Health Care Management Science

, Volume 6, Issue 4, pp 271–283 | Cite as

The Effect of Activity-Based Financing on Hospital Efficiency: A Panel Data Analysis of DEA Efficiency Scores 1992–2000

  • Erik Biørn
  • Terje P. Hagen
  • Tor Iversen
  • Jon Magnussen


Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF as compared with global budgets. The prediction is tested using a panel data set from the period 1992–2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. The result is less uniform with respect to the effect on cost-efficiency.

public hospitals financing efficiency DEA-scores panel data Norway 


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  1. [1]
    S.C. Ahn and S. Low, A reformulation of the Hausman test for regression models with pooled cross-section-time-series data, Journal of Econometrics 71 (1996) 300-319.Google Scholar
  2. [2]
    M. Arellano and S. Bond, Some tests of specification for panel data: Monte Carlo evidence and an application to employment equations, Review of Economic Studies 58 (1991) 277-297.Google Scholar
  3. [3]
    B.H. Baltagi, On seemingly unrelated regressions with error components, Econometrica 48 (1980) 1547-1551.Google Scholar
  4. [4]
    B.H. Baltagi, Econometric Analysis of Panel Data, 2nd Ed. (Wiley, Chichester, 2001).Google Scholar
  5. [5]
    B.H. Baltagi and Q. Li, A monotonic property for iterative GLS in the two-way random effects model, Journal of Econometrics 53 (1992) 45-51.Google Scholar
  6. [6]
    R.D. Banker, A. Charnes and W.W. Cooper, Some models for estimating technical and scale inefficiencies in data envelopment analysis, Management Science 30 (1984) 1078-1092.Google Scholar
  7. [7]
    T.S. Breusch, Maximum likelihood estimation of random effects models, Journal of Econometrics 36 (1987) 383-389.Google Scholar
  8. [8]
    M. Chalkley and J.M. Malcomson, Contracting for health services when patient demand does not reflect quality, Journal of Health Economics 17 (1998) 1-19.Google Scholar
  9. [9]
    M. Chalkley and J.M. Malcomson, Government purchasing of health services, in: Handbook of Health Economics, Vol. 1A, eds. A.J. Culyer and J.P. Newhouse (Elsevier Science, Amsterdam, 2000) pp. 847-889.Google Scholar
  10. [10]
    A. Charnes, W.W. Cooper and E. Rhodes, Measuring the efficiency of decision making units, European Journal of Operational Research 2 (1978) 429-444.Google Scholar
  11. [11]
    C. Charpentier and L. Samuelsson, Effekter av en sjukvårdsreform - En analys av Stockholmsmodellen (Nerenius och Santerus Förlag AB, Stockholm, 1999).Google Scholar
  12. [12]
    D. Dranove and M.A. Satterthwaite, The industrial organization of health care markets, in: Handbook of Health Economics, Vol. 1B, eds. A.J. Culyer and J.P. Newhouse (Elsevier Science, Amsterdam, 2000) pp. 1093-1140.Google Scholar
  13. [13]
    R.P. Ellis, Creaming, skimping and dumping: Provider competition on the intensive and extensive margins, Journal of Health Economics 17 (1998) 537-555.Google Scholar
  14. [14]
    European Observatory on Health Care Systems, Health Care Systems in Transition - Norway (WHO Regional office for Europe, Copenhagen, 2000).Google Scholar
  15. [15]
    R. Färe and C.A. Knox Lovell, Measuring the technical efficiency of production, Journal of Economic Theory 19 (1978) 150-162.Google Scholar
  16. [16]
    M.J. Farrell, The measurement of productive efficiency, Journal of the Royal Statistical Society A 120(3) (1957) 253-281.Google Scholar
  17. [17]
    U.G. Gerdtham, C. Rehnberg and M. Tambour, The impact of internal markets on health care efficiency: Evidence from health care reforms in Sweden, Applied Economics 31 (1999) 935-945.Google Scholar
  18. [18]
    J. Hadley, S. Zuckerman and J. Feder, Profits and fiscal pressure in the prospective payment system: Their impacts on hospitals, Inquiry 26 (1989) 354-365.Google Scholar
  19. [19]
    T.P. Hagen, Agenda-setting power and moral hazard in principal-agent relations: Evidence from hospital budgeting in Norway, European Journal of Political Research 31 (1997) 287-314.Google Scholar
  20. [20]
