Evaluation of China's regional hospital efficiency: DEA approach with undesirable output

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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“…Generally, also in this context, authors observed that mergers increased a hospital's efficiency level [96, 97, 98, 99]. …”

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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“…In order to include them in a DEA model we use the extension developed by Seiford and Zhu (2002), since this is the method that fits better with the technology of production assumed. This model has been used previously in the health sector (Hu et al, 2012) as well as in other environmental contexts (Lu and Lo, 2007;.…”

Section: Introductionmentioning

confidence: 99%

Efficiency assessment of primary care providers: A conditional nonparametric approach

Ferrera

Alonso-Morán

Nuño-Solinís

et al. 2015

European Journal of Operational Research

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This paper uses a fully nonparametric approach to estimate efficiency measures for primary care units incorporating the effect of environmental factors. This methodology allows us to account for different types of variables (continuous and discrete) regarding the main characteristics of patients served by those providers. In addition, we use an extension of this nonparametric approach to deal with the presence of undesirable outputs in data, represented by the number of readmissions and hospitalization rates of ambulatory care sensitive condition (ASCS). The empirical results of our application show that all the exogenous variables considered have a significant and negative effect on efficiency estimates.

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“…This indicates that about half of hospitals are increasing the rates of perinatal mortality and perinatal near-miss a result of congestion, and if the How serious is congestion in ESSALUD hospitals? Although there are not benchmarks to classify an average score of 1.25 as low or high congestion, we reviewed international studies on hospital congestion [16][17][18] to obtain a relative assessment. Our review suggests that congestion in ESSALUD hospital's NCUs is relatively high.…”

Section: Resultsmentioning

confidence: 99%

“…Relatively high levels of congestion have also been found in other developing countries. In a sample of 30 hospitals from Zambia, the average congestion level was estimated at 1.36 [17], while in China, the average congestion level of hospitals aggregated by regions was estimated at 1.23 [18] 3 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Output congestion leads to compromised care in Peruvian public hospital neonatal units

Arrieta

Guillén

2015

Health Care Manag Sci

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Peru is moving toward a universal health insurance system, and it is facing important challenges in the provision of public health services. As more citizens gain access to health insurance, the flow of patients exceeds the capacity of public hospitals to provide care with quality. In this study we explore the relationship between technical efficiency and patient safety events in neonatal care units of Peru's public hospitals. We use Data Envelope Analysis (DEA) with output congestion to assess the association between technical efficiency and patient safety events. We study 35 neonatal care units of public hospitals in Peru's Social Security Health System, and identify two undesirable (risk-adjusted) safety outcomes: neonatal mortality and near-miss neonatal mortality. We found that for about half of hospital's neonatal care units, technical efficiency is affected by output congestion. For those hospitals, patient safety is being compromised by receiving too many patients. Our results are consistent with public reports indicating that hospitals in the Peru's Social Security Health System are overcrowded, affecting efficiency and jeopardizing quality of care. We found that most congested hospitals are located in the capital city and suburban areas, and are more likely to be hospitals with the lowest and the highest level of care. Our results call for improvements in the patient referral system and capacity expansion.

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Evaluation of China's regional hospital efficiency: DEA approach with undesirable output

Cited by 48 publications

References 28 publications

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

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

Efficiency assessment of primary care providers: A conditional nonparametric approach

Output congestion leads to compromised care in Peruvian public hospital neonatal units

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