In this paper, we present an empirical model to analyse the efficiency of youth care by local government, especially with regard to purchasing policies. Locally least squares is applied to data from 352 Dutch municipalities operating in 2021. The outcomes reveal significant variations in the cost efficiency related to purchasing policies among municipalities. For all municipalities, the average cost efficiency is 84%. However, the corresponding standard errors of cost efficiency vary between 2.6% and 14.8% with a mean of 8.6% implying that only a limited number of municipalities are able to achieve efficiency gains with a high degree of certainty. Open House outsourcing and a framework contract without intermediate access are the most influential instruments on cost efficiency. Other features such as the duration of the contract and collaboration with other municipalities appear to have only a modest effect.

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Local governments may seek efficient public service delivery through scaling up production, and the quest for the optimal local government size has attracted extensive attention of scholars and policy makers. Indeed, if scale matters for local government efficiency, increasing size may be a key factor in achieving more value for money for citizens. As such, getting scale right may contribute significantly to achieving the Sustainable Development Goals (SDGs) as set out in the 2030 Agenda. Nonetheless, there is considerable uncertainty with regard to how scale shapes the average cost of local government service delivery. These uncertainties may have contributed to policy makers and public organizations disregarding the often inconclusive and sometimes contradictory empirical evidence in stimulating and allowing mergers and consolidation in many Western countries. This Special Issue is concerned with economies of scale in local government. Interesting issues to be addressed relate to the existence of general and service specific economies of scale and the implications of both for local government policy regarding various types of scaling (amalgamation, cooperation, and outsourcing). Based on a brief literature review, we inventory a number of issues which warrant further research. One of the conclusions is that the relationship between scale and sustainability is a complex issue with many aspects. Examples include the relation between economies of scale and outsourcing and cooperation, issues concerned with multi-level aspects of scale, and the trade-off that may exist between achieving economies of scale and cost efficiency (e.g., transition cost of mergers). Another conclusion is that no such thing as “one size fits all” exists. Different perspectives may play a role and should be born in mind when suggesting solutions and providing recommendations to achieve sustainable goals.@en

Building operations and construction are responsible for a large part of global energy use and carbon dioxide emissions. In this paper, we present an analysis of the efficiency and productivity of the provision of school buildings by Dutch municipalities. A cost function is estimated for the years 2005–2016 using stochastic frontier methods based on data of Dutch municipalities. The results indicate that inefficiency and unproductiveness are substantial. The provision of school buildings on a more appropriate scale, detailed performance benchmarking and including more incentives for innovative behaviour may result in a more sustainable provision of school buildings and less energy use and emission of carbon dioxide.

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BACKGROUND: The development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007-2017) and discusses its implications for workforce planning, also in relation to the existing literature. METHODS: A regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per production output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007-2017 across 24 different specialties using regression methods. RESULTS: The results indicate an increase in the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms. CONCLUSIONS: The results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians' productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed, and some consensus has been reached.

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This article presents a one-stage efficiency frontier analysis based on the scaling property. This type of analysis is a not very often applied in empirical work in spite of its nice features. Due to the scaling property the influence of exogenous (managerial) variables on efficiency can be modelled and estimated in one stage. It also opens the possibility of estimating a system of equations, consisting of a cost function and the corresponding cost share equations. The model is applied to a unique data set of Dutch secondary education school boards in the period 2007–10, not only consisting of regular data on cost, inputs and outputs, but also of specific data on operational management. The model provides reliable and plausible estimates for the cost efficiency, scale elasticity, and technical change. Average cost efficiency is about 96%. Economies of scale prevail for school boards with size less than 0.8 times average size, whereas annual productivity growth is 2.2% on average.@en

In many countries, the provision of primary education is among the core responsibilities of local governments. One of the main questions local governments face concerns the optimal configuration of school boards and size of schools. In this paper we analyse the relation between cost and scale in school boards and in schools. The influence of both the governing layer (board) and the operational layer (school) on average cost are jointly modelled. Board cost is modelled as an aggregation of individual school cost functions so that individual school cost data are not required in order to estimate the model. The results indicate that small schools (<60) pupils are operating under sizable economies of scale. The optimum school size is estimated at roughly 450 pupils, but average cost remains roughly constant with regard to size. In contrast to school size, the effect of board size (in terms of the number of schools governed) on average cost is limited. The policy recommendation is that municipalities should create at least three schoolboards within their jurisdiction and take measures in case individual school size declines below 60 pupils.

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The judiciary is constantly undergoing change in order to respond to a wide range of social developments that have brought the sector under increasing pressure. In order to deal with the constant call for enhancing budgets, different policy measures have been taken to downsize the appeal to the judiciary and to improve productivity. One of the central questions hereby is whether these measures have actually contributed to a more productive sector. This paper focuses on the development of productivity in the judiciary and how policy measures have affected productivity. In this empirical analysis, we apply a cost function model to time series data of the Dutch judiciary between 1980 and 2016. The results show a dramatic decline of productivity over the entire period (−50%), in spite of various policy measures. The year 2001 can be regarded as a turning point, as since then productivity has remained more or less stable. It seems that this is largely due to the establishment of the Council for the Judiciary and the associated increase in (financial and operational) autonomy for the judiciary. Another striking result is that technical change is biased toward using more personnel through time.

