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1 – 10 of over 13000Hedayet Chowdhury, Walter Wodchis and Audrey Laporte
The purpose of this paper is to present a productivity measure for hospital services in Ontario.
Abstract
Purpose
The purpose of this paper is to present a productivity measure for hospital services in Ontario.
Design/methodology/approach
The study applied the Malmquist Productivity Index (MPI) to assess the efficiency of hospital services in Ontario, Canada, over the period 2003‐2006. The MPI was decomposed into efficiency change and technological change. Efficiency change was further decomposed into pure efficiency change and scale efficiency change. A bootstrapping technique was also used to obtain confidence intervals for the output oriented MPI and its decompositions.
Findings
By estimating confidence intervals it was found that a large number of hospitals did not achieve significant progress in terms of productivity. By taking geometric means of estimates for all years it was observed that while overall productivity and efficiency of hospitals in Ontario declined during the study period, technological progress increased at a rate of 5.95 percent on average.
Practical implications
The present study helps to understand the productivity and technological change and change in technical efficiency in this vital sector of the economy, which is important for policy making identifying improvement opportunities in resource allocation. It was observed that Ontario hospitals did not improve the efficiency with which they employed their inputs (i.e. staff and supplies) over the study period; they did achieve gains through application of technologies.
Originality/value
The paper provides a thorough study on productivity growth of health care services in Ontario using a non‐parametric framework with bootstrapping. It also provides a robust measurement and analysis of the contributions of technology, size of operation and use of inputs to the performance of hospitals in Ontario.
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Jos L.T. Blank and Vivian G. Valdmanis
It is well recognized that hospitals do not operate in a competitive market typically observed in the economics literature, but rather alternative measures of performance must be…
Abstract
It is well recognized that hospitals do not operate in a competitive market typically observed in the economics literature, but rather alternative measures of performance must be developed. In other words, health policy analysts, managers, and decision-makers cannot rely on determining efficiency via the typical profit maximizing/cost minimizing firm but develop techniques that address the issues germane to hospital productivity. What has been presented in this book demonstrates the research in both productivity and policy that must attend to this anomaly. In this introductory section, we briefly summarize the theoretical underpinnings of this book.
Saleh Mollahaliloglu, Sahin Kavuncubasi, Fikriye Yilmaz, Mustafa Z. Younis, Fatih Simsek, Mustafa Kostak, Selami Yildirim and Emeka Nwagwu
Turkish Ministry of Health (MoH) has Health Transformation Program (HTP). The purpose of this program has been to modify the structure of the current system in order to enhance…
Abstract
Purpose
Turkish Ministry of Health (MoH) has Health Transformation Program (HTP). The purpose of this program has been to modify the structure of the current system in order to enhance health system productivity, quality, and access in the Turkish health system. The paper aims to discuss these issues.
Design/methodology/approach
To measure the productivity, a data envelopment analysis-based Malmquist index approach was employed.
Findings
Results showed that the overall HTP have had a considerable positive impact on the productivity of general hospitals.
Research limitations/implications
The limitation is the availability of some data that might not be collected or reported to the MoH in Turkey.
Practical implications
This research’s findings will have an impact on reforming the health care system in Turkey to be competitive and efficient as possible.
Social implications
The research will have implication on reducing cost and provide value to the Turkish population.
Originality/value
This is one of the very few articles that targeted the efficiency of hospital system in Turkey.
Details
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The purpose of this paper is to examine the relative efficiency and productivity of hospitals during the health reform process.
Abstract
Purpose
The purpose of this paper is to examine the relative efficiency and productivity of hospitals during the health reform process.
Design/methodology/approach
Data envelopment analyses method (DEA) with the input‐oriented variable‐returns‐to‐scale model was used to calculate efficiency scores. Malmquist total factor productivity index approach was then employed to calculate productivity of hospitals. Data of 101 hospitals was extracted from databases of the Ministry of Health, Vietnam from the years 1998 to 2006.
Findings
There was evidence of improvement in overall technical efficiency from 65 per cent in 1998 to 76 per cent in 2006. Hospitals' productivity progressed around 1.4 per cent per year, which was mainly due to the technical efficiency improvement. Furthermore, provincial hospitals were more technically efficient than their central counterparts and hospitals located in different regions performed differently.
Originality/value
The paper provides an insight in the performance of Vietnamese public hospitals that has been rarely examined before and contributes to the existing literature of hospital performance in developing countries
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James F. Burgess and Jr.
Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days…
Abstract
Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days, and perhaps outpatient visits or numbers of surgeries performed. This simplicity represents an extreme of aggregation, focuses the attention of the analysis entirely on the structure of the organization at the highest levels, and provides no insight into the specific services that might be provided to each patient as well as the characteristics of those patients, which might lead to specialization of their care. This process is fundamentally complex, which makes it especially difficult to model. This table-setting chapter will characterize some of the key contextual choices that must be made by researchers in this field which are then applied in subsequent chapters. The key point of this chapter will be to argue that there are very few “one size fits all” decisions in this process and thus the context of particular research objectives and questions will determine how modeling choices are made in practice. Some intuition about how these decisions have substantial implications for outcomes of measurement for hospital productivity will be provided; however, no attempt will be made to conduct a literature review of all the choices that have been made. Instead, we will suggest that new careful attention to the choices made can make future studies more effective in communicating to the communities implementing the research.
Hasan Bağcı and Seyhan Çil Koçyiğit
Decree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the…
Abstract
Purpose
Decree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the effects of the public hospital unions (PHUs), which were a result of Decree Law No. 663, on the efficiency and productivity of public hospitals.
