Applied Performance Measurement: A Case Study Using DEA and Other Frontier Production Function-Related Indexes (S. 107-108)

Adolf Stepan, Margit Sommersguter-Reichmann Fakultat fiir Maschinenbau, Technische Universitat Wien

1. Introduction
"Efficiency" is a magic word and considered to be the solution to all problems in public management. Although it is a well-specified concept and is properly introduced in economics, "efficiency" has widely been misinterpreted so that it has become a buzzword among poHticians and journalists. Efficiency does not simply mean abstaining from wasting resources, it also means allowing for a substitution of inputs and outputs according to the goals and intentions of the productive units which are fully responsible for decision-making. This is particularly important in cases in which there is no functioning price system.

The health care sector is a very good example. In the health care system a wellworking price system and, thus, functioning markets are missing. People in need of medical services are not able to shop around for the best "offer", and if so they could hardly work out the information necessary to ask for services they actually need. Have you ever watched a physician searching for treatment for family members or himself/herself? It is surprising how difficult it is even for "insiders" to sort out where to go and what to ask for. The health care market is failing just when people are in need of services, information asymmetries are emerging and leading to supplier-induced demand.

It is a pity that the health care market has recently become a showcase concerning the attempt to change it into a competitive market, being well aware that the most important constituents, namely rational agents on the demand side, are lacking. Even if there were rational agents on both sides and competitive prices could be expected, the amount of supply promised by politicians and expected by the public would not correspond to the amount of supply provided/demanded by the agents. In Austria it is said there is enough supply, but prices and rational agents are missing.

For this reason, a surrogate price system (LKF, Leistungsorientierte Krankenanstalten Finanzierung), based on the concept of diagnoses related groups (DRGs) has been implemented for hospital service financing. Since the prices have been designed to cover full costs there is an incentive for the managers of a hospital to maximize margins given the hospital capacity. This incentive has led to a situation in which some diagnoses are profitable and others are not and, thus, services with high margins are enforced and services with low margins are "outsourced". Besides of these supply effects and other quality effects of the LKF we explore the question of whether the implementation of the surrogate price system LKF has improved the productivity of the hospital sector of a given region.

Since 1997, public hospital financing in Austria has been based on an activitybased hospital financing system called LKF. The LKF is a modified, Austrianspecific system of DRGs which is supposed to ensure that the billing of hospital services is based on services actually rendered. The serious changes in public sector hospital financing have been motivated by the necessary enhancement in hospital productivity to cope with increasing hospital costs.