Heterogenety in hospitals responses to a financial reform: A random coefficient analysis of the impact of activity-based financing on efficiency

The paper examines the heterogeneity with respect to the impact of a financial reform - Activity Based Financing (ABF) - on hospital efficiency in Norway. Measures of technical efficiency and of cost-efficiency are considered. The data set is from a contiguous ten-year panel of 47 hospitals covering both pre-ABF years and years after its imposition. Substantial heterogeneity in the responses, as measured by both estimated and predicted coefficients, is found. Rank correlations between the estimated/predicted coefficients of the ABF dummy and the pre-ABF/post-ABF efficiencies are examined. Overall, improvement seems to be more pronounced in technical efficiency than in cost-efficiency.Health econometrics; Panel data; Hospital efficiency; Activity-based financing; Random coefficients; Heterogeneity; Rank Correlation

The Effect of Activity-Based Financing on Hospital Efficiency: A Panel Data Analysis of DEA Efficiency Scores 1992-2000

Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction (30 to 50 per cent) of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF compared with global budgets. The prediction is tested using a panel data set from the period 1992-2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. Contrary to our prediction, the result is less uniform with respect to the effect on cost-efficiency. We suggest several reasons why this prediction fails. Keywords are poor information of costs, production-oriented drive, tight factor markets and soft budget constraints.Public Hospitals; Financing; Efficiency; DEA Scores; Panel Data; Norway

The effect of activity-based financing on hospital efficiency: A panel data analysis of DEA efficiency scores 1992-2000

Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction (30 to 50 per cent) of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF compared with global budgets. The prediction is tested using a panel data set from the period 1992-2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. Contrary to our prediction, the result is less uniform with respect to the effect on cost-efficiency. We suggest several reasons why this prediction fails. Keywords are poor information of costs, production-oriented drive, tight factor markets and soft budget constraints.Public hospitals; financing; efficiency; DEA-scores; panel data; Norway

Centralized or decentralized? A case study of Norwegian hospital reform

In recent years, decentralization of financial and political power has been perceived as a useful means to improve outcomes of the health care sector. Such reforms are often a result of fashion, rather than being based on knowledge of “what works”. If decentralization is the favored strategy in health care, studies of countries that go against the current trend will be of interest and importance as they provide information about the potential drawbacks of decentralization. In Norway, specialized health care has recently been recentralized. In this paper, we review some of the evidence now available on its economic effects. The most striking observation is that recentralization did not affect the variables related to cost containment and soft budgeting.Health care system; decentralization; recentralization; Norway.

Sykehusenes effektivitetsutvikling 1992-1999: Hvilke effekter ga innsatsstyrt finansiering?

Innsatsstyrt finansiering (ISF) ble innført for somatiske sykehus i Norge fra 1.7.1997. ISF innebærer at deler av fylkeskommunenes utgifter til behandling av inneliggende pasienter refunderes av staten. Refusjonen avhenger av antall og sammensetning av behandlede pasienter, og refusjonen var i 1999 på 50 prosent. Ordningen medfører samtidig at staten tilfører fylkeskommunene mindre frie inntekter enn før. En forskningsrapport fra Terje P. Hagen, Jon Magnussen og Tor Iversen viser at effektiviteten i de regionale og sentrale sykehusene har økt ved at flere får behandling i forhold til antall ansatte, men et negativt trekk er at kostnadene pr. pasient også øker. Ett av hovedmålene med ISF var å oppmuntre fylkeskommuner og sykehus til å øke antall behandlede pasienter uten at sykehusenes effektivitet ble redusert. Som en del av ISF har helsemyndighetene satt en prislapp på ulike sykehustjenestene. Slik skal sykehusene se sammenheng mellom inntekt og produksjon. Om et sykehus klarer å behandle flere pasienter, skal de ved ISF få større inntekter. Rapporten "Sykehusenes effektivitetsutvikling 1992-1999: Hvilke effekter ga innsatsstyrt finansiering?" er gjort på oppdrag fra Sosial- og helsedepartementet.Sykehusfinasiering; innsatsstyrt finansiering; ISF; effektivitet på sykehus

Dihydroartemisinin-piperaquine versus artesunate-amodiaquine for treatment of malaria infection in pregnancy in Ghana: an open-label, randomized, non-inferiority trial.

