title: The effects of stochastic demand and expense preference behaviour on public hospital costs and excess capacity.
abstract: The literature to date on the effect of demand uncertainty on public hospital costs and excess capacity has not taken into account the role of expense preference behaviour. Similarly, the research on expense preference behaviour has not taken demand uncertainty into account. In this paper, we argue that both demand uncertainty and expense preference behaviour may affect public hospital costs and excess capacity and that ignoring either of these effects may lead to biased parameter estimates and misleading inference. To show this, we extend the analysis of Rodríguez-Alvarez and Lovell (Health Econ. 2004; 13: 157-169) by incorporating demand uncertainty into the technology to account for the hospital activity of providing standby capacity or insurance against the unexpected demand. We find that demand uncertainty in Spanish public hospitals affects hospital production decisions and increases costs. Our results also show that overcapitalization in these hospitals can be explained by hospitals providing insurance demand when faced with demand uncertainty. We also find evidence of expense preference behaviour. We conclude that both stochastic demand and expense preference behaviour should be taken into account when analysing hospital costs and production.
authors.affiliation: University of Georgia, Athens, GA, USA.
authors.forename: C A Knox
authors.initials: CA
authors.lastname: Lovell
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Alvarez
authors.forename: Alan
authors.initials: A
authors.lastname: Wall
mesh_terms: D003659:Decision Making, Organizational; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D006742:Hospital Bed Capacity / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006752:Hospital Planning / Q000458:organization & administration; D006779:Hospitals, Public / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007350:Insurance, Hospitalization; D018803:Models, Economic; D017060:Patient Satisfaction / Q000191:economics / Q000706:statistics & numerical data*; D013030:Spain; D013269:Stochastic Processes; D035501:Uncertainty