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Do healthcare financing systems influence hospital efficiency? A metafrontier approach for the case of Mexico

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Abstract

The objective of this article is to discuss the impact of healthcare financing systems on the efficiency of Mexican hospitals. The Mexican healthcare system is undergoing a process of transformation to establish conditions for allocating limited health resources in order to achieve efficiency and transparency; in this line, there is a concern about the implications of different funding options. In terms of financing arrangements, the Mexican health system is divided into three categories (one private and two public). In the framework of New Public Management theory, non-parametric metafrontier methods are used to estimate differences in efficiency of hospitals under different financing schemes, and in relation to the potential technology available in the healthcare system. Empirical evidence suggests that: 1) an out-of-pocket funding system, on average, incentivizes more efficient behavior; and 2) public funding seems to be the best option for complex and high-technology hospitals, and capitation appears to be the most appropriate way of negotiating their funding.

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Notes

  1. In Mexico, decisions about investments and size of public hospitals are beyond the control of managers. For this reason, the efficiency of scale related to hospital size is not considered in our estimations.

  2. Tableau Public software was used for visual analytics

  3. R software was used to calculate the empirical results

References

  1. Bannick RR, Ozcan YA (1995) Efficiency analysis of federally funded hospitals: comparison of DoD and VA hospitals using data envelopment analysis. Health Serv Manag Res 8(2):73–85

    Article  Google Scholar 

  2. Ozcan YA, Luke RD, Haksever C (1992) Ownership and organizational performance: a comparison of technical efficiency across hospital types. Med Care 30(9):781–794

    Article  Google Scholar 

  3. Leidl R (1998) Health care and its financing in the single European market. IOS Press, Amsterdam

    Google Scholar 

  4. Biorn E, Hagen T, Iversen T, Magnussen J (2003) The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores 1992-2000. Health Care Manag Sci 6:271–283

    Article  Google Scholar 

  5. Blank J, Eggink E (2014) The impact of policy on hospital productivity: a time series analysis of Dutch hospitals. Health Care Manag Sci 17:139–149

    Article  Google Scholar 

  6. Hofmarcher M, Paterson I, Riedel M (2002) Measuring hospital efficiency in Austria —a DEA approach. Health Care Manag Sci 5:7–14

    Article  Google Scholar 

  7. Lopez-Valcarcel B, Perez P (1996) Changes in the efficiency of Spanish public hospitals after the introduction of program-contracts. Investig Econ 20(3):377–402

    Google Scholar 

  8. Maniadakis N, Hollingsworth B, Thanassoulis E (1999) The impact of the internal market on hospital efficiency, productivity and service quality. Health Care Manag Sci 2:75–85

    Article  Google Scholar 

  9. McCallion G, Glass J, Jackson R, Kerr C, McKillop D (2000) Investigating productivity change and hospital size: a nonparametric frontier approach. Appl Econ 32:161–174

    Article  Google Scholar 

  10. Sommersguter-Reichmann M (2000) 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 Manag Sci 3:309–332

    Article  Google Scholar 

  11. Montenegro H, Levcovitz E, Holder R, Ruales J, Suárez J (2010) Redes Integradas de Servicios de Salud: Conceptos, Opciones de Política y Hoja de Ruta para su Implementación en las Américas, Serie 4 La renovación de la atención primaria de salud en las Américas, Organización Panamericana de la Salud

  12. Vazquez M, Vargas I, Unger J, Mogollón A, Ferreira M, De Paepe P (2009) Integrated health care networks in Latin America: toward a conceptual framework for analysis. Rev Panam Salud Publica 26(4):360–267

    Article  Google Scholar 

  13. Buchanan J (1986) Liberty, market and state: political economy in the 1980s. Harvester Press, Brighton

    Google Scholar 

  14. Williamson O (1981) The economics of organization: the transaction cost approach. Am J Sociol 87(3):548–577

    Article  Google Scholar 

  15. Jensen M, Meckling W (1976) Theory of the firm: managerial behavior, agency costs, and ownership structure. J Financ Econ 3:305–360

    Article  Google Scholar 

  16. Demsetz H (1967) Toward a theory of property rights. Am Econ Rev 57:347–359

    Google Scholar 

  17. Andrews R, Van de Walle S (2013) New public management and citizens' perceptions of local service efficiency, responsiveness, equity and effectiveness. Public Manag Rev 15(5):762–783

