Sverre Kittelsen

• Kittelsen, Sverre A.C. (2023). Produktivitets- og effektivitetsanalyser i helsesektoren . Magma forskning og viten. ISSN 1500-0788. 26(05), p. 154–162. doi: 10.23865/magma.v26.1429. Full text in Research Archive Show summary

  Artikkelen gir en oversikt over analyser av produktivitet og effektivitet i helsesektoren med vekt på norske og nordiske anvendelser. Den effektive fronten blir beskrevet ved en produkteller kostnadsfunksjon. I begge tilfeller vil en skille mellom tjenesteprodusenter som er effektive, og de som er mindre effektive. Her presenteres de viktigste metodene, datainnhyllingsanalyse (DEA) og statistisk frontanalyse (SFA). I helsesektoren er det særlig institusjoner som er analysert, men også hele land, regioner og helsesystemer. Sykehusene i Finland er gjennomgående mer effektive og produktive enn sykehusene i de andre nordiske landene, men kvaliteten er ikke like høy. I Norge brukes produktivitetsanalyser i styringen av sektoren. En finner gjerne et effektivitetsnivå på 85–95 prosent med en produktivitetsvekst på 0–2 prosent per år. Øvrige analyser finner produktivitetsforbedringer ved større reformer, støtte til samdriftsfordeler og i senere analyser også stordriftsfordeler. Artikkelen identifiserer behov for videre forskning på medisinsk kvalitet, grensekostnader og kapasitet, samt effektivitet innen psykiatri og rusbehandling.

• Häkkinen, Unto; Hagen, Terje P. & Kittelsen, Sverre (2023). 20 years of Nordic comparative health economics research. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 59–79. doi: 10.5617/njhe.10133. Full text in Research Archive
• Goude, Fanny; Garellick, Göran; Kittelsen, Sverre; Malchau, Henrik; Peltola, Mikko & Rehnberg, Clas (2022). Effects of competition and bundled payment on the performance of hip replacement surgery in Stockholm, Sweden: results from a quasi-experimental study. BMJ Open. ISSN 2044-6055. 12(7). doi: 10.1136/bmjopen-2022-061077.
• Aune, Finn Roar; Gaure, Simen; Golombek, Rolf; Greaker, Mads; Kittelsen, Sverre & Ma, Lin (2022). Promoting CCS in Europe: A case for green strategic trade policy? Energy Journal. ISSN 0195-6574. 43(6), p. 71–102. doi: 10.5547/01956574.43.6.faun. Full text in Research Archive Show summary

  According to IEA (2018), there is a huge gap between the first-best social optimal utilization of Carbon Capture and Storage (CCS) technologies to lower global CO2 emissions and the current, negligible diffusion of this technology. This calls for a financial support mechanism for CCS. We study to what extent promotion of CCS in Europe should be through subsidizing development and production of CCS technologies—an upstream subsidy—or by subsidising the purchasers of CCS technologies—a downstream subsidy. This question is examined theoretically in a stylized model and numerically by using a new approach that integrates strategic trade policy with an economic model of the European energy markets. The theory model suggests that upstream subsidies should clearly be preferred, and this is confirmed by the numerical simulations. For the European power market, the numerical simulations suggest that subsidies to CCS coal power should exceed subsidies to CCS gas power.

• Goude, Fanny; Kittelsen, Sverre A.C.; Malchau, Henrik; Mohaddes, Maziar & Rehnberg, Clas (2021). The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery. BMC Health Services Research. ISSN 1472-6963. 21. doi: 10.1186/s12913-021-06397-1.
• Hoel, Michael; Kittelsen, Sverre A.C. & Kverndokk, Snorre (2019). Correcting the Climate Externality: Pareto Improvements Across Generations and Regions. Environmental and Resource Economics. ISSN 0924-6460. 74(1), p. 449–472. doi: 10.1007/s10640-019-00325-y.
• Goude, Fanny; Garellick, Göran; Kittelsen, Sverre A.C.; Nemes, Szilard & Rehnberg, Clas (2019). The productivity development of total hip arthroplasty in Sweden: A multiple registry-based longitudinal study using the Malmquist Productivity Index. BMJ Open. ISSN 2044-6055. 9. doi: 10.1136/bmjopen-2018-028722.
• Kittelsen, Sverre A.C.; Anthun, Kjartan Sarheim; Häkkinen, Unto; Kruse, Marie & Rehnberg, Clas (2018). Scale and quality in Nordic hospitals. Nordic Journal of Health Economics. ISSN 1892-9729. 6(2), p. 29–44. doi: 10.5617/njhe.4801. Full text in Research Archive Show summary

