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Performance and congestion analysis of the portuguese hospital services

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Abstract

The health care services have been characterized by a growing demand by the citizens leading to the need of more and more resources. Population aging, new pathologies, drugs, as well as new treatments are some of the major factors for this. However, in hospitals, for example, consumption of a large number of inputs has not frequently corresponded to the production of the same or more proportion of outputs. Sometimes, the outputs even decline with the increase of inputs due to the influence of the congestion effect on efficiency. The heavy burden of the health sector on the state budget brings about the interest of research over its efficiency. This paper aims to assess the performance of the Portuguese hospitals and particularly the contribution of the congestion effect. We use the non-parametric technique of data envelopment analysis for this purpose and a double-bootstrap procedure to take into account the influence of operational environment on efficiency. Afterwards, by comparing three different approaches, we determine the importance of congestion in efficiency measurement and discuss its computation methodologically. The results suggest significant levels of inefficiency in 68 major Portuguese hospitals for the year 2005 and more than half of them were found to be congested.

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References

  • Banker R, Charnes A, Cooper W (1984) Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manage Sci 30: 1078–1092

    Article  Google Scholar 

  • Barros P (2004) O mixed bang das reformas do sector da saúde pós-2002. Rev Port Saúde Pública Lisb 4: 51–56

    Google Scholar 

  • Björkgren M, Fries B, Häkkinen U, Brommels M (2004) Case-mix adjustment and efficiency measurement. Scand J Public Health 32: 464–471

    Article  Google Scholar 

  • Brailer D (1992) A theory of congestion in general hospitals. PhD Thesis, University of Pennsylvania, USA

  • Brockett P, Cooper W, Shin H, Wang Y (1998) Inefficiency and congestion in Chinese production before and after the 1978 economic reforms. Socioecon Plan Sci 32: 1–20

    Article  Google Scholar 

  • Byrnes P, Färe R, Grosskopf S (1984) Measuring productive efficiency: an application to Illinois strip mines. Manage Sci 30: 671–681

    Article  Google Scholar 

  • Charnes A, Cooper W, Rhodes E (1978) Measuring the efficiency of decision making units. Eur J Oper Res 2: 429–444

    Article  Google Scholar 

  • Cherchye L, Kuosmanen T, Post T (2001) Alternative treatments of congestion in DEA: a rejoinder to Cooper, Gu, and Li. Eur J Oper Res 132: 75–80

    Article  Google Scholar 

  • Clement J, Valdmanis V, Bazzoli G, Zhao M, Chukmaitov A (2008) Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion. Health Care Manage Sci 11: 67–77

    Article  Google Scholar 

  • Cooper W, Gu B, Li S (2001a) Comparisons and evaluations of alternative approaches to the treatment of congestion in DEA. Eur J Oper Res 132: 62–74

    Article  Google Scholar 

  • Cooper W, Gu B, Li S (2001b) Note: alternative treatments of congestion in DEA—a response to the Cherchye, Kuosmanen and post critique. Eur J Oper Res 132: 81–87

    Article  Google Scholar 

  • Cooper W, Thompson R, Thrall R (1996) Introduction: Extensions and new developments in DEA. Ann Oper Res 66: 3–45

    Google Scholar 

  • De Witte K, Marques R (2009). Incorporating heterogeneity in non-parametric models, a methodological comparison. Forthcoming in Int J Oper Res (in press)

  • Färe R, Svensson L (1980) Congestion of production factors. Econometrica 48: 1745–1753

    Article  Google Scholar 

  • Färe R, Grosskopf S, Lovell C (1985) The measurement of efficiency of production. Kluwer-Nijhoff, Boston

    Google Scholar 

  • Ferreira A, Harfouche A, Campos A, Ramos F (2006) Políticas de controlo dos gastos públicos com a saúde. O Economista - Anuário da Economia Portuguesa

  • Ferrier G, Valdmanis V (2006) The influence of competitors’ performance on hospital efficiency. Paper presented at the annual meeting of the economics of population health: inaugural conference of the American society of health economists, TBA, Madison, WI, USA, 4 June

  • Ferrier G, Rosko M, Valdmanis V (2006) Analysis of uncompensated hospital care using a DEA model of output congestion. Health Care Manage Sci 9: 181–188

    Article  Google Scholar 

  • Ferrier G, Valdmanis V, West T (2005) The impact of indigent care on output congestion in hospitals. Working paper. Available at SSRN: http://ssrn.com/abstract=774889

  • Flegg A, Allen D (2009) Congestion in the new British universities: a further analysis. J Oper Res Soc Japan 52: 186–203

    Google Scholar 

  • Fried H, Lovell C, Schmidt S (2008) The measurement of productive efficiency and productivity change. Oxford University Press, New York

    Book  Google Scholar 

  • Giraldes M (2003) Sistema de saúde versus sistema privado em Portugal. Editorial Estampa, Portugal

    Google Scholar 

  • Grosskopf S, Margaritis D, Valdmanis V (2001) The effects of teaching on hospital productivity. Socioecon Plan Sci 35: 189–204

    Article  Google Scholar 

  • Grosskopf S, Margaritis D, Valdmanis V (2004) Competitive effects on teaching hospitals. Eur J Oper Res 154: 515–525

    Article  Google Scholar 

  • Hofmarcher M, Lietz C, Schnabl A (2005) Inefficiency in Austrian inpatient care: identifying ailing providers based on DEA results. Cent Eur J Oper Res 13: 341–363

