Three essays on hospital efficiency

This dissertation analyzes hospital efficiency using various econometric techniques. The first essay provides additional and recent evidence to the presence of contract management behavior in the U.S. hospital industry. Unlike previous studies, which focus on either an input-demand equation or the cost function of the firm, this paper estimates the two jointly using a system of nonlinear equations. Moreover, it addresses the longitudinal problem of institutions adopting contract management in different years, by creating a matched control group of non-adopters with the same longitudinal distribution as the group under study. The estimation procedure then finds that labor, and not capital, is the preferred input in U.S. hospitals regardless of managerial contract status. With institutions that adopt contract management benefiting from lower labor inefficiencies than the simulated non-contract adopters. These results suggest that while there is a propensity for expense preference behavior towards the labor input, contract managed firms are able to introduce efficiencies over conventional, owner controlled, firms. Using data for the years 1998 through 2007, the second essay investigates the production technology and cost efficiency faced by Florida hospitals. A stochastic frontier multiproduct cost function is estimated in order to test for economies of scale, economies of scope, and relative cost efficiencies. The results suggest that small-sized hospitals experience economies of scale, while large and medium sized institutions do not. The empirical findings show that Florida hospitals enjoy significant scope economies, regardless of size. Lastly, the evidence suggests that there is a link between hospital size and relative cost efficiency. The results of the study imply that state policy makers should be focused on increasing hospital scale for smaller institutions while facilitating the expansion of multiproduct production for larger hospitals. The third and final essay employs a two staged approach in analyzing the efficiency of hospitals in the state of Florida. In the first stage, the Banker, Charnes, and Cooper model of Data Envelopment Analysis is employed in order to derive overall technical efficiency scores for each non-specialty hospital in the state. Additionally, input slacks are calculated and reported in order to identify the factors of production that each hospital may be over utilizing. In the second stage, we employ a Tobit regression model in order to analyze the effects a number of structural, managerial, and environmental factors may have on a hospital’s efficiency. The results indicated that most non-specialty hospitals in the state are operating away from the efficient production frontier. The results also indicate that the structural make up, managerial choices, and level of competition Florida hospitals face have an impact on their overall technical efficiency.

Effects of structured writing versus nonstructured writing as an effective and efficient teaching and learning strategy

This research investigated the effectiveness and efficiency of structured writing as compared to traditional nonstructured writing as a teaching and learning strategy in a training session for teachers.^ Structured writing is a method of identifying, interrelating, sequencing, and graphically displaying information on fields of a page or computer. It is an alternative for improving training and educational outcomes by providing an effective and efficient documentation methodology.^ The problem focuses upon the contradiction between: (a) the supportive research and theory to modify traditional methods of written documents and information presentation and (b) the existing paradigm to continue with traditional communication methods.^ A MANOVA was used to determine significant difference between a control and an experimental group in a posttest only experimental design. The experimental group received the treatment of structured writing materials during a training session. Two variables were analyzed. They were: (a) effectiveness; correct items on a posttest, and (b) efficiency; time spent on test.^ The quantitative data showed a difference for the experimental group on the two dependent variables. The experimental group completed the posttest in 2 minutes less time while scoring 1.5 more items correct. An interview with the training facilitators revealed that the structured writing materials were "user friendly." ^