  Empirical analysis of hospitals in production economics often find little or no evidence of scale economies and quite small optimal sizes. Medical literature on the other hand provides evidence of better results for hospitals with a large volume of similar procedures. Based on a sample of Nordic hospitals and patients, we have examined whether the inclusion of quality variables in the production models changes estimates of scale elasticity. A sample of 58 million patient records from 2008 and 2009 in 149 hospitals in Denmark, Finland, Norway and Sweden were collected. Patient data DRG-points were aggregated into 3 outputs (medical inpatients, surgical inpatients and outpatients) and linked to operating costs for 292 observations. The patient data were used to calculate quality indicators on emergency readmissions and mortality within 30 days, adjusted for age, gender, comorbidities, hospital transfers and DRG using DRG-specific logistic regressions. The hypothesis that the elasticity of scale increases when quality variables are included was tested against the null hypothesis of no change in the scale elasticity. The observations were used to estimate a cost function using Stochastic Frontier Analysis (SFA). Country dummies as well as dummies for University hospitals, capital city hospitals and the average travelling time for the patients were included as environmental variables. The estimated scale elasticities did not change with the inclusion of quality indicators in any of the tested models. This may be because medical volume effects are confined to few patient groups or possibly even offset by effects on other groups, where quality is reduced by volume. In one model, the scale elasticity was significantly larger than 1.0, a result that contradicts previous studies which have found decreasing returns

• Brekke, Kjell Arne; Golombek, Rolf; Kaut, Michal; Kittelsen, Sverre A.C. & Wallace, Stein W. (2017). Stochastic energy market equilibrium modeling with multiple agents. Energy. ISSN 0360-5442. 134, p. 984–990. doi: 10.1016/j.energy.2017.06.056. Full text in Research Archive Show summary

  The energy markets are characterized by many agents simultaneously solving decision problems under uncertainty. It is argued that Monte Carlo simulations are not an adequate way to assess behavioral uncertainty; one should rather rely on stochastic modelling. Drawing on economics, decision theory and operations research, a simple guide on how to transform a deterministic energy market equilibrium model - where several agents simultaneously make decisions - into a stochastic equilibrium model is offered. With our approach, no programming of a stochastic solution algorithm is required.

• Anthun, Kjartan Sarheim; Kittelsen, Sverre A.C. & Magnussen, Jon (2017). Productivity growth, case mix and optimal size of hospitals. A 16-year study of the Norwegian hospital sector. Health Policy. ISSN 0168-8510. 121(4), p. 418–425. doi: 10.1016/j.healthpol.2017.01.006. Full text in Research Archive Show summary

  Background and objectives This paper analyses productivity growth in the Norwegian hospital sector over a period of 16 years, 1999–2014. This period was characterized by a large ownership reform with subsequent hospital reorganizations and mergers. We describe how technological change, technical productivity, scale efficiency and the estimated optimal size of hospitals have evolved during this period. Material and methods Hospital admissions were grouped into diagnosis-related groups using a fixed-grouper logic. Four composite outputs were defined and inputs were measured as operating costs. Productivity and efficiency were estimated with bootstrapped data envelopment analyses. Results Mean productivity increased by 24.6% points from 1999 to 2014, an average annual change of 1.5%. There was a substantial growth in productivity and hospital size following the ownership reform. After the reform (2003–2014), average annual growth was <0.5%. There was no evidence of technical change. Estimated optimal size was smaller than the actual size of most hospitals, yet scale efficiency was high even after hospital mergers. However, the later hospital mergers have not been followed by similar productivity growth as around time of the reform. Conclusions This study addresses the issues of both cross-sectional and longitudinal comparability of case mix between hospitals, and thus provides a framework for future studies. The study adds to the discussion on optimal hospital size.

• Kittelsen, Sverre A.C.; Anthun, Kjartan Sarheim & Huitfeldt, Ingrid Marie Schaumburg (2017). Kvalitet og produktivitet i norske sykehus. Michael. ISSN 1893-9651. 14, p. 75–85. Full text in Research Archive Show summary

  I følge økonomisk teori vil sterke incentiver knyttet til kostnadsreduksjon kunne gå på bekostning av tjenestenes kvalitet, i det minste hvis tjenesteprodusentene driver effektivt, og incentiver knyttet til kvantitet bør derfor balanseres med belønning av kvalitet. Artikkelen er en bearbeiding av de norske dataene fra den nordiske studien på sykehusnivå i EU-prosjektet EuroHOPE for årene 2008 og 2009. Norske sykehus har høy kvalitet målt ved en klart lavere dødelighet enn de andre nordiske landene. Derimot er reinnleggelsesraten høy i Norge, og produktiviteten lavere enn i Finland og Danmark. Vi finner en signifikant positiv samvariasjon mellom produktivitet og kvalitetsindikatorer for dødelighet i nordiske sykehus, men ingen signifikante sammenhenger i de norske dataene. Kun reisetid har klar sammenheng med produktivitetsestimatene.

• Edvardsen, Dag Fjeld; Førsund, Finn R & Kittelsen, Sverre A.C. (2017). Productivity development of Norwegian institutions of higher education 2004–2013. Journal of the Operational Research Society. ISSN 0160-5682. 68(4), p. 399–415. doi: 10.1057/s41274-017-0183-x. Show summary

  Productivity growth of institutions of higher education is of interest for two main reasons: education is an important factor for productivity growth of the economy, and in countries where higher education is funded by the public sector, accountability of resource use is of key interest. Educational services consist of teaching, research and the ‘‘third mission’’ of dissemination of knowledge to the society at large. A bootstrapped Malmquist productivity change index is used to calculate productivity development for Norwegian institutions of higher education over the 10-year period 2004–2013. The confidence intervals from bootstrapping allow part of the uncertainty of point estimates stemming from sample variation to be revealed. The main result is that the majority of institutions have had a positive productivity growth over the total period. However, when comparing with growth in labour input, the impact on productivity varies a lot.

