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Crivelli, Luca; Filippini, Massimo; Lunati, Diego

doi:10.1023/a:1019975330960

Cited by 28 publications

(4 citation statements)

References 1 publication

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“…In studies where input prices were available, price (or cost) items follow the corresponding quantities of outputs and inputs. They often included labour prices, capital cost [21,22,23,38,39] and material expenditure [21].…”

Section: Resultsmentioning

confidence: 99%

“…The measurement of inputs and outputs, as well as facility characteristics and environmental factors, are relatively homogenous across studies. Most studies used number of beds [25,27,44,48,49], number of full-time nurses [33,35,40,44,54], or labour price [21,23,38,43,55] as inputs; and used number of resident days [2,32,33,40,55], number of residents [24,25,45,46,47], or case-mix index [20,28,30,31,51] as outputs. The use of inputs in nursing home efficiency measurement is similar to the input measures in hospital literature; i.e., number of beds, labour inputs such as doctors or nurses, or input prices [9,58].…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Tran

Nguyen

Gray

et al. 2019

IJERPH

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Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident’s quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Tran

Nguyen

Gray

et al. 2019

IJERPH

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“…DEA is a non-parametric frontier approach based on linear programming that converts multiple input and output measures of a decision-making unit (DMU) into a single comprehensive measure of its productive efficiency by comparing related DMUs ( Charnes et al, 1978 ). An advantage of DEA is that it does not assume frontiers to possess a particular functional form, unlike in the estimation of stochastic frontier models ( Crivelli et al, 2002 ). DEA also differs from ordinary least squares estimation, which is based on comparisons relative to an average unit.…”

Section: Methods and Datamentioning

confidence: 99%

Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan

Yamauchi¹

2015

GJHS

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Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care.

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“…Hence, there is room for improvement in specific institutions. Crivelli et al [ 3 ] investigated the relationship between cost efficiency, the alternative institutional forms, and the different regulatory settings. Their results “showed that only approximately 60% of the nursing homes included in our sample operate close to the national standard for efficiency.” In an earlier study, Fillipini [ 4 ] found that economies of scale exist for most output levels at Swiss nursing homes in the Ticino.…”

Section: Introductionmentioning

confidence: 99%

Effects of a mobility monitoring system on the cost of care in relation to reimbursement at Swiss nursing homes: learnings from a randomized controlled trial

et al. 2017

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Background/objectiveNursing homes in Switzerland are under pressure to efficiently coordinate staff activities to cover their personnel costs under the care financing system. In this study, the use of a mobility monitoring system accompanied with case conferences was investigated in order to improve sleep quality and estimate the cost benefit of this intervention.MethodIn an open two-phase randomized controlled trial at three nursing homes, residents with cognitive impairment were randomly assigned to an intervention group and a control group. In the intervention group, a 10-week period of intensive use of the monitoring system and case conferences led by an advanced nurse practitioner (Phase I) was followed by 3 months of reduced use of the monitoring system and case conferences led by an internal registered nurse (Phase II). In the control group, the monitoring system was only used for data acquisition. Nurses reported the activities with a specifically developed tool. Based on the recorded activities, the cost of care was calculated. The correlating reimbursement per patient was calculated from the care levels in the Swiss reimbursement system. Data from 44 residents was included in the analysis with a linear mixed model.ResultsAlthough analysis revealed no statistically significant effects, results indicate that the use of a monitoring system can guide nurses in organizing their tasks to increase effectiveness. Information systems such as the mobility monitor can help to identify single outliers that do not correspond with the overall situation.ConclusionIn the health care system, problematic individual cases can account for a disproportionally high cost levels. It was shown that information systems can have a significant economic impact in the long run.Trial registrationThe study is registered at the German Clinical Trials Register under the Nr. DRKS-ID: DRKS00006829.

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Untitled

Cited by 28 publications

References 1 publication

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan

Effects of a mobility monitoring system on the cost of care in relation to reimbursement at Swiss nursing homes: learnings from a randomized controlled trial

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