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Hospital Cost Flexibility in the Presence of Many Outputs: A Public-Private Comparison

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Abstract

This paper develops flexibility measures in the context of a multi-firm output based on a generalized average cost function. We then apply this methodology to assess and compare the relative flexibility of hospital services in Québec and California based on two very complete data sets. Results indicate that there is no clear distinction between private and public institutions and that there is no clear distinction between Québec and California hospitals. However, there are clear differences in flexibility among different outputs. This last result suggests that there are bottlenecks in the health care system and calls for a targeted approach on the part of hospital administrators, whether public or private, in Québec or California.

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References

  • W.J. Baumol, J.C. Panzar and R.D. Willig, Contestable Markets and the Theory of Industry Structure, revised edn., (Harcourt Brace Jovanovich Publishers, San Diego, 1988).

    Google Scholar 

  • D. Bilodeau, P.-Y. Crémieux and P. Ouellette, Hospital cost function in a non market health system, Review of Economics and Statistics 82, (2000) 1–11.

    Article  Google Scholar 

  • D. Bilodeau, P-Y. Crémieux and P. Ouellette, Hospital technology in a non market health system, Southern Economic Journal 68 (2002) 511–529.

    Google Scholar 

  • D.W. Caves, L.R. Christensen, M.W. Tretheway, Flexible cost function for multiproduct firms, Review of Economics and Statistics 62 (1979) 477–481.

    Google Scholar 

  • K. Carey, A panel data design for estimation of hospital cost functions, Review of Economics and Statistics 79 (1997) 235–259.

    Google Scholar 

  • P.-Y. Crémieux, and P. Ouellette, Omitted variable bias and hospital costs, Journal of Health Economic 20 (2000) 271–282.

    Article  Google Scholar 

  • W.E. Diewert, Duality Approaches to Microeconomic Theory, in: Handbook of Mathematical Economics, eds. K.J. Arrow and M.D. Intriligator, vol. 2 (North Holland: New York City, 1982) pp. 535–599.

  • W.E Diewert, and T.J. Wales, Flexible functional forms and global curvature conditions, Econometrica 55 (1987) 43–68.

    Google Scholar 

  • R. Färe, and D. Primont, Multi-output Production and Duality: Theory and Applications. (Kluwer Academic Publishers, Boston, 1995).

    Google Scholar 

  • R. Gagné, and P. Ouellette, On the choice of functional forms: summary of a monte carlo experiment, Journal of Business Economics and Statistics 16 (1998) 118–124.

    Google Scholar 

  • R. Gagné, and P. Ouellette, The performance of flexible functional forms in the presence of technological change, Journal of Productivity Analysis 17 (2002) 233–247.

    Article  Google Scholar 

  • G.A. Jensen and M.A. Morrisey, The role of physicians in hospital production. Review of Economics and Statistics 68 (1986a) 432–442.

    Google Scholar 

  • G.A. Jensen, and M.A. Morrisey, Medical staff speciality mix and hospital production, Journal of Health Economics 5 (1986b) 253–276.

    Article  CAS  Google Scholar 

  • T. Marschak, and R.R. Nelson Flexibility, uncertainty, and economic Theory, Metroeconomica 33 (1962) 42–60.

    Google Scholar 

  • F. McMahon, and M. Zelder, Making health spending work, Public Policy Sources 54 The Fraser Institute (2002) 19.

  • P. Milgrom and J. Roberts The economics of modern manufacturing: Technology, strategy, and organization, American Economic Review 80 (1990) 511–528.

    Google Scholar 

  • D.E. Mills, Demand fluctuation and endogenous firm flexibility, Journal of Industrial Economics 14 (1984) 55–72.

    Google Scholar 

  • D.E. Mills, Flexibility and firm diversity with demand fluctuation, International Journal of Industrial Organization 4 (1986) 203–215.

    Google Scholar 

  • D.E. Mills and L. Schumann, Industry structure withfluctuating demand, American Economic Review 75 (1985) 758–767.

    Google Scholar 

  • Ministère des Affaires sociales (1982–1986), Rapport financier annuel des établissements publics et privés conventionnés (Rapport AS-471), (1981-82 to 1984-1985).

  • Ministère des Affaires sociales (1982-1986), Rapport statistique annuel des centres hospitaliers (Rapport AS-477), (1981-82 to 1984-1985).

  • Ministère de la Santé et des Services sociaux (1986-1993), Rapport financier annuel des établissements publics et privés conventionnés (Rapport AS-471), (1985-86 to 1992-1993).

  • Ministère de la Santé et des Services sociaux (1986-1993), Rapport statistique annuel des centres hospitaliers (Rapport AS-477), 1985-86 to 1992-1993.

  • Ministère de la Santé et des Services Sociaux, Direction des politiques budgétaires et financières, Service des politiques de financement (1992), Méthodologie des mesures de la performance économique globale des établissements. Québec.

  • Office of the Statewide Health Planning and Development (various years), Annual Hospital Financial and Statistical Data, State of California, (1981 to 1997).

  • P. Ouellette and S. Vigeant, Measuring the flexibility of technologies: An application of a generalized dynamic duality to the canadian manufacturing sectors, Canadian Journal of Economics 36 (2003) 88–125.

    Google Scholar 

  • Régie de l’assurance-maladie du Québec (various years), Data on Number and Characteristics of Patients by Hospital and Specialty. Special Request, (1981-1982 to 1992-1993.)

  • G. Stigler, Production and distribution in the short run, Journal of Political Economy 47 (1939) 305–327.

    Google Scholar 

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Correspondence to Pierre Ouellette.

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Crémieux, PY., Ouellette, P., Rimbaud, F. et al. Hospital Cost Flexibility in the Presence of Many Outputs: A Public-Private Comparison. Health Care Manage Sci 8, 111–120 (2005). https://doi.org/10.1007/s10729-005-0394-6

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  • DOI: https://doi.org/10.1007/s10729-005-0394-6

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