• Johannessen, Karl-Arne; Kittelsen, Sverre A.C. & Hagen, Terje P. (2017). Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis. Social Science and Medicine. ISSN 0277-9536. 175, p. 117–126. doi: 10.1016/j.socscimed.2017.01.008. Full text in Research Archive
• Heijink, Richard; Engelfriet, Peter; Rehnberg, Clas; Kittelsen, Sverre A.C. & Häkkinen, Unto (2015). A window on geographic variation in health care: Insights from EuroHOPE. Health Economics. ISSN 1057-9230. 24, p. 164–177. doi: 10.1002/hec.3287.
• Kittelsen, Sverre A.C.; Anthun, Kjartan Sarheim; Goude, Fanny; Huitfeldt, Ingrid Marie Schaumburg; Häkkinen, Unto & Kruse, Marie [Show all 9 contributors for this article] (2015). Costs and quality at the hospital level in the nordic countries. Health Economics. ISSN 1057-9230. 24, p. 140–163. doi: 10.1002/hec.3260. Full text in Research Archive Show summary

  This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality–cost trade-offs. Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008–2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis. Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost–quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons. Copyright © 2015 John Wiley & Sons, Ltd.

• Kittelsen, Sverre A.C.; Winsnes, Benny Adam; Anthun, Kjartan Sarheim; Goude, Fanny; Hope, Øyvind Børslid & Häkkinen, Unto [Show all 11 contributors for this article] (2015). Decomposing the productivity differences between hospitals in the Nordic countries. Journal of Productivity Analysis. ISSN 0895-562X. 43(3), p. 281–293. doi: 10.1007/s11123-015-0437-z. Show summary

  Previous studies indicate that Finnish hospitals have significantly higher productivity than in the other Nordic countries. Since there is no natural pairing of observations between countries we estimate productivity levels rather than a Malmquist index of productivity differences, using a pooled set of all observations as reference. We decompose the productivity levels into technical efficiency, scale efficiency and country specific possibility sets (technical frontiers). Data have been collected on operating costs and patient discharges in each diagnosis related group for all hospitals in the four major Nordic countries, Denmark, Finland, Norway and Sweden. We find that there are small differences in scale and technical efficiency between countries, but large differences in production possibilities (frontier position). The countryspecific Finnish frontier is the main source of the Finnish productivity advantage. There is no statistically significant association between efficiency and status as a university or capital city hospital. The results are robust to the choice of bootstrapped data envelopment analysis or stochastic frontier analysis as frontier estimation methodology.

• Førsund, Finn R; Edvardsen, Dag Fjeld & Kittelsen, Sverre A.C. (2015). Productivity of tax offices in Norway. Journal of Productivity Analysis. ISSN 0895-562X. 43(3), p. 269–279. doi: 10.1007/s11123-015-0435-1.
• Golombek, Rolf; Kittelsen, Sverre A.C. & Rosendahl, Knut Einar (2013). Price and welfare effects of emission quota allocation. Energy Economics. ISSN 0140-9883. 36, p. 568–580. doi: 10.1016/j.eneco.2012.11.006.
• Medin, Emma; Häkkinen, Unto; Linna, Miika; Anthun, Kjartan Sarheim; Kittelsen, Sverre A.C. & Rehnberg, Clas (2013). International hospital productivity comparison: Experiences from the Nordic countries. Health Policy. ISSN 0168-8510. 112(1-2), p. 80–87. doi: 10.1016/j.healthpol.2013.02.004. Show summary

  This article focuses on describing the methodological challenges intrinsic in international comparative studies of hospital productivity and how these challenges have been addressed within the context of hospital comparisons in the Nordic countries. The hospital sectors in the Nordic countries are suitable for international comparison as they exhibit similar structures in the organisation for hospital care, hold administrative data of good quality at the hospital level, apply a similar secondary patient classification system, and use similar definitions of operating costs. The results of a number of studies have suggested marked differences in hospital cost efficiency and hospital productivity across the Nordic countries and the Finnish hospitals have the highest estimates in all the analyses. Explanatory factors that were tested and seemed to be of limited importance included institutional, structural and technical. A factor that is yet to be included in the Nordic hospital productivity comparison is the quality of care. Patient-level data available from linkable national registers in each country enable the development of quality indicators and will be included in the forthcoming hospital productivity studies within the context of the EuroHOPE (European health care outcomes, performance and efficiency) project.

• Golombek, Rolf; Brekke, Kjell Arne & Kittelsen, Sverre A.C. (2013). Is electricity more important than natural gas? Partial liberalizations of the Western European energy markets. Economic Modelling. ISSN 0264-9993. 35, p. 99–111. doi: 10.1016/j.econmod.2013.06.023.
• Brekke, Kjell Arne; Golombek, Rolf; Kaut, Michal; Kittelsen, Sverre A.C. & Wallace, Stein (2013). Modellering av usikkerhet i numeriske likevektsmodeller med stokastisk scenariometode :. Samfunnsøkonomen. ISSN 1890-5250. 127(2), p. 16–26. Full text in Research Archive
• Iversen, Tor & Kittelsen, Sverre A.C. (2012). Challenges in health care financing and provision. Nordic Economic Policy Review. ISSN 1904-4526. 2. doi: 10.6027/TN2013-514.
• Golombek, Rolf; Kittelsen, Sverre A.C. & Rosendahl, Knut Einar (2012). Tildeling av klimakvoter i Europa :. Samfunnsøkonomen. ISSN 1890-5250. 126(2), p. 30–37.
• Golombek, Rolf; Kittelsen, Sverre A.C. & Haddeland, Ingjerd (2012). Climate change: impacts on electricity markets in Western Europe. Climatic Change. ISSN 0165-0009. 113(2), p. 357–370. doi: 10.1007/s10584-011-0348-6. Show summary

