Managing for efficiency in health care: the case of Greek public hospitals

Abstract

This paper evaluates the efficiency of public hospitals with two alternative conceptual models. One model targets resource usage directly to assess production efficiency, while the other model incorporates financial results to assess economic efficiency. Performance analysis of these models was conducted in two stages. In stage one, we utilized data envelopment analysis to obtain the efficiency score of each hospital, while in stage two we took into account the influence of the operational environment on efficiency by regressing those scores on explanatory variables that concern the performance of hospital services. We applied these methods to evaluate 96 general hospitals in the Greek national health system. The results indicate that, although the average efficiency scores in both models have remained relatively stable compared to past assessments, internal changes in hospital performances do exist. This study provides a clear framework for policy implications to increase the overall efficiency of general hospitals.

Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit

“…Therefore, it's better to have the estimations done by Tobit or truncated regression. Mitropoulos et al (2013), the author who obtained the efficiency scores of Greek hospitals by DEA in the first stage, analyzed the effects of operational environment on hospital efficiency by truncated regression in the second stage. Nedelea and Fanin (2013), in their study on cost-effectiveness in US hospitals, used DEA in the first stage, and truncated regression in the second stage, using environmental variables as explanatory variables.…”

Factors affecting primary health care centers’ economic and production efficiency

“…However, one can gain some insight into the operations of a given HC by comparing its performance achievements for each respective model. This two model approach is similar with the studies (Athanassopoulos et al 1999;Mitropoulos et al 2013b) that applied to measure the efficiency Greek public hospitals. The main conclusion derived comparing these two studies were that during the last decade it has been a major qualitative change entailing the health system operation.…”

“…Therefore, in the past the production model that assesses mainly the human resources had strong associations with the assessments of the economic model (Athanassopoulos et al 1999). In contrast, the new treatments have risen uncontrollably the supplies cost which is currently almost two times greater than the human resource cost; therefore, the production and economic models now present only weak associations (Mitropoulos et al 2013b). Using similar conceptual models in a longitudinal analysis over the period 2005, Fragkiadakis (2014 indicate that the 2007 reform of the Greek National Health System (NHS) failed to achieve improvement in terms the hospitals' operational efficiency, whereas the economic efficiency present a weak enhancement.…”

Data Envelopment Analysis for Relative Efficiency Measurement of Chinese Hospitals: A Systematic Review

“…Novel applications and extensions of efficiency measurement in two stages includes DEA with Tobit (Fareed et al, 2012;Kirigia & Asbu, 2013;Nayar et al, 2013), multiple (Bates et al, 2006;Gok & Sezen, 2013), logistic (Chustz, 2012;Lobo et al, 2014) and truncated regression analysis (Araujo et al, 2014;Halkos & Tzeremes, 2011;Kounetas & Papathanassopoulos, 2013;Mitropoulos et al, 2013), etc. Furthermore, a considerable extended DEA models have been developed in international studies, including bootstrap-DEA (Halkos & Tzeremes, 2011;Puenpatom & Rosenman, 2008;Simões & Marques, 2011;Varabyova & Schreyogg, 2013), congestion-DEA (Ferrier et al, 2006;Masiye, 2007;Valdmanis et al, 2004;Valdmanis et al, 2008), DEA-R (Wei et al, 2011), post DEA cross-evaluation and cluster analysis (Flokou et al, 2011), and multi-criteria DEA models (Ajlouni et al, 2013;Zaim et al, 2007), etc.…”