    Article  Google Scholar 

  18. Mayston D (1999) The private finance initiative in the National Health Service: an unhealthy development in new public management? Financ Account Manag 15:249–274

    Article  Google Scholar 

  19. Acerete B, Stafford A, Stapleton P (2012) New development: new global health care PPP developments—a critique of the success story. Public Money Manag 32(4):311–314

    Article  Google Scholar 

  20. Alonso J, Clifton J, Díaz-Fuentes D (2015) The impact of new public management on efficiency: an analysis of Madrid's hospitals. Health Policy 119(3):333–340

    Article  Google Scholar 

  21. Barlow J, Roehrich J, Wright S (2013) Europe sees mixed results from public–private partnerships for building and managing health care facilities and services. Health Aff 32:146–154

    Article  Google Scholar 

  22. Pollitt C, Dan S (2013) Searching for impacts in performance-oriented management reform: a review of the European literature. Public Perform Manag Rev 37(1):7–32

    Article  Google Scholar 

  23. Knaul M, Frenk J (2005) Health insurance in México: achieving universal coverage through structural reform. Health Aff 24(6):1467–1476

    Article  Google Scholar 

  24. Frenk J (2006) Bridging the divide: global lessons from evidence-based health policy in México. Lancet 368(9539):954–961

    Article  Google Scholar 

  25. Frenk J, González-Pier E, Gómez-Dantés O, Lezana M, Knaul F (2006) Comprehensive reform to improve health system performance in México. Lancet 368(9546):1524–1534

    Article  Google Scholar 

  26. Knaul F, Arreola H, Méndez O, Miranda M (2006) Preventing impoverishment, promoting equity and protecting households from financial crisis: universal health insurance through institutional reform in Mexico. Fundación Mexicana para la Salud, Mexico

  27. Du Gay P (2000) In Praise of Bureaucracy: Weber, Organization and Ethics. Sage, London

    Google Scholar 

  28. Jørgensen T (2011) Weber and Kafka. The Rational and the Enigmatic Bureaucracy. Public Adm 90(1):194–210

    Article  Google Scholar 

  29. Langenbrunner J, Cashin C, O'Dougherty S (eds) (2009) Designing and implementing health care provider payment systems: how-to manuals. World Bank Publications

  30. Niskanen W (1968) The peculiar economics of bureaucracy. Am Econ Rev 57(2):293–321

    Google Scholar 

  31. Weber M (1992) Economía y sociedad. Fondo de Cultura Económica, Buenos Aires

    Google Scholar 

  32. Dahl R, Tufte E (1974) Size and democracy. Politics of the smaller European democracies. Stanford University Press, Stanford

    Google Scholar 

  33. Ostrom V (1973) The intellectual crisis in American public administration. University Alabama Press, Tuscaloosa

    Google Scholar 

  34. Simonet D (2015) The new public management theory in the British health care system: a critical review. Adm Soc 47(7):802–826

    Article  Google Scholar 

  35. Simonet D (2013) New public management and the reform of French public hospitals. J Public Aff 13(3):260–271

    Article  Google Scholar 

  36. Anessi-Pessina E, Cantú E (2006) Whither managerialism in the Italian National Health Service? Int J Health Plann Manag 21:327–255

    Article  Google Scholar 

  37. Correia T (2011) New public management in Portuguese health sector: a comprehensive reading. Sociología on Line 2:573–598

  38. Donnan M, Katz G (2015) Choice in the American healthcare system: changing dynamics under the affordable care act. Curr Sociol Monogr 63(5):746–762

    Article  Google Scholar 

  39. Mattei P (2006) The enterprise formula, new public management and the Italian health care system: remedy or contagion? Public Adm 84(4):1007–1027

    Article  Google Scholar 

  40. Maynard A (1994) Can competition enhance efficiency in health care? Lessons from the reform of the U.K. National Health Service. Soc Sci Med 39(10):1433–1445

    Article  Google Scholar 

  41. Moresi-Izzo S, Bankauskaite V, Gericke C (2010) The effect of market reforms and new public management mechanisms on the Swiss health care system. Int J Health Plann Manag 25:368–385

    Article  Google Scholar 

  42. Ferrari A (2006) The internal market and hospital efficiency: a stochastic distance function approach. Appl Econ 38(18):2121–2130