  This paper studies some impacts of climate change on electricity markets, focusing on three climate effects. First, demand for electricity is affected because of changes in the temperature. Second, changes in precipitation and temperature have impact on supply of hydro electric production through a shift in the inflow of water. Third, plant efficiency for thermal generation will decrease because the temperature of water used to cool equipment increases. To find the magnitude of these partial effects, as well as the overall effects, on Western European energy markets, we use the multi-market equilibrium model LIBEMOD. We find that each of the three partial effects changes the average electricity producer price by less than 2%, while the net effect is an increase of only 1%. The partial effects on total electricity supply are small, and the net effect is a decrease of 4%. The greatest effects are found for Nordic countries with a large market share for reservoir hydro. In these countries, annual production of electricity increases by 8%, reflecting more inflow of water, while net exports doubles. In addition, because of lower inflow in summer and higher in winter, the reservoir filling needed to transfer water from summer to winter is drastically reduced in the Nordic countries.

• Golombek, Rolf; Kittelsen, Sverre A.C.; Løfsnæs, Ole & Schemde, Arndt von (2011). Hvordan påvirkes kraftsektoren av klimaendringer? Samfunnsøkonomen. ISSN 1890-5250. p. 55–62.
• Golombek, Rolf; Greaker, Mads; Kittelsen, Sverre A.C.; Røgeberg, Ole Jørgen & Aune, Finn Roar (2011). Carbon Capture and Storage Technologies in the European Power Market. Energy Journal. ISSN 0195-6574. 32(3), p. 209–237. doi: 10.5547/ISSN0195-6574-EJ-Vol32-No3-8. Show summary

  We examine the potential of Carbon Capture and Storage (CCS) technologies in the European electricity markets, assessing whether CCS technologies will reduce carbon emissions substantially in the absence of investment subsidies, and how the availability of CCS technologies may affect electricity prices and the amount of renewable electricity. To this end we augment a multi-market equilibrium model of the European energy markets with CCS electricity technologies. The CCS technologies are characterized by costs and technical efficiencies synthesized from a number of recent CCS reviews. Our simulations indicate that with realistic values for carbon prices, new CCS coal power plants become profitable, totally replacing non-CCS coal power investments and to a large extent replacing new wind power. New CCS gas power also becomes profitable, but does not replace non-CCS gas power investment fully. Substantially lower costs, through subsidies on technological development or deployment, would be necessary to make CCS modification of existing coal and gas power plants profitable for private investors.

• Medin, Emma; Anthun, Kjartan Sarheim; Häkkinen, Unto; Kittelsen, Sverre A.C.; Linna, Miika & Magnussen, Jon [Show all 8 contributors for this article] (2011). Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis. European Journal of Health Economics. ISSN 1618-7598. 12(6), p. 509–519. doi: 10.1007/s10198-010-0263-1. Show summary

  This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.

• Linna, Miika; Häkkinen, Unto; Peltola, Mikko; Magnussen, Jon; Anthun, Kjartan Sarheim & Kittelsen, Sverre A.C. [Show all 10 contributors for this article] (2010). Measuring cost efficiency in the Nordic Hospitals-a cross-sectional comparison of public hospitals in 2002. Health Care Management Science. ISSN 1386-9620. 13(4), p. 346–357. doi: 10.1007/s10729-010-9134-7.
• Halsteinli, V; Kittelsen, Sverre A.C. & Magnussen, Jon (2010). Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment. Social Science and Medicine. ISSN 0277-9536. 70(3), p. 439–446. doi: 10.1016/j.socscimed.2009.11.002.
• Førsund, Finn R; Kittelsen, Sverre A.C. & Krivonozhko, Vladimir E (2009). Farrell revisited-Visualizing properties of DEA production frontiers. Journal of the Operational Research Society. ISSN 0160-5682. 60(11), p. 1535–1545. doi: 10.1057/jors.2008.185.
• Edvardsen, Dag Fjeld; Førsund, Finn R & Kittelsen, Sverre A.C. (2008). Far out or alone in the crowd: a taxonomy of peers in DEA. Journal of Productivity Analysis. ISSN 0895-562X. 29(3), p. 201–210. doi: 10.1007/s11123-007-0066-2. Show summary

  A method is presented for classifying strongly efficient units in DEA as interior or exterior, and as self-evaluators or active peers. The exterior strongly efficient units are found by running the enveloping procedure “from below”. There is no firm production-function evidence of the efficiency of exterior self-evaluators. Interior self-evaluators are more likely to have active peers as neighbours in more directions and may therefore represent technology. When performing a second stage regression analysis of efficiency scores, exterior self-evaluators should be removed. The proportion of exterior active peers also provides information on whether the variable specification is supported by the data.

