Does prospective payment increase hospital (in)efficiency? Evidence from the Swiss hospital sector

Several European countries have followed the United States in introducing prospective payment for hospitals with the expectation of achieving cost efficiency gains. This article examines whether theoretical expectations of cost efficiency gains can be empirically confirmed. In contrast to previous studies, the analysis of Switzerland provides a comparison of a retrospective per diem payment system with a prospective global budget and a payment per patient case system. Using a sample of approximately 90 public financed Swiss hospitals during the years 2004 to 2009 and Bayesian inference of a standard and a random parameter frontier model, cost efficiency gains are found, particularly with a payment per patient case system. Payment systems designed to put hospitals at operating risk are more effective than retrospective payment systems. However, hospitals are heterogeneous with respect to their production technologies, making a random parameter frontier model the superior specification for Switzerland.Hospital inefficiency, prospective payment system, Bayesian inference, stochastic frontier analysis

Public Good Provision in a Federalist Country: Tiebout Competition, Fiscal Equalization, and Incentives for Efficiency in Switzerland

The purpose of this paper is twofold. First, it measures the efficiency in the provision of public goods by local jurisdictions applying Data Envelopment Analysis (DEA). Second, it relates ef- ficiency scores to a fiscal equalization scheme designed to mitigate the negative consequences of Tiebout competition. The data come from the 26 cantons of Switzerland (2000-2004), a country characterized by marked federalism. Results show the equalization scheme to indeed have a negative influence on performance, resulting in an efficiency-equity trade-off (Stiglitz, 1988). However, substitution of earmarked payments by lump-sum payments as part of the 2008 reform is likely to enhance cantonal performance.DEA, efficiency measurement, federalism, fiscal equalization, public finance, Switzerland, Tiebout competition

Accounting for heterogeneity in the measurement of hospital performance

With prospective payment of hospitals becoming more common, measuring their performance is gaining in importance. However, the standard cost frontier model yields biased efficiency scores because it ignores technological heterogeneity between hospitals. In this paper, efficiency scores are derived from a random intercept and an extended random parameter frontier model, designed to overcome the problem of unobserved heterogeneity in stochastic frontier analysis. Using a sample of 100 Swiss hospitals covering the years 2004 to 2007 and applying Bayesian inference, significant heterogeneity is found, suggesting rejection of the standard cost frontier model. Estimated inefficiency decreases even below the 14 percent reported by Hollingsworth (2008) for European countries. Accounting for unobserved heterogeneity would make hospitals rated below 85 percent efficiency according to the standard model gain up to 12 percentage points, serving to highlight the importance of heterogeneity correction in the estimation of hospital performance.Hospital efficiency, unobserved heterogeneity, Bayesian inference, Switzerland, stochastic frontier analysis

Efficient provision of electricity for the United States and Switzerland

This study applies financial portfolio theory to determine efficient frontiers in the provision of electricity for the United States and Switzerland. Expected returns are defined by the rate of productivity increase of power generation (adjusted for external costs), volatility, by its standard deviation. Since unobserved productivity shocks are found to be correlated, Seemingly Unrelated Regression Estimation (SURE) is used to filter out the systematic component of the covariance matrix of the productivity changes. Results suggest that as of 2003, the feasible maximum expected return (MER) electricity portfolio for the United States contains more Coal, Nuclear, and Wind than actual but markedly less Gas and Oil. The minimum variance (MV) portfolio contains markedly more Oil, again more Coal, Nuclear, and Wind but almost no Gas. Regardless of the choice between MER and MV, U.S. utilities are found to lie substantially inside the efficient frontier. This is even more true of their Swiss counterparts, likely due to continuing regulation of electricity markets.Efficiency frontier, energy, electricity, portfolio theory, Seemingly Unrelated Regression Estimation (SURE)

Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty

Recommendations for cup containment and impingement may provide conflicting directions for component orientation in total hip arthroplasty. For optimal containment, the cup is positioned with respect to the acetabular bone, resulting in coincidence of the rim of the cup and the acetabulum. This results in good coverage and symmetric load transfer, leading to good long-term stability, but occasionally necessitates more abduction of the cup than that recommended by the safe zone. On the other hand, placement of the cup for an optimal range of motion would lead to only partial containment, with a higher risk of component loosening and revision. The most effective compromise is to use a prosthesis that has a large safe zone, realised by a high head-to-neck ratio, and orienting the cup such that a good containment is achieved and the safe zone is respected. Computer navigation or smart aiming devices may help to find the best relative orientatio

