title: Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis.
abstract: This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.
authors.affiliation: Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden. emma.medin@ki.se
authors.forename: Emma
authors.initials: E
authors.lastname: Medin
authors.forename: Kjartan S
authors.initials: KS
authors.lastname: Anthun
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.forename: Sverre A C
authors.initials: SA
authors.lastname: Kittelsen
authors.forename: Miika
authors.initials: M
authors.lastname: Linna
authors.forename: Jon
authors.initials: J
authors.lastname: Magnussen
authors.forename: Kim
authors.initials: K
authors.lastname: Olsen
authors.forename: Clas
authors.initials: C
authors.lastname: Rehnberg
mesh_terms: D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics; D017598:Efficiency, Organizational / Q000191:economics*; D005387:Finland; D017048:Health Care Costs; D006302:Health Services Research; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000706:statistics & numerical data; D015233:Models, Statistical; D005791:Patient Care; D012044:Regression Analysis; D012537:Scandinavian and Nordic Countries; D014146:Training Support / Q000191:economics