• Hagen, Terje P.; Iversen, Tor & Kittelsen, Sverre A.C. (2007). Ga prioritering og konkurranse høyere kostnadseffektivitet? En analyse av laboratorie- og røntgenvirksomheten. In Kaarbøe, Oddvar Martin & Lie, Terje (Ed.), Resultatevaluering av sykehusreformen. Tilgjengelighet, prioritering, effektivitet, brukermedvirkning og medbestemmelse. Norges forskningsråd. ISSN 978-82-12-02395-6.
• Førsund, Finn R; Edvardsen, Dag, Fjeld; Hansen, Wiljar; Kittelsen, Sverre A.C. & Neurauter, Thor (2006). Productivity and regulatory reform of Norwegian electricity distribution utilities. In Coelli, Tim & Lawrence, Denis (Ed.), Performance measurement and regulation of network utilities. Edward Elgar Publishing. ISSN 9781845423179. p. 97–131.
• Førsund, Finn R; Lindseth, Frode; Kittelsen, Sverre A.C. & Edvardsen, Dag Fjeld (2006). THE TAX MAN COMETH-BUT IS HE EFFICIENT? National Institute Economic Review. ISSN 0027-9501. 197(July), p. 106–119.
• Halsteinli, Vidar; Kittelsen, Sverre A.C. & Magnussen, Jon (2005). Productivity Growth in Norwegian Psychiatric Outpatient Clinics for Children and Youths. Journal of Mental Health Policy and Economics. ISSN 1091-4358. 8(4), p. 183–191.
• Kittelsen, Sverre A.C. & Magnussen, J (2005). The Journal of Mental Health Policy and Economics. Journal of Mental Health Policy and Economics. ISSN 1091-4358. 8(4), p. 183–191.
• Aune, Finn Roar; Golombek, Rolf; Kittelsen, Sverre A.C. & Rosendahl, Knut Einar (2004). Liberalizing the energy markets of Western Europe – a computable equilibrium model approach. Applied Economics. ISSN 0003-6846. 36(19), p. 2137–2149. doi: 10.1080/00036840310001641742. Show summary

  Using a computable equilibrium model, the short-run effects of a radical liberalization of the West European natural gas and electricity markets are examined. In each model country, oil, gas, coal and electricity are produced, traded and consumed. There are world markets for oil and coal, and well-integrated competitive markets for gas and electricity in Western Europe. Gas and electricity are transported and traded across markets under the assumption of ideal third-party access regimes for transportation and limited capacities in the transportation networks. It is found that relative to the data year 1996, radical liberalization reduces the average end-user price of natural gas by around 20%, and the average end-user price of electricity by around 50%. The supply of electricity increases by around 20%, mainly due to increased coal power production. After such liberalization, coal power emerges with the largest market share of electricity production in Western Europe.

• Aune, Finn Roar; Golombek, Rolf & Kittelsen, Sverre A.C. (2004). Does Increased Extraction of Natural Gas Reduce Carbon Emissions? Environmental and Resource Economics. ISSN 0924-6460. 29(4). doi: 10.1007/s10640-004-9456-3. Show summary

  Without an international climate agreement, extraction of more natural gas could reduce emissions of CO2 as more “clean” natural gas may drive out “dirty” coal and oil. Using a computable equilibrium model for the Western European electricity and natural gas markets, we examine whether increased extraction of natural gas in Norway reduces global emissions of CO2. We find that both in the short run and in the long run total emissions are reduced if the additional quantity of natural gas is used in gas power production in Norway. If instead the additional quantity is exported directly, total emissions increase both in the short run and in the long run. However, if modest CO2-taxes are imposed, increased extraction of natural gas will reduce CO2 emissions also when the additional natural gas is exported directed.

• Førsund, Finn & Kittelsen, Sverre A.C. (2001). empiriske forskningsresultater om effektivitet i offentlig tjenesteproduksjon. Oekonomisk Forum. 55(6), p. 22–29.
• Førsund, Finn & Kittelsen, Sverre A.C. (1998). productivity development of norwegian electricity distribution utilities. Resource and Energy Economics. ISSN 0928-7655. 20(3), p. 207–224. Show summary

  When regulating electricity distribution utilities, estimates of the past productivity improvement performance are very important for future requirements. A piecewise linear frontier technology, reflecting observed best practice, accommodating the multi-output nature of distribution utilities is specified. A Malmquist index and its components, shift in frontier technology and change in efficiency, have been calculated for the period 1983 to 1989. The main results are a positive productivity growth averaging nearly 2 per cent per year, and that this is mainly due to frontier technology shift. Outliers are scrutinised, but do not influence results for non-outliers.

• Torgersen, Arne Martin; Førsund, Finn & Kittelsen, Sverre A.C. (1996). Slack-adjusted efficiency measures and ranking of efficient units. Journal of Productivity Analysis. ISSN 0895-562X. 7(4), p. 379–398. Show summary

  When using a piecewise linear frontier production function as a reference for calculating efficiency measures, total potentials for improvement are often not revealed by calculating radial efficiency measures of the Farrell type only. The paper develops efficiency measures extending the radial measures to include slacks, and also suggests a method for ranking efficient units according to their importance as benchmarks for inefficient units. The new measures are applied to a typical many dimensions - small sample problem of a cross section data set for Norwegian state run employment offices.

