Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis

Sexton, Thomas R.; Leiken, Alan M.; Nolan, A.H.; Liss, Shari; Hogan, Andrew J.; Silkman, Richard H.

doi:10.1097/00005650-198912000-00009

Cited by 51 publications

(22 citation statements)

References 6 publications

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“…The DEA methodology assumes that facilities are to be identical with respect to organizational and environmental operating conditions (Sexton et al 1989). Since this is not necessarily true, there may be variation in efficiency measurements across facilities with different characteristics.…”

Section: Methodsmentioning

confidence: 99%

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

Özgen¹,

Özcan²

2002

Health Services Research

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Objective. To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. Study Setting. Freestanding dialysis facilities that operated in 1997 submitted cost report forms to the Health Care Financing Administration (HCFA), and offered all three outputs-outpatient dialysis, dialysis training, and home program dialysis.Data Sources. The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File.Study Design. Cross-sectional data for the year 1997 were utilized to obtain facilityspecific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis.Principal Findings. The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient.Conclusions. Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains 711 suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.Key Words. Dialysis market, efficiency, ownership, consolidationIn the health-care sector, the existence of conflicts of interest between the payers and the providers of health-care services are not surprising. The situation may take even more serious form in price-regulated health-care markets. The Medicare end-stage renal disease (ESRD) program, as a virtually monopsonistic buyer of ESRD-related services, offers an example of this phenomenon (Farley 1994).Medicare ...

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Section: Methodsmentioning

confidence: 99%

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

Özgen¹,

Özcan²

2002

Health Services Research

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“…Unfortunately, hospitals produce a multiple of intermediate goods, all of which go towards the improvement of the patient's health, a good that cannot be easily quantified. Due to the difficulty surrounding the measurement of true hospital output, requiring the measurement of a multiplicity of intermediate outputs, the analysis of hospital production often focuses on the production of intermediate goods; see for example Grosskopf and Valdmanis (1987) and Sexton, Lieken, Nolan, Liss, Hogan and Silkman (1989).…”

Section: Relevant Literaturementioning

confidence: 99%

DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS¹

Kibambe

Koch

2007

South African J Economics

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The research presented in this paper provides an analysis of the delivery of a few health care services by the public sector in Gauteng, South Africa. The data for the study was especially difficult to collect, suggesting the need for hospital level data information systems, as well as staff who are trained to analyze the information collected. The empirical results from the analysis suggest that services provided by small-scale medical facilities waste fewer resources, while medical centres offering more technical services, such as surgeries, also appear to deliver medical services more efficiently. Copyright (c) 2007 The Authors; Journal compilation (c) Economic Society of South Africa 2007.

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“…Because of this, DEA requires many fewer assumptions than other economic models and, as such, may be preferred over other methods. DEA has been gaining popularity as a benchmarking method in recent years and has been used to assess efficiency in several dimensions of health service delivery including hospitals, nursing services, hospital management, and the productive efficiency of blood centers in 2003 …”

Section: Methodsmentioning

confidence: 99%

Assessing productive efficiency and operating scale of community blood centers

Nielsen

2016

Transfusion

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Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis

Cited by 51 publications

References 6 publications

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS¹

Assessing productive efficiency and operating scale of community blood centers

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Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis

Cited by 51 publications

References 6 publications

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS1

Assessing productive efficiency and operating scale of community blood centers

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DEA APPLIED TO A GAUTENG SAMPLE OF PUBLIC HOSPITALS¹