Ce travail contribue à la définition des mesures de l'efficacité et de la productivité dans la théorie microéconomique. Il présente des apports théoriques et empiriques. En premier lieu, cette thèse élabore une critique sur certaines mesures classiques de l’efficacité et de la productivité. Il est montré que la mesure directionnelle, sous l'hypothèse de rendements d'échelle constants, pose un certain nombre de problèmes quant à l’évaluation des variations de la productivité. De plus, il est établi que la « slacks-based » et la directionnelle « slack-based » mesures (ou mesures de Färe-Lovell) ne permettent pas de caractériser la technologie de production. Il résulte que ce type de mesure ne permet pas d’évaluer l'efficacité et les variations de productivité. Une approche alternative est proposée qui permet de contourner cette difficulté. Ensuite, cette thèse introduit deux nouveaux indicateurs: un indicateur social de Luenberger-Hicks-Moorsteen et un indicateur de productivité généralisé. Le premier permet d'évaluer l'effet des politiques sur les capabilités au sens d'A. Sen. Il consiste en une transposition des indicateurs de Hicks-Moorsteen en considérant le rôle spécifique d’un sous-vecteur prenant en compte les facteurs sociaux. Le second indicateur généralise les indicateurs standards de productivité. Il permet de retrouver à la fois les indicateurs de Luenberger et le Luenberger Hicks-Moortsteen comme cas spéciaux de cet indicateur généralisé. En considérant la version multiplicative de l’indicateur généralisé, on retrouve comme cas particuliers, les indicateurs de Malmquist et le Hicks-Moorsteen. Enfin, cette thèse présente des applications empiriques qui illustrent la méthodologie. Ces études évaluent et comparent la performance des régions touristiques et plus précisément celle du Languedoc-Roussillon, qui mobilise un cadre d'analyse transfrontalier. / This phd contributes to the definition of efficiency measures and productivity indicator, in the microeconomic theory. It presents theoretical and empirical contributions. Firstly, this phd develops a review on standard measures of efficiency and productivity. It is shown that the directional measure, under the assumption of constant returns to scale, raises some problems in the assessment of productivity changes. Moreover, it is established that the "slacks-based" and directional "slack-based" measures (or Färe-Lovell measures) do not allow to characterize technology. It follows that such measures do not allow to evaluate efficiency and productivity changes. An alternative approach is proposed which overcomes this difficulty. Then, this phd introduces two new indicators: a social Luenberger-Hicks-Moorsteen indicator and a generalized indicator of productivity. The first mesure the impact of publics policies in the line of the capability theory introduce by A. Sen. This indicator consists on a transposition of the Hicks-Moorsteen indicator by considering a sub-vector of social factors. The second indicator generalizes standards productivity indicators. It allows to find the Luenberger and the Luenberger Hicks-Moortsteen as special cases of this general indicator. Considering the multiplicative version of the generalized indicator, on can find the Malmquist and Hicks-Moorsteen indicators, as special cases. Finally, this phd presents some empirical applications to illustrate the methodology. These studies evaluate and compare the performance of the tourist destination, and specifically for the Languedoc-Roussillon, which involves a cross-border analysis framework

本論文對於醫療市場的生產績效研究，係由兩篇獨立的學術研究報告所組成，研究重點在於利用非參數資料包絡分析方法 ( nonparametric DEA approach )，估計醫院的生產技術，以衡量醫院的技術效率及不同年度間之生產力變動，進而分析不同醫院間，生產績效差異的主要原因。本論文所採用的研究方法與探討的主題，不同於國內既有的相關文獻。 第一部分：生產不確定性與醫院效率 本部分主要探討在醫院面對不確定性時的效率評估。一般而言，醫院有兩種生產上的不確定性來源：醫師或醫院的診療結果所導致的生產不確定性；及消費者對醫療服務需求的不確定性 (Arrow, 1963)。當醫院面對生產不確定性時，醫院效率將與廠商如何處理不確定性問題有關，亦即，當廠商事前規劃愈縝密，未來可能的產出失靈水準愈低，則其生產效率表現愈佳。本文利用民國 82 及 83 年（準）醫學中心與（準）區域醫院資料，模擬醫院在面對生產不確定性時，各種可能的產出失靈水準，以chance constrained DEA 模式 (Land, Lovell and Thore, 1993) 估算醫院的隨機技術效率，並與傳統、確定性的DEA模式所得到之結果，做一比較。 Chance constrained DEA模式與傳統DEA模式的不同，在於前者估計出的生產前緣，並不總是包絡所有的樣本點，亦即，允許某廠商之產出超越生產前緣或說允許產出失靈可能性之存在，而後者則否。實證結果發現，在chance constrained DEA模式下，私立醫院的技術效率高於公立醫院，且呈現統計顯著性的差異，但兩者間的差異隨著醫院事前準備程度的提高而縮小；而傳統DEA模式也顯示，私立醫院的技術效率確實顯著地高於公立醫院。此外，若產出失靈水準夠低，則chance constrained DEA模式的效率值與傳統DEA模式的效率值，兩者間的分配會呈現統計顯著性差異。 