Page 146 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 7
unambiguously conclusion can be made that FP and NFP hospitals are more (cost and/or technical) efficient than public hospitals, although public hospitals seem to be just as efficient as or more efficient than private hospitals. The findings on the other efficiency measures indicate that private hospitals seem to be more responsive to (financial) incentives.
The studies that estimated technical and/or cost efficiency use a Data Envelopment Analysis (DEA) (Czypionka et al., 2014; Sommersguter-Reichmann and Stepan, 2015; Tiemann and Schreyögg, 2009, 2012) or a SFA model (Barros et al., 2013; Berta et al., 2010; Daidone and D’Amico, 2009; Herr, 2008; Herr et al., 2011). Other studies contrasts multiple approaches, SFA versus DEA (Barbetta et al., 2007; Herwartz and Strumann, 2012; Lindlbauer and Schreyögg, 2014). The (adjusted) discharged patients (Barbetta et al., 2007; Berta et al., 2010) and the number of inpatient (weighted) cases were most often used as output parameters (Herr, 2008; Herr et al., 2011; Lindlbauer and Schreyögg, 2014; Tiemann and Schreyögg, 2009, 2012). Diagnosis Related Groups (DRGs) (Czypionka et al., 2014; Sommersguter-Reichmann and Stepan, 2015), outpatient visits (Czypionka et al., 2014), and differentiation of specific procedures (e.g. number of complex surgery, ER treatments) (Barbetta et al., 2007; Daidone and D’Amico, 2009) were used less frequently. With regard to input factors, most studies used the number of beds as a proxy for capital investments; one study used the amount spent on supplies as measurement of the capital used (Tiemann and Schreyögg, 2012). To identify labour inputs, all studies incorporate the number of full- time equivalents (FTE) of physicians, nurses and other staff members (e.g. administrative, non clinicians, teaching staff); one study could not include FTE, but only the number of staff members due to data limitations (Daidone and D’Amico, 2009).
Productivity functions
Only the results on technical efficiency are grouped in Table 7.3, since this was the dominant outcome and enhances comparability. The findings show mixed results, but do indicate more favourable results for public hospitals. Four German studies found that public hospitals were more efficient than FP hospitals (Herwartz and Strumann, 2012; Lindlbauer and Schreyögg, 2014; Tiemann and Schreyögg, 2009). One possible explanation is that local governments sell the inefficient hospitals to the private sector (Herwartz and Strumann, 2012). Also German FP hospitals with over a thousand beds were found to operate more efficiently (Tiemann and Schreyögg, 2009). In Italy, one study found that FP hospitals (Lazio Regio) were less technical efficient than public hospitals (Daidone and D’Amico, 2009). Whereas, when comparing NFP hospitals and public hospitals, the different methodologies and years covered caused divergent results (Daidone and D’Amico, 2009). Three studies
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