The European Journal of Health Economics

, Volume 12, Issue 6, pp 509–519 | Cite as

Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis

  • Emma Medin
  • Kjartan S. Anthun
  • Unto Häkkinen
  • Sverre A. C. Kittelsen
  • Miika Linna
  • Jon Magnussen
  • Kim Olsen
  • Clas Rehnberg
Original Paper


This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.


International cost efficiency comparison University hospital Data envelopment analysis (DEA) Diagnose related groups (DRGs) 

JEL Classification


Supplementary material

10198_2010_263_MOESM1_ESM.doc (52 kb)
Supplementary Doc (DOC 52 kb)


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Emma Medin
    • 1
  • Kjartan S. Anthun
    • 2
  • Unto Häkkinen
    • 3
  • Sverre A. C. Kittelsen
    • 4
  • Miika Linna
    • 3
  • Jon Magnussen
    • 5
  • Kim Olsen
    • 6
  • Clas Rehnberg
    • 1
  1. 1.Medical Management CentreKarolinska InstitutetStockholmSweden
  2. 2.SINTEF Health ResearchTrondheimNorway
  3. 3.Centre for Health and Social EconomicsNational Institute for Health and WelfareHelsinkiFinland
  4. 4.Ragnar Frisch Centre for Economic ResearchOsloNorway
  5. 5.Department of Public Health and Community MedicineNorwegian University of Science and TechnologyTrondheimNorway
  6. 6.Danish Institute for Health Services ResearchCopenhagenDenmark

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