Abstract
Ukraine’s recent elections revealed deep divisions between eastern regions, which favored central economic planning, and western regions, which preferred more free market reforms. This study compares polyclinics in Ukraine to see if the inflexibility of Soviet-style planned economies results in lower economic efficiency in eastern regions. Using data from two geopolitical regions, Data Envelopment Analysis (DEA) scores for polyclinic efficiencies are modeled as a function of demographic and economic determinants. Surprisingly, results indicate that polyclinics in western Ukraine are less efficient. Possible explanations, including case mix intensity, responsiveness to local preferences, physician entrepreneurial behavior and a legacy of inequitable funding, are discussed.
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Notes
Details of the FEAR program and the bootstrapping techniques are available from Wilson (Unpublished working paper, 2005) and Simar and Wilson (2007).
Additional regressions were run to assess the possibility of any time-oblast interactions. None were found.
References
Aaronson WE (1997) Developing health management education in Central and Eastern Europe. J Health Adm Educ 15:165–173
Aaronson WE, West DJ (1997) Introduction: the transformation of healthcare in Central and Eastern Europe. J Health Adm Educ 15:159–164
Banaian K (1999) The Ukrainian economy since independence. Edward Elgar, Northampton
BBC News (2004) Yushchenko wins Ukraine election, analysis: Ukraine looks west <http://news.bbc.co.uk> [27 December 2004]
Deily M, McKay N (2006) Cost-inefficiency and mortality rates in Florida hospitals. Health Econ 15:419–431
DiMaggio P (1994) Culture and economy. In: Smelser N, Swedberg R (eds) The handbook of economic sociology. Princeton University Press, Princeton, 27–57
Färe R, Grosskopf S, Lovell CAK (1994) Production frontiers. Cambridge University Press, Cambridge
Guiffrida A, Gravelle H (2001) Measuring performance in primary care: econometric analysis and DEA. Appl Econ 33:163–175
Hollingsworth B (2003) Non-parametric and parametric applications measuring efficiency in health care. Health Care Manag Sci 6:203–218
Lekhan V, Rudiy V, Nolte E (2004) Health care systems in transition: Ukraine. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen
Lewis M (2000) Who is paying for health care in Eastern Europe and Central Asia? World Bank, Washington
Lewis M (2002) Informal health payments in Central and Eastern Europe and the former Soviet Union: issues, trends and policy implications. In: Mossialos E et al (eds) Funding health care: options for Europe. Open University Press, Buckingham
Liebenstein H (1978) On the basic proposition of X-Efficiency Theory. Am Econ Rev 68:328–333
Lincoln J, Kalleberg A (1990) Culture, control and commitment: a study of work organization and work attitudes in the United States and Japan. Cambridge University Press, New York
Mayo E (1933) The human problems of industrial civilization. Macmillan, New York
Pilyavsky A, Aaronson W, Golubchikov M (2002) Comparative efficiency of tertiary care hospitals in Ukraine. Eur J Health Econ 3:23–30
Pilyavsky A, Golubchikov M, Pshenychny I (2003) Technical and allocative efficiency of hospitals in Ukraine. In: Zeliaś A (ed) Przestrzenno-Czasowe Modelowanie i Prognozowanie Zjawisk Gospodarchych. Krakow, Academia Ekonomiczna w Krakowie
Pilyavsky A, Aaronson W, Bernet P, Rosko M, Valdmanis V, Golubchikov M (2006) East–West: does it make a difference on hospital efficiencies in Ukraine? Health Econ 15:1173–1186
Preker A et al (2002) Health financing reforms in Central and Eastern Europe and the former Soviet Union. In: Mossialos E et al (eds) Funding health care: options for Europe. Open University Press, Buckingham
Rosko M (2001) Impact of HMO penetration and other environmental factors on hospital X-inefficiency. Med Care Res Rev 58:430–454
Rosko M, Chilingerian J, Zinn J, Aaronson W (1995) The effects of ownership, operating environment, and strategic choices on nursing home efficiency. Med Care 33:1–20
Ryabchuk М (2003) Дві України: реальні межі, віртуальні війни, КРИТИКА, Київ 2003 (Ryabchuk, Mykola (2003) Two Ukraines. Kyiv: Krytyka)
Simar L, Wilson P (2007) Estimation and inference in two-stage, semi-parametric models of production processes. J Econom 136:31–64
Solchanyk R (2001) Ukraine and Russia: the post-Soviet transition. Littlefield Publishers, Lanham
Subtelny O (1994) Ukraine: a history. University of Toronto Press, Toronto
Tedstrom JF (2002) Ukraine: a crash course in economic transition. Comp Econ Stud 37:49–69
Tomer JF (2002) Intangible factors in the Eastern European Transition: a socio-economic analysis. Post-Communist Econ 14:421–445
Ukraine Ministry of Health (2003) Oblast level health data, health services use and health expenditures. Ukraine, 2003
Vitrenko Y, Nagorna A (1999) Health care policy. In: Hansen J, Nanivska V (eds) Economic growth with equity: Ukrainian perspectives. The World Bank, Washington
Walgate R (2002) Global fund: the gap to fill. Bull World Health Organ 80(4):335
World Bank (2001) The health sector in Ukraine: discussion paper on selected health reform options. The World Bank, Washington
Acknowledgement
The authors gratefully acknowledge the data and assistance provided by M.V. Golubchikov, PhD, Ministry of Health, Kyiv, Ukraine (Ukraine Ministry of Health 2003).
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Bernet, P.M., Rosko, M.D., Valdmanis, V.G. et al. Productivity efficiencies in Ukrainian polyclinics: lessons for health system transitions from differential responses to market changes. J Prod Anal 29, 103–111 (2008). https://doi.org/10.1007/s11123-007-0072-4
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DOI: https://doi.org/10.1007/s11123-007-0072-4