Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals.

Ricardo Ocaña-Riola,Carmen Pérez-Romero,José Jesús Martín-Martín,Mª Isabel Ortega-Díaz

doi:10.3390/ijerph181910166

Abstract

Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.

Highlights

Fluctuations in the demand for healthcare have an impact on the efficiency of hospitals, which has created uncertainty about the optimal use of installed capacity [1,2,3]
This empirical analysis was performed on a set of general hospitals of public, private, or private partnership (PPP) ownership which make up the Spanish National Health System (SNHS)
The statistical model proposed in this paper represents a methodological innovation for hospital efficiency studies in the field of health economics

Summary

Introduction

Fluctuations in the demand for healthcare have an impact on the efficiency of hospitals, which has created uncertainty about the optimal use of installed capacity [1,2,3] This uncertainty is most intense in hospital emergency departments [4,5,6] and emergency healthcare services [6,7]. This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Hospital ownership structure is related to the mean efficiency index of Spanish National

Objectives

Methods

Discussion

Conclusion