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

• DOI: 10.1007/s10198-010-0263-1
• Publication Date: 2010-07-28T12:12:16Z
• Authors: Emma Medin; Kjartan S. Anthun; Unto Häkkinen; Sverre A. C. Kitt...; Miika Linna; Jon Magnussen; Kim Olsen; Clas Rehnberg
• Keywords: Models, Statistical; Cost-Benefit Analysis; Internship and Residency; Health Care Costs; Scandinavian and Nordic Countries; Training Support; Efficiency, Organizational; 3. Good health; Hospitals, University; 03 medical and health sciences; Education, Medical, Graduate; Humans; Regression Analysis; Health Services Research; Patient Care; 0305 other medical science; Diagnosis-Related Groups; Finland

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.