Health Care Management Science

, Volume 11, Issue 1, pp 67-77

First online:

Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion

  • Jan P. ClementAffiliated withDepartment of Health Administration, Virginia Commonwealth University Email author 
  • , Vivian G. ValdmanisAffiliated withHealth Policy Program, University of the Health Sciences in Philadelphia
  • , Gloria J. BazzoliAffiliated withDepartment of Health Administration, Virginia Commonwealth University
  • , Mei ZhaoAffiliated withHealth Administration Programs, College of Health, University of North Florida
  • , Askar ChukmaitovAffiliated withFamily Medicine and Rural Health, College of Medicine, Florida State University

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This paper applies a new methodology to the study of hospital efficiency and quality of care. Using a data set of hospitals from several states, we jointly evaluate desirable hospital patient care output (e.g., patient stays) and the simultaneous undesirable output (e.g., risk-adjusted patient mortality) that occurs. With a DEA based approach under two different sets of assumptions, we are able to include multiple quality indicators as outputs. The results show that lower technical efficiency is associated with poorer risk-adjusted quality outcomes in the study hospitals. They are consistent with other studies linking poor quality outcomes to higher cost.


Hospital efficiency DEA Patient outcomes