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In the last four decades, the Dutch drinking water industry has undergone two major policy reforms, namely the consolidation of the industry by stimulating mergers and the introduction of yardstick competition by applying benchmarks. This paper addresses the question of whether these two instruments have improved productivity. Productivity changes are derived from an estimated cost function. The effects of average scale as well as the introduction of a form of yardstick competition on productivity are formally tested. Estimation is conducted on the basis of time series data in the period 1980-2015. Industry consolidation has taken place over a long period of time. Yardstick competition was introduced in 1997 on a voluntary basis. It shows that total factor productivity was rather stable in the period 1980-1998. Since 1998, annual productivity growth has been substantial (about 0.6% on average). There was an obvious break point in 1998, providing clear evidence that the introduction of the benchmark instrument has affected productivity change. Moreover, there are various indications that benchmarking has also contributed to improving quality and sustainability. We could not find any empirical evidence for the hypothesis that consolidation of the industry has improved productivity.@en

The academic literature provides excellent methodologies to identify best practices and to calculate inefficiencies by stochastic frontier analysis. However, these methodologies are regarded as a black box by policy makers and managers and therefore results are hard to accept. This paper proposes an alternative class of stochastic frontier estimators, based on the notion that some observations contain more information than others about the true frontier. If an observation is likely to contain much information, it is assigned a large weight in the regression analysis. In order to establish the weights, we propose an iterative procedure. The advantages of this more intuitive approach are its transparency and its easy application. The method is applied to Dutch local administrative services (LAS) in municipalities. The method converges quickly and produces reliable estimates. About 25% of the LAS are designated as efficient. The average efficiency score is 93%. For the average sized LAS no economies of scale exist.

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In this paper, we propose a method for cost efficiency measurement that is based on local estimation in several stages. The method is based on weighted least squares where weights depend on the distance of an observation to all other observations and on the distance to the cost frontier. The new element in the method is that it also includes the information from the cost share equations and includes cost efficiency in the weighting matrix. The latter is derived from a first stage and implemented in a second stage analysis. An application to a data set of Dutch school boards in secondary education shows that it works well in practice. It produces a number of reliable estimates. It also shows a variation in outcomes that would be hard to cover with, for instance, traditional procedures such as SFA on a translog cost function.@en

Voor de Spoedeisende Hulp gelden economische schaalvoordelen. Anders gezegd: bij een grotere SEH zijn de gemiddelde kosten per patiënt lager. Toch is dit geen reden om concentratie van de SEH ’s na te streven. Besparingen op kosten bij de SEH worden namelijk tenietgedaan door oplopende kosten in het vervolgtraject.@en

Background
Well-trained, well-distributed and productive health workers are crucial for access to high-quality, cost-effective healthcare. Because neither a shortage nor a surplus of health workers is wanted, policymakers use workforce planning models to get information on future labour markets and adjust policies accordingly. A neglected topic of workforce planning models is productivity growth, which has an effect on future demand for labour. However, calculating productivity growth for specific types of input is not as straightforward as it seems. This study shows how to calculate factor technical change (FTC) for specific types of input.

Methods
The paper first theoretically derives FTCs from technical change in a consistent manner. FTC differs from a ratio of output and input, in that it deals with the multi-input, multi-output character of the production process in the health sector. Furthermore, it takes into account substitution effects between different inputs. An application of the calculation of FTCs is given for the Dutch hospital industry for the period 2003–2011. A translog cost function is estimated and used to calculate technical change and FTC for individual inputs, especially specific labour inputs.

Results
The results show that technical change increased by 2.8% per year in Dutch hospitals during 2003–2011. FTC differs amongst the various inputs. The FTC of nursing personnel increased by 3.2% per year, implying that fewer nurses were needed to let demand meet supply on the labour market. Sensitivity analyses show consistent results for the FTC of nurses.

Conclusions
Productivity growth, especially of individual outputs, is a neglected topic in workforce planning models. FTC is a productivity measure that is consistent with technical change and accounts for substitution effects. An application to the Dutch hospital industry shows that the FTC of nursing personnel outpaced technical change during 2003–2011. The optimal input mix changed, resulting in fewer nurses being needed to let demand meet supply on the labour market. Policymakers should consider using more detailed and specific data on the nature of technical change when forecasting the future demand for health workers.
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Door fusies zijn Nederlandse ziekenhuizen in de laatste decennia steeds groter geworden. Uit een meta-analyse van internationale studies blijkt dat de zorgkosten juist het laagst zijn in ziekenhuizen die kleiner zijn dan de meeste Nederlandse ziekenhuizen. Het is daarom onwaarschijnlijk dat verdere schaalvergroting de zorgkosten zal drukken.@en

