Skip to main content
Log in

The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach

  • Published:
Health Care Management Science Aims and scope Submit manuscript

Abstract

The 1997 hospital financing reform has been supposed to reduce considerable inefficiencies in the provision of hospital care in Austria. This paper focuses on the changes in hospital productivity between 1994 and 1998, thus including three years before the reform and two years after the reform. Using Data Envelopment Analysis we calculated the input-based Malmquist index, which is then decomposed into indices of pure technical efficiency change, scale efficiency change and technology change. The results illustrated a considerably positive shift in technology between 1996 and 1998, whereas the intended enhancement in technical efficiency has not yet taken place.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Vereinbarung gemäß Art. 15a Bundes-Verfassungsgesetzüber die Reform des Gesundheitswesens und der Krankenanstaltenfi-nanzierung für die Jahre 1997 bis 2000, in: Krankenanstaltengesetze, Kodex des österreichischen Rechts (Orac Verlag, Wien, 1998).

  2. Bundesgesetz über die Dokumentation im Gesundheitswesen, in: Bundesgesetzblatt (Jahrgang 745/1996).

  3. Bundesministerium für Arbeit, Gesundheit und Soziales, Leistungsorientierte Krankenanstaltenfinanzierung - LKF - Systembeschreibung, Anhang 3 (Wien, 1997).

  4. Bundesministerium f¨ur Arbeit, Gesundheit und Soziales, Leistungsorientierte Krankenanstaltenfinanzierung - LKF - Systembeschreibung (Wien, 1998).

  5. S. Dienesch and G. Heitzenberger, Krankenanstaltenfinanzierung 9 mal anders. Ein Streifzug durch den Finanzierungsdschungel in den ¨osterreichischen Bundesländern, Österreichische Krankenhaus-Zeitung 38 (1997) 5–8.

    Google Scholar 

  6. Bundesministerium für Arbeit, Gesundheit und Soziales, Überregionale Auswertung der Kostenrechnungsergebnisse (Wien, 1996).

  7. Art. 7-10 der Vereinbarung gemäß Art. 15a Bundes-Verfassungsgesetz über die Reform des Gesundheitswesens und der Krankenanstaltenfinanzierung für die Jahre 1997 bis 2000, in: Krankenanstaltengesetze, Kodex des österreichischen Rechts (Orac Verlag, Wien, 1998).

  8. H. Gaugg and G. Embacher, Krankenanstaltenwesen in Österreich - Ansätze zur Reform, Zeitschrift für Gemeinwirtschaft 3-4 (1995) 105–114.

    Google Scholar 

  9. M.J. Farrell, The measurement of productive efficiency, Journal of the Royal Statistical Society A 120 (1957) 253–281.

    Google Scholar 

  10. A. Charnes et al., Measuring the efficiency of decision making units, European Journal of Operational Research 2 (1978) 429–444.

    Article  Google Scholar 

  11. S. Grosskopf and V. Valdmanis, Measuring hospital performance. A non-parametric approach, Journal of Health Economics 6 (1987) 89–107.

    Article  Google Scholar 

  12. V. Valdmanis, Sensitivity analysis for DEA models. An empirical example using public vs. NFP hospitals, Journal of Public Economics 48 (1992) 185–205.

    Article  Google Scholar 

  13. J.A. Chilingerian, Evaluating physician efficiency in hospitals: A multivariate analysis of best practices, European Journal of Operational Research 80 (1995) 548–574.

    Article  Google Scholar 

  14. M. Linna and U. Häkkinnen, A comparative application of econometric and DEA methods for assessing cost efficiency of Finnish hospitals, in: Health, the Medical Profession and Regulation, ed. P. Zweifel (Kluwer Academic, Boston/Dordrecht, 1998) pp. 169–187.

    Google Scholar 

  15. A.D. Athanassopoulos et al., A descriptive assessment of the production and cost efficiency of general hospitals in Greece, Health Care Management Science 2 (1999) 97–106.

    Article  Google Scholar 

  16. J.F. Burgess Jr. and P.W. Wilson, Hospital productivity changes, 1985-1988: A non-parametric approach, Journal of Productivity Analysis 6 (1995) 343–363.