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• Rødseth, Kenneth Løvold; Holmen, Rasmus Bøgh; Førsund, Finn R & Kittelsen, Sverre A.C. (2019). Effektivitet og produktivitet i norsk veibygging 2007-2016. Ex ante akademisk forlag. ISBN 978-82-93253-77-8. 103 p.
• Aune, Finn Roar; Golombek, Rolf; Kittelsen, Sverre A.C. & Rosendahl, Knut Einar (2008). Liberalizing European energy markets : an economic analysis. Edward Elgar Publishing. ISBN 9781843763741. 315 p.

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• Kittelsen, Sverre A.C.; Lindaas, Nils Arne; Anthun, Kjartan Sarheim & Magnussen, Jon (2023). Economies of scope in Norwegian hospitals.
• Kittelsen, Sverre A.C.; Lindaas, Nils Arne; Anthun, Kjartan Sarheim & Magnussen, Jon (2023). Economies of Scale and Scope in Norwegian Hospitals,
• Aas, Eline; Godager, Geir; Hagen, Terje P.; Häkkinen, Unto; Karlsson, Martin & Kittelsen, Sverre [Show all 8 contributors for this article] (2023). Advancing and Inspiring Health Economics: A Special Issue in Honor of Tor Iversen. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 1–5. doi: 10.5617/njhe.10299. Show summary

  Professor Tor Iversen is a distinguished and highly respected health economist who has made significant contributions to the field of health economics. With this special issue, we celebrate his work.

• Kittelsen, Sverre; Lindaas, Nils Arne; Anthun, Kjartan Sarheim & Magnussen, Jon (2023). Economies of Scale and Scope in Norwegian hospitals.
• Kittelsen, Sverre (2022). Måling av effektivitet i kommunesektoren.
• Kittelsen, Sverre (2022). Måling av effektivitet i kommunesektoren.
• Kittelsen, Sverre (2022). Optimal scale and size of Norwegian higher educational institutions.
• Lindaas, Nils Arne; Anthun, Kjartan Sarheim; Kittelsen, Sverre & Magnussen, Jon (2022). Breddefordeler i norske helseforetak.
• Lindaas, Nils Arne; Anthun, Kjartan Sarheim; Kittelsen, Sverre & Magnussen, Jon (2022). (Dis)economies of scope in Norwegian public hospitals.
• Kittelsen, Sverre A.C. (2021). Modelling energy markets with intermittent power supply.
• Kittelsen, Sverre A.C. (2019). Using performance measurement in economic regulation - a positive view.
• Kittelsen, Sverre A.C. (2016). Scale and quality in Nordic hospitals.
• Kittelsen, Sverre A.C. (2015). Scale and quality in Nordic hospitals.
• Hoel, Michael Olaf; Kittelsen, Sverre A.C. & Kverndokk, Snorre (2015). Pareto Improving Climate Policies: Distributing the Benefits across Generations and Regions.
• Kittelsen, Sverre A.C. (2013). Quality and Productivity in Nordic Hospitals.
• Kittelsen, Sverre A.C. (2013). Comparing Nordic Hospital efficiency and productivity.
• Kittelsen, Sverre A.C. (2013). Decomposing the Productivity Differences between Hospitals in the Nordic Countries.
• Kittelsen, Sverre A.C. (2012). Decomposing the Productivity Differences between Hospitals in the Nordic Countries.
• Halsteinli, Vidar; Kittelsen, Sverre A.C. & Magnussen, Jon (2008). Productivity growth in Outpatient Child and Adolescent Mental Health Services: The impact of case-mix adjustment.
• Kittelsen, Sverre A.C. & Magnussen, Jon (2007). Hospital reform and hospital efficiency - a Nordic Comparative Study.
• Linna, Miika; Häkkinen, Unto; Magnussen, Jon; Kittelsen, Sverre A.C. & Rehnberg, Clas (2007). Comparing efficiency between Nordic Hospitals.
• Førsund, Finn R; Kittelsen, Sverre A.C. & Lindseth, Frode (2006). Productivity of tax offices in Norway.
• Førsund, Finn R; Kittelsen, Sverre A.C.; Lindseth, Frode & Edvardsen, Dag Fjeld (2006). The tax man cometh-but is he efficient?
• Førsund, Finn R; Kittelsen, Sverre A.C. & Lindseth, Frode (2006). EFFICIENCY AND PRODUCTIVITY OF NORWEGIAN TAX OFFICES.
• Kittelsen, Sverre A.C.; Magnussen, Jon & Hernæs, Kjersti (2006). Quality, efficiency and scope in Norwegian Hospital Production.
• Kittelsen, Sverre A.C.; Magnussen, Jon; Häkkinen, Unto; Linna, Miika; Medin, Emma & Nicolaisen, Jeppe [Show all 8 contributors for this article] (2006). Hospital Financing and Efficiency in the Nordic Countries.
• Magnussen, Jon; Seppälä, Timo; Kittelsen, Sverre A.C.; Häkkinen, Unto; Rehnberg, Clas & Rød, Anette (2006). Efficiency aspects of Nordic Hospital Systems.
• Magnussen, Jon; Kittelsen, Sverre A.C. & Hernæs, Kjersti (2006). Quality, efficiency and scope in Norwegian hospital production.
• Førsund, Finn & Kittelsen, Sverre A.C. (2000). On the calculation of Farrell efficiency measures: the evolvment of linear programming. Show summary

