Productivity and quality of Dutch hospitals during system reform

Abstract

This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009–2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased.

Efficiency of Brazilian public services of kidney transplantation: Benchmarking Brazilian states via data envelopment analysis

“…Constant return to scale models assume that the size of the operation has no impact on DMU performance, because an increase in input would lead to a proportional increase in output. By contrast, VRS models assume that an increase in input may be accompanied by a greater than proportional (increasing returns to scale (IRS)) or less than proportional (decreasing returns to scale (DRS)) increase in output …”

“…The impact of scale on efficiency is measured by SE, defined as the ratio of technical efficiency (estimated by CRS models) and pure technical efficiency (calculated by VRS models) . An SE equal to 1 signals a DMU operating at an optimum scale size, whereas an SE greater than 0 and less than 1 indicates scale inefficiency, which can be determined by the sum of the weights in the CRS model specifications .…”

Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments

“…It has been argued that process indicators should not be included into the efficiency analysis because it is not an output of production process [45]; however, several previous studies included process indicators either to augment the production set [6,11,46] or to explore the relationship with the distribution of inefficiencies in the two-stage analysis [22,23,25]. To shed new light on this discussion we explored whether and how a process indicator enters the production process.…”

eHealth adoption factors in medical hospitals: A focus on the Netherlands

“…That budgets in smaller hospitals tend to be problematic matches with the lack of financial resources as forwarded as a relatively important barrier in this study. After years of efficiency increase, hospitals in the Netherlands -particularly smaller onesmay not have sufficient financial capability and time available to "experiment" and learn from some "trial and error" in the first adoption stage [10], while high costs of system maintenance later on after implementation may cause serious reluctance to move on. Therefore, smaller hospitals preferably identify ways in which their limited resources can be extended and more efficiently used, e.g.…”

“…Moreover, healthcare in the Netherlands belongs to the top healthcare systems in the world and has recently ranked first in the Euro Health Consumer Index [9]. At the background of this is a healthcare system reform starting in 2005 and intended to result in a more demand-oriented system, in which hospitals delivered higher quality at lower prices, thus increasing costeffectiveness [10]. On the one hand, it is reasonable to expect an extensive use of eHealth as a result of this development, but on the other, the increased cost-effectiveness and efficiency might have caused tightness and too small "room" for experimentation and learning preventing the actual adoption.…”