A mixture model approach to updating payment weights with an application to ICD-10 implementation

Case mix, Cost weights, DRG,

Cost effects of hospital mergers in Portugal

The Portuguese hospital sector has been restructured by wide-ranging hospital mergers, following a conviction among policy makers that bigger hospitals lead to lower average costs. Since the effects of mergers have not been systematically evaluated, the purpose of this article is to contribute to this area of knowledge by assessing potential economies of scale to explore and compare these results with realized cost savings after mergers. Considering the period 2003-2009, we estimate the translog cost function to examine economies of scale in the years preceding restructuring. Additionally, we use the difference-in-differences approach to evaluate hospital centres (HC) that occurred between 2004 and 2007, comparing the years after and before mergers. Our findings suggest that economies of scale are present in the pre-merger configuration with an optimum hospital size of around 230 beds. However, the mergers between two or more hospitals led to statistically significant post-merger cost increases, of about 8 %. This result indicates that some HC become too large to explore economies of scale and suggests the difficulty of achieving efficiencies through combining operations and service specialization

The Organizational Architecture of Nonprofit Governance: Economic Calculation Within an Ecology of Enterprises

This paper treats nonprofit firms as elements within the ecology of enterprises that constitute an economy. Within this ecological framework, nonprofit governance must to a significant extent be guided by economic signals generated through market competition. After we examine the problems of economic calculation that nonprofit enterprises face, we consider the organizational logic of nonprofit firms as one that is driven by the creation of points of contact with the market economy. The operation of this logic creates some general limit on the range and size of nonprofit firms, and also presents issues of governance that differ from those faced by profit-seeking firms. Subsequently, we use our conceptual framework to illuminate some issues concerning the organization of nonprofit firms. Copyright Springer Science+Business Media, LLC 2007agency, economic calculation, entrepreneurship, governance, nonprofit firms, D23, G32, J31, L31, M13,

Opportunity Cost Estimation of Ecosystem Services

Land-use changes rank among the most significant drivers of change in ecosystem services worldwide. The enhancement of important services such as biodiversity and carbon sequestration requires modifications in land-use that can lead to the decline in other ecosystems services. Targeting the most suitable areas for particular land-uses based on comparative advantages requires opportunity cost information across large regions. This is a demanding task because the input-output relations are ill-defined and determined by spatially heterogeneous operational and environmental conditions. To address this methodological challenge, this paper presents a two-stage semiparametric technique that enables multi-dimensional production possibility frontiers to be estimated from data provided by biophysical models. Specific advantages of the proposed frontier approach are its flexibility with regard to assumptions on the convexity of the production possibility set and its freedom from any separability assumptions for the input-output space and the space of the heterogeneous background variables. The method is illustrated for a case study of 18 Central and Eastern European countries. Results show that opportunity costs of changes in ecosystem services provision differ substantially between regions. Those areas having already relatively high levels of carbon sequestration have a comparative advantage in sequestering carbon. Opportunity costs of biodiversity are generally positively related with the level of biodiversity up to a turning point after which they are negatively related. To illustrate the policy consequences of the observed economies and diseconomies of scope we compare two management regimes to illustrate the potential gains from smart land management