Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Health Care Manag Sci. 2014 Dec;17(4):321-30. doi: 10.1007/s10729-013-9261-z. Epub 2013 Dec 11.
This study investigates the existence of economies of scale in the provision of breast and cervical cancer screening and diagnostic services by state National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees. A translog cost function is estimated as a system with input factor share equations. The estimated cost function is then used to determine output levels for which average costs are decreasing (i.e., economies of scale exist). Data were collected from all state NBCCEDP programs and District of Columbia for program years 2006-2007, 2008-2009 and 2009-2010 (N = 147). Costs included all programmatic and in-kind contributions from federal and non-federal sources, allocated to breast and cervical cancer screening activities. Output was measured by women served, women screened and cancers detected, separately by breast and cervical services for each measure. Inputs included labor, rent and utilities, clinical services, and quasi-fixed factors (e.g., percent of women eligible for screening by the NBCCEDP). 144 out of 147 program-years demonstrated significant economies of scale for women served and women screened; 136 out of 145 program-years displayed significant economies of scale for cancers detected. The cost data were self-reported by the NBCCEDP State programs. Quasi-fixed inputs were allowed to affect costs but not economies of scale or the share equations. The main analysis accounted for clustering of observations within State programs, but it did not make full use of the panel data. The average cost of providing breast and cervical cancer screening services decreases as the number of women screened and served increases.
本研究调查了州立国家乳腺癌和宫颈癌早期检测计划（NBCCEDP）受赠者提供乳腺癌和宫颈癌筛查和诊断服务是否存在规模经济。采用投入要素份额方程的对数成本函数进行了估计。然后，利用估计的成本函数来确定平均成本呈下降趋势的产出水平（即存在规模经济）。数据来自所有州立 NBCCEDP 计划和哥伦比亚特区，涵盖 2006-2007、2008-2009 和 2009-2010 年计划年度（N=147）。成本包括联邦和非联邦来源的所有计划和实物捐款，分配给乳腺癌和宫颈癌筛查活动。产出由接受服务的妇女、接受筛查的妇女和分别按乳腺和宫颈服务检测到的癌症来衡量。投入包括劳动力、租金和水电费、临床服务以及准固定因素（例如，符合 NBCCEDP 筛查条件的妇女百分比）。在 147 个计划年度中，有 144 个显示出为服务妇女和筛查妇女提供服务的规模经济显著；有 136 个计划年度显示出为检测到的癌症提供服务的规模经济显著。成本数据由 NBCCEDP 州计划自行报告。准固定投入被允许影响成本，但不影响规模经济或要素份额方程。主要分析考虑了州计划内观察结果的聚类，但未充分利用面板数据。提供乳腺癌和宫颈癌筛查服务的平均成本随着接受筛查和服务的妇女人数的增加而降低。
