Article ID: | iaor19971442 |
Country: | Netherlands |
Volume: | 67 |
Issue: | 1 |
Start Page Number: | 117 |
End Page Number: | 139 |
Publication Date: | Sep 1996 |
Journal: | Annals of Operations Research |
Authors: | Morey Richard C., Dittman David A. |
Keywords: | statistics: data envelopment analysis |
In both the private and public sectors, it is strongly believed that when goods and services are transferred at full cost, efficiency of operation is not encouraged. A cost pass-through payment mechanism, heavily used by the U.S. Federal Government prior to 1983 to reimburse hospitals for in-patient services, has been blamed for part of the annual double digit escalation in health care costs from 1965 to 1983. A cost pass-through formula is still in use for some types of outpatient care reimbursement (especially clinics and ancillary services); additionally retrospective reviews are still used to determine Medicare ‘outlier’ payments under the present prospective system. Finally some private health care plans still utilize a mixed retrospective/prospective payment system. Hence, the issue is still very relevant to health care professionals. Unfortunately it has been difficult to settle this issue empirically since hospitals are characterized by the provision of multiple services, with no clear resource/product allocations; additionally different client mixes and other uncontrollable factors complicate the issue of measurement of efficiency. The authors provide some quantitative insights into this issue, using a new formal hypothesis testing procedure developed by Banker which uses as