Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement

Wu, Chia-Hsuan; Chang, Ching‐Cheng; Chen, Po‐Chi; Kuo, Ken-Nan

doi:10.1007/s10100-012-0238-7

Cited by 23 publications

(9 citation statements)

References 36 publications

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“…While hospital efficiency has been extensively studied (Hollingsworth 2008;Rosko and Mutter 2008), we found only one paper (Wu et al 2013) that investigated hospital efficiency under global budgeting. The authors applied a non-radial data envelopment analysis (DEA) on Taiwanese data and found that hospital efficiency decreased after global budgeting.…”

Section: Introductionmentioning

confidence: 96%

Hospital efficiency under global budgeting: evidence from Taiwan

Lai

Tang

2017

Empir Econ

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Global budgeting sets a predetermined cap to restrain health expenditure, but the fixed budget for medical providers could result in less efficient services. This paper measures hospital efficiency under global budgeting using simultaneous stochastic frontier analysis, stressing that physicians and dentists within a hospital were under separate budgets in Taiwan. Empirical results show that hospital efficiency was not improved after global budgeting, and physicians were found to be less efficient than dentists. The physicians and dentists within the same hospital were also found to be less integrated after global budgeting. Empirical results show that a joint analysis improves the estimation efficiency from separate analysis and suggest that the aggregate inefficiency came mostly from physicians in hospitals that were small, public, non-teaching, located in small markets and had a low market share. Except for public We thank Subal Kumbhakar and two anonymous referees for their comments and suggestions. We are grateful to

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Section: Introductionmentioning

confidence: 96%

Hospital efficiency under global budgeting: evidence from Taiwan

Lai

Tang

2017

Empir Econ

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“…These studies often performed some transformation to the quality measures in order to represent the idea that more is better for the production of outputs (e.g., mortality rate would be transformed to inverse mortality). Alternatively, other studies included the lack of quality (more is worse) in the efficiency model as an additional weakly disposable output [13][14][15][16][17]. The assumption of weak disposability in these so-called congestion models imposes an opportunity cost on the disposal of "bad" outputs [18].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, previous studies relied on the indicators of outcome quality (e.g., mortality rate [3,7,8,10,20], hospital-acquired infections [14,16], and readmissions [17]), process quality (e.g., acute myocardial infarction (AMI) patients who received aspirin within 24 hours of arrival [11]), structural quality (e.g., extra nursing hours [4]), and patient experience (e.g., patient satisfaction [5]) as well as various combinations of multiple quality measures. However, different measures of quality may have a different relationship to efficiency.…”

Section: Introductionmentioning

confidence: 99%

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

Varabyova

Blankart

Schreyögg

2016

Health Care Manag Sci

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. In the past decades, hospitals have been facing pressure to increase the efficiency of resource allocation. One way to achieve higher levels of technical efficiency is to treat more patients with the same amount of personnel, which could potentially lead to a trade-off between improving efficiency and maintaining good patient service. The aim of this study is to demonstrate how the nonparametric conditional approach can be used to integrate quality into the analysis of efficiency. The conditional approach allows investigating the mechanism through which quality enters the production process. Generally, an external variable may enter the production process by affecting either the attainable frontier or the distribution of inefficiencies inside the production set. To account for the heterogeneity of hospital services, we focus on a hospital department as the unit of analysis. We use data from 178 departments of interventional cardiology and consider three different measures of quality: patient satisfaction, risk-adjusted mortality, and patient radiation exposure. Our empirical assessment shows that the impact of quality on the production process differs according to the utilized quality measure. Patient satisfaction does not affect the attainable frontier but does have an inverted -shaped effect on the distribution of inefficiencies; risk-adjusted mortality negatively impacts the attainable frontier at high values of mortality but does not impact the distribution of inefficiencies; and patient radiation exposure is not associated with the production process. Our results refute the existence of a clear trade-off between efficiency and quality. The conditional approach can be applied to deal with the complexity of the underlying relationships between efficiency and quality. Terms of use: Documents in

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“…After reviewing more than two hundred and sixty papers using DEA to the hospital sector, Kohl et al ( 2019 ) divided such a utilization into four main groups depending on the goals: to estimate efficiency; to answer specific management questions; to evaluate a specific health policy; or simply to develop or apply new benchmarking methodologies. In this sense, several techniques have been integrated with DEA and applied to healthcare, e.g., bootstrapping (Araújo et al 2014 ), neural networks (Chuang et al 2011 ), productivity indices (Wu et al 2013 ), and spatial analysis to identify predominant clusters (de Almeida Botega et al 2020 ). Another recent literature analysis shows that researchers focus mainly on hospitals' technical efficiency, where various resources lead to the providing health care process (Patra and Ray 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Economic Analysis of Portuguese Public Hospitals Through the Construction of Quality, Efficiency, Access, and Financial Related Composite Indicators

2021

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Hospitals consume most of the health systems' financial resources. In Portugal, for instance, public hospitals represent more than half of the National Health Service debt and are decisive in their financial insufficiency. Although profit is not the primary goal of hospitals, it is essential to guarantee their financial sustainability to ensure users' health care and the necessary resources. An analysis of the existing literature shows that researches focus mainly on the hospital's technical efficiency. The literature has paid little or even no attention to the use of composite indicators in hospital benchmarking studies. This study uses the Benefit of Doubt methodology alongside recent data about Portuguese public hospitals (2013–2017) to understand the factors that contribute to low performance and high indebtedness levels. Our results suggest that hospitals perform better in terms of access (average score: 0.982). The group of criteria with the lowest performance was efficiency and productivity (average score: 0.919), suggesting resources waste. Financial performance is, in general, higher than quality, raising social concerns about the way that public hospitals have been managed. Findings bring relevant implications. For example, the way hospitals are currently financed should consider efficiency, productivity, quality, and access. Regulators should ensure that minimum performance levels are fulfilled, applying preventive and corrective measures to avoid future low-performance levels. We suggest that hospital managers introduce satisfaction inquiries to improve quality. These improvements can attract more patients in the medium- or long-term; thus, our results are useful to citizens to make a better choice.

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Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement

Cited by 23 publications

References 36 publications

Hospital efficiency under global budgeting: evidence from Taiwan

Hospital efficiency under global budgeting: evidence from Taiwan

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

Economic Analysis of Portuguese Public Hospitals Through the Construction of Quality, Efficiency, Access, and Financial Related Composite Indicators

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