Output congestion leads to compromised care in Peruvian public hospital neonatal units
- 239 Downloads
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.
KeywordsHospital 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.
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.
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.
- 6.Djema H, Djerdjouri M (2012) A two-stage DEA with partial least squares regression model for performance analysis in healthcare in Algeria. Int J Appl Decis Sci 5(2)Google Scholar
- 7.UNICEF (2008) The State of The World’s Children 2009: Maternal and Newborn Health. In. United Nations Children’s Fund, New YorkGoogle Scholar
- 10.Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A (2007) Socio-economic differences in health, nutrition, and population. The World Bank, WashingtonGoogle Scholar
- 11.Ozcan YA (2014) Health care benchmarking and performance evaluation: an assessment using Data Envelopment Analysis (Dea), vol 210. Springer, NewtonGoogle Scholar
- 25.Fare R, Grosskopf S, Lovell CK (1994) Production frontiers. Cambridge University PressGoogle Scholar
- 27.Ganley J, Cubbin J (1992) Public sector efficiency measurement: applications of data envelopment analysis. Elsevier Science Inc, New YorkGoogle Scholar
- 29.Iezzoni L (2003) Risk adjustment for measuring health care outcomes, 3 edn. Health Administration PressGoogle Scholar
- 30.Allison P (2001) Missing data. Sage, New YorkGoogle Scholar
- 31.Arrieta A, Riesco G (2009) Risk factors for perinatal mortality in Peruvian Social Security Hospitals: using the data of the Perinatal Surveillance System of ESSALUD. Anales de la Facultad de Medicina 70(4):241–246 [Spanish].Google Scholar
- 32.Arroyo A (2013) Daily chaos takes over the hospital network ESSALUD. In: Peru 21. A12 [Spanish]Google Scholar
- 33.Ramos C (2013) Overcrowding and queues at ESSALUD : Doctors care for 200 patients per day. In: Diario Correo. A8 [Spanish]Google Scholar