The effects of provider contract types and fiscal decentralization on the efficiency of the Polish hospital sector: A data envelopment analysis across 16 health regions

Abstract

BackgroundExpenditures on hospitals constitute a large proportion of total health expenditures. In Poland the share of hospital spending is higher than the European Union average. The efficiency of the Polish hospital sector merits investigation. Research goalThe goal of this study is to estimate the relative technical efficiencies of Polish hospital regions, and to measure the impacts of provider contract types, fiscal decentralization, and the 2017 reform on the relative efficiencies. MethodsUsing data from 16 hospital regions in Poland for the years 2007 to 2019, we estimate relative technical efficiencies and their determinants using a two-stage approach. In the first stage, we apply Data Envelopment Analysis, in which we assume variable returns to scale and an output orientation. In the second stage we use a truncated regression with double bootstrapping. ResultsOur findings are threefold. First, fiscal decentralization may reduce technical efficiency, but the results was not statistically significant. Second, efficiency tended to be higher in regions where a greater proportion of nurses and midwives were offered employment as opposed to consulting contracts. Contract types offered to physicians were not statistically significant. Third, the 2017 reforms seem to have had a positive impact on efficiency to date. ConclusionPolicy makers may wish to consider offering less fiscal autonomy and control to regions and encouraging employment contracts with nurses and midwives.