PMID- 11967468
OWN - NLM
STAT- Publisher
LR  - 20191120
IS  - 1091-4358 (Print)
IS  - 1099-176X (Linking)
VI  - 4
IP  - 2
DP  - 2001 Jun 1
TI  - Scale, Efficiency and Organization in Norwegian Psychiatric Outpatient Clinics 
      for Children.
PG  - 79-90
AB  - BACKGROUND: It is generally believed that 5 percent of the population under 18 
      years is in need of specialist psychiatric care. In 1998, however, services were 
      delivered to only 2.1 percent of the Norwegian population. Access to services can 
      be improved by increasing capacity, but also by increasing the utilization of 
      existing capacity. Changing financial incentives has so far not been considered. 
      Based on a relatively low number of registered consultations per therapist (1.1 
      per therapist day) the ministry has stipulated that productivity should increase 
      by as much as 50 percent. AIMS OF THE STUDY: Measuring productivity in 
      psychiatric care is difficult, but we believe that studies of productivity should 
      be an important input in policy making. The aim of this paper is to provide such 
      an analysis of the productive efficiency of psychiatric outpatient clinics for 
      children and youths, and in particular to focus on three issues: (i) is an 
      increase in productivity of 50 percent a realistic goal, (ii) are there economies 
      of scale in the sector, and (iii) to what extent can differences in productivity 
      be explained by differences in staff-mix and patient-mix? METHODS: We utilize an 
      approach termed Data Envelopment Analysis (DEA) to estimate a best-practice 
      production frontier. The potential for efficiency improvement is measured as the 
      difference between actual and best-practice performance, while allowing for 
      trade-offs between different staff groups and different mixes of service 
      production. The DEA method gives estimates of efficiency and productivity for 
      each clinic without the need for prices, and thus avoids the pitfalls of partial 
      productivity ratios. The Kolmogorov-Smirnov statistic is used to compare 
      efficiency distributions, providing tests of variable specification and scale 
      properties. RESULTS: Based on 135 observations for the years 1997 to 1999, the 
      tests lead to a model with two inputs, two outputs and variable returns to scale. 
      The outputs are number of hours spent on direct and indirect interventions, while 
      neither the number of interventions nor the number of patients was found to be 
      significant. The inputs are the number of university-educated staff and other 
      staff, but disaggregation of the latter group was not significant. The average of 
      estimated clinic efficiencies is 71%. The mean productivity is 64%, but many 
      large clinics have considerably lower performance due mainly to scale 
      inefficiency. DISCUSSION: There seems to be considerable room for improved 
      performance in these clinics. It is interesting that the potential is not that 
      far from the officially stipulated goal of 50% increased productivity. Staff 
      composition does matter for clinic performance, but the different groups do not 
      have significantly different marginal productivities, indicating a lack of 
      ability to utilize specialized skills. It should be noted that these results to 
      some extent depend on the assumptions that medical practice is efficient, and 
      that the available data accurately captures the activities of the clinics. 
      IMPLICATIONS FOR FURTHER RESEARCH AND HEALTH POLICY: More appropriate outcome 
      measures, e.g. global assessment of functioning scores (GAF), will soon be 
      available and will improve the policy value of this type of analysis, as will a 
      more refined data set with information about the number of personnel in training 
      positions. The analyses in this paper indicate that a lack of consensus on the 
      issues of who should be treated, how they should be treated and by whom results 
      in large variations in productive efficiency. These issues are being debated in 
      Norway, and it should be interesting to see whether this in itself leads to 
      higher efficiency or whether a change in the incentive structure will be needed.
FAU - Halsteinli, Vidar
AU  - Halsteinli V
AD  - Master of Sc., Research Scientist, SINTEF Unimed, Health Services Research, 
      Trondheim, Norway.
FAU - Kittelsen, Sverre AC
AU  - Kittelsen SA
FAU - Magnussen, Jon
AU  - Magnussen J
LA  - eng
PT  - Journal Article
PL  - Italy
TA  - J Ment Health Policy Econ
JT  - The journal of mental health policy and economics
JID - 9815374
EDAT- 2002/04/23 10:00
MHDA- 2002/04/23 10:00
CRDT- 2002/04/23 10:00
PHST- 2001/06/25 00:00 [received]
PHST- 2001/09/28 00:00 [accepted]
PHST- 2002/04/23 10:00 [pubmed]
PHST- 2002/04/23 10:00 [medline]
PHST- 2002/04/23 10:00 [entrez]
PST - ppublish
SO  - J Ment Health Policy Econ. 2001 Jun 1;4(2):79-90.