To determine whether dihydroartemisinin-piperaquine (DHA-PPQ) is non-inferior to artesunate-amodiaquine (ASAQ) for treating uncomplicated malaria infection in pregnancy. 417 second/ third trimester pregnant women with confirmed asymptomatic Plasmodium falciparum parasitaemia were randomized to receive DHA-PPQ or ASAQ over 3 days. Women were followed up on days 1, 2, 3, 7, 14, 28 and 42 after treatment start and at delivery for parasitological, haematological, birth outcomes and at 6-weeks post-partum to ascertain the health status of the babies. Parasitological efficacy (PE) by days 28 and 42 were co-primary outcomes. Analysis was per-protocol (PP) and modified intention-to-treat (ITT). Non-inferiority was declared if the two-sided 95% confidence interval for PE at the endpoints excluded 5% lower efficacy for DHA-PPQ. Secondary outcomes were assessed for superiority. In PP analysis, PE was 91.6% for DHA-PPQ and 89.3% for ASAQ by day 28 and 89.0% and 86.5% respectively by day 42. DHA-PPQ was non-inferior to ASAQ with respect to uncorrected PE {adjusted difference by day 28 (DHA-PPQ-ASAQ); 3.5% (95%CI: -1.5, 8.5) and day 42: 3.9% (95%CI: -2.7, 10.4)}. ITT analysis gave similar results. PCR to distinguish recrudescence and reinfection was unsuccessful. DHA-PPQ recipients had fewer adverse events of vomiting, dizziness and general weakness compared to ASAQ. Both drugs were well-tolerated and there was no excess of adverse birth outcomes. DHA-PPQ was non-inferior to ASAQ for treatment of malaria infection during pregnancy. No safety concerns were identified. Our findings contribute to growing evidence that DHA-PPQ is useful for control of malaria in pregnancy. This article is protected by copyright. All rights reserved

Modeling the effects of concentration of solid nanoparticles in liquid feedstock injection on high-velocity suspension flame spray process

This paper presents the effects of the concentration of solid nanoparticles in the liquid feedstock injection on the high-velocity suspension flame spray (HVSFS) process. Four different concentrations of solid nanoparticles in suspension droplets with various droplet diameters are used to study gas dynamics, vaporization rate, and secondary breakup. Two types of injections, viz. surface and group, are used. The group-type injection increases the efficiency of droplet disintegration and the evaporation process and reduces the gas cooling. The initiation of the fragmentation process is difficult for small droplets carrying a high concentration of nanoparticles. Also, smaller droplets undergo rapid vaporization, leaving clogs of nanoparticles in the middle of the barrel. For larger droplets, severe fragmentation occurs inside the combustion chamber. For a higher concentration of nanoparticles, droplets exit the gun without complete evaporation. The results suggest that, in coating applications involving a higher concentration of nanoparticles, smaller droplet sizes are preferred

Surface Screening Charge and Effective Charge

The charge on an atom at a metallic surface in an electric field is defined as the field-derivative of the force on the atom, and this is consistent with definitions of effective charge and screening charge. This charge can be found from the shift in the potential outside the surface when the atoms are moved. This is used to study forces and screening on surface atoms of Ag(001) c$(2\times 2)$ -- Xe as a function of external field. It is found that at low positive (outward) fields, the Xe with a negative effective charge of -0.093 $|{e}|$ is pushed into the surface. At a field of 2.3 V \AA$^{-1}$ the charge changes sign, and for fields greater than 4.1 V \AA$^{-1}$ the Xe experiences an outward force. Field desorption and the Eigler switch are discussed in terms of these results.Comment: 4 pages, 1 figure, RevTex (accepted by PRL

Atomic layering at the liquid silicon surface: a first- principles simulation

We simulate the liquid silicon surface with first-principles molecular dynamics in a slab geometry. We find that the atom-density profile presents a pronounced layering, similar to those observed in low-temperature liquid metals like Ga and Hg. The depth-dependent pair correlation function shows that the effect originates from directional bonding of Si atoms at the surface, and propagates into the bulk. The layering has no major effects in the electronic and dynamical properties of the system, that are very similar to those of bulk liquid Si. To our knowledge, this is the first study of a liquid surface by first-principles molecular dynamics.Comment: 4 pages, 4 figures, submitted to PR

Surface Structure of Liquid Metals and the Effect of Capillary Waves: X-ray Studies on Liquid Indium

We report x-ray reflectivity (XR) and small angle off-specular diffuse scattering (DS) measurements from the surface of liquid Indium close to its melting point of $156^\circ$C. From the XR measurements we extract the surface structure factor convolved with fluctuations in the height of the liquid surface. We present a model to describe DS that takes into account the surface structure factor, thermally excited capillary waves and the experimental resolution. The experimentally determined DS follows this model with no adjustable parameters, allowing the surface structure factor to be deconvolved from the thermally excited height fluctuations. The resulting local electron density profile displays exponentially decaying surface induced layering similar to that previously reported for Ga and Hg. We compare the details of the local electron density profiles of liquid In, which is a nearly free electron metal, and liquid Ga, which is considerably more covalent and shows directional bonding in the melt. The oscillatory density profiles have comparable amplitudes in both metals, but surface layering decays over a length scale of $3.5\pm 0.6$ \AA for In and $5.5\pm 0.4$ \AA for Ga. Upon controlled exposure to oxygen, no oxide monolayer is formed on the liquid In surface, unlike the passivating film formed on liquid Gallium.Comment: 9 pages, 5 figures; submitted to Phys. Rev.