Efficiency of physician specialist groups
TL;DR: Overall findings indicate that participation in disease management programs and the degree of specialization are associated with significantly higher technical- cost-, and profit-efficiency for most physician specialist groups, e.g. due to the standardization of processes.
Abstract: This is the first study to use stochastic frontier analysis to simultaneously estimate the technical, cost and profit efficiency of physician practices for different physician specialist groups. We base our analysis on a unique panel data set of 4964 physician practices in Germany for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician characteristics and practice characteristics. Additionally we consider a wide range additional variables not previously analyzed in this context (e.g. sub-specialization of physician groups and environmental factors such as physician density in the area). We investigate differences in cost, technical and profit efficiency utilizing production−/cost- and profit-functions with a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data following Battese and Coelli (Empir Econ 20(2): 325–332, 10). Overall findings indicate that participation in disease management programs and the degree of specialization are associated with significantly higher technical- cost-, and profit-efficiency for most physician specialist groups, e.g. due to the standardization of processes. In addition, our analyses show that group practices perform significantly better than single practices. This may be due to indivisibilities in expensive technical equipment, which can lead to different health care services being provided by different practice types. A more thorough look at specialist groups suggests that it is important to investigate all efficiency types for different physician groups, as results may depend on the type of efficiency analyzed as well as the physician group in question.
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TL;DR: This paper demonstrates, conceptually and through simulation, that it is not appropriate to use imputations of the dependent variable within the SFA modelling, although they can be useful to predict the values of missing explanatory variables.
14 citations
TL;DR: It is indicated that patient migration plays an important role in contributing to regional differences in the utilisation of the medical infrastructure and policy should take spatial patterns of health care utilisation into account to improve the allocation of medical resources.
Abstract: The German health care system is among the most patient-oriented systems in Europe. Nevertheless, distinct utilisation patterns, access barriers due to socio-economic profiles, and potentials of misallocation of medical resources lead to disparities in the provision of health care services. We analyse how a possible over- and undersupply of services and the utilisation of and the access to the health care system relate to regional variations in the population’s well-being. For this purpose, we employ a recent Bayesian stochastic frontier approach that allows for spatial dependence structures. Our results indicate that patient migration plays an important role in contributing to regional differences in the utilisation of the medical infrastructure. As a consequence, policy should take spatial patterns of health care utilisation into account to improve the allocation of medical resources.
7 citations
TL;DR: In this paper, a scoping review was performed based on the methodology proposed by Arksey and O'Malley, and refined by Levac et al. to identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems.
Abstract: Objective To identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems. Study design A scoping review was performed based on the methodology proposed by Arksey and O’Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quantitative analysis was performed to assess the type, year and region of publication, as well as the population studied. A qualitative descriptive analysis was performed to identify common themes. Study setting MEDLINE, EMBASE and Cochrane databases were searched from database inception to October 2018 for papers which assessed outcomes relevant to the research question. Results Our search strategy returned 2408 papers and 98 were included in the final analysis. Most papers were from the USA, were surveys and assessed physician outcomes. Advantages of group practices for patients included improved satisfaction and quality of care. Studies of physicians reported improved quality of life and income, while disadvantages included increased stress due to poor interpersonal relationships. Studies of healthcare systems reported improved efficiency and better utilisation of resources. Conclusions Group practices have many benefits for patients and physicians. However, further work needs to be done assessing patient outcomes and establishing the elements that make a group practice successful.
5 citations
TL;DR: It is demonstrated that an increase in the number of operations performed by a surgeon significantly reduces operating room inefficiency, whereas the revision of the fee-for-service schedule for surgical treatments does not have a significant impact on inefficiency.
Abstract: Japan’s healthcare expenditures, which are largely publicly funded, have been growing dramatically due to the rapid aging of the population as well as the innovation and diffusion of new medical technologies Annual costs for surgical treatments are estimated to be approximately USD 20 billion Using unique longitudinal clinical data at the individual surgeon level, this study aims to estimate the technical efficiency of surgical treatments across surgical specialties in a high-volume Japanese teaching hospital by employing stochastic frontier analysis (SFA) with production frontier models We simultaneously examine the impacts of potential determinants that are likely to affect inefficiency in operating rooms Our empirical results show a relatively high average technical efficiency of surgical production, with modest disparity across surgical specialties We also demonstrate that an increase in the number of operations performed by a surgeon significantly reduces operating room inefficiency, whereas the revision of the fee-for-service schedule for surgical treatments does not have a significant impact on inefficiency In addition, we find higher technical efficiency among surgeons who perform multiple daily surgeries than those who perform a single operation in a day We suggest that it is important for hospital management to retain efficient surgeons and physicians and provide efficient healthcare services given the competitive Japanese healthcare market
4 citations
TL;DR: In this paper , the authors explore different triadic patterns between general practitioners and medical specialists by applying exponential random graph models to study the structure of one patient-sharing network by differentiating between these two mechanisms.