在面對生產不確定性時，欲提升公立醫院的生產效率，應提高廠商事先規劃的程度，才能與私立醫院之生產效率並駕齊驅。一般而言，廠商事先準備的程度高低，與醫院本身的特性有關，因此，欲改善公立醫院緩衝產能的準備程度，以降低產出失靈水準，有必要進行體制層面的改革，亦即，從進行人事變革、財務之授權與彈性化等方向開始做起，如此應可提高公立醫院的生產效率。 第二部分：全民健康保險制度與醫院生產力變動 全民健保實施後，民眾對醫療服務的可近性提高，醫院間的市場結構改變，因此，醫院生產力與效率的提升，成為眾所關切的焦點。為瞭解醫院在全民健保實施後，資源是否有效配置，本部分利用民國 82 至 86 年醫學中心、區域醫院與地區醫院等大小型醫院資料，以範疇DEA模式估計Malmquist生產力變動指標，並將之分解為技術變動、純技術效率變動、及規模效率變動等三項變動來源。 實證結果發現，從82至86年醫院整體平均效率而言，CRS（VRS）生產技術下的平均效率為 66.00%（74.87%），表示不論大小型醫院，平均而言，皆存在技術不效率的情形。再者，在民國84年，亦即全民健保實施的年度，其效率水準明顯較其他年度為低，其餘年度的效率水準都相對較高，此一結果意謂，政策干擾對於醫院效率表現的影響，是短期性的。另外，小型醫院皆較大型醫院不效率，兩者的效率差異呈現統計顯著性；以權屬別而言，不論是大型醫院或小型醫院中的私立醫院，其生產效率均優於公立醫院，且兩者的效率差異呈現統計顯著性。而透過迴歸分析顯示，全民健保實施、權屬別之虛擬變數、佔床率、平均住院日、及以醫院產出衡量的集中度指標等，是影響醫院生產效率的重要因素。 從Malmquist生產力變動（　et al., 1994）來看，平均而言，82-86年間醫院生產力成長率約在 -3.06 % 左右。就生產力變動來源而言，技術成長率（-2.74 %）與整體效率成長率（-0.33 %）均為負，而技術變動則是阻礙生產力成長的主要原因。此外，若以醫院整體效率變動來源來看，平均而言，整體效率退步是由於規模效率變動所致（-0.74%）。 此外，本文著重在　et al.(1994)、Ray and Desli (1997) 及Grifell and Lovell (1998) 三種定義下的Malmquist生產力變動指標之比較。研究結果發現，Grifell and Lovell (1998) 的一般化Malmquist生產力指數，並沒有正確衡量廠商的生產力變動及其變動來源項。而利用Kruskal-Wallis檢定結果發現，三個模式中的生產力變動差異，並不具統計顯著性，而變動來源項（技術變動與規模效率變動）亦顯示相同的結果。 / This dissertation is focused on the efficiency and productivity studies of hospitals in Taiwan. It includes two independent academic papers. The primary intention is to introduce the newly developed ideas in the measurement of efficiency and productivity, rather than to create new ones. The utilization of these ideas has not, however, been discussion in print. And some of the arguments we used and brought together are new regarding to the literature of hospital efficiency and productivity measurement. Utilizing the non-parametric data envelopment analysis (DEA) approaches, efficiency scores and productivity change indexes were estimated. Efforts were made to explain the difference of productivity performance among individual hospitals. Nevertheless, the methods we used and the economic approach behind them distinguish this study from other empirical studies of the medical market. Part I　 Market Uncertainty and Hospital Efficiency This part of the dissertation is focused on the measurement of efficiency of hospitals, incorporating uncertainty. There are stochastic variations in production relationships for hospitals. Generally speaking, the uncertainty of hospitals comes from two major sources: the natural uncertainty of medical cares; and the uncertainty of demands for medical cares (Arrow, 1963). Given the uncertainty in the medical market, the efficiency of hospitals hinges on how decision-makers deal with it. Undoubtedly, an optimal planning of the output buffers improves the efficiency performance. Using the hospital survey data in 1993 and 1994, and employing the chance constrained DEA model (Land, Lovell and Thore, 1993), the stochastic efficiency indexes of public and private medical centers and regional hospitals were estimated. Compared with deterministic frontier enveloping a given set of sample observations all the time, the chance-constrained frontier envelops them most of the time. That is, the chance constrained DEA allows the possibilities of output failure. Imposing different values of output failure probability, the estimation results were compared with the traditional (deterministic) DEA models. The empirical evidences of the chance constrained DEA model showed that, on average, private hospitals performed significantly better than public hospitals. This result matches with the result of the traditional DEA model. With Mann-Whitney U test, we compared the distributions of efficiency indexes under chance constrained DEA and deterministic DEA models. The test results showed that the difference between these two different models is statistically significant given a higher probability of output failure. These results imply that the nature of risk and the manipulation for risk are different for public and private hospitals. We also find that that the efficiency performance of public hospitals could be improved by the increasing of its reserve capacity. Part II　 National Health Insurance and Hospital Productivity Change In this part of the dissertation, we examine the impact of NHI on hospitals, and trace the sources of hospital productivity growth in Taiwan. To pursue our goal, we employ a data consisting of 157 medical centers, regional hospitals and district