title: Technical efficiency of Critical Access Hospitals: an application of the two-stage approach with double bootstrap.
abstract: The Critical Access Hospital (CAH) Program has offered Medicare cost-based reimbursement to small hospitals that meet certain eligibility criteria to improve their financial viability and quality of care. However, cost-based reimbursement has been associated with inefficiency in hospital operations. This study uses a two-stage approach and bootstrap procedures to examine the effects of environmental variables on the technical efficiency of CAHs. The two-stage approach with quality controls significantly improved statistical efficiency of parameter estimates in the second stage bootstrapped truncated regression relative to a similar model without quality controls. Overall, our results suggest that enhanced Medicare reimbursement may not have had detrimental effects on the technical efficiency of CAHs.
authors.affiliation: Department of Agricultural Economics and Agribusiness, Louisiana State University Agricultural Center, Baton Rouge, LA 70803, USA. inedel1@lsu.edu
authors.forename: Iustin Cristian
authors.initials: IC
authors.lastname: Nedelea
authors.forename: James Matthew
authors.initials: JM
authors.lastname: Fannin
mesh_terms: D017598:Efficiency, Organizational / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D006278:Medicare / Q000191:economics; D015233:Models, Statistical; D011786:Quality Control; D014481:United States