OBJECTIVES This study examines the factors that influence make or buy decisions corresponding to ... more OBJECTIVES This study examines the factors that influence make or buy decisions corresponding to four generic services (housekeeping, laundry, food services, and maintenance and security) in Spanish hospitals (3,160 transactions in 790 hospitals). METHODS The empirical estimation of a logistic model based on hospital utility maximization is presented. Factors included in the model are not only those related to transaction costs, but also those related to public intervention and the political dimension. RESULTS A total of 55.7% of hospitals contracted-out at least one of the generic services. The services most frequently contracted-out were housekeeping and maintenance and security(45.1 and 32.5%, respectively). In contrast, the services (94.3% and 80.1%, respectively). Hospital size (economies of scale), measured by the number of beds, was one of the most important factors influencing make or buy decisions. CONCLUSIONS We find evidence that economies of scale are related to a higher...
This paper investigates the impact of the Bolsa Familia program, a conditional cash transfer prog... more This paper investigates the impact of the Bolsa Familia program, a conditional cash transfer program focused on Brazilian poor families, on children‘s nutritional status in a context of low monitoring of conditionalities. The analysis is carried out using data from a baseline survey conducted in 2005, the “Bolsa Família” Impact Evaluation Research. The evaluation is made using the Propensity Score Matchingtechnique. Besides considering observational differences between beneficiaries and non-beneficiaries of Bolsa Família Program, our empirical strategy also addresses some concerns about informational issues in order to take into account potential endogeneity of the decision to participate in the Program. Our final results show a positive effect of Bolsa Família Program on children nutritional status only whencontrolling for the informational bias and for those children fulfilling educational requirements; however, this positive impact on nutritional status is restricted to BMIfor-ag...
Compare the cost-effectiveness of self-monitoring of blood glucose (MBG) with your non-use. Descr... more Compare the cost-effectiveness of self-monitoring of blood glucose (MBG) with your non-use. Descriptive and retrospective study covering the period 1995-97 in the 597 type-2 diabetes patients: 286 practicing MBG on a stable basis and 311 not doing so. All are registered in seven health districts in the territorial ambit of Tortosa Primary Care. Were quantified the direct costs in relation to consumption of reagent strips for the practice of MBG, outpatients visits in your primary care center, derivations to specialist of reference and complementary test according to recommendations of the European NIDDM Policy Group in the population user of MBG and no-user; the annual cost increment, the average annual cost and the total annual cost in the population user of MBG and in the application of a ideal model of quantitative and qualitative cover according to clinical recommendations of the Gedaps; and the cost-effectiveness. While the 78% of the total diabetic population satisfy some clin...
The object of this paper is to review applied research on primary care efficiency in Spain perfor... more The object of this paper is to review applied research on primary care efficiency in Spain performed using parametric and nonparametric production and cost frontiers. A review of the most important bibliographic databases showed 12 applied papers that used frontier approach to measure primary care efficiency in Spain. The most part of these papers only used Data Envelopment Approach to measure technical efficiency scores. There is only one study that has employed a stochastic and nonparametric approach to obtain cost efficiency estimates. Activity measures such as number of visits are a usual measure of output and inefficiency sources are rarely analysed in this literature. Important methodological problems observed in this literature severely limit their practical utility. Future research should consider more accurate output measures, use available methods more appropriately, and shed light on the sources of inefficiency.
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 15, 1999
To investigate the results of metabolic control among type-2 diabetics who practise self-monitori... more To investigate the results of metabolic control among type-2 diabetics who practise self-monitoring of their blood glucose (MBG) and compare them with those who do not; the adequacy of MBG prescription according to clinical criteria and frequency of use; and to analyse the presence of factors predicting metabolic control. Descriptive and retrospective study covering 1995, 1996 and 1997. The seven health districts in the territorial ambit of Tortosa Primary Care. 597 type-2 diabetes patients were evaluated: 286 practising MBG, and 311 not doing so. All of them belonged to the health districts reference population. The sample was systematized and stratified by health districts in order to obtain data through a pre-designed data collection form. 41.06% of diabetics practised MBG on a stable basis, without any significant differences showing in either HbA1c percentage, in any of the biological variables defining metabolic control in relation to the practice or otherwise of MBG, or in it...