hospitals over the period 1993 to 1997, and resort to the Malmquist productivity index to measure total factor productivity change. The index could be decomposed into three components: technical change, pure technical efficiency change and scale efficiency change. The estimation technique used in the study is the deterministic non-parametric DEA approach. The results we find are revealing and suggestive to the public and the government in order to promote and assure the efficient delivery of quality health care. The average efficiency scores are 66.00% (74.87%) for CRS (VRS) technology and it means that there are substantial efficiency losses for the sample hospitals during the study period. The efficiency score of the hospitals as a whole in 1995 (the beginning year of NHI) was much lower than the other 4 years' efficiency scores. A censored Tobit regression analysis is used and identifies that NHI policy, ownership, rate of bed occupancy, average length of stay and the output-specific concentration level were all the significant determinants of technical efficiency. Empirical results indicate that most medical care regions became more output-specific concentrated. Total factor productivity on average deteriorated at an annual rate of -3.1%, and it was dominated by substantial technical regresses at an annual rate of -2.74%. The small hospitals were severely affected by NHI. Furthermore, within large and small hospital groups, the difference in technical change was statistically significant, but the differences in TFP and the associated components between ownership were not. Special attention was paid to compare　 et al.(1994), Ray and Desli (1997) and Grifell and Lovell (1998) approaches to decomposing the Malmquist productivity index. Empirical results indicate that the first 2 approaches yield accurate productivity changes, while GL doesn't. However, they produce almost the same magnitude of average TFP. In addition, no significant differences in the measured technical change and efficiency change were found among the three approaches.

Diese Dissertation umfasst sowohl einen theoretisches als auch einen empirischen Beitrag zur Analyse der Messung der gesamten Faktorproduktivität (TFP). Das erste Kapitel inspiziert die bestehende Literatur über die häufigsten Techniken der TFP Messung und gibt einen Überblick über deren Limitierung. Das zweite Kapitel betrachtet Daten, die durch ein Real Business Cycle Modell generiert wurden und untersucht das quantifizierbare Ausmaß von Messfehlern des Solow Residuums als ein Maß für TFP Wachstum, wenn der Kapitalstock fehlerhaft gemessen wird und wenn Kapazitätsauslastung und Abschreibungen endogen sind. Das dritte Kapitel schlägt eine neue Methodologie in einem bayesianischen Zusammenhang vor, die auf Zustands- Raum-Modellen basiert. Das vierte Kapitel führt einen neuen Ansatz zur Bestimmung möglicher Spill-over Effekte auf Grund neuer Technologien auf die Produktivität ein und kombiniert eine kontrafaktische Zerlegung, die von den Hauptannahmen des Malquist Indexes abgeleitet wird mit ökonometrischen Methoden, die auf Machado and Mata (2005) zurückgehen. / This dissertation consists of theoretical and empirical contributions to the study on Total Factor Productivity (TFP) measurement. The first chapter surveys the literature on the most used techniques in measuring TFP and surveys the limits of these frameworks. The second chapter considers data generated from a Real Business Cycle model and studies the quantitative extent of measurement error for the Solow residual as a measure of TFP growth when the capital stock is measured with error and when capacity utilization and depreciation are endogenous. Furthermore, it proposes two alternative measurements of TFP growth which do not require capital stocks. The third chapter proposes a new methodology based on State-space models in a Bayesian framework. Applying the Kalman Filter to artificial data, it proposes a computation of the initial condition for productivity growth based on the properties of the Malmquist index. The fourth chapter introduces a new approach for identifying possible spillovers emanating from new technologies on productivity combining a counterfactual decomposition derived from the main properties of the Malmquist index and the econometric technique introduced by Machado and Mata (2005).

