Hospital Cost AnalysisSpringer Science & Business Media, 31. 1. 1995 - Počet stran: 393 Hospital Cost Analysis provides an overview of theoretical developments in the economic analysis of production and costs in the multiproduct firm, and discusses these developments. Following a lucid explanation of the concepts of jointness, input/output separability and returns to scale, a detailed discussion of the concept measurement and classification of hospital output is provided. A fundamental dilemma confronting economists interested in estimating hospital cost functions is highlighted, viz. the trade-off between flexibility in functional form and homogeneity within hospital output categories. Empirical results on the effects of case mix, scale and utilisation, public/private ownership, and the centralised administration of hospital systems on hospital costs are presented. The implications of hospital cost analysis for public policy with respect to hospital payment schemes, including schemes based on Diagnosis Related Groups (DRGs), are also considered. This book brings together the literature on hospital cost analysis with theoretical developments in the analysis of the multiproduct cost functions. It will be of considerable interest to teachers and students of health economics and health policy advisers interested in the determinants of hospital costs and the design of hospital payment schemes. |
Obsah
Introduction | xxiii |
THEORETICAL CONSIDERATIONS | 5 |
The Economic Theory of Production and Cost in the Multiproduct Firm | 7 |
22 Multiproduct Production Functions | 9 |
222 InputOutput Separability | 13 |
223 Returns to Scale | 14 |
23 Multiproduct Cost Functions | 15 |
232 InputOutput Separability | 19 |
72 Theory and Specification | 216 |
722 Teaching Output and the Specification of the Cost Function | 221 |
73 Differences Between Teaching and Non Teaching Hospitals | 222 |
732 CostVolume Differences | 223 |
733 Case Mix Differences18 and 47 Diagnostic Categories | 226 |
734 Case Mix DifferencesOther Case Mix Dimensions | 232 |
74 Empirical Results on the Effects of Teaching on Hospital Costs | 233 |
75 Summary and Conclusions | 245 |
234 NonJointness and InputOutput Separability | 22 |
235 InputOutput Separability and Overall Constant Returns to Scale | 24 |
237 NonJointness InputOutput Separability and Overall Constant Returns to Scale | 27 |
24 Joint and Common Costs | 28 |
25 Specific Functional Forms | 31 |
251 The Generalised LinearGeneralised Leontief Cost Function | 32 |
252 The Translog Cost Function | 34 |
26 Selected Empirical Examples | 35 |
27 Summary and Conclusions | 39 |
NonJointness Overall and ProductSpecific Returns to Scale | 41 |
The Concept Measurement and Classification of Hospital Output | 43 |
32 Conceptual Issues | 44 |
322 The Concept of Output | 46 |
33 The Unit of Measurement | 53 |
332 Cases vs Days | 57 |
34 The Classification of Output | 66 |
341 Case Mix Classification Schemes | 67 |
342 Scalar Case Mix Indexes | 74 |
35 Summary and Conclusions | 80 |
EMPIRICAL RESULTS | 83 |
The Queensland Public Hospital SystemAn Overview | 85 |
43 Interstate Differences | 88 |
44 Summary and Conclusions | 95 |
The Effect of Case Mix on Hospital CostsEvidence from Queensland | 99 |
53 The Data | 107 |
532 Hospital Finance Data | 108 |
54 Descriptive Statistics | 109 |
55 Empirical Results | 115 |
552 The Multicollinearity Problem | 127 |
553 Principal Components Analysis | 133 |
554 Information Theory Indexes | 142 |
56 Summary and Conclusions | 153 |
Characteristic Roots Characteristic Vectors and Multicollinearity | 156 |
The Derivation of Principal Components | 163 |
The Effects of Scale Utilisation and Input Prices on Hospital CostsEvidence from Queensland | 169 |
62 Definition and Measurement Issues | 171 |
622 Measuring Scale and Utilisation | 173 |
623 Measuring Input Price Differences | 176 |
Specification | 177 |
64 Descriptive Statistics | 185 |
65 Empirical Results | 188 |
652 Scale and Utilisation with Disaggregated Case Mix Classifications197879 to 198081 | 204 |
653 Scale and Utilisation with Information Theory Case Mix Indexes197778 | 206 |
654 Input Price Differences | 211 |
66 Summary and Conclusions | 212 |
A Comparison of the Costs of Teaching and NonTeaching Public Hospitals in Queensland | 215 |
A Comparison of Public and Private Hospital Costs in Queensland | 247 |
82 Theoretical Background | 248 |
83 Differences between Public and Private Hospitals in Queensland | 253 |
832 Private Hospital Data | 254 |
833 CostVolume Differences | 255 |
834 Case Mix Differences | 256 |
84 Empirical Analysis of Cost Differences | 260 |
841 Specification | 261 |
843 Results with Public Hospital Medical Salaries and Private Hospital Outpatient Costs Excluded | 265 |
85 Summary and Conclusions | 268 |
A Comparison of Public Hospital Costs in Queensland and New South Wales | 271 |
92 The Grants Commission Procedures | 273 |
93 Descriptive Statistics | 275 |
932 CostVolume Characteristics | 276 |
Case Mix Differences | 278 |
94 Empirical Results on the Causes of Interstate Cost Differences | 279 |
941 Separate State Estimates | 282 |
Pooled Results | 286 |
943 Effects of Other Adjustments | 290 |
95 Summary and Conclusions | 293 |
HOSPITAL COST ANALYSIS AND HOSPITAL PAYMENT SCHEMES | 295 |
A Hospital Performances Appraisal and Payment Scheme based on Estimated Cost Functions | 297 |
1022 The Cost per CaseCost per DayLength of Stay Relationship | 302 |
1023 Cost per Day Predictions | 303 |
1024 Length of Stay Predictions | 304 |
1025 Disaggregating Cost per Case by Input Components | 306 |
1031 The Estimated Cost per Day Equations | 307 |
1032 Costliness Ratios and the Relative Stay Index | 311 |
1033 Prediction Intervals and Costliness Ratios for Input Components | 316 |
104 Some Problems | 321 |
1042 Multicollinearity and Prediction | 322 |
1043 Replication with other Methods of Estimation | 323 |
105 Summary and Conclusions | 324 |
Proof that the Sum of Predicted Input Component Costs per Case Equals Predicted Average Cost per Case | 326 |
The DRG Hospital Payment Scheme Some Economic Aspects | 329 |
112 The DRO Hospital Payment Scheme | 331 |
113 Hospital Costs and the DRG Payment Scheme | 333 |
1132 Application to the DRG Payment Scheme | 336 |
114 Predicting Hospital Case Mix | 342 |
115 Summary and Conclusions | 350 |
Conclusion | 353 |
References | 361 |
Index of Names | 378 |
384 | |
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47 diagnostic category additional case mix aggregation analysis average and marginal average cost average length beds chapter characteristic roots classification scheme coefficients Commonwealth Grants Commission correlation cost function cost per day Costliness Ratios diagnostic category classification differences disaggregated discussed diseconomies of scale economies of scale effects empirical flow rate functional form health status Hospital Morbidity Data hospital output hospital's increase indicates information theory information theory index inpatient input component input prices input/output separability length of stay linear marginal cost matrix mean measure mix categories mix dimensions mix index mix proportions multicollinearity non-jointness Nurse occupancy output categories parameter estimates patients payment scheme prediction interval principal components private hospitals problem production function Queensland Public Hospitals reduce average cost relative returns to scale scale and utilisation separable cost South Wales specification t-value teaching hospitals teaching status total cost treated treatment unit of output variation in average y₂
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