Abstract
This paper examines the impact of an endogenous cost function variable on the inefficiency estimates generated by stochastic frontier analysis (SFA). The specific variable of interest in this application is endogenous quality in nursing homes. We simulate a dataset based on the characteristics of for-profit nursing homes in California, which we use to assess the impact on SFA-generated inefficiency estimates of an endogenous regressor under a variety of scenarios, including variations in the strength and direction of the endogeneity and whether the correlation is with the random noise or the inefficiency residual component of the error term. We compare each of these cases when quality is included and excluded from the cost equation. We provide evidence of the impact of endogeneity on inefficiency estimates yielded by SFA under these various scenarios and when the endogenous regressor is included and excluded from the model.
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Notes
See Mukamel et al. 2011 for more information about this dataset and variables definitions.
The negative coefficients on the price and output variables in the above regression are probably due to multicolinearity. We used a Cobb-Douglas model in a robustness check and the coefficients on the price and output variables were all positive.
References
Anderson RI, Lewis D, Webb JR (1999) The efficiency of nursing home chains and the implications of non-profit status. J Real Estate Portfolio Manage 5(3):235–245
Chirikos T (1998) Identifying efficiently and economically operated hospitals: the prospects and pitfalls of applying frontier regression techniques. J Health Polit Policy Law 23(December):879–904
Deming W (1982) Out of the Crisis. Massachusetts Institute of Technology, Cambridge
Farsi M, Filippini M (2004) An empirical analysis of cost efficiency in non-profit and public nursing homes. Ann Public Cooper Econ 75:339–365
Gertler P, Waldman D (1992) Quality-adjusted cost functions and policy evaluation in the nursing home industry. J Polit Econ 100(6):1232–1256
Greene W (2011) Econometric Analysis, 7th edn. Prentice-Hall, Upper Saddle River
Hollingsworth B (2008) The measurement of efficiency and productivity of health care delivery. Health Econ 17:1107–1128
Hussey P, de Vries H, Romley J, Wang M, Chen S, Shekell P, McGlynn E (2009) A systematic review of health care efficiency measures. Health Serv Res 44(3):784–805
Jondrow J, Lovell CK, Materov I, Schmidt P (1982) On the estimation of technical efficiency in the stochastic frontier production function model. J Econ 19:233–238
Li T, Rosenman R (2001) Cost efficiency in Washington hospitals: a stochastic frontier approach using panel data. Health Care Man Sci 4(2):73–81
Li Y, Harrington C, Spector W, Mukamel D (2010) State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs. Health Serv Res 45(6):1796–1814
Lovell CK (1994) Production frontiers and productive efficiency. In: Fried H, Lovell C, Schmidt S (eds) The Measurement of Productive Efficiency. Oxford University Press, New York, pp 1–67
Mukamel D, Li Y, Harrington C, Spector W, Weimer D, Bailey L (2011) Does state regulation of quality impose costs on nursing homes? Med Care 49(6):529–534
Mutter R, Rosko M, Wong H (2008) Measuring hospital inefficiency: the effects of controlling for quality and patient burden of illness. Health Serv Res 43(6):1992–2013
Nyman J (1988) The marginal cost of nursing home care: New York, 1983. J Health Econ 7:393–412
Rosko M, Mutter R (2008) Assessing the robustness of hospital inefficiency estimates: an assessment of stochastic frontier regression. Med Care Res Rev 65:131–166
Stock JH, Wright JH, Yogo M (2002) A survey of weak instruments and weak identification in generalized method of moments. J Bus Econ Stat 20(4): 518–529
Vitaliano D, Toren M (1991) Cost and efficiency in nursing homes: a stochastic frontier approach. J Health Econ 13:281–300
Vitaliano D, Toren M (1996) Hospital cost and efficiency in a regime of stringent regulation. East Econ J 22:161–173
Acknowledgments
This paper does not represent the policy of either the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services (DHHS). The views expressed herein are those of the authors and no official endorsement by AHRQ or DHHS is intended or should be inferred. This research was partially funded by contracts from AHRQ: AHRQ Contract Number HHSP233200900285P (Michael Rosko, Dana Mukamel) and HHSN263200500063293 (William Greene).
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Mutter, R.L., Greene, W.H., Spector, W. et al. Investigating the impact of endogeneity on inefficiency estimates in the application of stochastic frontier analysis to nursing homes. J Prod Anal 39, 101–110 (2013). https://doi.org/10.1007/s11123-012-0277-z
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DOI: https://doi.org/10.1007/s11123-012-0277-z