Health care quality in nonparametric efficiency studies: a review

Abstract

Scientists are increasingly considering quality in nonparametric frontier efficiency studies in health care. There are many ways to include quality in efficiency analyses. These approaches differ, among other things, in the underlying assumptions about the influence of quality on the attainable efficiency frontier and the distribution of inefficiency scores. The aim is to provide an overview of how scholars have taken quality into account in nonparametric frontier efficiency studies and, at the same time, to address the underlying assumptions on the relationship between efficiency and quality. To this end, we categorized empirical efficiency studies according to the methodological approaches and quality dimensions and collected the quality indicators used. We performed a Web of Science search for studies published in journals covered by the Science Citation Index Expanded, the Social Sciences Citation Index, and the Emerging Sources Citation Index between 1980 and 2020. Of the 126 studies covered in this review, 78 are one-stage studies that incorporate quality directly into the efficiency model and thus assume that quality impacts the attainable efficiency frontier. Forty-four articles are two-stage studies that consider quality in the first and the second stage or the second stage only. Four studies do not assume a priori a specific association between efficiency and quality. Instead, they test for this relationship empirically. Outcome quality is by far the most frequently incorporated quality dimension. While most studies consider structural quality as an environmental variable in the second stage, they include outcome quality predominantly directly in the efficiency model. Process quality is less common.

Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain

“…These comprise the distinct period of time, measurement of efficiency with a static method for a single time period, and a different configuration of the input-output matrix, working with restrictions over the hospital size and making their results not comparable with those of our study. In a recent international review [ 11 ], 62% of studies incorporated quality directly into the efficiency model and thus assume that quality affects the efficiency feasible frontier. Another 35% are two-stage which take into account quality in a second stage.…”

“…For example, quality and efficiency—usually reported separately—are both closely related when aiming for the maximization of healthcare value (i.e., increasing efficiency while improving quality) [ 9 ]. Identifying the impact of the quality of healthcare services on efficiency is a hot topic in health economics and healthcare systems management [ 11 ]. In fact, many researchers argued that most of the productivity growth in healthcare has come in the form of quality improvement rather than cost containment [ 12 ].…”

Healthcare System Efficiency and Its Drivers in Pre- And Covid-19 Pandemic Settings

“…The main advantage of DEA is the ability to conduct multi-dimensional analysis that allows the use of different categories of multiple inputs and outputs simultaneously, which is important for assessing the efficiency of complex healthcare systems (Behr & Theune, 2017). Moreover, the DEA technique could be customised to analyse different parts of healthcare systems (Kujawska, 2018;Ozcan & Khushalani, 2017;Sommersguter-Reichmann, 2022;Walters et al, 2022). As a result, it permits us to compare the efficiency of one healthcare system to another, rather than measuring efficiency in absolute terms and helps to establish benchmarking by identifying best practices and areas for improvement (Behr & Theune, 2017;Kujawska, 2018;Nyawira et al, 2021;Ozcan & Khushalani, 2017;Rostamzadeh et al, 2021;Vörösmarty & Dobos, 2023).…”