我國國立高級中等學校實施校務基金之目的除了提升績效外，尚期以增進各校自籌財源之動力，以減輕政府財政負擔，自2007年起開始實施校務基金後之績效為何?值得進一步探討。 本研究係以資料包絡分析法評估各國立高級中等學校2010年至2012年的經營績效，並運用麥氏指數衡量其跨期效率變動情形，最後以Tobit迴歸分析，探討外在環境變數對校務基金實施績效之影響。實證研究結果如下： 一、總技術效率分析：2010、2011及2012年平均總技術效率值依序為0.712、0.714、0.705，表示各該年度尚有28.8%、28.6%及29.5%的效率改善空間。若將各國立高級中等學校依照類別區分，普通高中平均總技術效率表現最佳，綜合高中的表現比職業學校佳，特教學校最差。 二、純技術效率分析：2010、2011及2012年平均純技術效率值依序為0.768、0.781、0.771，表示各該年度尚有23.2%、21.9%及22.9%的效率改善空間。普通高中平均純效率表現最佳，綜合高中的表現比職業學校佳，特教學校最差。 三、規模效率分析：2010、2011及2012年平均規模效率值依序為0.923、 0.908、0.908，表示各該年度尚有7.7%、9.2%及9.2%的效率改善空間。2010年以職業學校表現最佳，2011年以綜合高中表現最佳，2012年度以普通高中表現最佳。特教學校在三個年度的平均規模效率均為最差。 四、麥氏指數分析：2010至2012年度之總要素生產力變動值均小於1，呈現衰退現象， 2010至2011年度及2011至2012年度二個跨期均呈現衰退。 五、Tobit迴歸分析：除實施校務基金的年限無顯著影響外，學校區位、校舍面積及學校成立年限等三項外在環境對學校的經營績效均具有影響。 / The purpose of national senior high schools in Taiwan implementing National Senior High Schools Operation Fund is not only improving performance, but also enhancing the schools’ self-motivation of the financial resources to reduce the fiscal burden of government. How is the performance of implementing National Senior High Schools Operation Fund since 2007?It is worthy of further study. This study is based on Data Envelopment Analysis to evaluate the operating performance of national senior high schools from 2010 to 2012. In addition, this study uses Malmquist Index to measure the efficiency changes. Finally, Tobit regression analysis is used and tried to find effects of the external environment variables on the implemenetation performance of National Senior High Schools Operation Fund. The findings of this study are as follows: 1.Overall technical efficiency analysis：the average value of the overall technical efficiency is 0.712、0.714、0.705 in sequence of year 2010、2011 and 2012, and it means that the efficiency improvement is 28.8%, 28.6% and 29.5% each year. If we evaluate the performance of national senior high schools by category, the general high schools are the best, the comprehensive high schools are better than vocational high schools, and the special education schools are the worst. 2.Pure technical efficiency analysis.：the average value of the pure technical efficiency is 0.768、0.781、0.771 in sequence of year 2010、2011 and 2012, and it means that the efficiency improvement is 23.2%、21.9% and 22.9% each year. The general senior high schools are the best, the comprehensive senior high schools are better than vocational senior high schools, and the special education schools are the worst. 3.Scale efficiency analysis: the average value of the scale efficiency is 0.923、 0.908、0.908 in sequence of year 2010、2011 and 2012,and it means that the efficiency improvement is 7.7%、9.2% and 9.2% each year. The best performance is the vocational senior high schools in 2010, the comprehensive senior high schools in 2011, and the general senior high schools in 2012, the special education schools are the worst in all three years. 4.Malmquist Index analysis: the value of the total factor productivity change is totally less than 1 from 2010 to 2012, and shows the recession .And the inter-temporal total factor productivity changes show the recession from 2010 to 2011, and 2011 to 2012. 5.Tobit regression analysis: there is no significant impact in the factor of the years of the National Senior High Schools Operation Fund, but the external factors such as the size, the history, and the location of the schools, would affect the performance of national senior high schools.