A systematic review of health care efficiency measures: Health care efficiency

Health Services Research

Volumn 44, Issue 3, 2009, Pages 784-805

  Hussey, Peter S ^a   De Vries, Han ^b   Romley, John ^a,c   Wang, Margaret C ^a   Chen, Susan S ^a,d   Shekelle, Paul G ^a,e   McGlynn, Elizabeth A ^a  

^a RAND CORPORATION   (United States)

^b RAND   (United Kingdom)

^c OCCIDENTAL COLLEGE   (United States)

^d MICHIGAN STATE UNIVERSITY   (United States)

^e VA GREATER LOS ANGELES HEALTHCARE SYSTEM   (United States)

Author keywords

Efficiency; Performance measurement; Provider profiling; Systematic review

Indexed keywords

ARTICLE; CONTROLLED STUDY; HEALTH CARE; HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH SERVICE; METHODOLOGY; PEER REVIEW; PRODUCTIVITY; RELIABILITY; SENSITIVITY ANALYSIS; SYSTEMATIC REVIEW; VALIDITY;

COMMUNITY HEALTH PLANNING; COST-BENEFIT ANALYSIS; DATA COLLECTION; DATA INTERPRETATION, STATISTICAL; EFFICIENCY, ORGANIZATIONAL; EPISODE OF CARE; HEALTH SERVICES RESEARCH; HUMANS; LENGTH OF STAY; MODELS, STATISTICAL; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); PATIENT DISCHARGE; QUALITY INDICATORS, HEALTH CARE; QUALITY OF HEALTH CARE; RELATIVE VALUE SCALES; REPRODUCIBILITY OF RESULTS; RESEARCH DESIGN; RISK ADJUSTMENT; UNITED STATES;

EID: 65649140116     PISSN: 00179124     EISSN: 14756773     Source Type: Journal    
DOI: 10.1111/j.1475-6773.2008.00942.x     Document Type: Article

References (48)