Design/methodology/approach
Data envelopment analysis (DEA) and DEA-based Malmquist total factor productivity (TFP) index were used from 2011 to 2016. Raw materials and supply expenses, salaries and fringe benefits, other service costs, general administrative expenses, total number of beds, number of specialists, number of residents, number of general practitioners, number of nurses and midwives and other medical officials were used as input variables. Working capital turnover, number of inpatients, number of outpatients and number of surgical operations for Groups A, B and C were used as output variables.
Findings
According to the DEA scores, the percentage of efficient hospitals showed a declining trend from 2011 to 2016. The TFP results also showed a decreasing trend from 2011 to 2016.
Practical implications
Providing administrative and financial autonomy to public hospital managers may cause efficiency and productivity losses, which is contrary to expectations.
Originality/value
This study is the first to reveal the impact of decentralization of public healthcare providers on their performance levels in Turkey.
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Jos L.T. Blank and Vivian G. Valdmanis
Hospitals worldwide command the majority of any countries’ health care budget. Reasons for these higher costs include the aging of the population requiring more intensive health…
Abstract
Hospitals worldwide command the majority of any countries’ health care budget. Reasons for these higher costs include the aging of the population requiring more intensive health care treatments provided in hospitals, the relatively high costs of labor in this labor intensive industry and payment systems that may encourage inefficient behavior on the part of hospital managers and physicians, that have not been fully mitigated via reforms and regulations.
Gary D. Ferrier and Vivian G. Valdmanis
Based on the Current Population Survey, 46.6 million Americans did not have health insurance in 2005 (Center on Budget and Policy Priorities, 2006). Lack of insurance is often…
Abstract
Based on the Current Population Survey, 46.6 million Americans did not have health insurance in 2005 (Center on Budget and Policy Priorities, 2006). Lack of insurance is often associated with lower utilization rates, which may in turn adversely affect health status (Ayanian, Weissman, Schneider, Ginsburg, & Zaslavsky, 2000). Since universal health insurance is not provided for in the US, uninsured individuals must either self-pay or rely on charity care provided by hospitals and health clinics. The majority of charity care is produced in the public sector, either at the state, county, or local level (federal hospitals primarily serve a particular segment of the population – e.g., veterans in the case of Veterans Administration hospitals). Public hospital provision of “safety net” hospital services is particularly prevalent in large urban areas (Lipson & Naierman, 1996). These safety net hospitals are defined by the Institute of Medicine as having an “open door policy to serve all patients regardless of their ability to pay and provide substantial levels of care to Medicaid, the uninsured, and other vulnerable patients” (IOM, 2000). Private not-for-profit (NFP) hospitals also provide charity care but to a lesser extent than public providers, especially since the imposition of cost cutting measures both by Medicare and Medicaid (federal programs that fund health care for the elderly and indigent, respectively) and by managed care. Given that approximately 15% of US GDP is allocated to health care, cost cutting measures are laudable; however, care still needs to be provided for individuals who cannot afford it, and the burden of providing this care has to be borne somewhere in the health care system.
Aradhana Vikas Gandhi and Dipasha Sharma
The purpose of this paper is to ascertain the performance of Indian hospitals in recent past and derive meaningful insights for policy makers and practicing managers in this area.
Abstract
Purpose
The purpose of this paper is to ascertain the performance of Indian hospitals in recent past and derive meaningful insights for policy makers and practicing managers in this area.
Design/methodology/approach
This paper analyses the technical efficiency of select Indian private hospitals using three related methodologies: data envelopment analysis (DEA), Malmquist Productivity Index (MPI) and Tobit regression. Two output variables (i.e. total income and profit after tax) and four input variables (i.e. cost of labour, net fixed assets, current assets and other operating expenses) were selected for the purpose of the study.
Findings
DEA analysis has shown that 14 out of 37 hospitals are found to be efficient under the Cooper and Rhodes model of DEA and 20 out of 37 hospitals are efficient under the Banker, Charles and Cooper model of DEA. The empirical results pertaining to MPI indicate an overall productivity progress in the private Indian hospital industry during the study period, which is largely due to technological advancement in the industry. Tobit regression demonstrates that chain affiliated, specialized and multi-city located hospitals exhibit a higher technical efficiency.
Research limitations/implications
This study has a limitation with reference to the unavailability of data on the input and output parameters of the model. The data related to the number of beds, number of doctors, number of nurses, etc., were not available for the period under consideration.
Originality/value
This study seems to be one of the few studies applying productivity and performance analysis using DEA, MPI and Tobit regression for the Indian private hospital industry.
Details
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There is a large body of literature on the efficiency and productivity of hospitals. Most studies focus on the effects of environmental pressures on hospital efficiency, such as…
Abstract
There is a large body of literature on the efficiency and productivity of hospitals. Most studies focus on the effects of environmental pressures on hospital efficiency, such as payment systems (Dismuke & Sena, 1999; Sommersguter-Reichmann, 2000), competition (Rosko, 1999, 2004), Sari, 2003), and property rights (Gruca & Nath, 2001). Other studies pinpoint their attention to economic phenomena, such as economies of scale (Lindrooth, Lo Sasso, & Bazzoli, 2003; Dranove & Lindrooth, 2003), economies of scope (Prior & Sola, 2000; Grosskopf, Margaritis, & Valdmanis, 2001; Li & Rosenman, 2001), chain membership (Menke, 1997), economic behavior (Blank & Merkies, 2004), and expense preference (Rodriguez-Alvarez & Lovell, 2004).