Bruce Hollingsworth

The measurement of efficiency and productivity of health care delivery

The measurement of efficiency and productivity of health service delivery has become a small industry. This is a review of 317 published papers on frontier efficiency measurement. The techniques used are mainly based on non-parametric data envelopment analysis, but there is increasing use of parametric techniques, such as stochastic frontier analysis. Applications to hospitals and other health care organizations and areas are reviewed and summarised, and some meta-type analysis undertaken. Cautious conclusions are that public provision may be potentially more efficient than private, in certain settings. The paper also considers conceptualizations of efficiency, and points to dangers and opportunities in generating such information. Finally, some criteria for assessing the use and usefulness of efficiency studies are established, with a view to helping both researchers and those assessing whether or not to act upon published results.

Non-parametric and parametric applications measuring efficiency in health care.

This paper reviews 188 published papers on frontier efficiency measurement. The techniques used are mainly based on non-parametric data envelopment analysis, but there is increasing use of parametric techniques, such as stochastic frontier analysis. Applications both to hospitals and wider health care areas are reviewed and summarised, and some meta-type analysis undertaken. Results appear to confirm earlier findings that public provision demonstrates less variability than private. The paper is meant as a resource in itself, but also points to the future in terms of possible directions for research in efficiency measurement in health care and health.

Use of ratios in data envelopment analysis

It is often necessary to use ratios rather than absolute numbers as inputs and outputs in data envelopment analysis. This may be necessary in order to reflect accurately the underlying production function, or because of the nature of the data available. This note explains why the Banker, Charnes and Cooper formulation of DEA must be used when a ratio model is deployed.

Measuring production efficiency of acute hospitals in Scotland, 1991-94: validity issues in data envelopment analysis

Data Envelopment Analysis is a potentially useful technique for measuring production efficiency and is being increasingly applied to health care services, as with other areas. However, some fundamental concerns need to be addressed before Data Envelopment Analysis can be accepted widely as a routine tool. These include issues of validity and specification error. This paper suggests a broad framework for assessing validity, which should be developed further, and gives illustrative examples of the problems in a real application within health care. Data from 75 Scottish acute hospitals for three years from 1991-94 are analysed. Internal validity is assessed by examining the effect on the results obtained of the choice of inputs and outputs selected for analysis. External validity is assessed by examining differences in the results obtained from the data for each of the three years. In both cases, it is concluded that there is a disturbing lack of concordance between the different results obtained. Caution must therefore be exercised in using Data EnvelopmentAnalysis in the health sector and in looking at its results, particularly those from a single time period.

Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls

It has been proposed that cross-country comparisons of the technical efficiency of health production, estimated using data envelopment analysis (DEA), have useful applications for policy makers. In theory such an analysis utilizes measures of the socioeconomic determinants of health relevant to all social policy, not just health policy. Using OECD and WHO data, this article critically analyses a number of outstanding theoretical questions regarding the use of DEA in this setting. It concludes that until such questions are addressed, the resultant implications for policy will be based on misleading information.

What population factors influence the decision to donate blood

Summary.  Donations of blood in most of the developed world are by nonremunerated volunteers. As such factors, which impact upon the motivation of individuals to donate, are critical to achieving a stable supply, we analyze the factors, which influence the decision to donate. Using data on 29 762 individuals from 1999 and 2000, we investigate which factors determine the proportion of blood donors in postcode areas. Variables analyzed include blood donation status and sociodemographic characteristics in order to provide information on donation decisions. We find the proportion of donors in an area is significantly increased by higher proportions of women aged 20–29 and 40–49, and of men aged 60–69. Conversely, a higher proportion of males aged 20–29 significantly reduces proportion of donors. Also, a higher proportion of individuals born overseas significantly reduces the proportion of blood donors in an area. To increase supplies, blood collection agencies should target specific groups. Young men and men and women aged 30–49 need to be encouraged to donate. Collection agencies also need to target individuals who are born overseas to participate in the process. Using these results to aid targeting should help to maintain the blood supply.

THE EFFECTS OF TAXING SUGAR-SWEETENED BEVERAGES ACROSS DIFFERENT INCOME GROUPS

This paper investigates the impact of sugar-sweetened beverages (SSB) taxes on consumption, bodyweight and tax burden for low-income, middle-income and high-income groups using an Almost Ideal Demand System and 2011 Household level scanner data. A significant contribution of our paper is that we compare two types of SSB taxes recently advocated by policy makers: A 20% flat rate sales (valoric) tax and a 20 cent/L volumetric tax. Censored demand is accounted for using a two-step procedure. We find that the volumetric tax would result in a greater per capita weight loss than the valoric tax (0.41 kg vs. 0.29 kg). The difference between the change in weight is substantial for the target group of heavy purchasers of SSBs in low-income households, with a weight reduction of up to 3.20 kg for the volumetric and 2.06 kg for the valoric tax. The average yearly per capita tax burden on low-income households is

Minimum Pricing of Alcohol versus Volumetric Taxation: Which Policy Will Reduce Heavy Consumption without Adversely Affecting Light and Moderate Consumers?

17.87 (0.21% of income) compared with

Efficiency Measurement in Health and Health Care

15.17 for high-income households (0.07% of income) for the valoric tax, and

Blood donation and the nature of altruism.

13.80 (0.15%) and