OBJECTIVES This study examines the factors that influence make or buy decisions corresponding to ... more OBJECTIVES This study examines the factors that influence make or buy decisions corresponding to four generic services (housekeeping, laundry, food services, and maintenance and security) in Spanish hospitals (3,160 transactions in 790 hospitals). METHODS The empirical estimation of a logistic model based on hospital utility maximization is presented. Factors included in the model are not only those related to transaction costs, but also those related to public intervention and the political dimension. RESULTS A total of 55.7% of hospitals contracted-out at least one of the generic services. The services most frequently contracted-out were housekeeping and maintenance and security(45.1 and 32.5%, respectively). In contrast, the services (94.3% and 80.1%, respectively). Hospital size (economies of scale), measured by the number of beds, was one of the most important factors influencing make or buy decisions. CONCLUSIONS We find evidence that economies of scale are related to a higher...
This paper investigates the impact of the Bolsa Familia program, a conditional cash transfer prog... more This paper investigates the impact of the Bolsa Familia program, a conditional cash transfer program focused on Brazilian poor families, on children‘s nutritional status in a context of low monitoring of conditionalities. The analysis is carried out using data from a baseline survey conducted in 2005, the “Bolsa Família” Impact Evaluation Research. The evaluation is made using the Propensity Score Matchingtechnique. Besides considering observational differences between beneficiaries and non-beneficiaries of Bolsa Família Program, our empirical strategy also addresses some concerns about informational issues in order to take into account potential endogeneity of the decision to participate in the Program. Our final results show a positive effect of Bolsa Família Program on children nutritional status only whencontrolling for the informational bias and for those children fulfilling educational requirements; however, this positive impact on nutritional status is restricted to BMIfor-ag...
Compare the cost-effectiveness of self-monitoring of blood glucose (MBG) with your non-use. Descr... more Compare the cost-effectiveness of self-monitoring of blood glucose (MBG) with your non-use. Descriptive and retrospective study covering the period 1995-97 in the 597 type-2 diabetes patients: 286 practicing MBG on a stable basis and 311 not doing so. All are registered in seven health districts in the territorial ambit of Tortosa Primary Care. Were quantified the direct costs in relation to consumption of reagent strips for the practice of MBG, outpatients visits in your primary care center, derivations to specialist of reference and complementary test according to recommendations of the European NIDDM Policy Group in the population user of MBG and no-user; the annual cost increment, the average annual cost and the total annual cost in the population user of MBG and in the application of a ideal model of quantitative and qualitative cover according to clinical recommendations of the Gedaps; and the cost-effectiveness. While the 78% of the total diabetic population satisfy some clin...
The object of this paper is to review applied research on primary care efficiency in Spain perfor... more The object of this paper is to review applied research on primary care efficiency in Spain performed using parametric and nonparametric production and cost frontiers. A review of the most important bibliographic databases showed 12 applied papers that used frontier approach to measure primary care efficiency in Spain. The most part of these papers only used Data Envelopment Approach to measure technical efficiency scores. There is only one study that has employed a stochastic and nonparametric approach to obtain cost efficiency estimates. Activity measures such as number of visits are a usual measure of output and inefficiency sources are rarely analysed in this literature. Important methodological problems observed in this literature severely limit their practical utility. Future research should consider more accurate output measures, use available methods more appropriately, and shed light on the sources of inefficiency.
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 15, 1999
To investigate the results of metabolic control among type-2 diabetics who practise self-monitori... more To investigate the results of metabolic control among type-2 diabetics who practise self-monitoring of their blood glucose (MBG) and compare them with those who do not; the adequacy of MBG prescription according to clinical criteria and frequency of use; and to analyse the presence of factors predicting metabolic control. Descriptive and retrospective study covering 1995, 1996 and 1997. The seven health districts in the territorial ambit of Tortosa Primary Care. 597 type-2 diabetes patients were evaluated: 286 practising MBG, and 311 not doing so. All of them belonged to the health districts reference population. The sample was systematized and stratified by health districts in order to obtain data through a pre-designed data collection form. 41.06% of diabetics practised MBG on a stable basis, without any significant differences showing in either HbA1c percentage, in any of the biological variables defining metabolic control in relation to the practice or otherwise of MBG, or in it...
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Papers by J. Puig-junoy