title: Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis.
abstract: Although health care reforms may improve efficiency at the macro level, less is known regarding their effects on the utilization of health care personnel. Following the 2002 Norwegian hospital reform, we studied the productivity of the physician workforce and the effect of personnel mix on this measure in all nineteen Norwegian hospitals from 2001 to 2013.
  
  
  
  We used panel analysis and non-parametric data envelopment analysis (DEA) to study physician productivity defined as patient treatments per full-time equivalent (FTE) physician. Resource variables were FTE and salary costs of physicians, nurses, secretaries, and other personnel. Patient metrics were number of patients treated by hospitalization, daycare, and outpatient treatments, as well as corresponding diagnosis-related group (DRG) scores accounting for differences in patient mix. Research publications and the fraction of residents/FTE physicians were used as proxies for research and physician training.
  
  
  
  The number of patients treated increased by 47% and the DRG scores by 35%, but there were no significant increases in any of the activity measures per FTE physician. Total DRG per FTE physician declined by 6% (p < 0.05). In the panel analysis, more nurses and secretaries per FTE physician correlated positively with physician productivity, whereas physician salary was neutral. In 2013, there was a 12%-80% difference between the hospitals with the highest and lowest physician productivity in the differing treatment modalities. In the DEA, cost efficiency did not change in the study period, but allocative efficiency decreased significantly. Bootstrapped estimates indicated that the use of physicians was too high and the use of auxiliary nurses and secretaries was too low.
  
  
  
  Our measures of physician productivity declined from 2001 to 2013. More support staff was a significant variable for predicting physician productivity. Personnel mix developments in the study period were unfavorable with respect to physician productivity.
authors.affiliation: Sykehuspartner Health Enterprise, Oslo, Norway. Electronic address: xakljo@sykehuspartner.no.
authors.forename: Karl Arne
authors.initials: KA
authors.lastname: Johannessen
authors.affiliation: Frisch Centre, Oslo, Norway; Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Sverre A C
authors.initials: SA
authors.lastname: Kittelsen
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Terje P
authors.initials: TP
authors.lastname: Hagen
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000191:economics* / Q000706:statistics & numerical data*; D018166:Health Care Reform / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D009664:Norway; D010820:Physicians / Q000706:statistics & numerical data*
keywords: Data envelopment analysis; Health care reform; Norway; Panel analysis; Personnel mix; Physician productivity