Health Care Management Science

, Volume 20, Issue 2, pp 157–164 | Cite as

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



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.


Hospital efficiency DEA Neonatal care units Peru 



Data Envelope Analysis


World Health Organization


United Nations Children’s Fund


Peru’s Social Security Health System


Perinatal Surveillance System


Neonatal Care Unit


Ministry of Health


Demographical Health Surveys


Appearance, Pulse, Grimace, Activity, and Respiration



The authors thank the Consorcio de Investigación Económica y Social, and anonymous reviewers of this manuscript. 

Authors’ contributions

AA contributed to the study design, acquisition of data, analysis and manuscript writing. JG contributed with DEA estimation, literature review and manuscript writing. All authors read and approved the final manuscript.

Compliance with Ethical Standards

This study received expedited IRB approval by the IUPUI / Clarian Institutional Review Board (Protocol number 1010002619). All administrative data provided by ESSALUD was de-identified.

Competing interests

The study is part of a larger research project funded by the Consorcio de Investigación Económica y Social (CIES). The authors assure the absence of competing interests.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Robert Stempel College of Public HealthFlorida International UniversityMiamiUSA
  2. 2.Graduate School of BusinessESANLima 33Peru

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