Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry

Lindlbauer, Ivonne; Schreyögg, Jonas; Winter, Vera

doi:10.1016/j.ejor.2015.10.029

Cited by 64 publications

(56 citation statements)

References 47 publications

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“…These two models have become standards in the literature of performance measurement under the assumptions of constant and variable returns to scale respectively [ 63 ]. Because public hospitals serve the public demand as given and must manage their resources accordingly, therefore, they target input minimizing rather than output maximization which recommends using the input-oriented DEA models [ 35 , 64 – 66 ]. We address the potential input savings and constructs input-oriented frontiers guided by the space of managers’ control.…”

Section: Methodsmentioning

confidence: 99%

Measuring the efficiency of Palestinian public hospitals during 2010–2015: an application of a two-stage DEA method

Sultan

Crispim

2018

BMC Health Serv Res

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BackgroundWhile health needs and expenditure in the Occupied Palestinian Territories (OPT) are growing, the international donations are declining and the economic situation is worsening. The purpose of this paper is twofold, to evaluate the productive efficiency of public hospitals in West Bank and to study contextual factors contributing to efficiency differences.MethodsThis study examined technical efficiency among 11 public hospitals in West Bank from 2010 through 2015 targeting a total of 66 observations. Nationally representative data were extracted from the official annual health reports. We applied input-oriented Data Envelopment Analysis (DEA) models to estimate efficiency scores. To elaborate further on performance, we used Tobit regression to identify contextual factors whose impact on inefficient performance is statistically significant.ResultsDespite the increase in efficiency mean scores by 4% from 2010 to 2015, findings show potential savings of 14.5% of resource consumption without reducing the volume of the provided services. The significant Tobit model showed four predictors explaining the inefficient performance of a hospital (p < 0.01) are: bed occupancy rate (BOR); the outpatient-inpatient ratio (OPIPR); hospital’s size (SIZE); and the availability of primary healthcare centers within the hospital’s catchment area (PRC). There is a strong effect of OPIPR on efficiency differences between hospitals: A one unit increase in OPIPR will lead a decrease of 19.7% in the predicted inefficiency level holding all other factors constant.ConclusionTo date, no previous studies have examined the efficiency of public hospitals in the OPT. Our work identified their efficiency levels for potential improvements and the determinants of efficient performance. Based on the measurement of efficiency, the generated information may guide hospitals’ managers, policymakers, and international donors improving the performance of the main national healthcare provider. The scope of this study is limited to public hospitals in West Bank. For a better understanding of the Palestinian market, further research on private hospitals and hospitals in Gaza Strip will be useful.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3228-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Measuring the efficiency of Palestinian public hospitals during 2010–2015: an application of a two-stage DEA method

Sultan

Crispim

2018

BMC Health Serv Res

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“…the findings of [ 94 ]). We adapt the procedure of [ 95 ] to the SFA context and apply in Model 18 a combination of a matching approach and a Difference-In-Difference (DID) estimation to investigate the impact of certification on hospital performance. In a first step, we use propensity-score matching to ensure that any observed differences between certified and non-certified hospitals can be attributed to certification.…”

Section: Resultsmentioning

confidence: 99%

Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany

Proß¹,

Strumann

Geißler³

et al. 2018

PLoS ONE

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We specify a Bayesian, geoadditive Stochastic Frontier Analysis (SFA) model to assess hospital performance along the dimensions of resources and quality of stroke care in German hospitals. With 1,100 annual observations and data from 2006 to 2013 and risk-adjusted patient volume as output, we introduce a production function that captures quality, resource inputs, hospital inefficiency determinants and spatial patterns of inefficiencies. With high relevance for hospital management and health system regulators, we identify performance improvement mechanisms by considering marginal effects for the average hospital. Specialization and certification can substantially reduce mortality. Regional and hospital-level concentration can improve quality and resource efficiency. Finally, our results demonstrate a trade-off between quality improvement and resource reduction and substantial regional variation in efficiency.

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“…The public hospitals have the mission of serving the public demand as given and must manage their limited resources accordingly. Hence, when seeking efficiency assessments, it is recommended to employ the input-oriented DEA models with the aim of input minimizing given a certain level of outputs [ 42 ]. We applied the DEA-CCR and the DEA-BCC models to score the overall efficiency, managerial efficiency, and scale efficiency [ 8 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

Are public hospitals reforming efficiently in West Bank?

Sultan¹,

Crispim

2018

Confl Health

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BackgroundThe structure, function, and capacity of the health care system in the Occupied Palestinian Territories (OPT) had been largely shaped by the complex political history of the country. Since the establishment of the Palestinian Authority in 1994, the reform efforts were subsidized much by the international aids to rebuild the country’s institutional capacity. No previous studies have provided a realistic evaluation of Palestinian achievements in the conduct of public healthcare, we examine the relative productive efficiency of public hospitals (their managers’ success in the usage of resources) during 2010–2015 within West Bank and Jordan. Then, we estimate the efficiency of policies within which managers operate (the program efficiency) across the two countries.MethodsWe employ the Data Envelopment Analysis (DEA) models to distinguish between within-country managerial efficiencies and public policy “program” efficiencies across the two countries. The study follows two key steps, the first step evaluates managerial efficiencies and explores trends in performance within each country. Then, we examine the program efficiencies across the two countries.ResultsPublic hospitals improved their year-specific overall efficiency from 75 to 80% in the West Bank and from 78 to 86% in Jordan in 2010 and 2015 respectively. Changes in efficiency are driven by scale effects in West Bank and by managerial enhancements in Jordan. Program efficiency in West Bank outperformed Jordan during 2010–2012, there was no significant difference in mean program efficiencies between the two countries during 2013–2015.ConclusionsThis work addresses a gap in the DEA literature by empirically investigating the efficiency of public hospitals as distinct from program efficiency in a developing country, namely, Palestine. Findings stimulate hospital managers to enhance potential improvements, policymakers to allocate resources, and international donors to focus on the right adoption of new technology to get better benefits from their considerable investments in public hospitals.

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Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry

Cited by 64 publications

References 47 publications

Measuring the efficiency of Palestinian public hospitals during 2010–2015: an application of a two-stage DEA method

Measuring the efficiency of Palestinian public hospitals during 2010–2015: an application of a two-stage DEA method

Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany

Are public hospitals reforming efficiently in West Bank?

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