform variables 43
V
vi Contents
3.2.3 Whether to estimate a total or an average function 44
3.2.4 Which explanatory variables to include 47
3.2.5 How to model the residual 50
3.2.6 How to extract the efficiency estimates 57
3.3 Application to acute hospitals in England 58
3.4 Conclusions 65
4 Stochastic frontier analysis of panel data 69
4.1 Introduction 69
4.2 Time invariant efficiency 70
4.2.1 Empirical application 73
4.3 Time varying efficiency 79
4.3.1 Empirical application 81
4.4 Unobserved heterogeneity 82
4.4.1 Empirical application 84
4.5 Summary and sensitivity analysis 86
4.6 Conclusions 89
5 Data envelopment analysis 91
5.1 Introduction 91
5.2 The DEA methodology 91
5.2.1 Input oriented efficiency 92.
5.2.2 Output oriented efficiency 94
5.2.3 DEA formulation 96
5.3 Considerations in data envelopment analysis 100
5.3.1 Whether to assume constant or variable returns to scale 101
5.3.2 Whether to assume an input or an output orientation 105
5.3.3 Whether to apply weight restrictions 106
5.3.4 Dealing with'slacks' 109
5.3.5 Model specification and judging the quality of a DEA model 111
5.3.6 How to adjust for environmental factors 115
5.4 Application to acute hospitals in England 117
5.4.1 The methods and data 117
5.4.2 Model specifications 118
5.4.3 Results 118
5.5 Conclusions 127
6 The Malmquist index 129
6.1 Introduction 129
6.2 The Malmquist methodology 130
6.2.1 A graphical illustration 130
6.2.2 The general form of the Malmquist index 133
6.3 Considerations in using the Malmquist index 137
6.4 Previous literature on the Malmquist index in health care 138
6.5 Application to acute hospitals in England 139
6.5.1 The methods and data 139
Contents vn
6.5.2 Model specifications 139
6.5.3 Results 139
6.6 Conclusions 149
7 A comparison of SFA and DEA 151
7.1 Introduction 151
7.2 Why SFA and DEA produce different efficiency estimates 151
7.3 Other differences between SFA and DEA 154
7.4 Comparison of different methodologies 156
7.4.1 The methods and data 156
7.4.2 Model specifications 156
7.4.3 Results 159
7.5 Conclusions 164
8 Unresolved issues and challenges in efficiency measurement 167
8.1 Introduction 167
8.2 Output weights 167
8.3 Modelling the production process 171
8.4 Environmental constraints 174
8.5 Dynamic effects 177
8.6 Conclusions 178
9 Some alternative approaches to measuring performance 179
9.1 Introduction 179
9.2 Multilevel modelling 180
9.3 Generalised statistical modelling 187
9.3.1 Illustrative example 192
9.4 Seemingly unrelated regression (SUR) in a multilevel context 197
9.4.1 Illustrative example 199
9.5 Conclusions 204
10 Conclusions 207
10.1 Introduction 207
10.2 Output weights 208
10.3 Partitioning unexplained variation 209
10.4 Unresolved technical issues 211
10.5 For policy makers and regulators 213
Appendix: Data description 215
References 219
Author index 233
Subject index 237
Figures
1.1 Efficiency measurement under constant returns to scale page 5
1.2 The case of two outputs 6
1.3 The case of two inputs 6
1.4 Allocative efficiency with two inputs 8
1.5 Allocative efficiency with two outputs 8
1.6 Technical and allocative inefficiency 9
1.7 Economies of scale 10
2.1 The naive model of organisational performance 18
2.2 Change in health status: before and after intervention 25
2.3 Change in health status: with and without intervention 25
2.4 The dynamic nature of organisational performance 32
2.5 The broader context of efficiency analysis 38
3.1 Linear and logarithmic functional forms 44
3.2 Illustration of heteroscedastic data 46
3.3 Illustration of an OLS regression and COLS frontier 52
3.4 Illustration of a stochastic frontier 54
3.5 Histograms showing (a) the residual from the
OLS model; (b) the inefficiency term from the
half normal model; (c) the inefficiency term from the
truncated model; (d) the inefficiency term from the
exponential model 56
4.1 Mean changes in costs and activity over time 77
5.1 Technical and allocative efficiency under an
input orientation 93
5.2 Technical and allocative efficiency under an
output orientation 95
5.3 Constant and variable returns to scale 102
