Margit Sommersguter-Reichmann

The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach.

The 1997 hospital financing reform has been supposed to reduce considerable inefficiencies in the provision of hospital care in Austria. This paper focuses on the changes in hospital productivity between 1994 and 1998, thus including three years before the reform and two years after the reform. Using Data Envelopment Analysis we calculated the input-based Malmquist index, which is then decomposed into indices of pure technical efficiency change, scale efficiency change and technology change. The results illustrated a considerably positive shift in technology between 1996 and 1998, whereas the intended enhancement in technical efficiency has not yet taken place.

Priority setting in Austria

Priority setting and rationing are not yet matters of public debate in Austria. Before a discussion on rationing is undertaken, the incentive system concerning the financing of health care services needs to be reformed, especially in relation to the reimbursement of hospitals and physicians. This is necessary if a waste of scarce resources is to be avoided. Although methods and principles of priority setting and rationing are not openly discussed, several rationing techniques are already performed as organisational tools. A Eurobarometer survey of the population regarding their satisfaction with the health care system confirms the presumption that Austrians are not aware of the fact that rationing methods already exist.

Efficiency measures and productivity indexes in the context of university library benchmarking

Data envelopment analysis (DEA) has attracted considerable attention during the last few decades as an intuitively clear method for performance assessment. Theoretical developments have taken turns with empirical efficiency studies. In this paper we empirically analyse performance differences across university libraries from different countries from a cross-section and a longitudinal perspective. We use the Malmquist index approach to disentangle environmental efficiency from technical efficiency (TE) to highlight performance differences eventually induced by environmental factors beyond the control of library management, as well as to decompose productivity changes over time into changes in TE and changes in technology. In our cross-section analysis we found that North American (NA) libraries are more productive at higher input levels than the European libraries from Germany and Austria at which we looked in this contribution. Moreover, the largest NA libraries are still able to improve performance, as the results of panel data analysis revealed.

The Austrian Tobacco Act in practice – Analysing the effectiveness of partial smoking bans in Austrian restaurants and bars

The purpose of this study is to examine the effectiveness of partial smoking bans in restaurants and bars, such as those currently in place in Austria, by evaluating adherence to the relevant regulations and assessing the satisfaction levels of those affected by these regulations. To evaluate adherence, 127 randomly selected restaurants and bars were observed using a form of structured observation. In order to evaluate their level of satisfaction with the regulations, 342 randomly selected customers and 29 restaurant owners were interviewed using standardized questionnaires. The customers widely adhered to the partial smoking bans, but many of them were dissatisfied with the fragmented Austrian solution. Most restaurant owners showed neither adherence to the relevant regulations nor satisfaction with the partial smoking bans. The present study reveals that partial bans on smoking are an ineffective solution. The presumed advantages of these regulations, such as still allowing smoking in restaurants provided a spatial separation of smoking and non-smoking areas is guaranteed, cannot be confirmed; adherence to the partial bans is rather inadequate, especially among restaurant owners, and the level of satisfaction with the Austrian solution is poor as well, not only among smoking and non-smoking customers, but also restaurant owners.

Evaluating the New Activity-Based Hospital Financing System in Austria

This paper analyses the effects of the new activity-based hospital financing system on hospital performance and hospital costs in Austria. The research concentrates on differences in response among publicly-owned and privately-owned, not for profit hospitals by exploring hospital data from 1994 to 1997 with regard to credit point optimisation, shifts in performance from the inpatient to the outpatient care unit and from the outpatient care unit to physicians with their own practice, and changes in average length of stay. Techniques applied range from index figures to weighting figures and, at least, Data Envelopment efficiency scores.

Ein hierarchisches Informationssystem zur Analyse von Anreizwirkungen in Spitälern

■ Die Einfuhrung der leistungsorientierten Krankenanstaltenfinanzierung am 1.1.1997 mit Gultigkeit bis zum 31.12.2000 in Osterreich hat zu einer deutlichen Veranderung des auf die Spitaler wirkenden Anreizsystems gefuhrt. In diesem Beitrag wird mit einem hierarchischen Informationssystem analysiert, wie sich dieses geanderte Anreizsystem auf die Kosten- und Leistungsstruktur der Spitaler ausgewirkt hat. ■ Zu diesem Zweck werden mit Hilfe von Indexzahlen, Aquivalenzzahlen sowie der Data Envelopment Analysis (DEA) Hypothesen bezuglich des zu erwartenden Verhaltens der Spitaler untersucht, wobei insbesondere die Unterschiede im Hinblick auf die Tragerschaft der Krankenanstalten erforscht werden. ■ Mit Hilfe der Ergebnisse der Indexzahlen sowie der DEA konnte von 96 auf 97 ein deutlicher, creeping ‘-Effekt nachgewiesen werden. Daruberhinaus wurde mit den Aquivalenzzahlenreihen gezeigt, das Spitaler unter privater Tragerschaft fruher und in einem hoheren Ausmas am erwarteten ‚LDF-Punktewettkampf ‘ teilgenommen haben als Krankenanstalten unter offentlicher Tragerschaft.

Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies

In recent years, the fight against healthcare corruption has intensified. Estimates from the European Healthcare Fraud and Corruption Network calculate an approximate €56 billion annual loss to Europe as a result of corruption. To promote understanding of the complexity and interconnection of corrupt activities, we aim to present healthcare-related corruption typologies of the European Union and European Healthcare Fraud and Corruption Network. We subsequently link them to the typology of individual and institutional corruption introduced by Dennis Thompson in the context of investigating misconduct of US Congressional members. According to Thompson, individual corruption is the personal gain of individuals performing duties within an institution in exchange for nurturing private interests, while institutional corruption pertains to the failure of the institution in directing the individual’s behaviour towards the achievement of the institution’s primary purpose because the institutional design promotes the pursuit of individual goals. Effective anti-corruption activities not only require the enactment of anti-corruption laws but also the monitoring and, where appropriate, revision of institutional frameworks to prevent the undermining of the primary purposes of health systems or institutions. To gain further understanding of the similarities and differences of the three typologies, prime examples of corrupt activities in the health sector in the European Union and USA (along with their potential remedies) are provided. Linking corruption cases to Thompson’s typology revealed that many corrupt activities may show elements of both individual and institutional corruption because they are intertwined, partly overlap and may occur jointly. Hence, sanctioning individual actors only does not target the problem.

Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system’s purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician’s possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system’s primary purposes.

Benchmarking the rescue departments of the Austrian Red Cross using data envelopment analysis and fractional regression models

We performed a radial, input-oriented variable returns-to-scale data envelopment analysis to benchmark 52 rescue departments of the Austrian Red Cross from a single province. Three inputs (working hours of employed personnel/non-employed personnel and number of vehicles) and two output variables (duration-weighted number of two service transportation categories) were selected. First, we assessed the service production process of the Red Cross to obtain an insight into the level of performance, and performance differences among the rescue departments. We found that the average technical efficiency of the rescue departments amounted to almost 88%. The theoretically derived potentials of input reductions for inefficient rescue departments were, among others, restricted by several settings, which were analysed in the second step. Here, several socio-economic, environmental and institutional factors were investigated using a second stage regression analysis based on fractional regression models to find out whether they impacted on the performance of the rescue departments. We found a negative relationship between wintry weather conditions, measured as the number of ice days, and performance, while we identified a positive impact of the number of people aged 64+ and the number of hospital beds in the catchment area on Red Cross performance.

Gesundheitsversorgung in Österreich unter besonderer Berücksichtigung des ländlichen Raums

Im Rahmen dieses Beitrags werden zentrale Aspekte der Gesundheitsversorgung in Osterreich vorgestellt und analysiert, wobei insbesondere auf die Gesundheitsversorgung im landlichen Raum eingegangen wird. Zu diesem Zweck wird zunachst ein knapper Uberblick uber die osterreichische Gesundheitspolitik der letzten 50 Jahre gegeben, welcher erkennen lasst, dass sich eine Versorgungsforschung im engeren Sinn, die auf eine bedarfsgerechte Versorgung der Bevolkerung mit Gesundheitsleistungen abzielt, derzeit noch im Aufb au befindet. Im Hinblick auf die Gesundheitsversorgung im landlichen Raum ist festzuhalten, dass dieser in den politischen Programmen zwar durchaus Beachtung geschenkt wird, eine einheitliche Abgrenzung, was im Gesundheitsbereich unter landlichem Raum zu verstehen ist, allerdings fehlt. Deshalb werden im empirischen Teil mehrere Varianten zur Abgrenzung des landlichen Raums im Gesundheitsbereich vorgestellt. Diese werden anschliesend herangezogen, um zu uberprufen, ob es wesentliche Unterschiede in der Gesundheitsversorgung zwischen landlichem und stadtischem Raum gibt. Dabei wird auf einige zentrale Leistungsanbieter, namlich Krankenanstalten, Arzte/Arztinnen und Apotheken, abgestellt. Die Analyse der vorhandenen Daten zeigt, dass Unterschiede, sofern uberhaupt vorhanden, im Zeitablauf tendenziell geringer geworden sind.