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Table 1 Overview of empirical studies on the efficiency of hospitals in Germany

From: Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany

Author

Basis of analysis

Inputs and outputs / main findings

Taube 1988

613 German hospitals

Outputs: patients in different departments

Inputs: Costs

Helmig 2005

418 German hospitals

Inputs: Number of beds, treatment cases per year, sponsorship

Dittrich et al. 2005

105 Saxon and 251 Swiss hospitals

Inputs: Number of staff, costs, days of care

Main findings: Swiss hospitals are less efficient than German hospitals

Staat 2006

160 German hospitals

Inputs: daily rates, number of beds

Outputs: Treatment cases per year, length of stay

Frohloff 2007

1500 German general hospitals

Inputs: e.g., ownership

Main findings: private and non-profit hospitals are on average less efficient than public hospitals

Herr 2008

1500 German hospitals

(Data from the years 2000 to 2003)

Inputs: Number of beds, treatment cases per year, sponsorship

Main findings: private and non-profit hospitals are less cost-effective and technically less efficient than publicly owned hospitals

Herr et al. 2009

374 German hospitals

(Data from the years 2002 to 2005)

Inputs: Number of beds, treatment cases per year, ownership

Main findings: private (for-profit) and (private) non-profit hospitals are less cost-efficient but more profitable than publicly owned hospitals

Tiemann und Schreyögg 2009

1046 German hospitals

Main findings: Public hospitals performed significantly better than their private for-profit and non-profit counterparts. A significant positive association between hospital size and efficiency is shown

Augurzky und Schmitz 2010

1865 German general hospitals

(Data from the years 2003 to 2008)

Inputs: Staff (physicians, nurses, other staff) and material costs

Outputs: Number of cases weighted with level of severity

Main findings: Average efficiency increased slightly between 2003 and 2008. However, hospitals are on average 3% points more inefficient than the top 10% hospitals. But there are notable differences at the state level

Herwartz und Strumann 2011

1500 German general hospitals

Inputs: Material costs, personnel, number of beds

Outputs: Treatment cases per year, number of trainees

Main findings: Improvement of overall efficiency after DRG introduction

Herr et al. 2011

541 German hospitals

Main findings: Higher profit efficiency of private hospitals compared to public hospitals—but differences in cost efficiency

Tiemann und Schreyögg 2011

1878 German acute hospitals

Main findings: Conversion from public to private ownership resulted in increased efficiency

Lindlbauer und Schreyögg 2014

1239 acute care German hospitals

(Data from the years 2000 to 2010)

Inputs: Number of staff (physicians, nurses, other staff) and number of beds

Output: Weighted cases

Main findings: Efficiency is negatively associated with case-mix specialization, and positively with medical specialization

Lindlbauer et al. 2016b

225 German Public law hospitals

(Data from the years 2002 to 2010)

Inputs: Number of staff (physicians, nurses, other

clinical staff, administrative staff, other nonclinical staff) and cost of medical supplies

Output: Weighted cases

Main findings: The results of the difference-in-difference regressions indicate that corporatization has a positive effect on efficiency

Lindlbauer et al. 2016a

830 acute care German hospitals (with or without quality certification)

(Data from the years 2000 to 2010)

Inputs: Number of staff (physicians, nurses, other

clinical staff, administrative staff, other nonclinical staff) and number of beds

Output: the number of treated inpatient cases (weighted cases)

Main findings: The national standard KTQ has significant positive effects on efficiency. The international standard ISO 9001 has a significant negative impact on efficiency

Karmann and Rösel 2016

State-level aggregates of the 16 states (Bundesländer) (Data from the years 1993 to 2013)

Inputs: physicians, nurses, and other staff

Outputs: number of discharges, a quality index, and the quality-adjusted number of discharges

Main findings: The influence of policy decisions on TFP growth is higher in quality improvement than in increases in input or input amounts. However, hospital policy also depends strongly on the respective reimbursement schemes

Pross et al. 2018

1100 stroke treating German acute care hospitals

(Data from the years 2006 to 2013)

Inputs: Resource inputs (physicians and nurses)

Outputs: Risk-adjusted patient volume (stroke-unit)

Main findings: A conflict of objections is shown between quality improvement and resource reduction. Also, high substantial regional variation in efficiency

Schneider et al. 2020

Emergency cases of 1428 German acute care hospitals

(Data from the years 2015 to 2017)

Inputs: Number of nurses and physicians, number of beds

Outputs: In- and outpatient cases

Main findings: A negative relationship between the urgency score and hospital efficiency is proven. Either a high or low overall urgency score is beneficial. The results indicate that with the medical urgency score hospitals’ efficiency is decreasing