5.4 Input and output orientation 106
5.5 Efficiency measurement and input slacks 110
5.6 Efficiency measurement and output slacks 110
viii
List of figures ix
5.7 Distribution of efficiency scores for five DEA models 123
6.1 Illustration of productivity change with one input
and one output 131
6.2 Mean expenditure and activity, 1994/95 1997/98 142
6.3 Malmquist TFP indices 145
6.4 Decomposition of Malmquist index for Model 2 146
8.1 The production possibility frontier: different
preferences lead to different weights 168
8.2 Composite scores indicated by the lines
QQ and C2C2 169
8.3 Observed performance of five systems with
identical expenditure and environment 170
9.1 Performance ranking using aggregate
organisational data 181
9.2 Changes in performance ranking based on
hierarchical structure 182
9.3 Hierarchical data structure 183
9.4 The production possibility frontier with two
performance indicators 188
9.5 Multivariate hierarchical data structure 201
9.6 Waiting time for routine surgery sensitivity
analysis of health authority effects 204
Tables
3.1 Calculating individual efficiency estimates for each
organisation page 57
3.2 Descriptive statistics 60
3.3 Regression results for average cost function 63
3.4 Correlations across average cost specifications 65
3.5 Regression results for total cost function 66
3.6 Correlations across total cost specifications 68
3.7 Correlations across average and total cost
specifications 68
4.1 Summary of time invariant SF panel data models 74
4.2 Descriptive statistics 75
4.3 Estimates from time invariant SF models 78
4.4 Estimates from time varying SF models 82
4.5 Estimates from 'true' SF models 85
4.6 Comparison of estimates from different models 87
4.7 Sensitivity analysis of mean efficiency 88
5.1 DEA model variables, 1997/98 119
5.2 DEA model specifications 121
5.3 DEA model specifications and efficiency results 122
5.4 Correlations between efficiency scores 123
5.5 Correlations between efficiency ranks 124
5.6 Individual hospital scores and rankings under various
specifications 125
5.7 Data for Models 1 and 2 of DEA specifications for
ten hospitals 126
5.8 Tobit Model of DEA efficiency scores regressed against
a single environmental factor 127
6.1 Mean values for Malmquist model variables 140
6.2 Malmquist model specifications 143
6.3 Malmquist TFP results 144
6.4 Correlations between Malmquist TFP scores 145
x
List of tables xi
6.5 Individual hospital scores and rankings for each year
for Model 2 147
6.6 Data for Model 2 of Malmquist specification for
hospital I 148
7.1 Comparison of SFA and DEA 154
7.2 Model variables, 1997/98 157
7.3 Model specifications 159
7.4 Model 1 efficiency scores 160
7.5 Correlations of SFA and DEA efficiency scores
for Model 1 160
7.6 Individual hospital scores and rankings for Model 1 161
7.7 Descriptive statistics for SFA and DEA efficiency scores 162
7.8 Individual hospital scores and rankings under various
specifications 163
9.1 Socio deraographic data used in needs index 184
9.2 Three level random intercept model to explain
proportion of variability in performance indicators
attributable to regional and district health authorities 186
9.3 OLS and SUR results for three performance indicators 194
9.4 Correlations of OLS residuals 197
9.5 Performance indicators and socio economic variables 200
9.6 Correlation of health authority effects from the
multivariate multilevel model 202 |
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author | Jacobs, Rowena Smith, Peter 1952- Street, Andrew |
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discipline | Soziologie Wirtschaftswissenschaften |
discipline_str_mv | Soziologie Wirtschaftswissenschaften |
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geographic | Großbritannien |
geographic_facet | Großbritannien |
id | DE-604.BV021599315 |
illustrated | Illustrated |
index_date | 2024-07-02T14:47:06Z |
indexdate | 2025-02-11T13:00:56Z |
institution | BVB |
isbn | 0521851440 9780521851442 |
language | English |
oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-014814676 |
oclc_num | 254717001 |