Pomp en Heida plaatsen een aantal vraagtekens bij ons artikel 'Nederlandse ziekenhuizen te groot voor verdere schaalvoordelen'. In deze reactie laten wij zien dat de kritiek een aantal onjuistheden, denkfouten en drogredenen bevat.@en

Verhoging van de productiviteit van publieke diensten draagt sterk bij aan vergroting van de welvaart en beheersing van de overheidsuitgaven. De afgelopen decennia zijn ingrijpende hervormingen doorgevoerd om de productiviteit in de publieke sector te stimuleren. In de reeks Productiviteit van overheidsbeleid wordt het succes en falen van deze overheidsinterventies in beeld gebracht. Belangrijk doel hiervan is lessen te trekken voor het huidige en toekomstige beleid. Welke instrumenten werken en welke ingrepen kan de overheid beter nalaten? Om daar zicht op te krijgen wordt de samenhang tussen beleid en productiviteit op vier beleidsterreinen onderzocht: onderwijs, zorg, veiligheid en infrastructuur. Dit vierde en laatste deel van de reeks behandelt de (fysieke) infrastructuur. Centraal staan drie Nederlandse netwerksectoren: de drinkwater-, energie- en spoorsector. Deze sectoren hebben de afgelopen 35 jaar sterke veranderingen ondergaan. Dit is voor een belangrijk deel toe te schrijven aan het liberaliseringsbeleid, dat in de jaren tachtig een aanvang neemt en als eerste bij de netwerksectoren wordt toegepast. Verzelfstandiging en deels ook privatisering van de overheidsbedrijven én de introductie van marktwerking zijn de belangrijkste ingrediënten van het liberaliseringsbeleid. Daarnaast wordt in de drinkwater- en energiesector aangestuurd op een aanzienlijke schaalvergroting. Wat dit beleid en de daarbij toegepaste instrumenten hebben betekend voor de productiviteitsontwikkeling van de verschillende netwerksectoren wordt in dit boek uitvoerig belicht. Op basis van deze bevindingen gaan de auteurs na welke beleidsinstrumenten de beste kansen bieden om de productiviteit van de netwerksectoren – of nog breder de publieke sector – positief te beïnvloeden. @en

Inter-municipal cooperation is increasingly popular in European countries. Saving cost is a key motivation. This paper analyses the relation between inter-municipal cooperation and cost efficiency among Dutch municipal tax departments between 2005 and 2012. Motivated by the notion that cost savings are ascribed to scale economies, the relation between cooperation and cost is modelled explicitly through scale. The size of the cooperation is incorporated as a determinant of cost efficiency. The results indicate that inter-municipal cooperation can contribute to reducing cost and that the relation can be explained by scale. Municipalities or cooperations sized around 10,000 inhabitants are estimated up to 30% inefficient. At 60,000 inhabitants, the benefits of scaling are largely exhausted. Other than through scale, municipalities that cooperate are not estimated to operate significantly more or less efficient.

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Verhoging van de productiviteit van publieke diensten draagt sterk bij aan vergroting van de welvaart en beheersing van de overheidsuitgaven. De afgelopen decennia zijn ingrijpende hervormingen doorgevoerd om de productiviteit in de publieke sector te stimuleren. In de reeks Productiviteit van overheidsbeleid wordt het succes en falen van deze overheidsinterventies in beeld gebracht. Belangrijk doel hiervan is lessen te trekken voor het huidige en toekomstige beleid. Welke instrumenten werken en welke ingrepen kan de overheid beter nalaten? Om daar zicht op te krijgen wordt de samenhang tussen beleid en productiviteit op vier beleidsterreinen onderzocht: onderwijs, zorg, veiligheid en infrastructuur. Dit vierde en laatste deel van de reeks behandelt de (fysieke) infrastructuur. Centraal staan drie Nederlandse netwerksectoren: de drinkwater-, energie- en spoorsector. Deze sectoren hebben de afgelopen 35 jaar sterke veranderingen ondergaan. Dit is voor een belangrijk deel toe te schrijven aan het liberaliseringsbeleid, dat in de jaren tachtig een aanvang neemt en als eerste bij de netwerksectoren wordt toegepast. Verzelfstandiging en deels ook privatisering van de overheidsbedrijven én de introductie van marktwerking zijn de belangrijkste ingrediënten van het liberaliseringsbeleid. Daarnaast wordt in de drinkwater- en energiesector aangestuurd op een aanzienlijke schaalvergroting. Wat dit beleid en de daarbij toegepaste instrumenten hebben betekend voor de productiviteitsontwikkeling van de verschillende netwerksectoren wordt in dit boek uitvoerig belicht. Op basis van deze bevindingen gaan de auteurs na welke beleidsinstrumenten de beste kansen bieden om de productiviteit van de netwerksectoren – of nog breder de publieke sector – positief te beïnvloeden. @en