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.

The relationship of student and teacher variables on academic achievement in Florida schools

Since 1995, Florida has been one of the leading states in the country initiating a high-stakes school accountability system. Public schools in Florida receive letter grades based on their performance on the Florida Comprehensive Assessment Test (FCAT). These school grades have significant effects on schools' reputations and funding. Consequently, the plan has been criticized for grading all schools in the same manner, without taking into account such variables as student poverty and mobility rates which are beyond the control of the school. ^ The purpose of this study was to examine the relationship of student variables (poverty and mobility rates) and teacher variables (average years of teacher experience and attained degree level) on FCAT math and reading performance. This research utilized an education production function model to examine which set of inputs (student or teacher) has a stronger influence on student academic output as measured by the FCAT. ^ The data collected for this study was from over 1500 public elementary schools in Florida that listed all pertinent information for 2 school years (1998/1999 & 1999/2000) on the Florida Department of Education's website. ^ It was concluded that student poverty, teacher average years of experience and student mobility taken together, provide a strong predictive measure of FCAT reading and math performance. However, the set of student inputs was significantly stronger than the teacher inputs. High student poverty was highly correlated with low FCAT scores. Teacher experience and student mobility rates were not nearly as strongly related to FCAT scores as was student poverty. The results of this study provide evidence for educators and other school stakeholders of the relative degree to which student and teacher variables are related to student academic achievement. The underlying reasons for these relationships will require further examination in future studies. These results raise questions for Florida's school policymakers about the educational equity of the state's accountability system and its implementation. ^

The effect of domestic credit in the economic *development process

A commonly held view is that creation of excessive domestic credit may lead to inflation problems, however, many economists uphold the possibility that, generous domestic credit under appropriate conditions will result in increases of output. This hypothesis is examined for Japan and Colombia for the period 1950-1993.^ Domestic credit theories are reviewed since the times of Thornton and Smith, until the recent times of Lewis, McKinnon, Stiglitz and of Japanese economists like K. Emi, Tachi R. and others. It is found that in Japan of the Post-War period, efficient financial markets and the decisive role of the government in orienting investment decisions seem to have influenced positively the effectiveness of domestic credit as an output-stimulating variable. On the contrary, in Colombia the absence of the above features seems to explain why domestic credit is not very effective as an output-stimulating variable.^ Multiple regression analyses show that domestic credit is a strong explanatory variable for output increases in Japan and a weak one for Colombia's case in the studied period. For Japan the correlation depicts a positive relationship between the two variables with a decreasing rate very similar to a typical production function. Moreover, the positive decreasing rate is confirmed if net domestic credit is used in the correlations. For Colombia a positive relationship is also found when accumulated domestic credit is used, but, if net domestic credit is the source of correlations, the positive decreasing rate is not obtained.^ Granger causality tests determined causality from domestic credit to output for Japan and no-causality for Colombia at the 1% significance level; the differences are explained by: (1) The low development level of the financial system in Colombia. (2) The nonexistence of consistent domestic credit policy to foster economic development. (3) The lack of an authoritative orientation in the allocation of financial resources and the nonexistence of long range industrialization programs in Colombia that could channel productively credit resources. For the system of equations relating domestic credit and exports, the Granger causality tests determined no-causality between domestic credit and exports for both Japan and Colombia also at the 1% significance level. ^

The contribution of higher education to economic *development in a globalized environment

