# Efficiency of Thai provincial public hospitals during the introduction of universal health coverage using capitation

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## Abstract

We investigate the impact of implementing capitated-based Universal Health Coverage (UC) in Thailand on technical efficiency in larger public hospitals during the policy transition period. We measure efficiency before and during the transition period of UC using a two-stage analysis with Data Envelopment Analysis, bootstrap DEA, and truncated regressions. Our analysis indicates that during the transition period efficiency in larger public hospitals across the country increased. The findings differed by region, and hospitals in provinces with more wealth not only started with greater efficiency, but improved their relative position during the transitional phases of the UC system.

## Keywords

Hospital Efficiency DEA Bootstrap Thailand## References

- 1.Abbott M, Doucouliagos C (2003) The efficiency of Australian universities: a data envelopment analysis. Econ Educ Rev 22:89–97CrossRefGoogle Scholar
- 2.Banker RD (1993) Maximum likelihood, consistency and data envelopment analysis: a statistical foundation. Manage Sci 39(10):1265–1273CrossRefGoogle Scholar
- 3.Badin L, Simar L (2003) Confidence intervals for DEA-type efficiency scores: how to avoid the computational burden of the bootstrap. Discussion paper 0316, Universit’e Catholique de LouvainGoogle Scholar
- 4.Barnum H, Kutzin J (1993) Public hospitals in developing countries: resource use, cost financing. The Johns Hopkins University Press, BaltimoreGoogle Scholar
- 5.Burgess J Jr, Wilson P (1998) Variation in inefficiency among US Hospitals. Infor 36(3):84–102Google Scholar
- 6.Carey K (2000) Hospital cost containment and length of stay: an econometric analysis. South Econ J 67(2):363–380CrossRefGoogle Scholar
- 7.Chang H (1998) Determinants of hospital efficiency: the case of central government-owned hospitals in Taiwan. Int J Manag Sci 26(2):307–317Google Scholar
- 8.Chattopadhyay S, Ray C (1996) Technical, scale and size efficiency in nursing home care: a non-parametric analysis of Connecticut homes. Health Econ 5:363–373CrossRefGoogle Scholar
- 9.Chilingerian JA (1995) Evaluating physician efficiency in hospitals: a multivariate analysis of best practices. Eur J Oper Res 80:548–574CrossRefGoogle Scholar
- 10.Chinlingerian JA, Sherman HD (2004) Health care applications: from hospitals to physicians, from productive efficiency to quality frontiers. In: Cooper WW, Zhu J (eds) Handbook on data envelopment analysis. Kluwer, Boston, MAGoogle Scholar
- 11.Conrad D, Wickizer T, Maynard C, Klastorin T, Lesser D et al (1996) Managing care, incentives, and information: an exploratory look inside the black box of hospital efficiency. Health Serv Res 31:235–59Google Scholar
- 12.Chu HL, Lui HZ, Romeis JC (2004) Does capitated contracting improve efficiency? Evidence from California hospitals. Health Care Manage Rev 29(4):344–352Google Scholar
- 13.Coelli T, Prasada Rao DS, Battese GE (1998) An introduction to efficiency and productivity analysis. Kluwer, Boston, MAGoogle Scholar
- 14.Defelice L, Bradford W (1997) Relative inefficiencies in production between solo and group practice physicians. Health Econ 6:455–465CrossRefGoogle Scholar
- 15.Delsi E, Ray H (2004) A bootstrap-regression procedure to capture unit specific effects in data envelopment analysis. Working Paper 2004-15, University of ConnecticutGoogle Scholar
- 16.Donaldson D, Pannarunothai S, Tangcharoensathien V (1999) Health financing in Thailand: technical report. Health Management and Financing Study Project, ADB no. 2997, Boston. Available at http://www.msh.org/resources/online_reports/pdf/thaihf0.PDF
