Abstract
Substitution of inpatient for outpatient care is seen as a means to increase patient throughput and control costs. The purpose of this study was to assess the impact of increased outpatient care on hospital costs and efficiency using Finnish specialty-level data from years 2003–2006 to which we applied stochastic frontier analysis. The results reveal that outpatient services have a smaller impact on total costs than inpatient services. At the same time, increased outpatient activity appears to have an adverse effect on estimated cost efficiency. This counterintuitive finding is probably due to the low weight given to outpatient activities by the Diagnosis Related Groups (DRG) system. A common weighting for inpatient and outpatient services is required in order to assess accurately the impact of outpatient care on efficiency.
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Notes
More information on the Benchmarking project and data collection can be found from http://info.stakes.fi/benchmarking/EN/benchmarking.htm
Information on wages can be found from the website of Statistics Finland: http://www.tilastokeskus.fi/index_en.html
‘Pure’ outpatient groups belong to the 700-, 800- and 900-series in the FullDRG grouper. The grouper is available at http://norddrg.kuntaliitto.fi/index_keski.html.
We tried the truncated normal specification, but the non significant test statistics (μ) indicated that the half-normal was appropriate.
A more flexible translog functional form could not be used as the sample size cannot support that many explanatory variables.
References
Davis, K., Russell, L.B.: The substitution of hospital outpatient care for inpatient care. Rev Econ Stat 54, 109–120 (1972)
WHO: European health for all database. WHO Regional Office for Europe, Copenhagen (2001)
Stakes.: Somaattinen erikoissairaanhoito 2004 (Specialised somatic care 2004). Tilastotiedote 30/2005, Helsnki (2005)
Kittelsen, S.A., Magnussen, J.: Economies of scope in Norwegian hospital production—a DEA analysis. University of Oslo, Working Paper 2003:8 (2003)
Martinussen, P.E., Midttun, L.: Day surgery and hospital efficiency: empirical analysis of Norwegian hospitals, 1999–2001. Health Policy 68, 183–196 (2004)
Battese, G.E., Coelli, T.J.: A model for technical inefficiency effects in a stochastic frontier production function for panel data. Empir. Econ. 20, 325–332 (1995)
Pitt, M.M., Lee, L.F.: The measurement and sources of technical inefficiency in the Indonesian weaving industry. J. Dev. Econ. 9, 43–64 (1981)
Schmidt, P., Sickles, R.C.: Production frontiers and panel data. J. Bus. Econ. Stat. 2, 367–374 (1984)
Linna, M.: Measuring hospital cost efficiency with panel data models. Health Econ. 7, 415–427 (1998)
Rosko, M.D.: Performance of US teaching hospitals: a panel analysis of cost inefficiency. Health Care Manag. Sci. 7, 7–16 (2004)
Ferrari, A.: The internal market and hospital efficiency: a stochastic distance function approach. Appl. Econ. 38, 2121–2130 (2006)
Frohloff, A.: Cost and technical efficiency of German hospitals: a stochastic frontier analysis. Ruhr Economic Paper No. 2, Available at SSRN: http://ssrn.com/abstract=961559 (2007)
Rosko, M.D., Mutter, R.L.: Stochastic frontier analysis of hospital inefficiency: a review of empirical issues and an assessment of robustness. Med. Care. Res. Rev. (2008). doi: 10.1177/j.medcareresrev.2008.06.020
Hilbe, J.M.: A review of LIMDEP 9.0 and NLOGIT 4.0. Am. Stat. 60, 187–202 (2006)
Hollingsworth, B.: Non-parametric and parametric applications measuring efficiency in health care. Health Care Manag. Sci. 6, 203–218 (2003)
Vitikainen, K.: Review of hospital efficiency studies. M.Sc. dissertation, University of York (2006)
Vitikainen, K., Street, A., Linna, M.: Estimation of hospital efficiency—do different definitions and casemix measures for hospital output affect the results?. Health Policy. (2008). doi:10.1016/j.healthpol.2008.05.012
Linna, M., Häkkinen, U.: A comparative application of econometric frontier and DEA methods for assessing cost efficiency of Finnish hospitals. Dev. Health Econ. Public Policy 6, 169–187 (1998)
Sutherland, J.M., Borz, C.K.: The effect of misclassification errors on case mix measurement. Health Policy 79, 195–202 (2006)
Farrell, M.: The measurement of productive efficiency. J. R. Stat. Soc. 120, 253–290 (1957)
Greene, W.: Fixed and random effects in stochastic frontier models. J. Prod. Anal. 23, 7–32 (2005)
Smith, P.: Performance indicators and outcome in the public sector. Public Money Manag. 15, 13–16 (1995)
Acknowledgments
The authors thank the Yrjö Jahnsson Foundation in Finland for financial support. We are grateful for comments from Professor Peter C. Smith, participants in HESG/NHESG in Aberdeen, as well as participants in the York Seminars in Health Econometrics. We would also like to thank the journal’s referees for their constructive comments. Any errors are our own.
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Vitikainen, K., Linna, M. & Street, A. Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?. Eur J Health Econ 11, 395–404 (2010). https://doi.org/10.1007/s10198-009-0211-0
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DOI: https://doi.org/10.1007/s10198-009-0211-0