Accounting for quality in the measurement of hospital performance: evidence from Costa Rica

Arocena, Pablo; García-Prado, Ariadna

doi:10.1002/hec.1204

Cited by 53 publications

(30 citation statements)

References 42 publications

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“…Authors provided insights into how hospitals responded to the pressure for increased efficiency and quality introduced by the reforms by the adoption of management contracts [70, 71] and by the introduction of the DRG-based payment system [72]. Results showed an improvement in hospital performance primarily driven by quality increases.…”

Section: Resultsmentioning

confidence: 99%

Efficiency and optimal size of hospitals: Results of a systematic search

Giancotti¹,

Guglielmo²,

Mauro³

2017

PLoS ONE

122

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BackgroundNational Health Systems managers have been subject in recent years to considerable pressure to increase concentration and allow mergers. This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes through the exploitation of economies of scale. In this context, the opportunity to measure scale efficiency is crucial to address the question of optimal productive size and to manage a fair allocation of resources.Methods and findingsThis paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. We performed a systematic search of 45 past years (1969–2014) of research published in peer-reviewed scientific journals recorded by the Social Sciences Citation Index concerning this topic. We classified articles by the journal’s category, research topic, hospital setting, method and primary data analysis technique. Results showed that most of the studies were focussed on the analysis of technical and scale efficiency or on input / output ratio using Data Envelopment Analysis. We also find increasing interest concerning the effect of possible changes in hospital size on quality of care.ConclusionsStudies analysed in this review showed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.

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Section: Resultsmentioning

confidence: 99%

Efficiency and optimal size of hospitals: Results of a systematic search

Giancotti¹,

Guglielmo²,

Mauro³

2017

PLoS ONE

122

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show abstract

“…Two different assumptions can be made while measuring relative efficiency, constant return to scale (CRS) and variable returns to scale (VRS). This technique has been commonly used in measuring efficiency of hospitals (Chang 1998, Helmig and Lapsley 2001, Steinmann and Zweifel 2003, Chang et al 2004, Nguyen and Giang 2004, Arocena and Garcia-Prado 2007, Masiye 2007, primarily because it allows for substitutability among inputs in hospitals and does not require any pricing information. The DEA method neither assumes cost-minimizing behaviour nor knowledge about factor prices.…”

Section: Methodsmentioning

confidence: 99%

Measurement and determinants of public hospital efficiency in West Bengal, India

Dutta

Bandyopadhyay²,

Ghose

2014

Journal of Asian Public Policy

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This article focuses on analysing the efficiency of secondary-level government-run hospitals in West Bengal, a medium performer state in terms of health indicators, in India. Two main objectives of this article are (1) to measure the technical efficiency of the same and (2) to identify the factors determining their inefficiency. For the first purpose, output-oriented data envelopment analysis (DEA) under variable returns to scale has been used. For the second purpose, we have used two-part regression models, first showing why some hospitals are efficient while others are not and, secondly, what are the factors that determine the relative efficiency of inefficient hospitals. We have used different forms of regression models for both types. The results show that the overall mean efficiency of all hospitals is 0.728, suggesting that on average the hospitals could produce at least 37 per cent more of output with same input volume if they had produced efficiently. The results also reveal that the highest contributor to slack is the group D staff, followed by doctors. It is found that increase in average length of stay, availability of free medicine from the hospital, ratio between doctor and non-doctor staff strength, outpatient bed day and share of emergency admission significantly decrease the efficiency of a hospital, while the ratio of nurses to non-nurses affects it positively. The article concludes with policy suggestions based on the analysis that decrease in average length of stay (ALOS) by better medical intervention and improved quality of care would definitely allow for more patients to be treated, while increase in nursing staff vis-à-vis other staff would also result in better care. Furthermore, as far as availability of medicines is concerned, the policy should not be to reduce access and coverage, but should rather centre round improving the quality of the drugs procured and distributed through the hospitals. The article concludes that the main source of inefficiency in a specialist hospital in a typical developing country is not just resource crunch, but huge gaps in planning and implementation by the central authorities as well as managerial inefficiency of the local hospital establishment. The determinants that play a vital role in increasing efficiency levels also indicate that most of the inefficiencies can be tackled either with long-term planning or by quick intercession by the hospital authority itself.

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“…A seguinte combinação destacada anteriormente refere-se à aplicação das técnicas DEA e Índice de Produtividade de Malmquist, também direcionada ao cálculo da eficiência (PRIOR, 2006;AROCENA, GARCÍA-PRADO, 2007;KIRIGIA et al, 2008;WENG et al, 2009;WODCHIS;LAPORTE, 2011;CASTRO LOBO et al, 2010;CHOWDHURY et al, 2014), com 5,62%. Tais informações vão ao encontro do mencionado acima, reforçando, em relação à melhoria, que o uso combinado de técnicas matemáticas e estatísticas pode trazer à teoria e prática do desempenho hospitalar.…”

Section: Performance Outcomes Of Balanced Scorecard Application In Hounclassified

Desempenho Hospitalar: Proposta de Pesquisa Bibliográfica sob as Orientações do Método de Revisão Sistemática

Peixoto

Musetti

Mendonça

2017

RFSA

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Accounting for quality in the measurement of hospital performance: evidence from Costa Rica

Cited by 53 publications

References 42 publications

Efficiency and optimal size of hospitals: Results of a systematic search

Efficiency and optimal size of hospitals: Results of a systematic search

Measurement and determinants of public hospital efficiency in West Bengal, India

Desempenho Hospitalar: Proposta de Pesquisa Bibliográfica sob as Orientações do Método de Revisão Sistemática

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