- 17.Efron B (1982) The jackknife, the bootstrap, and other resampling plans. Monograph 38. Society for Industrial and Applied Mathematics, Philadelphia, PAGoogle Scholar
- 18.Enthoven AC (1988) Managing competition: an agenda for action. Health Aff 7(3):25–47CrossRefGoogle Scholar
- 19.Enthoven AC, Richard K (1989a) A consumer-choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy (part 1). N Engl J Med 320(1):29–37CrossRefGoogle Scholar
- 20.Enthoven AC, Richard K (1989b) A consumer-choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy (part 2). N Engl J Med 320(2):94–101CrossRefGoogle Scholar
- 21.Ferrier GD, Hirschberg JG (1997) Bootstrapping confidence intervals for linear programming efficiency scores: with an illustration using Italian bank data. Journal of Productivity Analysis 8:19–33CrossRefGoogle Scholar
- 22.Folland S, Hofler R (2001) How reliable are hospital efficiency estimates? Exploiting the dual to homothetic production. Health Econ 10:683–698CrossRefGoogle Scholar
- 23.Friesner D, Rosenman R, McPherson M (2008) Are hospitals seasonally inefficient? Evidence from Washington State Hospitals. Appl Econ. Published online at http://dx.doi.org/10.1080/00036840600749730
- 24.Grootendorst PV (1997) Health care policy evaluation using longitudinal insurance claims data: an application of the panel Tobit estimator. Health Econ 6:365–382CrossRefGoogle Scholar
- 25.Hamilton BH (1999) HMO selection and Medicare costs: Bayesian MCMC estimation of a robust panel data Tobit model with survival. Health Econ 8:403–414CrossRefGoogle Scholar
- 26.Heflinger CA, Northrup DA (2000) What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract. Journal of Behavioral Health Services and Research 27:390–405CrossRefGoogle Scholar
- 27.Hollingsworth B, Dawson P, Manadiakis N (1999) Efficiency measurement of health care: a review of nonparametric methods and applications. Health Care Manage Sci 2(3):161–172CrossRefGoogle Scholar
- 28.Hollingsworth B (2003) Non-parametric and parametric applications measuring efficiency in health care. Health Care Manage Sci 6(4):203–218CrossRefGoogle Scholar
- 29.Koopmans TC (1951) An analogus of production as an efficient combinations of activities. In: Koopmans TC (ed) Activity analysis of production and allocation. Cowles commission for research in economics. Monograph 13. Wiley, New YorkGoogle Scholar
- 30.Leger PT (2000) Quality control mechanism under capitation for medical services. Can J Econ 33(2):564–586CrossRefGoogle Scholar
- 31.Lovell CAK (1993) Production frontiers and production efficiency. In: Fried HO, Lovel CAK, Schmidet SS (eds) The measurement of productive efficiency: techniques and applications. Oxford University Press, New York, pp 3–67Google Scholar
- 32.Mills A, Bennett S, Siriwanarangsun P, Tangcharoensathien V (2000) The response of providers to capitation payment: a case-study from Thailand. Health Policy 51:163–180CrossRefGoogle Scholar
- 33.Ministry of Public Health, Thailand (2001) Health insurance systems in Thailand. Health Systems Research Institute, Nonthaburi, ThailandGoogle Scholar
- 34.Na Ranong V et al (2002) Evaluation of the universal coverage scheme in Thailand FY2001. Thailand Development Research Institute, ThailandGoogle Scholar
- 35.Na Ranong V et al (2004) The monitoring and evaluation of the universal health coverage in Thailand, second phase 2003–2004. Thailand Development Research Institute, ThailandGoogle Scholar
- 36.Ngorsuraches S, Sornlertlumvanich A (2006) Determinants of hospital loss in Thailand: experience from the first year of a universal coverage health insurance program. Health Care Manage Sci 9:59–70CrossRefGoogle Scholar
