Decomposing the productivity differences between hospitals in the Nordic countries

HERO WP 2013/04: Authors: Sverre A.C. Kittelsen, Frisch Centre, Oslo. Et al.


  • Sverre A.C. Kittelsen, Frisch Centre, Oslo.
  • Benny Adam Persson, Frisch Centre, Oslo, and Oslo University Hospital, Oslo
  • Kjartan S. Anthun , SINTEF, Trondheim
  • Fanny Goude, Karolinska Institutet, Stockholm
  • Øyvind Hope, SINTEF, Trondheim
  • Unto Häkkinen, National Institute for Health and Welfare – THL, Helsinki
  • Birgitte Kalseth, SINTEF, Trondheim
  • Jannie Kilsmark, Danish Institute of health research, Copenhagen
  • Emma Medin, Karolinska Institutet, Stockholm
  • Clas Rehnberg, Karolinska Institutet, Stockholm
  • Hanna Rättö, National Institute for Health and Welfare – THL, Helsinki


Previous studies indicate that Finnish hospitals have significantly higher productivity than in the other Nordic countries. We decompose the productivity levels into technical efficiency, scale efficiency and country specific possibility sets (technical frontiers). Data have been collected on operating costs and patient discharges in each DRG group for all hospitals in the Nordic countries. We find that there are small differences in scale and technical efficiency between countries, but large differences in production possibilities (frontier position). The results are robust to the choice of bootstrapped Data Envelopment Analysis (DEA) or Stochastic Frontier Analysis (SFA) as frontier estimation methodology.

JEL classification: C14, I12

Keywords: Productivity, Hospitals, Efficiency, DEA, SFA


We acknowledge the contribution of other participants in the Nordic Hospital Comparison Study Group in the collection of data and discussion of study design and results.

During this study the NHCSG consisted of Mikko Peltola and Jan Christensen in addition to the authors listed. The data has been processed by Anthun, Kalseth and Hope, while Kittelsen and Persson have performed the DEA and SFA analysis respectively and drafted the manuscript. All authors have critically reviewed the manuscript and approved the final version. We thank the Norwegian board of health and the Health Economics Research Programme at the University of Oslo as well as the respective employers, for financial contributions. We finally thank the participants of the Conference in Memory of Professor Lennart Hjalmarsson in December 2012 in Gothenburg for helpful comments and suggestions.

ISBN 978-82-7756-234-6

Publisert 26. juni 2013 14:46 - Sist endret 15. mai 2017 12:29