  The evolvement of the use of linear programming in DEA analyses from Farrell to Boles

• Magnussen, Jon & Kittelsen, Sverre A.C. (1999). Testing DEA Models of Efficiency in NOrwegian Psychiatric Outpatient Clinics.
• Sæther, Erik Magnus; Anthun, Kjartan Sarheim; Bilet, Anders M.; Jansen, Halvard S.; Kittelsen, Sverre A.C. & Lidman, Johanna [Show all 8 contributors for this article] (2024). Marginalkostnader i spesialisthelsetjenesten. Oslo Economics.
• Rødseth, Kenneth Løvold; Holmen, Rasmus Bøgh; Kittelsen, Sverre & Førsund, Finn (2022). Forbedringspotensial ved måling av effektivitet i kommunal sektor. Transportøkonomisk institutt. ISSN 978-82-480-1924-4. Show summary

  Teknisk beregningsutvalg for kommunal og fylkeskommunal økonomi (TBU) ønsket et prosjekt som vurderer mulighetene for og den praktiske anvendbarheten av effektivitetsanalyser av offentlig tjenesteyting. Denne rapporten gir en gjennomgang av beste praksis innen metodikk for effektivitetsanalyse, aktuelle data til måling av kommuneeffektivitet og empiriske sammenlikninger av metoder og modellspesifikasjoner. Rapporten gir anbefalinger om hvordan TBUs etablerte metodikk for måling av kommuneeffektivitet kan forbedres samt aktuelle temaer til videre utredning i TBUs arbeid med å etablere et solid metodisk rammeverk.

• Wangsness, Paal Brevik; Kittelsen, Sverre; Steinsland, Christian; Aune, Finn Roar & Nævdal, Eric (2020). Elektriske biler og den gjensidige påvirkningen mellom transport- og kraftsektorene. Transportøkonomisk institutt. ISSN 978-82-480-2324-1. Show summary

  Elektrifisering av bilparken gjør at elektrisitetsmarkedet og transportsystemet blir mer sammenflettet. Ved sambruk av spesialiserte modeller for energi og transport har vi analysert en rekke scenarioer (inkludert stresstesting) for hvordan disse markedene vil påvirke hverandre i 2030. Vi finner at det norske kraftmarkedet som helhet er i hovedsak er robust overfor de utfordringene som norsk elbillading av elbiler i Norge inne¬bærer. Kraftprisen påvirker heller ikke transportetterspørselen nevneverdig, da strømmen er en liten del av kostnadene ved å eie eller drive og bruke en elbil.

• Anthun, Kjartan Sarheim; Kittelsen, Sverre A.C. & Magnussen, Jon (2016). Produktivitet i spesialisthelsetjenesten. Universitetet i Oslo. ISSN 978-82-7756-256-8.
• Hoel, Michael Olaf; Kittelsen, Sverre A.C. & Kverndokk, Snorre (2015). Pareto Improving Climate Policies: Distributing the Benefits across Generations and Regions. CESifo Working Paper No. 5487.
• Rygh, Liv; Helgeland, Jon; Braut, Geir Sverre; Bukholm, Geir; Fredheim, Nanna & Frich, Jan C. [Show all 12 contributors for this article] (2010). Forslag til rammeverk for et nasjonalt kvalitetsindikatorsystem for helsetjenesten. Nasjonalt kunnskapssenter for helsetjenesten. ISSN 978-82-8121-356-2.
• Rygh, Liv Helen; Helgeland, Jon; Braut, Geir Sverre; Bukholm, Geir; Fredheim, Nanna & Frich, Jan C [Show all 12 contributors for this article] (2010). Forslag til rammeverk for et nasjonalt kvalitetsindikatorsystem for helsetjenesten. Nasjonalt kunnskapssenter for helsetjenesten. ISSN 978-82-8121-356-2.
• Kittelsen, Sverre A.C.; Magnussen, Jon; Anthun, Kjartan Sarheim; Häkkinen, Unto; Linna, Mika & Olsen, Kim Rose [Show all 8 contributors for this article] (2008). Hospital productivity and the Norwegian ownership reform - A Nordic comparative study. Helseøkonomisk forskningsprogram, Universitetet i Oslo. ISSN 1501-9071. 2008(10).
• Kittelsen, Sverre A.C.; Magnussen, Jon & Anthun, Kjartan Sarheim (2007). Sykehusproduktivitet etter statlig overtakelse: En nordisk komparativ studie. Helseøkonomisk forskningsprogram ved Universitetet i Oslo. ISSN 82-7756-172-5. 2007(1).
• Hagen, Terje P.; Iversen, Tor & Kittelsen, Sverre A.C. (2007). Laboratorie- og røntgenvirksomheten i kjølvannet av sykehusreformen: Mer privatisering og lavere kostnader? Helseøkonomisk forskningsprogram, Universitetet i Oslo. ISSN 1501-9071. 2007(2).
• Hagen, Terje P.; Iversen, Tor & Kittelsen, Sverre A.C. (2005). ”Kartlegging av produksjon og kostnader til offentlige og private leverandører av laboratorie- og røntgentjenester.” HERO Skriftserie 2005: 14. Universitetet i Oslo.
• Torp, Hege; Edvardsen, Dag Fjeld & Kittelsen, Sverre A.C. (2000). Evaluering av formidling : en effektivitetsanalyse av arbeidskontorenes samlete virksomhet basert på DEA. Institutt for samfunnsforskning. ISSN 82-7763-142-1. Full text in Research Archive Show summary