- 37.Ozcan Y, McCue M, Okasha A (1996) Measuring the technical efficiency of psychiatric hospitals. J Med Syst 20(3):141–150CrossRefGoogle Scholar
- 38.Ozcan Y, Wogen S, Mau L (1998) Efficiency evaluation of skilled nursing facilities. J Med Syst 22(4):211–224CrossRefGoogle Scholar
- 39.Pannarunothai S, Patmasiriwat D, Srithamrongsawat S (2004) Universal health coverage in Thailand: ideas for reform and policy struggling. Health Policy 68(1):17–30CrossRefGoogle Scholar
- 40.Rodriguez-Alvareza A, Fernandez V, Lovell CAK (2004) Allocative inefficiency and its cost: the case of Spanish public hospitals. Int J Prod Econ 92(2):99–111CrossRefGoogle Scholar
- 41.Rosenman R, Friesner D (2004) Scope and scale inefficiencies in physician practices. Health Econ 13:1091–1116CrossRefGoogle Scholar
- 42.Rosko M et al (1995) The effects of ownership, operating environment, and strategic choices on nursing-home efficiency. Med Care 33(10):1001–1021CrossRefGoogle Scholar
- 43.Sheskin DJ (1997) Handbook of parametric and nonparametric statistical procedures. CRC Press, FloridaGoogle Scholar
- 44.Silverman BW (1986) Density estimation for statistics and data analysis. Chapman and Hall, LondonGoogle Scholar
- 45.Simar L, Wilson PW (2000) A general methodology for bootstrapping in non-parametric frontier models. J Appl Stat 27(6):779–802CrossRefGoogle Scholar
- 46.Simar L, Wilson PW (2000) Statistical inference in nonparametric frontier models: the state of the art. Journal of Productivity Analysis 13:49–78CrossRefGoogle Scholar
- 47.Simar L, Wilson PW (2003) Estimation and inference in two-stage, semi-parametric models of production processes. Discussion paper 0307, Universit’e Catholique de LouvainGoogle Scholar
- 48.Simar L, Wilson PW (2004) Performance of the bootstrap for DEA estimators and iterating the principle. In: Cooper WW, Zhu J (eds) Handbook on data envelopment analysis. Kluwer, Boston, MAGoogle Scholar
- 49.Simar L, Wilson PW (2007) Estimation and inference in two-stage, semi-parametric models of production processes. J Econom 136:31–64CrossRefGoogle Scholar
- 50.Suraratdecha C, Okunade A (2006) Measuring operational efficiency in a health care system: a case study from Thailand. Health Policy 77:2–23CrossRefGoogle Scholar
- 51.Suraratdecha C, Saithanu S, Tangcharoensathien V (2005) Is the universal coverage a solution for disparities in healthcare? Finding from three low-income provinces of Thailand. Health Policy 73:272–284CrossRefGoogle Scholar
- 52.Tangcharoensathien V et al (2002) Universal coverage and its impact on reproductive health services in Thailand. Reprod Health Matters 10(20):59–69CrossRefGoogle Scholar
- 53.Tobin J (1958) Estimation of relationships for limited dependent variables. Econometrica 26(1):24–36CrossRefGoogle Scholar
- 54.Valdmanis V (1992) Sensitivity analysis for DEA models—an empirical examination using public versus NFP Hospitals. J Public Econ 48(2):185–205CrossRefGoogle Scholar
- 55.Valdmanis V, Kumanarayake L, Lertiendumrung J (2004) Capacity in Thai public hospitals and the production of care for poor and non-poor patients. Health Serv Res 39(6 Pt 2):2117–2134CrossRefGoogle Scholar
- 56.Worthington A (1999) An empirical survey of frontier efficiency measurement techniques in healthcare services. Working paper, School of Economics and Finance, Queensland University of Technology, AustraliaGoogle Scholar
- 57.Xue M, Harker PT (1999) Overcoming the inherent dependency of DEA efficiency scores: a bootstrap approach. Unpublished working paper, Wharton Financial Institutions Center, University of PennsylvaniaGoogle Scholar
- 58.Zuckerman S, Hadley S, Iezzoni L (1994) Measuring hospital efficiency with frontier cost functions. J Health Econ 13:255–280CrossRefGoogle Scholar

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