    Article  Google Scholar 

  43. Jakobsen M (2010) The effects of new public management: activity-based reimbursement and efficiency in the Scandinavian hospitals sectors. Scand Polit Stud 33(2):113–134

    Article  Google Scholar 

  44. Cashin C, O’Dougherty S, Samyshkin Y, Katsaga A, Ibraimova A, Kutanov Y, Lyachshuk K, Olga Z (2005) Case-based hospital payment systems: a step-by-step guide for design and implementation in low- and middle-income countries. USAID Abt Associates Inc, Zdrav Reform Project

    Google Scholar 

  45. Kutzin J (2001) A descriptive framework for country-level analysis of health care financing arrangements. Health Policy 56(3):171–204

    Article  Google Scholar 

  46. Maceira M (1998) Provider payment mechanisms in health care: incentives, outcomes and organizational impact in developing countries, major applied research 2, working paper 2. Partnerships for health reform project. Abt Associates Inc., Bethesda

    Google Scholar 

  47. Barnum H, Kutzin J, Saxenian H (1995) Incentives and provider payment methods. Int J Health Plann Manag 10(1):23–45

    Article  Google Scholar 

  48. Joumard I, André C, Nicq C (2010) Health care systems: efficiency and institutions. OECD economics department working papers (769):1–133

  49. Battese G, Rao D (2002) Technology gap, efficiency and a stochastic metafrontier function. Int J Bus Econ 1(2):87–93

    Google Scholar 

  50. Mitropoulus P, Talias M, Mitropoulus I (2015) Combining stochastic DEA with Bayesian analysis to obtain statistical properties of the efficiency scores: an application to Greek public hospitals. Eur J Oper Res 243:302–311

    Article  Google Scholar 

  51. O’Donnell C, Rao D, Battese G (2008) Metafrontier frameworks for the study of firm-level efficiencies and technology ratios. Empir Econ 34:231–255

    Article  Google Scholar 

  52. Asmild M (2015) Frontier differences and the Global Malmquist Index. In: Zhu J (ed) Data Envelopment Analysis. International Series in Operations Research & Management Science, vol 221. Springer, Boston

  53. Färe R, Primont D (1995) Multi-output production and duality: theory and applications. Kluwer, Boston

    Book  Google Scholar 

  54. Battese G, Rao D, O’Donnell C (2004) A metafrontier production function for estimation of technical efficiencies and technology gaps for firms operating under different technologies. J Prod Anal 21:91–103

    Article  Google Scholar 

  55. Thiry B, Tulkens H (1992) Allowing for inefficiency in parametric estimation of production functions for urban transit firms. J Prod Anal 3(1-2):45–65.

    Article  Google Scholar 

  56. Charnes A, Cooper W, Rhodes E (1978) Measuring the efficiency of decision making units. Eur J Oper Res 2(6):429–444

    Article  Google Scholar 

  57. Ozcan YA (2014) Health care benchmarking and performance evaluation: an assessment using data envelopment analysis (DEA), 2nd edn. Springer, Newton

    Google Scholar 

  58. Banker R, Charnes A, Cooper W (1984) Some models for estimating technical and scale efficiencies in data envelopment analysis. Manag Sci 30(9):1078–1092

    Article  Google Scholar 

  59. Asmild M, Hollingsworth B, Birch S (2013) The scale of hospital production in different settings: one size does not fit all. J Prod Anal 40:197–206

    Article  Google Scholar 

  60. Hollingsworth B, Street A (2006) The market for efficiency analysis of health care organizations. Health Econ 15:1055–1059

    Article  Google Scholar 

  61. Sodani P, Madnani G (2008) Measuring hospital performance through data envelopment analysis: understanding basic concepts to help novice researchers. J Health Manag 10(1):129–142

    Article  Google Scholar 

  62. Jacobs R, Smith P, Street A (2006) Measuring efficiency in healthcare. Analytic techniques and health policy. Cambridge University Press

  63. Simar L, Wilson PW (2002) Non-parametric tests of returns to scale. Eur J Oper Res 139(1):115–132

    Article  Google Scholar 

  64. Instituto Nacional de Estadística y Geografía. Censo Poblacional 2010. [Online] Available at: http://www.censo2010.org.mx. Accessed 5 March 2016

  65. Instituto Mexicano del Seguro Social. Datos abiertos 2015. [Online] Available at: http://datos.imss.gob.mx. Accessed 29 Aug 2015

