Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354, Hamburg, Germany.
Health Care Manag Sci. 2014 Jun;17(2):150-61. doi: 10.1007/s10729-013-9260-0. Epub 2013 Dec 12.
This is the first study to use stochastic frontier analysis to estimate both the technical and cost efficiency of physician practices. The analysis is based on panel data from 3,126 physician practices for the years 2006 through 2008. We specified the technical and cost frontiers as translog function, using the one-step approach of Battese and Coelli to detect factors that influence the efficiency of general practitioners and specialists. Variables that were not analyzed previously in this context (e.g., the degree of practice specialization) and a range of control variables such as a patients' case-mix were included in the estimation. Our results suggest that it is important to investigate both technical and cost efficiency, as results may depend on the type of efficiency analyzed. For example, the technical efficiency of group practices was significantly higher than that of solo practices, whereas the results for cost efficiency differed. This may be due to indivisibilities in expensive technical equipment, which can lead to different types of health care services being provided by different practice types (i.e., with group practices using more expensive inputs, leading to higher costs per case despite these practices being technically more efficient). Other practice characteristics such as participation in disease management programs show the same impact throughout both cost and technical efficiency: participation in disease management programs led to an increase in both, technical and cost efficiency, and may also have had positive effects on the quality of care. Future studies should take quality-related issues into account.
这是第一项使用随机前沿分析来估计医师实践的技术效率和成本效率的研究。该分析基于 2006 年至 2008 年 3126 个医师实践的面板数据。我们将技术和成本前沿指定为双对数函数，使用 Battese 和 Coelli 的一步法来检测影响全科医生和专家效率的因素。在这方面以前没有分析过的变量（例如，实践专业化程度）以及一系列控制变量（如患者病例组合）被包括在估计中。我们的结果表明，调查技术效率和成本效率都很重要，因为结果可能取决于分析的效率类型。例如，团队实践的技术效率明显高于个体实践，而成本效率的结果则不同。这可能是由于昂贵的技术设备的不可分割性所致，这可能导致不同类型的医疗服务由不同类型的实践提供（即，团队实践使用更昂贵的投入，导致每个病例的成本更高，尽管这些实践在技术上更有效率）。其他实践特征，如参与疾病管理计划，在成本和技术效率方面都表现出相同的影响：参与疾病管理计划提高了技术效率和成本效率，并且可能对护理质量也产生了积极影响。未来的研究应考虑与质量相关的问题。
