Measuring Hospital Performance in the Presence of Quasi-Fixed Inputs: An Analysis of Québec Hospitals

This research proposes an approach to measure hospital performance based on a generalization of Banker and Morey (1986) and Førsund (1996). This approach considers quasi-fixed inputs explicitly, calculates their implicit cost, and quantifies returns to scale. The performance measure is decomposed into allocative and technical inefficiencies. Based on a very complete data set of Québec hospitals, we find that significant inefficiencies of up to 17% ($700 CAN million) could have been saved through improved performance. Postestimation analyses that include qualitative measures of care suggest that differences in performance are attributable to differences in management or unobservable quality of care rather than patient case mix.     

Hospital Technology in a Nonmarket Health Care System

This article presents a quantitative analysis of the production of hospital services in a nonmarket environment based on production theory and a very complete data set on the hospital industry. It provides both insights into the optimality of the hospital industry structure and a useful framework to evaluate the impact of anticipated industry structural changes. We find that the industry structure is far from optimal; it is characterized by overcapitalization and would experience difficulty responding to increased demand for some types of services.     

Volunteering a public service: an experimental investigation

In some public goods environments it may be advantageous for heterogeneous groups to be coordinated by a single individual. This “volunteer” will bear private costs for acting as the leader while enabling each member of the group to achieve maximum potential gains. This environment is modeled as a War of Attrition game in which everyone can wait for someone else to volunteer. Since these games generally have multiple Nash equilibria but a unique subgame-perfect equilibrium, we tested experimentally the predictive power of the subgame-perfection criterion. Our data contradict that subjects saw the subgame-perfect strategy combination as the obvious way to play the game. An alternative behavioral hypothesis—that subjects were unable to predict accurately how their opponents would play and tried to maximize their expected payoff—is proposed. This hypothesis fits the observed data generally well.     

Rational Nonprofit Entrepreneurship

This paper derives the decision to found a nonprofit firm as the equilibrium outcome of a multistage game among individuals who would like a public good to be provided. The model predicts that if individuals will voluntarily contribute towards provision of the public good, then it is in the self-interest of the entrepreneur to impose a nondistribution constraint on herself by founding a nonprofit firm.