Influence of cost systems on efficiency. An analysis of Spanish hospitals using public national databases

Abstract

This paper analyzes whether the level of development of the hospital cost systems (CS) implemented by the Spanish Regional Health Services (RHS) has an effect on hospital efficiency. For this purpose, we used the public data of 159 hospitals of the Spanish National Health System (NHS) between 2010 and 2013, the period of the most stringent budgetary constraints derived from the economic crisis. We apply three methodologies: first, a conventional data envelopment analysis (DEA) model followed by a Tobit regression; second, a two-step procedure with a double bootstrap proposed by Simar & Wilson (2007), and third, the calculation of the Malmquist index and the application of logistic regression to explain the change in efficiency. We find that in the context studied there is a direct relationship between the most developed CS and the improvement of efficiency. Our findings suggest that policy makers and regulators should incentivize the development of standardized hospital CS.