title: Health systems: changes in hospital efficiency and profitability.
abstract: This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.
authors.affiliation: Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
authors.forename: Vera Antonia
authors.initials: VA
authors.lastname: Büchner
authors.affiliation: Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Hinz
authors.affiliation: Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany. Jonas.Schreyoegg@wiso.uni-hamburg.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schreyögg
mesh_terms: D000465:Algorithms; D003695:Delivery of Health Care / Q000191:economics*; D004469:Economics, Hospital; D017598:Efficiency, Organizational; D005858:Germany; D006739:Hospital Administration / Q000379:methods*; D006761:Hospitals; D006801:Humans; D012044:Regression Analysis
keywords: Data envelopment analysis; Difference-in-difference; Genetic matching; Hospital systems; Performance measurement; Profitability