Towards Grower-friendly Apple Crop Thinning by Tree Shading

Light management with shading nets, which reduce sunlight by 74%, might be an alternative to chemicals commonly used for thinning on apple trees. To study the effect of shading on crop load and fruit quality, trials were conducted in field experiments with the cultivars Golden Delicious and Elstar in 2006. Trees were either covered 25 days after full bloom (DAFB) with a net during three days, or until the peak of fruit fall, observed after seven days shading. Ideal time length for optimal crop yield was seven days shading for Elstar and three days shading for Golden Delicious. Alternate bearing could be decreased as flower initiation counts the following year showed. In both experiments, inner quality of fruit such as sugar and firmness showed good values at optimal shading duration compared with chemical + hand thinning. In 2007, a second field trial was conducted with cultivars Golden Delicious and Topaz to study the time period for shading in further detail. Shading was done for three days at 19, 26 and 33 DAFB using two net types (three- and two-meter-net width, covering the trees entirely or only down to 50 cm above ground). For Golden Delicious, shading after 19 and 26 days reduced fruits per 100 flower cluster to the same extent as with chemical + hand thinning. There was no difference between the two net types. For Topaz, shading after 19 days showed the best results. Regarding inner quality of both cultivars, only sugar content for Golden Delicious could be significantly improved after 19 and 26 days shading. Further analyses are still under way (e.g. for acidity). This study is part of an effort for increasing European consumption with fruit from sustainable production systems, the ISAFRUIT-EU-project

Avalanches and Dynamical Correlations in supercooled liquids

We identify the pattern of microscopic dynamical relaxation for a two dimensional glass forming liquid. On short timescales, bursts of irreversible particle motion, called cage jumps, aggregate into clusters. On larger time scales, clusters aggregate both spatially and temporally into avalanches. This propagation of mobility, or dynamic facilitation, takes place along the soft regions of the systems, which have been identified by computing isoconfigurational Debye-Waller maps. Our results characterize the way in which dynamical heterogeneity evolves in moderately supercooled liquids and reveal that it is astonishingly similar to the one found for dense glassy granular media.Comment: 4 pages, 3 figure

Irreversible reorganization in a supercooled liquid originates from localised soft modes

The transition of a fluid to a rigid glass upon cooling is a common route of transformation from liquid to solid that embodies the most poorly understood features of both phases1,2,3. From the liquid perspective, the puzzle is to understand stress relaxation in the disordered state. From the perspective of solids, the challenge is to extend our description of structure and its mechanical consequences to materials without long range order. Using computer simulations, we show that the localized low frequency normal modes of a configuration in a supercooled liquid are causally correlated to the irreversible structural reorganization of the particles within that configuration. We also demonstrate that the spatial distribution of these soft local modes can persist in spite of significant particle reorganization. The consequence of these two results is that it is now feasible to construct a theory of relaxation length scales in glass-forming liquids without recourse to dynamics and to explicitly relate molecular properties to their collective relaxation.Comment: Published online: 20 July 2008 | doi:10.1038/nphys1025 Available from http://www.nature.com/nphys/journal/v4/n9/abs/nphys1025.htm

On the Study of Collective Dynamics in Supercooled Liquids through the Statistics of the Iso-Configurational Ensemble

The use of the isoconfigurational ensemble to explore structure-dynamic correlations in supercooled liquids is examined. The statistical error of the dynamic propensity and its spatial distribution are determined. The authors present the spatial distribution of the particle non-Gaussian parameter as a measure of the intermittency with which particles exhibit their propensity for motion. The ensemble average of the direction of particle motion is introduced to establish the anisotropy of the dynamic propensity.Comment: Published - see below or http://link.aip.org/link/?JCPSA6/126/154503/

High-quality lowest-frequency normal mode strain observations at the Black Forest Observatory (SW-Germany) and comparison with horizontal broad-band seismometer data and synthetics

International audienceWe present spectra concentrating on the lowest-frequency normal modes of the Earth obtained from records of the invar-wire strainmeters and STS-1 broad-band seismometers located in the Black Forest Observatory, Germany after the disastrous earthquakes off the NW coast of Sumatra in 2004 and off the coast near Tohoku, Japan in 2011. We compare the spectra to ones obtained from synthetic seismograms computed using a mode summation technique for an anelastic, elliptical, rotating, spherically symmetric Earth model. The synthetics include strain– strain-coupling effects by using coupling coefficients obtained from comparisons between Earth tide signals recorded by the strainmeters and synthetic tidal records. We show that for the low-frequency toroidal and spheroidal modes up to 1 mHz, the strainmeters produce better signal-to-noise ratios than the broad-band horizontal seismometers. Overall, the comparison with the synthetics is satisfactory but not as good as for vertical accelerations. In particular, we demonstrate the high quality of the strainmeter data by showing the Coriolis splitting of toroidal modes for the first time in individual records, the first clear observation of the singlet 2 S 0 1 and the detection of the fundamental radial mode 0 S 0 with good signal-to-noise ratio and with a strain amplitude of 10 −11. We also identify the latter mode in a record of the Isabella strainmeter after the great Chilean quake in 1960, the detection of which was missed by the original studies