Unexpected Demand and its Impact on Hospital Cost: The Case of Greece

Edited by Zoe Boutsioli

ISBN: 978-960-6672-59-0, 180 pages

First published in 2010 by ATINER

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Table of Contents

 

Abstract                                                                                                                                                                      v

 

Acknowledgments                                                                                                                                                 vii

 

Table of Contents                                                                                                                                                   ix

 

Chapter 1: Hospital cost and unexpected demand: an introduction

1.1. Introduction                                                                                                                                                       1

1.2. Health care costs: a growing policy concern                                                                                                2

1.3. The basic hypothesis, research questions and methods                                                                             6

1.4. Conclusions                                                                                                                                                      11

 

Chapter 2: The Greek NHS and its cost efficiency problems

2.1. Introduction                                                                                                                                                     13

2.2. The pre-NHS era                                                                                                                                             15

2.3. The establishment of the Greek NHS and its organization                                                                     17

2.4. An evaluation of the Greek NHS                                                                                                                 24

2.5. The cost efficiency problems of the Greek NHS                                                                                       38

2.6. Conclusions                                                                                                                                                      40

 

Chapter 3: Hospital costs: a review of the literature

3.1. Introduction                                                                                                                                                     41

3.3. The standard theory of hospital cost                                                                                                          42

3.3. Demand variability, unexpected demand and hospital cost                                                                  51

3.4. Empirical hospital cost studies with demand variability and unexpected demand                           55

3.5. Efficiency concepts                                                                                                                                        64

3.6. Conclusions                                                                                                                                                      67

 

Chapter 4: Data, estimation and model specifications

4.1. Introduction                                                                                                                                                     69

4.2. Models and variables                                                                                                                                     70

4.3. Sample and data                                                                                                                                             80

4.4. Sampled and population characteristics of the Greek hospital sector                                                  85

4.5. Estimation of hospital cost functions and hospital efficiency                                                               87 

4.6. Data deficiencies                                                                                                                                             89

4.7. Validity and comparability issues                                                                                                                91

4.8. Conclusions                                                                                                                                                      92 

 

Chapter 5: Measuring unexpected demand

5.1. Introduction                                                                                                                                                     93

5.2. Forecasting emergency admissions                                                                                                             94

5.3. Emergency admissions: descriptive statistics                                                                                            97

5.4. Univariate measurement of unexpected emergency demand                                                             102

5.5. Multivariate measurement of unexpected emergency demand                                                          107

5.6. Comparing the univariate and multivariate measures                                                                          110

5.7. Conclusions                                                                                                                                                   112

 

Chapter 6: Hospital costs and unexpected demand: the empirical evidence

6.1. Introduction                                                                                                                                                   113

6.2. Data summary                                                                                                                                              114

6.3. Model specification                                                                                                                                      116

6.4. Empirical results                                                                                                                                            119

6.5. Economies of scale and economies of scope                                                                                          127

6.6. Conclusions                                                                                                                                                   131

 

Chapter 7: Policy implications

7.1. Introduction                                                                                                                                                   133

7.2. Data, information and policy                                                                                                                     134

7.3. Improving hospital cost efficiency                                                                                                            137

7.4. Restructuring the Greek public hospital sector                                                                                        140

7.5. Policy implementation issues and policy limitations                                                                             145

7.6. Conclusions                                                                                                                                                   148

 

Chapter 8: Conclusions and further research

8.1. Introduction                                                                                                                                                   149

8.2. The cost efficiency issues and public hospitals in Greece                                                                     150

8.3. Measurement of unexpected demand for hospital admissions in Greece                                         151

8.4. Hospital cost determination and policies of cost containment                                                            152

8.5. Further research and limitations                                                                                                                154

8.6. Conclusions                                                                                                                                                   156

 

Annexes

Annex I: The questionnaire                                                                                                                                157

Annex II: Stationarity of emergency admissions series for the ten hospitals                                           163

Annex III: Descriptive statistics of hospital cost and explanatory variables (2001-2005)                    165

 

Bibliography                                                                                                                                                        167