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Swedish county council's efficiency in production of specialized somatic care

Javid Gholam, Reza LU (2017) NEKN01 20171
Department of Economics
Abstract
Data Envelopment Analysis (DEA) which compares different Decision Making Units (DMUs) has been used by some scholars to find the most efficient hospitals within Sweden or within Nordic countries. In Sweden, healthcare is decentralized and provided mostly by the 21 county councils. Even private providers have to sign contracts with the county councils in order to be permitted to operate within their geographical areas. County councils are the responsible authorities for the hospitals. For that reason, this master’s thesis in economics has county councils rather than individual hospitals as DMUs for comparing specialized somatic care provision. One county council, Gotland, is excluded from the comparison as it differs from the others by... (More)
Data Envelopment Analysis (DEA) which compares different Decision Making Units (DMUs) has been used by some scholars to find the most efficient hospitals within Sweden or within Nordic countries. In Sweden, healthcare is decentralized and provided mostly by the 21 county councils. Even private providers have to sign contracts with the county councils in order to be permitted to operate within their geographical areas. County councils are the responsible authorities for the hospitals. For that reason, this master’s thesis in economics has county councils rather than individual hospitals as DMUs for comparing specialized somatic care provision. One county council, Gotland, is excluded from the comparison as it differs from the others by being both county and municipality council. Even the data for Gotland has been inadequate, so the models used in this paper are based on 20 county councils.

DEA can either be output-oriented in which the goal is to maximize output levels given certain levels of inputs or input-oriented in which outputs are treated as fixed and the goal is to minimize the inputs. In this thesis, the later type is used as the output variables are treated as mostly uncontrollable given the fact that county councils are obliged to provide care for the inhabitants and most admissions are unplanned. 4 monetary-based input variables and 2 production-based output variables are used. 6 years; 2006, 2008, 2010, 2012, 2014 and 2015 are used in order to assess the robustness of the technique.

The results show that there are scale effects in place as the bigger county councils, especially those with university hospitals, perform better than the smaller ones in terms of resource efficiency. The efficiency frontier also demonstrates a tendency for presence of variable returns to scale for the input variables capturing expenditures related to provision of specialized somatic care. (Less)
Abstract (Swedish)
Sverige brukar få hög placering i internationella jämförelser av sjukvårdssystem. Det gäller inte minst patientnöjdhet och kvalitet, läkartäthet och hälsoutfall. Ändå har de senaste åren varit mycket vanligt med larmrapporter om kris på sjukhusen med påstådda överfulla vårdsalar och personal som lämnar sjukvården pga för hög arbetsbörda och ohållbar arbetsmiljö. Situationen har dragit igång debatter om huruvida svensk sjukvård lider av bristande effektivitet, med tanke på att Sverige är bland länder med högst läkar- och sjukskötersketäthet.

Enligt en nordisk jämförelse är svenska sjukhus de minst effektiva i Norden. Statlig utredning har också slagit fast att svensk sjukvård är ineffektiv och för sjukhustung. Denna masteruppsats ämnar... (More)
Sverige brukar få hög placering i internationella jämförelser av sjukvårdssystem. Det gäller inte minst patientnöjdhet och kvalitet, läkartäthet och hälsoutfall. Ändå har de senaste åren varit mycket vanligt med larmrapporter om kris på sjukhusen med påstådda överfulla vårdsalar och personal som lämnar sjukvården pga för hög arbetsbörda och ohållbar arbetsmiljö. Situationen har dragit igång debatter om huruvida svensk sjukvård lider av bristande effektivitet, med tanke på att Sverige är bland länder med högst läkar- och sjukskötersketäthet.

Enligt en nordisk jämförelse är svenska sjukhus de minst effektiva i Norden. Statlig utredning har också slagit fast att svensk sjukvård är ineffektiv och för sjukhustung. Denna masteruppsats ämnar att jämföra landstingen, sjukhusens huvudmän, i termer av effektivitet i produktion av specialiserad somatisk vård. Uppsatsen är baserad på 4 monetära input-variabler och 2 produktionsbaserade output för den slutna respektive den öppna somatiska specialiserade vården. I arbetet ingår 6 år; 2006, 2008, 2010, 2012, 2014 och 2015.

Resultatet visar att de befolkningsmässigt stora landstingen har relativt högre effektivitet. Av de mindre landstingen har landsting med universitetssjukhus relativt högre effektivitet än övriga. Landstingen i Norrland, förutom Västerbotten som inhyser Norrlands universitetssjukhus, lider av bristande effektivitet. (Less)
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author
Javid Gholam, Reza LU
supervisor
organization
course
NEKN01 20171
year
type
H2 - Master's Degree (Two Years)
subject
keywords
DEA, Data Envelopment Analysis, Sweden, Swedish healthcare, Swedish county councils, somatic care, specialized care, efficiency, relative efficiency
language
English
additional info
For inpatient care, the episodes of care are given DRG-points so the casemix is very reliable and certain. For outpatient care, DRG is quite new and therefore the DRG-equivalents are not as certain. Therefore, the results may have been affected by this uncertainty.
id
8925389
date added to LUP
2017-09-12 11:53:59
date last changed
2017-09-12 11:53:59
@misc{8925389,
  abstract     = {Data Envelopment Analysis (DEA) which compares different Decision Making Units (DMUs) has been used by some scholars to find the most efficient hospitals within Sweden or within Nordic countries. In Sweden, healthcare is decentralized and provided mostly by the 21 county councils. Even private providers have to sign contracts with the county councils in order to be permitted to operate within their geographical areas. County councils are the responsible authorities for the hospitals. For that reason, this master’s thesis in economics has county councils rather than individual hospitals as DMUs for comparing specialized somatic care provision. One county council, Gotland, is excluded from the comparison as it differs from the others by being both county and municipality council. Even the data for Gotland has been inadequate, so the models used in this paper are based on 20 county councils. 

DEA can either be output-oriented in which the goal is to maximize output levels given certain levels of inputs or input-oriented in which outputs are treated as fixed and the goal is to minimize the inputs. In this thesis, the later type is used as the output variables are treated as mostly uncontrollable given the fact that county councils are obliged to provide care for the inhabitants and most admissions are unplanned. 4 monetary-based input variables and 2 production-based output variables are used. 6 years; 2006, 2008, 2010, 2012, 2014 and 2015 are used in order to assess the robustness of the technique.

The results show that there are scale effects in place as the bigger county councils, especially those with university hospitals, perform better than the smaller ones in terms of resource efficiency. The efficiency frontier also demonstrates a tendency for presence of variable returns to scale for the input variables capturing expenditures related to provision of specialized somatic care.},
  author       = {Javid Gholam, Reza},
  keyword      = {DEA,Data Envelopment Analysis,Sweden,Swedish healthcare,Swedish county councils,somatic care,specialized care,efficiency,relative efficiency},
  language     = {eng},
  note         = {Student Paper},
  title        = {Swedish county council's efficiency in production of specialized somatic care},
  year         = {2017},
}