[Show abstract][Hide abstract] ABSTRACT: This study assesses which factors explain the development of health care expenditures in Finnish hospital districts during 1993?2005. According to the results, real health care expenditures in hospital districts during the study period increased by 25%, but four fifths of this increase could be explained by the economic situation of the municipalities, demographic factors, the morbidity of the population and registered alcohol consumption. The increase in taxable income in municipalities and the number of diagnosed diabetes patients had a clear positive effect on health care expenditures. With favourable development of local economy municipalities increased health care resources, but this has not led to a respective growth in the service output. The relative size of the Swedishspeaking population and expenditures were also positively associated. In addition, the increase in alcohol consumption had a significant effect on expenditures. Respectively, the decrease in the proportion of disability pensioners had a modest restraining effect on expenditures.
[Show abstract][Hide abstract] ABSTRACT: We examine the expenditure and efficiency effects of secessions of health centre federations between 1990 and 2003. Using both regression and matching techniques we find statistically significant effects. According to results, the per capita primary health care expenditure growth is approximately five percent higher in seceded health centres compared to all non-seceded health centres. Using nearest neighbour matching, we find that the average secession effect is eight percent on per capita primary health care expenditures. We find no effect on specialised health care expenditures. Using an indicator of health centre service volume, we find that secessions had no positive effects on the productivity development in the long term. The rapid expenditure growth of seceded health centres can thus be explained both by increasing service volume and decreasing productivity. Key words: Health care expenditures, health centre secessions, economies of scale
[Show abstract][Hide abstract] ABSTRACT: This study measures efficiency differences and productivity changes of Finnish municipalities providing comprehensive school education during 1998-2004 by estimating both production and cost functions. The average inefficiency was approximately 6-10 percent during 1998-2004 based on both production and cost function estimations. Both approaches also produced very similar inefficiency rankings for the municipalities. Based on the results of cost functions, both the size of the municipality and average school size had a nonlinear impact on costs. The optimal municipal size was approximately 24 000-37 000 inhabitants and optimal school size was 690 students. The share of students in remedial instruction, the share of students using transportation, and taxable income per inhabitant had a positive impact on costs whereas the share of students in lower school decreased the costs. The productivity of the comprehensive schools decreased on average 12 percent during the period. The increase in per capita taxable income and the share of students in remedial instruction had the biggest impact on the productivity decrease whereas the increase in school size clearly enhanced productivity.
[Show abstract][Hide abstract] ABSTRACT: We measure productivity changes of primary care in Finland between 1988 and 2003 as a ratio of key services produced and real operating costs. In the second stage we estimate a truncated regression model that quantifies the contribution of certain internal and exogenous factors to productivity. We use newly developed techniques to correct asymptotic bias in non-parametric efficiency scores and bootstrap the confidence intervals for the explanatory model parameter estimates. The bias accounts on average 2.8 percent decrease in efficiency level. From 1997 to 2003 the average productivity declined 13.7 percent; the result is insensitive to estimated bias. Even if standard parametric confidence intervals do not generally apply when efficiency scores are regressed, our bootstrapped intervals are almost equal to parametric ones. Of the correlates used the increased income subject to municipal taxation accounted for three percentage points of the productivity decrease. The correlates, that are expected to decrease the need of primary care services, had a negative impact on productivity, implying that health centres have not been able to adjust their resource usage correspondingly. Organisational changes that have taken place within primary care have not resulted in desired productivity improvements.