    T.P. Hagen and T. Iversen, Målestokk-konkurranse eller kostnadskompensasjon? Analyse av sykehussektoren 1989-1996, Arbeidsnotat 1999:4 (Senter for helseadministrasjon, Universitetet i Oslo, Oslo, 1999).Google Scholar
  21. [21]
    T.P. Hagen and S.M. Nerland, Sykehuslegenes oppfatning av ISF: Kartlegging basert på en spørreundersøkelse, Working paper 2001:3 (Center for Health Administration, University of Oslo, Oslo, 2001).Google Scholar
  22. [22]
    I.J. Harris, H. Ozgen and Y. Ozcan, Do mergers enhance performance of hospital efficiency? Journal of Operational Research Society 51 (2000) 801-811.Google Scholar
  23. [23]
    J.A. Hausman and W.E. Taylor, Panel data and unobservable individual effects, Econometrica 49 (1981) 1377-1398.Google Scholar
  24. [24]
    D. Hodgkin and T.G. McGuire, Payment levels and hospital response to prospective payment, Journal of Health Economics 13 (1994) 1-29.Google Scholar
  25. [25]
    E. Kjerstad, Prospective funding of somatic hospitals in Norway - Incentives for higher production? Skriftserie i helseøkonomi, nr 10 (Program for helseøkonomi, Universitetet i Bergen, januar 2000).Google Scholar
  26. [26]
    V. Koen, Public expenditure reform: The health care sector in the United Kingdom, OECD Economics Department Working Paper ECO/WKP (2000) 29.Google Scholar
  27. [27]
    J. Kornai, Hardening the budget constraint: The experience of the postsocialist countries, European Economic Review 45 (2001) 1573-1599.Google Scholar
  28. [28]
    J. Le Grand, Competition, cooperation or control? Tales from the British National Health Service, Health Affairs 18(3) (1999) 27-39.Google Scholar
  29. [29]
    Ministry of Health and Social Affairs, Ventetidsgarantien - kriterier og finansiering, Stortingsmelding nr 44, 1995-1996 (Statens trykning, Oslo, 1995).Google Scholar
  30. [30]
    W.K. Newey, Generalized method of moments specification testing, Journal of Econometrics 29 (1985) 229-256.Google Scholar
  31. [31]
    J.P. Newhouse, Do unprofitable patients face access problems? Health Care Financing Review 11 (1989) 33-42.Google Scholar
  32. [32]
    J.P. Newhouse, Reimbursing health plans and health providers: Efficiency in production versus selection, Journal of Economic Literature XXXIV (1996) 1236-1263.Google Scholar
  33. [33]
    C. Propper and N. Söderlund, Competition in the NHS internal market: An overview of its effects on hospital prices and costs, Health Economics 7 (1998) 187-197.Google Scholar
  34. [34]
    P. Sevestre and A. Trognon, A note on autoregressive error component models, Journal of Econometrics 28 (1985) 231-245.Google Scholar
  35. [35]
    M. Sommersguter-Reichmann, The impact of the Austrian hospital financing reform of hospital productivity: Empirical evidence on ef-ficiency and technology changes using a non-parametric input-based Malmquist approach, Health Care Management Science 3 (2000) 309-321.Google Scholar
  36. [36]
    H. Tulkens and P. Vanden Eeckaut,Non-parametric efficiency, progress and regress measures for panel data: Methodological aspects, CORE Discussion Paper no 9316, Louvain-la-Neuve: Center for Operations Research and Econometrics, Universite Catholique de Louvain (1993).Google Scholar
  37. [37]
    P. van den Noord, T.P. Hagen and T. Iversen, The Norwegian health care system, Economics Department working paper no. 198 (OECD, Paris, 1998).Google Scholar
  38. [38]
    H. White, Asymptotic Theory for Econometricians (Academic Press, Orlando, 1984).Google Scholar
  39. [39]
    C. Yip and K. Eggleston, Provider payment reform in China: The case of hospital reimbursement in Hainan Province, Health Economics 10 (2001) 325-339.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Erik Biørn
    • 1
    • 2
  • Terje P. Hagen
    • 3
    • 2
  • Tor Iversen
    • 3
    • 2
  • Jon Magnussen
    • 4
    • 2
  1. 1.Department of EconomicsUniversity of OsloOsloNorway
  2. 2.Health Economics Research Programme at the University of Oslo (HERO)Norway
  3. 3.Center for Health AdministrationUniversity of Oslo, RikshospitaletOsloNorway
  4. 4.SINTEF Unimed Health Services ResearchTrondheimNorway

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