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Decomposition of potential efficiency gains from hospital mergers in Greece

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Abstract

This paper evaluates the technical efficiency of 71 Greek public hospitals and examines potential efficiency gains from 13 candidate mergers among them. Efficiency assessments are performed using bootstrapped Data Envelopment Analysis (DEA) whilst merger analysis is conducted by applying the Bogetoft and Wang methodology which allows the overall potential merger gains to be decomposed into three main components of inefficiency, namely technical (or learning), scope (or harmony) and scale (or size) effects. Thus, the analysis provides important insights not only on the magnitude of the potential total efficiency gains but also on their sources. The overall analysis is conducted in the context of a complete methodological framework where methods for outlier detection, returns to scale identification, and bias corrections for DEA estimations are also applied. Mergers are analyzed under the assumptions of constant, variable and non-decreasing returns to scale in an input oriented DEA model with three inputs and three outputs. The main finding of the study indicates that almost all mergers show substantial potential room for efficiency improvement, which is mainly attributed to the pre-merger technical inefficiencies of the individual hospitals and therefore it might be possible to be achieved without the need of implementing full-scale mergers. The same -though, at a lower extent- applies to the harmony effect whilst the size effect shows marginal or even negative gains.

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Authors and Affiliations

  1. School of Social Sciences, Hellenic Open University, Parodos Aristotelous 18, 26 335, Patra, Greece

    Angeliki Flokou, Vassilis Aletras & Dimitris Niakas

  2. Department of Business Administration, University of Macedonia, 156 Egnatia Street, 54636, Thessaloniki, Greece

    Vassilis Aletras

Authors
  1. Angeliki Flokou
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  2. Vassilis Aletras
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  3. Dimitris Niakas
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Correspondence to Angeliki Flokou.

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Flokou, A., Aletras, V. & Niakas, D. Decomposition of potential efficiency gains from hospital mergers in Greece. Health Care Manag Sci 20, 467–484 (2017). https://doi.org/10.1007/s10729-016-9365-3

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