Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals

Ricardo Ocaña-Riola, Carmen Pérez-Romero, Isabel Ortega-Díaz Mª and José Jesús Martín-Martín
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Ricardo Ocaña-Riola: Escuela Andaluza de Salud Pública, Cuesta del Observatorio, 4. Campus Universitario de Cartuja, 18011 Granada, Spain
Carmen Pérez-Romero: Escuela Andaluza de Salud Pública, Cuesta del Observatorio, 4. Campus Universitario de Cartuja, 18011 Granada, Spain
Isabel Ortega-Díaz Mª: Cátedra de Economía de la Salud y Dirección de Organizaciones Sanitarias (Esalud2) Cuesta del Observatorio, 4. Campus Universitario de Cartuja, 18011 Granada, Spain
José Jesús Martín-Martín: Instituto de Investigación Biosanitaria ibs.GRANADA, Avda. de Madrid, 15. 18012 Granada, Spain

IJERPH, 2021, vol. 18, issue 19, 1-18

Abstract: Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.

Keywords: efficiency; data envelopment analysis; multilevel zero-one inflated beta regression; public hospitals; private hospitals; public-private partnership; intensive care units; emergency services (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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