    Google Scholar 

  • Hollingsworth B (2003) Non-parametric and parametric applications measuring efficiency in health care. Health Care Manage Sci 6: 203–218

    Article  Google Scholar 

  • HSJ (2009) NHS direct useful but ‘inefficient. Health Serv J. Available in http://www.hsj.co.uk/home/board-talk/nhs-direct-useful-but-inefficient/5006308.article

  • Jacobs R, Smith P, Street A (2006) Measuring efficiency in health care. Cambridge University Press, Cambridge

    Book  Google Scholar 

  • Johnson G, Happ W (1977) Digital simulation for detecting congestion in hospital facilities. Proceedings of the 9th conference on winter simulation, vol 2. Gaitersburg, MD

  • Kittelsen S, Magnussen J (2003) Economies of scope in Norwegian hospital production—a DEA analysis. Working Paper 2003: 8. Health economics research programme, University Of Oslo

  • Lobo M, Ozcan Y, Silva A, Lins M, Fiszman M (2009) Financing reform and productivity change in Brazilian teaching hospitals: Malmquist approach. Cent Eur J Oper Res (in press)

  • Lotfi F, Pourzarandi M, Namin M, Jahantighey M, Abolghasemzadeh Sh (2007) Congestion in stochastic DEA for restructure strategy: an application to Iranian commercial banks. Int Math Forum 2(64): 3169–3180

    Google Scholar 

  • Ma X, Ryan C, Bao J (2008) Chinese national parks—resource usage efficiencies, spatial proximity and roles. An application of data envelopment analysis. In: Ryan C, Gu H (eds) Tourism in China: destination, cultures and communities. Routledge, New York pp 67–87

    Google Scholar 

  • Marques R, Silva D (2006) Análise da variação da produtividade dos serviços de água portugueses entre 1994 e 2001 usando a abordagem de Malmquist. Pesqui Operacional 26: 145–168

    Google Scholar 

  • McKillop D, Glass C, Kerr C, McCallion G (1999) Efficiency in northern Ireland hospitals: a non-parametric analysis. Econ Soc Rev 30: 175–196

    Google Scholar 

  • Nunes R (2009) Regulação da saúde. Vida Económica, Porto

    Google Scholar 

  • Odeck J (2006) Congestion, ownership, region of operation, and scale: their impact on bus operator performance in Norway. Socioecon Plan Sci 40: 52–69

    Article  Google Scholar 

  • O’Neill L, Rauner M, Heidenberger K, Krau M (2008) A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socioecon Plan Sci 42: 158–189

    Article  Google Scholar 

  • Ozcan Y (2008) Health care benchmarking and performance evaluation. An assessment using data envelopment analysis (DEA). Springer, New York

    Book  Google Scholar 

  • Rosa E (2006) Serviço nacional de saúde é sustentável. Resistir, 26 de Março

  • Schaffhauser-Linzatti M, Zeileis A, Rauner M (2009) Effects of the Austrian performance-oriented inpatient reimbursement system on treatment patterns: illustrated on cases with knee-joint problems. Cent Eur J Oper Res 17: 293–314

    Article  Google Scholar 

  • Simar L, Wilson P (1998) Sensitivity analysis of efficiency scores: how to bootstrap in nonparametric models. Manage Sci 44: 46–61

    Article  Google Scholar 

  • Simar L, Wilson P (2007) Estimation and inference in two-stage, semi-parametric models of production processes. J Econom 136: 31–64

    Article  Google Scholar 

  • Thorpe K (1995) Health care cost containment: reflections and directions. In: Kovner A (eds) Healthcare delivery in the United States. Springer, New York pp 294–321

    Google Scholar 

  • Tone K (2001) A slacks-based measure of efficiency in data envelopment analysis. Eur J Oper Res 130: 498–509

    Article  Google Scholar 

  • Tone K, Sahoo B (2004) Degree of scale economies and congestion: a unified DEA approach. Eur J Oper Res 158: 755–772

    Article  Google Scholar 

  • Valdmanis V, Kumanarayake L, Lertiendumrong J (2004) Capacity of Thai public hospitals and the production of care for poor and non-poor patients. Health Serv Res 39: 2117–2134

    Article  Google Scholar 

  • Valdmanis V, Rosko M, Muller R (2008) Hospital quality, efficiency, and input slack differentials. Health Serv Res 43: 1830–1848

    Article  Google Scholar 

  • Wang J, Zhao Z, Mahmood A (2006) Relative efficiency, scale effect, and scope effect of public hospitals: evidence from Australia. Discussion Paper No. 2520, Institute for the study of labor

  • Wholey D, Feldman R, Christianson J, Engberg J (1996) Scale and scope economies among health maintenance organizations. J Health Econ 15: 657–684

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Centre of Urban and Regional Systems (CESUR), DECivil-IST, Technical University of Lisbon, Av. Rovisco Pais, 1049-001, Lisbon, Portugal

    Pedro Simões & Rui Cunha Marques

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  1. Pedro Simões
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  2. Rui Cunha Marques
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Correspondence to Rui Cunha Marques.

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Simões, P., Marques, R.C. Performance and congestion analysis of the portuguese hospital services. Cent Eur J Oper Res 19, 39–63 (2011). https://doi.org/10.1007/s10100-009-0122-2

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  • DOI: https://doi.org/10.1007/s10100-009-0122-2

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