Doctoral thesis

La valutazione dell'(in)efficienza produttiva nel settore delle case per anziani in Svizzera : stima econometrica di una frontiera di costo stocastica

  • 2009

PhD: Università della Svizzera italiana

English In every European country health care expenditure containment is a big issue. That is true also in Switzerland, where every year health care absorbs steadily more than 10% of GDP. Nursing homes industry, counting for more than 12% of the expenditures, has a considerable weight on the total cost and for this reason it is interesting to address and empirically evaluate the cost efficiency of the sector. Following the stochastic frontier analysis literature, in particular Greene (2005), Schmidt and Sickles (1984) and Pitt and Lee (1981), we estimated a (Translog) total cost function for a hypothetical nursing home production process, designed considering both previous international literature and Swiss peculiarities. The sample used for the estimates is a balanced panel consisting of 354 nursing homes over 5 years (1998-2002) for a total of 1770 observation, scattered among whole Switzerland. From a methodological point of view, the issue of the unobserved heterogeneity is widely discussed and a comparison between the different estimation models is presented. The main empirical results are: (1) the presence of economies of scale at the sample median (around 50 beds), (2) using the more conservative econometric model a non-negligible cost inefficiency of 8% is detected, and (3) as far the inefficiency rankings of the nursing homes are concerned, the need of high-quality data to ease the problem of sensitiveness of the results to the econometric technique.
  • Italian
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