Amidst concerns about achieving high levels of technology to remain competitive in the global market without compromising economic development, national economies are experiencing a high demand for human capital. As higher education is assumed to be the main source of human capital, this analysis focused on a more specific and less explored area of the generally accepted idea that higher education contributes to economic growth. The purpose of this study, therefore, was to find whether higher education also contributes to economic development, and whether that contribution is more substantial in a globalized context. ^ Consequently, a multiple linear regression analysis was conducted to support with statistical significance the answer to the research question: Does higher education contributes to economic development in the context of globalization? The information analyzed was obtained from historical data of 91 selected countries, and the period of time of the study was 10 years (1990–2000). Some variables, however, were lagged back 5, 10 or 15 years along a 15-year timeframe (1975–1990). The resulting comparative static model was based on the Cobb-Douglas production function and the Solow model to specify economic growth as a function of physical capital, labor, technology, and productivity. Then, formal education, economic development, and globalization were added to the equation. ^ The findings of this study supported the assumption that the independent contribution of the changes in higher education completion and globalization to changes in economic growth is more substantial than the contribution of their interaction. The results also suggested that changes in higher and secondary education completion contribute much more to changes in economic growth in less developed countries than in their more developed counterparts. ^ As a conclusion, based on the results of this study, I proposed the implementation of public policy in less developed countries to promote and expand adequate secondary and higher education systems with the purpose of helping in the achievement of economic development. I also recommended further research efforts on this topic to emphasize the contribution of education to the economy, mainly in less developed countries. ^

Importance of storm events in controlling ecosystem structure and function in a Florida gulf coast estuary

From 8/95 to 2/01, we investigated the ecological effects of intra- and inter-annual variability in freshwater flow through Taylor Creek in southeastern Everglades National Park. Continuous monitoring and intensive sampling studies overlapped with an array of pulsed weather events that impacted physical, chemical, and biological attributes of this region. We quantified the effects of three events representing a range of characteristics (duration, amount of precipitation, storm intensity, wind direction) on the hydraulic connectivity, nutrient and sediment dynamics, and vegetation structure of the SE Everglades estuarine ecotone. These events included a strong winter storm in November 1996, Tropical Storm Harvey in September 1999, and Hurricane Irene in October 1999. Continuous hydrologic and daily water sample data were used to examine the effects of these events on the physical forcing and quality of water in Taylor Creek. A high resolution, flow-through sampling and mapping approach was used to characterize water quality in the adjacent bay. To understand the effects of these events on vegetation communities, we measured mangrove litter production and estimated seagrass cover in the bay at monthly intervals. We also quantified sediment deposition associated with Hurricane Irene's flood surge along the Buttonwood Ridge. These three events resulted in dramatic changes in surface water movement and chemistry in Taylor Creek and adjacent regions of Florida Bay as well as increased mangrove litterfall and flood surge scouring of seagrass beds. Up to 5 cm of bay-derived mud was deposited along the ridge adjacent to the creek in this single pulsed event. These short-term events can account for a substantial proportion of the annual flux of freshwater and materials between the mangrove zone and Florida Bay. Our findings shed light on the capacity of these storm events, especially when in succession, to have far reaching and long lasting effects on coastal ecosystems such as the estuarine ecotone of the SE Everglades.

Segregation of Palaemonid Shrimp Along an Everglades Estuarine Gradient: Do Multiple Species Have Similar Trophic Function?

Variation in physical gradients and production along estuaries can alter species compositions. Spatiotemporal variation in abundance and distribution of palaemonid shrimp species was investigated in relation to seasonal freshwater inputs and salinity in the Shark River Estuary, Everglades National Park, Florida, USA. Using trapping techniques, multiple sites were sampled repeatedly extending from the headwaters to the Gulf of Mexico. Stable isotope analyses were also performed on a subset of samples. Five palaemonid species occurred in the samples: Palaemonetes paludosus (Gibbes, 1850), Palaemonetes pugio (Holthuis, 1949), Palaemonetes intermedius (Holthuis, 1949), Palaemon floridanus (Chace, 1942), and Leander paulensis(Ortmann, 1897). Overall, shrimp catches in traps doubled in the dry season. Catches in the upper estuary were dominated by P.paludosus, particularly in the wet season, while catch per unit effort at the most downstream and highest salinity sites were dominated by P. floridanus. At mid-estuary, several species co-occurred. δ15n analyses revealed that most species filled similar roles in the community, with the exception of P. paludosus, which shifted from enrichment in the dry season to depletion in the wet season as it expanded downstream in the estuary. Palaemonid δ13C values varied between sites and seasons, with shrimp in upstream sites being more depleted. These data suggest that changes in salinity regimes resulting from Everglades restoration efforts may result in species replacement, with potential implications for trophic dynamics.