open_access_boolean | |
owner | DE-19 DE-BY-UBM DE-N2 DE-83 DE-384 DE-92 |
owner_facet | DE-19 DE-BY-UBM DE-N2 DE-83 DE-384 DE-92 |
physical | XVII, 243 S. graph. Darst. |
publishDate | 2006 |
publishDateSearch | 2006 |
publishDateSort | 2006 |
publisher | Cambridge Univ. Press |
record_format | marc |
spelling | Jacobs, Rowena Verfasser (DE-588)171878825 aut Measuring efficiency in health care analytic techniques and health policy Rowena Jacobs, Peter C. Smith and Andrew Street 1. publ. Cambridge Cambridge Univ. Press 2006 XVII, 243 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gesundheitsversorgung / Technische Effizienz / Data-Envelopment-Analyse / Gesundheitswesen / Krankenhaus / Großbritannien Gesundheitswesen - Stochastische Analysis - Effizienzmessung - Data Envelopment Analysis Medical care Standards Great Britain Medical care Great Britain Evaluation Effizienz (DE-588)4013585-8 gnd rswk-swf Effizienzmessung (DE-588)4151076-8 gnd rswk-swf Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Messung (DE-588)4038852-9 gnd rswk-swf Großbritannien Gesundheitswesen (DE-588)4020775-4 s Effizienzmessung (DE-588)4151076-8 s DE-604 Effizienz (DE-588)4013585-8 s Messung (DE-588)4038852-9 s 1\p DE-604 Smith, Peter 1952- Verfasser (DE-588)170188426 aut Street, Andrew Verfasser aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014814676&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis 1\p cgwrk 20201028 DE-101 https://d-nb.info/provenance/plan#cgwrk |
spellingShingle | Jacobs, Rowena Smith, Peter 1952- Street, Andrew Measuring efficiency in health care analytic techniques and health policy Gesundheitsversorgung / Technische Effizienz / Data-Envelopment-Analyse / Gesundheitswesen / Krankenhaus / Großbritannien Gesundheitswesen - Stochastische Analysis - Effizienzmessung - Data Envelopment Analysis Medical care Standards Great Britain Medical care Great Britain Evaluation Effizienz (DE-588)4013585-8 gnd Effizienzmessung (DE-588)4151076-8 gnd Gesundheitswesen (DE-588)4020775-4 gnd Messung (DE-588)4038852-9 gnd |
subject_GND | (DE-588)4013585-8 (DE-588)4151076-8 (DE-588)4020775-4 (DE-588)4038852-9 |
title | Measuring efficiency in health care analytic techniques and health policy |
title_auth | Measuring efficiency in health care analytic techniques and health policy |
title_exact_search | Measuring efficiency in health care analytic techniques and health policy |
title_exact_search_txtP | Measuring efficiency in health care analytic techniques and health policy |
title_full | Measuring efficiency in health care analytic techniques and health policy Rowena Jacobs, Peter C. Smith and Andrew Street |
title_fullStr | Measuring efficiency in health care analytic techniques and health policy Rowena Jacobs, Peter C. Smith and Andrew Street |
title_full_unstemmed | Measuring efficiency in health care analytic techniques and health policy Rowena Jacobs, Peter C. Smith and Andrew Street |
title_short | Measuring efficiency in health care |
title_sort | measuring efficiency in health care analytic techniques and health policy |
title_sub | analytic techniques and health policy |
topic | Gesundheitsversorgung / Technische Effizienz / Data-Envelopment-Analyse / Gesundheitswesen / Krankenhaus / Großbritannien Gesundheitswesen - Stochastische Analysis - Effizienzmessung - Data Envelopment Analysis Medical care Standards Great Britain Medical care Great Britain Evaluation Effizienz (DE-588)4013585-8 gnd Effizienzmessung (DE-588)4151076-8 gnd Gesundheitswesen (DE-588)4020775-4 gnd Messung (DE-588)4038852-9 gnd |
topic_facet | Gesundheitsversorgung / Technische Effizienz / Data-Envelopment-Analyse / Gesundheitswesen / Krankenhaus / Großbritannien Gesundheitswesen - Stochastische Analysis - Effizienzmessung - Data Envelopment Analysis Medical care Standards Great Britain Medical care Great Britain Evaluation Effizienz Effizienzmessung Gesundheitswesen Messung Großbritannien |
url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014814676&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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