The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals

Abstract

The healthcare sector in general and hospitals in particular represent a main application area for Data Envelopment Analysis (DEA). This paper reviews 262 papers of DEA applications in healthcare with special focus on hospitals and therefore closes a gap of over ten years that were not covered by existing review articles. Apart from providing descriptive statistics of the papers, we are the first to examine the research purposes of the publications. These research goals can be grouped into four distinct clusters according to our proposed framework. The four clusters are (1) "Pure DEA efficiency analysis", i.e. performing a DEA on hospital data, (2) "Developments or applications of new methodologies", i.e. applying new DEAy approaches on hospital data, (3) "Specific management question", i.e. analyzing the effects of managerial specification, such as ownership, on hospital efficiency, and (4) "Surveys on the effects of reforms", i.e. researching the impact of policy making, such as reforms of health systems, on hospital efficiency. Furthermore, we analyze the methodological settings of the studies and describe the applied models. We analyze the chosen inputs and outputs as well as all relevant downstream techniques. A further contribution of this paper is its function as a roadmap to important methodological literature and publications, which provide crucial information on the setup of DEA studies. Thus, this paper should be of assistance to researchers planning to apply DEA in a hospital setting by providing information on a) what has been published between 2005 and 2016, b) possible pitfalls when setting up a DEA analysis, and c) possible ways to apply the DEA analysis in practice. Finally, we discuss what could be done to advance DEA from a scientific tool to an instrument that is actually utilized by managers and policymakers.

Efficiency of Iranian Hospitals before and after Health Sector Evolution Plan: A systematic Review and Meta-Analysis Study

“…The study of Contor VJM and Poh Kl provides some theoretical and methodological limitations of DEA method to capture full view of e ciency of healthcare centers, too [29]. However, with a suitable study design, DEA method is among the most important and most applicable methods in assessment health system e ciency specially hospitals [30].…”

Measuring Efficiency of the New Zealand District Health Boards: An Empirical Research Using Two‐Stage Data Envelopment Analysis

“…However, Simar and Wilson (2011, p. 205-206) contend that "conventional inference methods fail to give valid inference due to the fact that in the second-stage, true efficiency remains unobserved and must be replaced with DEA estimates of efficiency, and these are correlated by construction". In practice, the Simar-Wilson approach has been widely adopted as the norm in second-stage analysis (Kohl et al, 2018).…”

Going beyond health efficiency: What really matters?

“…Because of its characteristics, Data Envelopment Analysis (DEA) is the approach most widely used to measure the efficiency of healthcare systems . However, environmental factors also influence health systems, so in addition to the main DEA method, regression models are often used in conjunction with statistical tests in order to give a more comprehensive analysis and to determine the impact of environment on efficiency or inefficiency . Thus, a two‐stage DEA is often used to explain differences in efficiency, the first stage being a classic efficiency evaluation and the second stage consisting of statistical tests and analyses.…”

“…Also, if only one time point is observed, irregularity or current turbulence can mask actual efficiency. Observing the change in efficiency within a specific time frame can determine whether policy changes have led to better or worse efficiency . Therefore, most authors analyze efficiency at multiple time points.…”