    Article  Google Scholar 

  17. M. Linna, Measuring hospital cost efficiency with panel data models, Health Economics 7 (1998) 415–427.

    Article  Google Scholar 

  18. C.E. Dismuke and V. Sena, Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portugese public hospitals? An empirical analysis using parametric and non-parametric methods, Health Care Management Science 2 (1999) 107–116.

    Article  Google Scholar 

  19. N. Maniadakis et al., The impact of the internal market on hospital efficiency, productivity and service quality, Health Care Management Science 2 (1999) 75–85.

    Article  Google Scholar 

  20. D. Caves et al., The economic theory of index numbers and the measurement of input, output, and productivity, Economic Journal 92 (1982) 73–86.

    Article  Google Scholar 

  21. R. Färe et al., Productivity changes in Swedish pharmacies 1980- 1989: A non-parametric approach, Journal of Productivity Analysis 3 (1992) 85–101.

    Article  Google Scholar 

  22. S.E. Atkinson and P.W. Wilson, Comparing mean efficiency and productivity scores from small samples: A bootstrap methodology, Journal of Productivity Analysis 6 (1995) 137–152.

    Article  Google Scholar 

  23. R.W. Shepard, Theory of Cost and Production Functions (Princeton University Press, Princeton, 1970).

    Google Scholar 

  24. S. Grosskopf, Efficiency and productivity, in: The Measurement of Productive Efficiency, eds. H.O. Fried et al. (Oxford University Press, New York/Oxford, 1993) pp. 160–194.

    Google Scholar 

  25. R. Färe et al., The Measurement of Efficiency of Production (Kluwer-Nijhoff, Boston, 1985).

    Google Scholar 

  26. E. Grifell-Tatjé and C.A.K. Lovell, A note on the Malmquist productivity index, Economics Letters 47 (1995) 169–175.

    Article  Google Scholar 

  27. S.C. Ray and E. Desli, Productivity growth, technical progress, and efficiency change in industrialized countries: Comment, American Economic Review 87 (1997) 1033–1039.

    Google Scholar 

  28. R. Färe et al., Productivity growth, technical progress, and efficiency change in industrialized countries: Reply, American Economic Review 87 (1997) 1040–1043.

    Google Scholar 

  29. R. Färe et al., Productivity developments in Swedish hospitals: A Malmquist output index approach, in: Data Envelopment Analysis. Theory, Methodology, and Application, eds. A. Charnes et al., 2nd ed. (Kluwer Academic, Boston/Dordrecht/London, 1997) pp. 253–272.

    Google Scholar 

  30. M. Tambour, The impact of health care policy initiatives on productivity, Health Economics 6 (1997) 57–70.

    Article  Google Scholar 

  31. A. Giuffrida, Productivity and efficiency changes in primary care: a Malmquist index approach, Health Care Management Science 2 (1999) 11–26.

    Article  Google Scholar 

  32. P. Ladreiter and M. Sommersguter-Reichmann, A note on the conversion of Malmquist indices, Working Paper in progress.

  33. Krankenanstaltengesetze des Bundes, in: Krankenanstaltengesetze, Kodex des österreichischen Rechts (Orac Verlag, Wien, 1998).

  34. M. Sommersguter-Reichmann and A. Stepan, Ein hierarchisches Informationssystem zur Analyse von Anreizwirkungen in Spitälern. Aufbau und praktische Anwendung am Beispiel der geänderten Spitalsfinanzierung in Österreich, Working Paper 1999 (forthcoming in: Zeitschrift für Betriebswirtschaft). M. Sommersguter-Reichmann / The impact of the Austrian hospital financing reform on hospital productivity 321

  35. M. Sommersguter-Reichmann, Benchmarking im Gesundheitswesen - Eine Untersuchung zur Effizienz von Krankenanstalten mit Hilfe der Data Envelopment Analysis, Dissertation, Graz (1999).

  36. T. Coelli, A Guide to DEAP version 2.1: A data envelopment analysis (computer) program, CEPA Working Paper (1996/08).

  37. B. Efron and R.J. Tibshirani, An Introduction to the Bootstrap (Chapman/ Hall, New York, 1993).

    Google Scholar 

  38. A. Stepan, Finanzierungssysteme im Gesundheitswesen. Ein internationaler Vergleich (Manz Verlag, Wien, 1997).

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sommersguter-Reichmann, M. The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach. Health Care Management Science 3, 309–321 (2000). https://doi.org/10.1023/A:1019022230731

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1019022230731

Keywords

Navigation