PubMed · 16604926
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MargaretAnn Cross. 2006. Deciding factor.. https://pubmed.ncbi.nlm.nih.gov/16604926/
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In this paper we attempt to identify behavioral differences between public and private not-for-profit hospitals, by exploiting the introduction of the DRG-based payment system in the Italian NHS during the second half of the 1990s. We estimate the technical efficiency of a sample of hospitals for the period 1995-2000 considering an output distance function, and adopting both parametric (COLS and SF) and nonparametric (DEA) approaches. Our results show a convergence of mean efficiency scores between not-for-profit and public hospitals, and seem to suggest that differences in economic performances between competing ownership forms are more the result of the institutional settings in which they operate than the effect of the incentive structures embedded in the different proprietary forms. We also observe a decline in technical efficiency, probably due to policies aimed at reducing hospitalization rates.
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We previously showed that a multifaceted intervention designed to contain costs of prescribing selective serotonin reuptake inhibitors (SSRIs) at a Veterans Affairs hospital resulted in substantial projected savings. Intervention components included clinician education and pharmacy and computer information process changes. We now report on effects of altering the intervention to promote prescribing of generic fluoxetine. Over 30 months, fluoxetine's market-share increased from 12 to 32% of all SSRIs prescribed. A total of $2,500,000 in cost avoidance resulted from substituting generic for brand fluoxetine, and $600,000 resulted from increases in market-share of fluoxetine. The results highlight the robustness and flexibility of the intervention approach.