Measuring hospital performance in the presence of quasi-fixed inputs:: An analysis of Quebec hospitals

This research proposes an approach to measure hospital performance based on a generalization of Banker and Morey ( 1986) and Forsund ( 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 Quebec 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.