Advertisement

Efficiency in the Provision of Municipal Nursing- and Home-Care Services: The Norwegian Experience

  • Espen Erlandsen
  • Finn R. Førsund
Chapter
Part of the Studies in Productivity and Efficiency book series (SIPE, volume 1)

Abstract

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).

Keywords

Efficiency Score Efficiency Measure Scale Efficiency Malmquist Productivity Index Inefficient Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Afriat, S. (1972): “Efficiency estimation of production functions”, International Economic Review 13(3), 568–598.CrossRefGoogle Scholar
  2. Banker, R.D. (1993): “Maximum likelihood, consistency and Data Envelopment Analysis: a statistical foundation”, Management Science 39(10), 1265–1273.CrossRefGoogle Scholar
  3. 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
  4. Chattopadhyay, S. and S.C. Ray (1996): “Technical, scale, and size efficiency in nursing home care: a nonparametric analysis of Connecticut homes”, Health Economics 5, 363–373.CrossRefGoogle Scholar
  5. Chames, A., W.W. Cooper and E. Rhodes (1978): “Measuring the efficiency of decision making units”, European Journal of Operationational Reasearch 2(6), 429–444.CrossRefGoogle Scholar
  6. Dusansky, R. and P.W. Wilson (1994): “Technical efficiency in the decentralized care of the development disabled”, The Review of Economics and Statistics 76, 340–345.CrossRefGoogle Scholar
  7. 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
  8. Farrell, M. (1957): “The measurement of productive efficiency”, Journal of the Royal Statistical Society, Series A (General), 120 (HI), 253–281 (290)CrossRefGoogle Scholar
  9. Frisch, R. (1965): Theory of production, Dordrecht: D. Reidel.Google Scholar
  10. Fare, R. and C. A. K. Lovell (1978): “Measuring the technical efficiency of production”, Journal of Economic Theory 19, 150–162.CrossRefGoogle Scholar
  11. Fare, R., S. Grosskopf and C. A. K. Lovell (1985): The measurement of efficiency of production, Boston: Kluwer—Nijhoff.CrossRefGoogle Scholar
  12. Fare, R., S. Grosskopf and C. A. K. Lovell (1994): Production frontiers, Cambridge: Cambridge University Press.Google Scholar
  13. 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
  14. Førsund, F. R. and L. Hjalmarsson (1974): “On the measurement of productive efficiency”, Swedish Journal of Economics 76 (2), 141–154.CrossRefGoogle Scholar
  15. Førsund, F. R. and L. Hjalmarsson (1979): “Generalised Farrell measures of efficiency: an application to milk processing in Swedish dairy plants”, Economic Journal 89, 294–315.CrossRefGoogle Scholar
  16. 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
  17. Gjerberg, E. (1995): “Nursing home quality: different perspectives among residents, relatives and staff, a qualitative study”, Vård i Norden 15, 4–9.Google Scholar
  18. 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
  19. Kooreman, P. (1994): “Nursing home care in The Netherlands: a nonparametric efficiency analysis”, Journal of Health Economics 13, 301–316.CrossRefGoogle Scholar
  20. Lewin, A.Y. and Minton, J.W. (1986): “Determining organizational effectiveness: Another look and an agenda for research”, Management Science 32(5), 514–538.CrossRefGoogle Scholar
  21. Newhouse, J.P. (1994): “Frontier estimation: How useful a tool for health economics ?”, Journal of Health Economics 13, 317–322.CrossRefGoogle Scholar
  22. Nyman, J.A. and D.L. Bricker (1989): “Profit incentives and technical efficiency in the production of nursing home care”, The Review of Economics and Statistics 71, 586–594.CrossRefGoogle Scholar
  23. Roos, P. (2000): “Measuring output of hospital services”, this volume.Google Scholar
  24. Rosko, M. D. et al (1995): “The effects of ownership, operating environment and strategic choices on nursing home efficiency”, Medical Care 33, 1001–1021.CrossRefGoogle Scholar
  25. Shephard, R. W. (1953): Cost and production functions, Princeton: Princeton University Press.Google Scholar
  26. Statistics Norway (1996): Statistical Yearbook 1996, Oslo-Kongsvinger.Google Scholar
  27. Torgersen, A.M., F.R. Forsund, and S.A.C. Kittelsen (1996): “Slack-adjusted efficiency measures and ranking of efficient units”, Journal of Productivity Analysis, 7, 379–398CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Espen Erlandsen
    • 1
  • Finn R. Førsund
    • 2
    • 3
  1. 1.Ministry of FinanceOsloNorway
  2. 2.Department of EconomicsUniversity of OsloNorway
  3. 3.The Ragnar Frisch Centre for Economic ResearchNorway

Personalised recommendations

Cite chapter

Buy options