  Den gjennomsnittlige effektiviteten i de lokale enhetene i aetat er 87 prosent. Dette er resultatet av en analyse basert på data fra 1998 for praktisk talt samtlige arbeidskontorer i Norge.Formålet med studien er å beskrive effektivitetsfordelingen i arbeidsmarkedsetaten. En slik beskrivelse identifiserer både de arbeidskontorene som utnytter tilgjengelige ressurser på en effektiv måte når de produserer tjenester for arbeidsgivere og arbeidssøkere, og de ikke- effektive arbeidskontorene. Kunnskap om hva som kjennetegner de effektive arbeidskontorene setter oss på sporet av hva de ikkeeffektive arbeidskontorene kan lære av de effektive, for å bli mer lik dem. Den beregnede gjennomsnittseffektiviteten på 87 prosent innebærer at dersom alle arbeidskontorene var 100 prosent effektive, ville det være mulig å opprettholde produksjonen av tjenester med en ressursinnsats tilsvarende 87 prosent av dagens ressursinnsats. En etteranalyse av effektivitetstallene viser at om lag 35 prosent av variasjonen i effektivitet mellom arbeidskontorene kan forklares ved forskjeller i forholdene på det lokale arbeidsmarkedet. Det meste av variasjonen er med andre ord forskjeller i ren effektivitet.

• Kittelsen, Sverre A. C. (1998). Using Data Envelopment Analysis to measure production efficiency in the public sector. Økonomiske doktoravhandlinger. ISSN 0803-0162. Show summary

  Avhandlingen er skrevet innen fagområdet produksjonsteori og viser hvordan metodeapparatet som går under navnet datainnhyllingsanalyse (DEA) kan gjøres anvendelig i målingen av effektivitet og produktivitet innen offentlig sektor. Metoden kan utvikles til å ha et statistisk fundament, og kan i stor grad gi vesentlig informasjon om ressursbruk i enkeltsektorer. Innenfor sektorer som norske domstoler, arbeidskontorer og elektrisitetsdistribusjon er det i arbeidet med avhandlingen funnet betydelig ineffektivitet, samtidig som det er gitt informasjon som kan bidra til å forbedre effektiviteten i disse sektorene. Effektivitet sier noe om hvor god ressursutnyttingen er i forhold til det som er mulig. Produktivitet er et beslektet begrep som på en mere beskrivende måte uttrykker forholdet mellom produksjon og ressursbruk, men også her kreves en målestokk for produktivitetsnivået. Hvis en privateid sektor produserer flere produkter eller har flere målsettinger, er det vanlig å veie sammen disse ved hjelp av markedsprisene. Produktene i offentlig sektor omsettes ofte ikke på markeder, og en har da ikke priser som kan brukes som vekter ved beregning av effektivitet og produktivitet. I stedet kan en bruke informasjon om teknologien, dvs det fysiske mulighetsområdet for omforming av ressurser til produkter. I komplekse prosesser og i tjenesteyting er det ikke mulig å skaffe ingeniørmessig informasjon om teknologien; derfor må en basere seg på å anslå teknologien fra observasjoner av faktisk atferd. DEA er en metode for å anslå teknologien utfra atferden til de beste (mest effektive) enhetene. I motsetning til alternative metoder, legges det liten struktur på teknologianslaget på forhånd, men metoden har en del andre svakheter. Spesielt er det et problem at metoden er følsom for målefeil, og at statistiske tester inntil nylig ikke har vært tilgjengelige. Avhandlingen setter fokus på ulike svakheter ved DEA-metoden, og hvordan en eventuelt kan forbedre den. Hvis en har få observasjoner, vil en f. eks. ha vanskelighet for å avsløre ineffektivitet fordi mange enheter vil bli målt som effektive. Avhandlingen tar for seg hvordan en kan modifisere metoden for likevel å avsløre forskjeller mellom de effektive enhetene. Samtidig er det lagt vekt på å vise hvordan en for de ineffektive enhetene får informasjon om hvilke effektive enheter som kan tjene som forbilder. Resultatene er anvendt på norske by- og herredsretter og på arbeidskontorene. Avhandlingen tar også for seg statistiske tester som er foreslått i litteraturen, og gjennomfører storskala simuleringer for å finne om testene har de ønskede egenskapene. Resultatene er oppmuntrende for metoden, ettersom testene i stor grad har utsagnskraft, samtidig som det er viktig med flere observasjoner enn i alternative metoder. Disse funnene blir anvendt på norske elektrisitetsfordelingsverk for å finne ut hvilke variable som bør inngå når en måler effektivitet og produktivitet. Eksempelvis ble det ikke funnet grunn til å ta hensyn til klimaforskjeller når en allerede har tatt hensyn til energimengden, abonnenttallet og forsyningsarealets utstrekning.

• von der Fehr, Nils-Henrik M.; Førsund, Finn & Kittelsen, Sverre A.C. (1996). The Zambia RPED Study: Report no III. The World Bank.

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