Productivity analysis of regional-level hospital care in the Czech republic and Slovak Republic

Abstract

Background Providing hospital care is an essential objective of national health policies. The countries that share common history, when they emerged from the same health system and similar conditions in the early 1990s, after the division of Czechoslovakia, became the objects of evaluation of the development of technical efficiency of hospital care. The subsequent development of their health care system also was very similar, but no longer entirely identical. The article aims to identify the trends and disparities in the productivity of the capacities of hospital care on the regional level (NUTS III.) in the Czech Republic and the Slovak Republic in 2009–2018 before the COVID-19 pandemic using the multi-criteria decision methods. Methods The window analysis as a dynamic DEA method based on moving averages and also the Malmquist Index, that allows the evaluation of changes in relative efficiency and of changes in the production possibilities frontier have become the key methods for evaluating the over time efficiency evolution. To model technical efficiency, an output-oriented method assuming constant returns to scale was chosen. Aggregated input and output parameters for each region were the object of study. Results The results showed that differences in the efficiency trends in terms of the examined parameters among the individual regions are slightly greater in the Czech Republic than in the Slovak Republic. The least efficient regions are those where capital cities are located. Furthermore, the analysis showed that in 2018 all of the Slovak Republic regions improved its productivity compared to 2009 and that technological conditions had a significant impact on this improvement. The results of the Czech Republic regions show productivity improvement in 57% of the regions that, on the contrary, was due to changes in technical efficiency. Conclusions It should be recommended to the state- and regional-level governments to refrain from unilaterally preferring the orientation of public policies on the efficiency of the provision of hospital care, and rather focus on increasing the quality and availability of hospital care, especially in smaller, rural, and border regions, in the interest of population safety during pandemics and other emergencies.

Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany

“…Published works [9,16] show that the orientation towards reduction of human resources in health care for the sake of increasing efficiency can lead to a reduction in the quality of care provided. Which in general could lead to a reduction in the resilience of the health system to surges and unpredictable demands for health care in a given region.…”

“…This knowledge is valid in many countries of Europe and the World. The key, but not the only, determining differences between regions are the size of the territory and the number of inhabitants [14][15][16].…”

“…This is happening in the context of changes in the payment mechanisms for financing inpatient care, new medical options, whether it comes to the equipment of medical facilities, or new patient treatment procedures. Integrated systems of community and home care are being implemented in some medical fields in some countries (e.g., interns, psychiatry) [16,24].…”

Productivity and efficiency in the health care system with special focus on hospital performance

“…Poredeći efikasnosti bolnica u Slovačkoj i Češkoj, Vrangela i Vrapkova su u obe republike najmanju efikasnost pronašle u regionima u kojima su smešteni najveći gradovi (50). One su svoj nalaz objasnile velikim brojem postelјa i brojnim srednjomedicinskim kadrom u prestonicama.…”

“…One su svoj nalaz objasnile velikim brojem postelјa i brojnim srednjomedicinskim kadrom u prestonicama. S druge strane, pokazalo se da, u odnosu na ostale regione, ovi regioni pružaju kvalitetnu, specijalizovanu zdravstvenu zaštitu šireg asortimana (50).…”