Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market

Abstract

With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals’ efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals’ urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals’ efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.

Exploring characteristics of specialization as moderators of the link between specialization and patient experience of care

“…In addition, this study adds to the emerging literature on the performance implications of hospitals' medical urgency score. Although previous research suggests that the urgency score directly relates to hospitals' operational performance, that is, their technical efficiency (Schneider et al, 2020), our study shows that medical urgency constitutes also an important moderator of the link between specialization and patient experiences. More precisely, our findings indicate that the marginal effect of specialization in orthopedic and trauma care on patient experiences becomes larger as the urgency score of this service area increases.…”

Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals

“…The results suggest that increasing the number of public beds in hospital intensive care units increases the probability of a hospital being situated on the efficiency frontier. Only one study in Germany assessed the relationship between emergency departments and the technical efficiency of hospitals [ 16 ], finding a negative relationship between the dispersion of emergency departments, their caseloads, and hospital efficiency. However, the studies are not comparable due to the different emergency variables used, as well as the different methods and objectives.…”

“…However, there is no previous research which analyzes the relationship between hospital efficiency and the characteristics of the emergency department and primary care structure as a whole. Only one study in Germany has evaluated the relationship between emergency departments and the technical efficiency of hospitals [ 16 ]. The study used a two-stage double bootstrap data envelopment analysis approach with truncated regression and found a negative relationship between the dispersion of emergency departments, their caseload, and hospital efficiency.…”

“…Traditionally, the literature on hospital efficiency differentiates between the characteristics of hospitals (such as technological provision, teaching nature of the center, rural or urban location, type of ownership) [12][13][14], and those of the environment in which they operate (region, gross domestic product per capita, population density) [13][14][15][16]. However, there is no previous research which analyzes the relationship between hospital efficiency and the characteristics of the emergency department and primary care structure as a whole.…”

Homogeneity and Best Practice Analyses in Hospital Performance Management: An Analytical Framework

“…The DEA model has been recognized to be a powerful tool for performance analysis and benchmarking, spanning a wide range of industries and functional areas, including healthcare (Kohl et al 2019 ; Almeida Botega et al 2020 ; Araújo et al 2014 ). In a recent study on the German hospital market, Schneider et al ( 2020 ) investigate hospital urgency scores (noting the average level of medical urgency in all cases treated at a hospital) are compared to technical efficiency. They use the data of 1,428 hospitals throughout Germany for the years 2015, 2016, and 2017.…”