Abstract: The sharing of patients reflects collaborative relationships between various healthcare providers. Patient-sharing in the outpatient sector is influenced by both physicians' activities and patients' preferences. Consequently, a patient-sharing network arises from two distinct mechanisms: the initiative of the physicians on the one hand, and that of the patients on the other. We draw upon medical claims data to study the structure of one patient-sharing network by differentiating between these two mechanisms. Owing to the institutional requirements of certain healthcare systems rather following the Bismarck model, we explore different triadic patterns between general practitioners and medical specialists by applying exponential random graph models. Our findings imply deviation from institutional expectations and reveal structural realities visible in both networks.
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TL;DR: In this paper, the authors define the disturbance term as the sum of symmetric normal and (negative) half-normal random variables, and consider various aspects of maximum-likelihood estimation for the coefficients of a production function with an additive disturbance term of this sort.
8,058 citations
Book•
30 Nov 1997
TL;DR: This book is the first systematic survey of performance measurement with the express purpose of introducing the field to a wide audience of students, researchers, and practitioners.
Abstract: The second edition of An Introduction to Efficiency and Productivity Analysis is designed to be a general introduction for those who wish to study efficiency and productivity analysis. The book provides an accessible, well-written introduction to the four principal methods involved: econometric estimation of average response models; index numbers, data envelopment analysis (DEA); and stochastic frontier analysis (SFA). For each method, a detailed introduction to the basic concepts is presented, numerical examples are provided, and some of the more important extensions to the basic methods are discussed. Of special interest is the systematic use of detailed empirical applications using real-world data throughout the book. In recent years, there have been a number of excellent advance-level books published on performance measurement. This book, however, is the first systematic survey of performance measurement with the express purpose of introducing the field to a wide audience of students, researchers, and practitioners. Indeed, the 2nd Edition maintains its uniqueness: (1) It is a well-written introduction to the field. (2) It outlines, discusses and compares the four principal methods for efficiency and productivity analysis in a well-motivated presentation. (3) It provides detailed advice on computer programs that can be used to implement these performance measurement methods. The book contains computer instructions and output listings for the SHAZAM, LIMDEP, TFPIP, DEAP and FRONTIER computer programs. More extensive listings of data and computer instruction files are available on the book's website: (www.uq.edu.au/economics/cepa/crob2005).
7,616 citations
6,067 citations
"Efficiency of physician specialist ..." refers background in this paper
...[34] and Meeusen and van Den Broeck [35]....
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...Early work on frontier functions is credited to research by Aigner and Chu [33], while the methodology of utilizing production frontiers to estimate efficiency was independently proposed by Aigner et al. [34] and Meeusen and van Den Broeck [35]....
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TL;DR: In this paper, a stochastic frontier production function is defined for panel data on firms, in which the nonnegative technical inefficiency effects are assumed to be a function of firm-specific variables and time.
Abstract: A stochastic frontier production function is defined for panel data on firms, in which the non-negative technical inefficiency effects are assumed to be a function of firm-specific variables and time. The inefficiency effects are assumed to be independently distributed as truncations of normal distributions with constant variance, but with means which are a linear function of observable variables. This panel data model is an extension of recently proposed models for inefficiency effects in stochastic frontiers for cross-sectional data. An empirical application of the model is obtained using up to ten years of data on paddy farmers from an Indian village. The null hypotheses, that the inefficiency effects are not stochastic or do not depend on the farmer-specific variables and time of observation, are rejected for these data.
5,783 citations
"Efficiency of physician specialist ..." refers methods in this paper
...A review by Coelli et al. [36] found that no particular efficiencymethodology has been established as a standard to date....
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...Huang and Liu [38], generalized to panel data following the specification of Battese and Coelli [10]....
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...[30] estimated technical efficiency of physicians and ambulatory surgery centers using data from diabetes and cataract-patients, respectively A study by Rosenman and Friesner [10] was the first to estimate both cost and technical efficiency of physician practices, albeit only using cross sectional data for the analysis....
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...Especially in regard to the robustness and reliability of SFA (being a parametric method), studies in the hospital sector have shown that panel data is preferable over cross-sectional data [20, 31, 32] Rosenman and Friesner find that there are scope inefficiencies from combining different types of providers into a single practice, with most of the inefficiency resulting from technical rather than allocative inefficiencies....
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...The paper utilizes the comprehensive one-step approach of Battese and Coelli (1995) [10] and is based on data from 4964 physician practices in Germany for the years 2008– 2010....
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TL;DR: In this paper, the authors developed asymptotic distribution theory for instrumental variable regression when the partial correlation between the instruments and a single included endogenous variable is weak, here modeled as local to zero.
Abstract: This paper develops asymptotic distribution theory for instrumental variable regression when the partial correlation between the instruments and a single included endogenous variable is weak, here modeled as local to zero. Asymptotic representations are provided for various instrumental variable statistics, including the two-stage least squares (TSLS) and limited information maximum- likelihood (LIML) estimators and their t-statistics. The asymptotic distributions are found to provide good approximations to sampling distributions with just 20 observations per instrument. Even in large samples, TSLS can be badly biased, but LIML is, in many cases, approximately median unbiased. The theory suggests concrete quantitative guidelines for applied work. These guidelines help to interpret Angrist and Krueger's (1991) estimates of the returns to education: whereas TSLS estimates with many instruments approach the OLS estimate of 6%, the more reliable LIML and TSLS estimates with fewer instruments fall between 8% and 10%, with a typical confidence interval of (6%, 14%).
5,249 citations