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

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Abstract

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.

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Notes

  1. Iceland is not included in this study because of dissimilarities in output data.

  2. The university hospitals are defined in http://www.sum.dk/publikationer/offentligg_produktivitet_sygehus_tredje_drap/html/index.htm.

  3. In 2004, two university hospitals in Stockholm County were merged (with expectations on economies of scale in health care production and research activities) into one super specialised university hospital creating the largest university hospital in northern Europe. These hospitals are included as one single hospital in the study.

  4. The university hospitals are defined in http://www.sintef.no/Projectweb/Startsiden/Om-SAMDATA.

  5. One Swedish university hospital was excluded because of missing data.

  6. In the Swedish data teaching costs are included in operating costs.

  7. In Sweden, the cost figures are based on governmental funding of medical research and in Finland and Norway on governmental funding of medical teaching and research.

  8. Under the assumption that materials, equipment and rents take a share of 30 percent from the total operating costs, the country-specific shares of doctors and nurses, according to OECD health data 2007, yield the following results: Sweden: 17.1 percent and 52.9 percent; Norway: 13.5 percent and 56.5 percent, Finland: 17.1 percent and 52.9 percent and Denmark: 21.9 percent and 48.1 percent.

  9. The quality of a bibliometric analysis improves with increasing coverage of publications in the area. ISI Thomson Scientific received excellent coverage of publications in the subject area of clinical medicine in a recent study.

  10. The indicator shows the share of publications attributed to a unit that belongs to the five percent most cited publications in the world from the same year, in the same subject and of the same document type.

  11. The indicator corresponds to the relative number of citations of publications from a specific unit compared to the world average of citations of publications of the same document type, age and subject area. As an example, 0.9 implies that a unit’s publications are cited 10 percent below average and 1.2 that they are cited 20 percent above average.

  12. The citation window is 2002–2009.

  13. The data collections were made on Aug 12 2009 (except for the Swedish data for 2002, which were drawn between March 24 and April 2 2009). Data are derived from the 1995–2004 Science Citation Index Expanded, Social Sciences Citation Index and Arts & Humanities Citation Index Tagged data prepared by the Thomson Scientific Inc (TS), Philadelphia, Pennsylvania, USA: ©Copyright Thomson Scientific Inc® 2006. All rights reserved.

  14. Available from sverre.kittelsen@frisch.uio.no upon request.

  15. Release 9.1. SAS Institute, Inc. Cary, NC, USA.

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Authors and Affiliations

  1. Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, Sweden

    Emma Medin & Clas Rehnberg

  2. SINTEF Health Research, 7465, Trondheim, Norway

    Kjartan S. Anthun

  3. Centre for Health and Social Economics, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland

    Unto Häkkinen & Miika Linna

  4. Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349, Oslo, Norway

    Sverre A. C. Kittelsen

  5. Department of Public Health and Community Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway

    Jon Magnussen

  6. Danish Institute for Health Services Research, 2100, Copenhagen, Denmark

    Kim Olsen

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  1. Emma Medin
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Medin, E., Anthun, K.S., Häkkinen, U. et al. Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis. Eur J Health Econ 12, 509–519 (2011). https://doi.org/10.1007/s10198-010-0263-1

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