  66. Instituto de Seguridad y Servicios Social de los Trabajadores del Estado. Anuarios Estadísticos de la Dirección de Finanzas 2015. [Online] Available at: http://www2.issste.gob.mx:8080/index.php/mder-int-finanzas-anuarios. Accessed 29 Aug 2015

  67. Instituto de Seguridad Social para las Fuerzas Armadas Mexicanas. [Online] Available at: https://datos.gob.mx/busca/organization/issfam. Accessed 8 March 2016

  68. Dirección General de Información de Salud. [Online] Available at: https://www.gob.mx/salud/acciones-y-programas/direccion-general-de-informacion-en-salud-dgis. Accessed 20 March 2016

  69. Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales. Sistema INFORMEX Gobierno Federal 2015. [Online] Available at: https://www.infomex.org.mx. Accessed 5 Nov 2014

  70. O’Neill L, Rauner M, Heidenberger K, Kraus M (2008) A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socio Econ Plan Sci 42(3):158–189

    Article  Google Scholar 

  71. Billor N, Hadi A, Velleman P (2000) BACON: blocked adaptive computationally efficient outlier nominators. Comput Stat Data Anal 34:279–298

    Article  Google Scholar 

  72. Weber S (2018) Bacon: an effective way to detect outliers in multivariate data using stata (and Mata). Stata J: Promoting Communications on Statistics and Stata 10(3):331–338

  73. Wilson P (1993) Detecting outliers in deterministic nonparametric frontier models with multiple outputs. J Bus Econ Stat 11:319–323

    Google Scholar 

  74. North DC (1990) Institutions, institutional change and economic performance. Cambridge University Press, New York

    Book  Google Scholar 

  75. Cavagnero E, Bilger M (2010) Equity during an economic crisis: financing of the argentine health system. J Health Econ 29:479–488

    Article  Google Scholar 

  76. Bertranou F (1999) Are market-oriented health insurance reforms possible in Latin America? The cases of Argentina, Chile and Colombia. Health Policy 47:19–36

    Article  Google Scholar 

  77. Antonanzas F (2013) The impact of the economic downturn on healthcare in Spain: consequences and alternatives. Expert Rev Pharmacoecon Outcomes Res 13(4):433–439

    Article  Google Scholar 

  78. Dahlgren G (2014) Why public health services? Experiences from profit-driven health care reforms in Sweden. Int J Health Serv 44(3):507–524

    Article  Google Scholar 

  79. Zweifel P, Tai-Seale M (2009) An economic analysis of payment for health care services: the United States and Switzerland compared. Int J Health Care Finance Econ 9:197–210

    Article  Google Scholar 

  80. O'Reilly J, Busse R, Häkkinen U, Or Z, Street A, Wiley M (2012) Paying for hospital care: the experience with implementing activity-based funding in five European countries. Health Econ Policy Law 7(1):73–101

    Article  Google Scholar 

  81. Iriart C, Merhy EE, Waitzkin H (2001) Managed care in Latin America: the new common sense in health policy reform. Soc Sci Med 52(8):1243–1253

    Article  Google Scholar 

  82. Wranik D (2012) Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD. Health Econ Policy Law 7:197–226

    Article  Google Scholar 

  83. Keith J, Prior D (2014) Scale and scope economies in Mexican private medical units. Salud Publica Mex 56(4):348–354

    Article  Google Scholar 

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Acknowledgments

Víctor Giménez and Diego Prior acknowledge the financial support of the Spanish Ministerio de Economía y Competitividad (ECO2017-88241-R).

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Authors and Affiliations

  1. Department of Business, Universitat Autònoma de Barcelona, Barcelona, Spain

    Víctor Giménez & Diego Prior

  2. Departament d’Empresa. Edifici B, Eix Central, Universitat Autónoma de Barcelona, 08193 Bellatera, Barcelona, Spain

    Víctor Giménez

  3. Tecnológico de Monterrey, Monterrey, Mexico

    Jorge R. Keith

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  1. Víctor Giménez
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Correspondence to Víctor Giménez.

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Giménez, V., Keith, J.R. & Prior, D. Do healthcare financing systems influence hospital efficiency? A metafrontier approach for the case of Mexico. Health Care Manag Sci 22, 549–559 (2019). https://doi.org/10.1007/s10729-019-9467-9

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