1. Albritton, T. A., M. D. Miller, M. H. Johnson D. W. Rahn. 1997 Using Relative Value Units to Measure Faculty Clinical Productivity Journal of General Internal Medicine 12 (11) : 715 7. (Pubitemid 27495371)
2. American Medical Association. 2007 Tiered and Narrow Physician Networks [accessed on June 15, 2007]. Available at
3. AQA. 2007 AQA Principles of 'Efficiency' Measures [accessed on February 10, 2007]. Available at
4. Ashby, J., S. Guterman T. Greene. 2000 An Analysis of Hospital Productivity and Product Change Health Affairs 19 (5) : 197 205.
5. Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Insurance Trust Funds. 2007 2007 Annual Report [accessed on June 15, 2007]. Available at
6. Bush, R. W. 2007 Reducing Waste in US Health Care Systems Journal of the American Medical Association 297 (8) : 871 4. (Pubitemid 46333952)
7. Carey, K. 2003 Hospital Cost Efficiency and System Membership Inquiry 40 (1) : 25 38. (Pubitemid 36718096)
8. Cassel, C. K. T. E. Brennan. 2007 Managing Medical Resources: Return to the Commons? Journal of the American Medical Association 297 (22) : 2518 21. (Pubitemid 46953406)
9. Chernew, M., D. M. Cutler P. S. Keenan. 2005 Increasing Health Insurance Costs and the Decline in Insurance Coverage Health Services Research 40 (4) : 1021 39. (Pubitemid 41040659)
10. Conrad, D. A., A. Sales, S. Y. Liang, A. Chaudhuri, C. Maynard, L. Pieper, L. Weinstein, D. Gans N. Piland. 2002 The Impact of Financial Incentives on Physician Productivity in Medical Groups Health Services Research 37 (4) : 885 906. (Pubitemid 36125123)
11. Conrad, D., T. Wickizer, C. Maynard, T. Klastorin, D. Lessler, A. Ross, N. Soderstrom, S. Sullivan, J. Alexander K. Travis. 1996 Managing Care, Incentives, and Information: An Exploratory Look Inside the 'Black Box' of Hospital Efficiency Health Services Research 31 (3) : 235 59. (Pubitemid 26268773)
12. Davis, K., C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss K. K. Shea. 2007 Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care [accessed on June 15, 2007]. Available at
13. DeFelice, L. C. W. D. Bradford. 1997 Relative Inefficiencies in Production between Solo and Group Practice Physicians Health Economics 6 (5) : 455 65. (Pubitemid 27474914)
14. Dewar, D. M. J. Lambrinos. 2000 Does Managed Care More Efficiently Allocate Resources to Older Patients in Critical Care Settings? Cost and Quality Quarterly Journal 6 (2) : 18 26.
15. Draper, D. A., A. Liebhaber P. B. Ginsburg. 2007 High-Performance Health Plan Networks: Early Experiences [accessed on June 15, 2007]. Available at
16. Fiscella, K., P. Franks, M. R. Gold C. M. Clancy. 2000 Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care Journal of the American Medical Association 283 (19) : 2579 84. (Pubitemid 30324204)
17. Fisher, E., D. Wennberg, T. Stukel, D. Gottlieb, F. Lucas E. Pinder. 2003a The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care Annals of Internal Medicine 138 (4) : 273 87. (Pubitemid 36205924)
18. Fisher, E. 2003b The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care Annals of Internal Medicine 138 (4) : 288 98. (Pubitemid 36205924)
19. Folland, S. R. Hofler. 2001 How Reliable Are Hospital Efficiency Estimates? Exploiting the Dual to Homothetic Production Health Economics 10 (8) : 683 98. (Pubitemid 34041383)
20. Fuchs, V. 2005 Health Care Expenditures Reexamined Annals of Internal Medicine 143 (1) : 76 8. (Pubitemid 40923337)
21. Harrison, J. P. M. N. Coppola. 2007 The Impact of Quality and Efficiency on Federal Healthcare International Journal of Public Policy 2 (3) : 356 71.
22. Hollingsworth, B. 2003 Non-Parametric and Parametric Applications Measuring Efficiency in Health Care Health Care Management Science 6 (4) : 203 18. (Pubitemid 39030686)
23. Iglehart, J. K. 2002 Changing Health Insurance Trends New England Journal of Medicine 347 (12) : 956 62.
24. Institute of Medicine (IOM). 2001. Crossing the Quality Chasm. Washington, DC : National Academies Press.
25. Kessler, D. P. M. B. McClellan. 2002 The Effects of Hospital Ownership on Medical Productivity RAND Journal of Economics 33 (3) : 488 506.
26. The Leapfrog Group and Bridges to Excellence. 2007 Measuring Provider Efficiency Version 1.0 [accessed on January 5, 2009]. Available at
27. Massachusetts Medical Society. 2008 MMS Files Legal Action Against the Group Insurance Commission, Its Executive Director, and Two Health Plans [accessed on May 31, 2008]. Available at
28. McGlynn, E., P. Shekelle, S. Chen, G. Goldman, J. Romley, P. S. Hussey, H. de Vries, M. Wang, M. Timmer, J. Carter, C. Tringale R. Shanman. 2008 Health Care Efficiency Measures: Identification, Categorization, and Evaluation AHRQ Publication No. 08-0030 [accessed September 16, 2008]. Available at
29. Medicare Payment Advisory Commission (MedPAC). 2006. Report to the Congress: Increasing the Value of MEDICARE. Washington, DC : MedPAC.
30. Medicare Payment Advisory Commission (MedPAC). 2007. Report to Congress: Assessing Alternatives to the Sustainable Growth System. Washington, DC : MedPAC.
31. Milstein, A. 2004 Hot Potato Endgame Health Affairs 23 (6) : 32 4. (Pubitemid 39531448)
32. Milstein, A. T. H. Lee. 2007 Comparing Physicians on Efficiency New England Journal of Medicine 357 (26) : 2649 52.
33. Newhouse, J. P. 1994 Frontier Estimation: How Useful a Tool for Health Economics? Journal of Health Economics 13 (3) : 317 22. (Pubitemid 24327188)
34. O'Kane, M., J. Corrigan, S. M. Foote, S. R. Tunis, G. J. Isham, L. M. Nichols, E. S. Fisher, J. C. Ebeler, J. A. Block, B. E. Bradley, C. K. Cassel, D. L. Ness J. Tooker. 2008 Crossroads in Quality Health Affairs 27 (3) : 749 58.
35. Reid, P. P., W. D. Compton, J. H. Grossman G. Fanjiang, eds. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC : National Academies Press.
36. Rosenman, R. D. Friesner. 2004 Scope and Scale Inefficiencies in Physician Practices Health Economics 13 (11) : 1091 116. (Pubitemid 39496945)
37. Rosko, M. D. 2004 Performance of US Teaching Hospitals: A Panel Analysis of Cost Inefficiency Health Care Management Science 7 (1) : 7 16. (Pubitemid 39024060)
38. Schuster, M. A., E. A. McGlynn R. H. Brook. 1998 How Good Is the Quality of Health Care in the United States? The Milbank Quarterly 76 (4) : 517 63. (Pubitemid 128463044)
39. Sherman, H. D. 1984 Hospital Efficiency Measurement and Evaluation. Empirical Test of a New Technique Medical Care 22 (10) : 922 38. (Pubitemid 15180301)
40. Skinner, J., E. Fisher J. E. Wennberg. 2007 The Efficiency of Medicare [accessed on June 15, 2007]. Available at
41. Thomas, J. W. 2006 Should Episode-Based Economic Profiles Be Risk Adjusted to Account for Differences in Patients' Health Risks? Health Services Research 41 (2) : 581 98. (Pubitemid 43374288)
42. Thomas, J. W., K. L. Grazier K. Ward. 2004 Economic Profiling of Primary Care Physicians: Consistency among Risk-Adjusted Measures Health Services Research 39 (4, part 1) : 985 1003. (Pubitemid 38924689)
43. Thomas, J. W. K. Ward. 2006 Economic Profiling of Physician Specialists: Use of Outlier Treatment and Episode Attribution Rules Inquiry 43 (3) : 271 82.
44. Timbie, J. W. S. L. Normand. 2007 A Comparison of Methods for Combining Quality and Efficiency Performance Measures: Profiling the Value of Hospital Care Following Acute Myocardial Infarction Statistics in Medicine 27 (9) : 1351 70.
45. Vitaliano, D. F. M. Toren. 1996 Hospital Cost and Efficiency in a Regime of Stringent Regulation Eastern Economic Journal 22 : 161 75. (Pubitemid 126087371)
46. Weingarten, S. R., L. Lloyd, C. F. Chiou G. D. Braunstein. 2002 Do Subspecialists Working Outside of Their Specialty Provide Less Efficient and Lower-Quality Care to Hospitalized Patients Than Do Primary Care Physicians? Archives of Internal Medicine 162 (5) : 527 32. (Pubitemid 34193539)
47. The White House. 2007 Executive Order: Promoting Quality and Efficiency Health Care in Federal Government Administered or Sponsored Health Programs [accessed on July 1, 2007]. Available at
48. Zuckerman, S., J. Hadley L. Iezzoni. 1994 Measuring Hospital Efficiency with Frontier Cost Functions Journal of Health Economics 13 (3) : 255 80 discussion 335-40. (Pubitemid 24327185)