Efficiency in the Provision of Municipal Nursing- and Home-Care Services: The Norwegian Experience
Municipalities of Norway are, by law, responsible for provision of care of persons in need, due to old age or physical and psychological handicaps, etc. The care can take place either in institutions or in peoples’ homes. This is public sector production, with a few private not-for-profit institutions, and is the most important municipal spending sector consuming about 25 per cent of the total budget. The services of the sector are not traded in a market. There is therefore neither an automatic check on the efficiency in the use of resources, nor on the match between services demanded and type of services provided. The purpose of the paper is to explore the potential for improvement as to the former aspect by using observed best practice as a norm for efficient operation (but see Newhouse (1994) for a critique of a frontier approach in the health sector). A nationwide cross-section study is undertaken for the first time in Norway, with municipalities, and organisational independent townships within the three largest cities, as the units. Earlier studies for Norway have been focussed on institutions within a limited region, e.g. for the largest cities. Home-based care has not been included in any efficiency studies before in Norway. And also internationally the focus has been only on institutions, like nursing homes (see e.g. Chattopadhyay and Ray (1996), Dusansky and Wilson (1994), Kooreman (1994), Nyman and Bricker (1989), Rosko et al., 1995).
KeywordsEfficiency Score Efficiency Measure Scale Efficiency Malmquist Productivity Index Inefficient Unit
Unable to display preview. Download preview PDF.
- Banker, R. D., Chames, A., and W. W. Cooper (1984): “Some models for estimating technical and scale inefficiencies”, Management Science 39, 1261–1264.Google Scholar
- Erlandsen, E., F.R. Førsund, E. Hernaes og S.B. Waalen (1997): “Effektivitet, kvalitet og organisering av pleie- og omsorgssektoren i norske kommuner”, SNF-rapport nr 91/97, Stiftelsen for Samfunns- og Naeringslivsforskning, Oslo.Google Scholar
- Frisch, R. (1965): Theory of production, Dordrecht: D. Reidel.Google Scholar
- Fare, R., S. Grosskopf and C. A. K. Lovell (1994): Production frontiers, Cambridge: Cambridge University Press.Google Scholar
- Førsund, F.R. (1997): “The Malmquist productivity index, TFP and scale”, Memorandum no. 233, Dept. of Economics, School of Economics and Commercial Law, Göteborg University.Google Scholar
- Førsund, F.R. and L. Hjalmarsson (1987): Analysis of industrial structure — A putty-clay approach, The Industrial Institute for Economic and Social Research, Stockholm: Almqvist & Wiksell International.Google Scholar
- Gjerberg, E. (1995): “Nursing home quality: different perspectives among residents, relatives and staff, a qualitative study”, Vård i Norden 15, 4–9.Google Scholar
- Kittelsen, S.A.C. (1998): Using Data Envelopment Analysis to Measure Production Efficiency in the Public Sector, Universitetet i Oslo 0konomiske Doktoravhandlinger Nr. 45–1998, Sosialokonomisk Institutt.Google Scholar
- Roos, P. (2000): “Measuring output of hospital services”, this volume.Google Scholar
- Shephard, R. W. (1953): Cost and production functions, Princeton: Princeton University Press.Google Scholar
- Statistics Norway (1996): Statistical Yearbook 1996, Oslo-Kongsvinger.Google Scholar