Ocaña-Riola, RicardoPérez-Romero, CarmenOrtega-Díaz, Mª IsabelMartín-Martín, José Jesús2022-12-192022-12-192021-09-27Ocaña-Riola R, Pérez-Romero C, Ortega-Díaz MI, Martín-Martín JJ. Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals. Int J Environ Res Public Health. 2021 Sep 27;18(19):101661661-7827http://hdl.handle.net/10668/4528Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.enAtribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/EfficiencyData envelopment analysisMultilevel zero-one inflated beta regressionPublic hospitalsPrivate hospitalsPublic-private partnershipIntensive care unitsEmergency servicesEficienciaAnálisis de datosAnálisis de niveles múltiplesHospitales públicosHospitales privadosAsociaciones entre el sector público y el privadoUnidades de cuidados intensivosServicios médicos de urgenciaMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals::Hospitals, PrivateMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals::Hospitals, PublicMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Statistics as Topic::Multilevel AnalysisMedical Subject Headings::Health Care::Health Services Administration::Organization and Administration::Efficiency, OrganizationalMedical Subject Headings::Health Care::Health Care Economics and Organizations::State MedicineMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Odds RatioMedical Subject Headings::Geographical Locations::Geographic Locations::Europe::SpainMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Unitsresearch article34639468Acceso abierto10.3390/ijerph1819101661660-4601PMC8508497