Advertisement

Health Care Management Science

, Volume 17, Issue 4, pp 321–330 | Cite as

Economies of scale in federally-funded state-organized public health programs: results from the National Breast and Cervical Cancer Early Detection Programs

  • Justin G. Trogdon
  • Donatus U. Ekwueme
  • Sujha Subramanian
  • Wesley Crouse
Article

Abstract

This study investigates the existence of economies of scale in the provision of breast and cervical cancer screening and diagnostic services by state National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees. A translog cost function is estimated as a system with input factor share equations. The estimated cost function is then used to determine output levels for which average costs are decreasing (i.e., economies of scale exist). Data were collected from all state NBCCEDP programs and District of Columbia for program years 2006–2007, 2008–2009 and 2009–2010 (N = 147). Costs included all programmatic and in-kind contributions from federal and non-federal sources, allocated to breast and cervical cancer screening activities. Output was measured by women served, women screened and cancers detected, separately by breast and cervical services for each measure. Inputs included labor, rent and utilities, clinical services, and quasi-fixed factors (e.g., percent of women eligible for screening by the NBCCEDP). 144 out of 147 program-years demonstrated significant economies of scale for women served and women screened; 136 out of 145 program-years displayed significant economies of scale for cancers detected. The cost data were self-reported by the NBCCEDP State programs. Quasi-fixed inputs were allowed to affect costs but not economies of scale or the share equations. The main analysis accounted for clustering of observations within State programs, but it did not make full use of the panel data. The average cost of providing breast and cervical cancer screening services decreases as the number of women screened and served increases.

Keywords

Cost Cost function Breast cancer Cervical cancer Screening 

Notes

Financial disclosures

None.

Disclaimer

The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References

  1. 1.
    Brownson RC, Baker EA, Leet TL, Gillespie KN, True WR (2011) Evidence-based public health, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC) (2012) National Breast and Cervical Cancer Early Detection Program (NBCCEDP)., Retrieved from http://www.cdc.gov/cancer/nbccedp/about.htm. Accessed 27 June 2013Google Scholar
  3. 3.
    Ekwueme DU, Gardner JG, Subramanian S, Tangka FK, Bapat B, Richardson LC (2008) Cost analysis of the National Breast and Cervical Cancer Early Detection Program: selected states, 2003 to 2004. Cancer 112:626–635. doi: 10.1002/cncr.23207 CrossRefGoogle Scholar
  4. 4.
    Mansley EC, Dunet DO, May DS, Chattopadhyay SK, McKenna MT (2002) Variation in average costs among federally sponsored state-organized cancer detection programs: economies of scale? Med Decis Mak 22(5):S67–S79CrossRefGoogle Scholar
  5. 5.
    Christensen LR, Greene WH (1976) Economies of scale in U.S. electric power generation. J Polit Econ 84:655–676CrossRefGoogle Scholar
  6. 6.
    Deller SC, Chicoine DL, Walzer N (1988) Economies of size and scope in rural low-volume roads. Rev Econ Stat 70:459–465CrossRefGoogle Scholar
  7. 7.
    Zellner A (1962) An efficient method of estimating seemingly unrelated regressions and tests for aggregation bias. J Am Stat Assoc 57(298):348–368CrossRefGoogle Scholar
  8. 8.
    StataCorp (2011) Stata statistical software: Release 12. StataCorp, College StationGoogle Scholar
  9. 9.
    Bilodeau D, Cremieux P-Y, Ouellette P (2000) Hospital cost function in a non-market health care system. Rev Econ Stat 82:489–498CrossRefGoogle Scholar
  10. 10.
    Subramanian S, Ekwueme DU, Gardner JG, Trogdon J (2009) Developing and testing a cost-assessment tool for cancer screening programs. Am J Prev Med 37(3):242–247. doi: 10.1016/j.amepre.2009.06.002 CrossRefGoogle Scholar
  11. 11.
    Crawford M, Church J, Rippy D (2012) CPI detailed report—Data for March 2012. U.S. Bureau of Labor Statistics, Washington, DC, Retrieved from http://www.bls.gov/cpi/cpid1203.pdf. Accessed 27 June 2013Google Scholar
  12. 12.
    U. S. Bureau of Labor Statistics (2006–2009) State occupational employment and wage estimates., Retrieved from http://www.bls.gov/oes/. Accessed 27 June 2013Google Scholar
  13. 13.
    Council for Community and Economic Research (2006–2010) ACCRA cost of living index., Available from http://www.coli.org/. Accessed 27 June 2013Google Scholar
  14. 14.
    Gyourko J (2009) Understanding commercial real estate: how different from housing is it? J Portf Manag 34(5):23–37CrossRefGoogle Scholar
  15. 15.
    U.S. Census Bureau (2011) Intercensal estimates of the resident population by single year of age and sex for states and the United States: April 1, 2000 to July 1, 2010. Available from http://www.census.gov/popest/data/intercensal/state/state2010.html. Accessed 27 June 2013
  16. 16.
    O’Brien-Strain M, Addison W, Theobald N (2010) Final report on the sixth update of the Geographic Practice Cost Index for the Medicare physician fee schedule. Centers for Medicare & Medicaid Services, Washington, DCGoogle Scholar
  17. 17.
    United States Census Bureau (2011) Current population survey., Available from http://www.census.gov/cps/. Accessed 27 June 2013Google Scholar
  18. 18.
    Tangka FKL, Dalaker J, Chattopadhyay SK, Gardner JG, Royalty J, Hall IJE et al (2006) Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States). Cancer Causes Control 17:1145–1154CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Justin G. Trogdon
    • 1
  • Donatus U. Ekwueme
    • 2
  • Sujha Subramanian
    • 3
  • Wesley Crouse
    • 3
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  3. 3.RTI InternationalResearch Triangle ParkUSA

Personalised recommendations