Assessing French nursing home efficiency: An indirect approach via budget-constrained DEA models

In this paper, data envelopment analysis (DEA) techniques are applied to the French nursing home industry in order to address two policy issues. The first involves nursing home size and returns to scale, while the second deals with the potential effects of a change in nursing home reimbursement from a flat rate to one based on the severity of case-mix. To accomplish this, our analysis expands on the existing nursing home literature to analyze technical and allocative efficiency along with budget-constrained models rather than the more common direct input-based distance function. Technical efficiency is evaluated via an indirect output distance function while allocative output efficiency is computed with a cost indirect revenue function. The findings suggest that system-wide efficiency and equity may result from coming reforms since payments would more accurately reflect resource use.