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Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems

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Abstract

In recent years, most countries around the world have struggled with the consequences of budget cuts in health expenditure, obliging them to utilize their resources efficiently. In this context, performance evaluation facilitates the decision-making process in improving the efficiency of the healthcare system. However, the performance evaluation of many sectors, including the healthcare systems, is, on the one hand, a challenging issue and on the other hand a useful tool for decision- making with the aim of optimizing the use of resources. This study proposes a new methodology comprising two well-known analytical approaches: (i) data envelopment analysis (DEA) to measure the efficiencies and (ii) data science to complement the DEA model in providing insightful recommendations for strategic decision making on productivity enhancement. The suggested method is a first attempt to combine two DEA extensions: flexible measure and cross-efficiency. We develop a pair of benevolent and aggressive scenarios aiming at evaluating cross-efficiency in the presence of flexible measures. Next, we perform data mining cluster analysis to create groups of homogeneous countries. Organizing the data in similar groups facilitates identifying a set of benchmarks that perform similarly in terms of operating conditions. Comparing the benchmark set with poorly performing countries we can obtain attainable goals for performance enhancement which will assist policymakers to strategically act upon it. A case study of healthcare systems in 120 countries is taken as an example to illustrate the potential application of our new method.

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Notes

  1. A non- discretionary input is not subject to management control.

  2. Available at https://www.fico.com/en/products/fico-xpress-optimization

  3. Available at https://www.r-project.org/

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Acknowledgements

The authors wish to express their appreciation to the guest editor Prof. Vincent Charles along with three anonymous reviewers for their insightful comments. This research was supported from the 2018 grant of the school of engineering at Universidad de los Andes, Bogotá, Colombia and the Czech Science Foundation through project No. 17-23495S. Moreover, we would like to thank Lina Patricia Navas Castaño for her collaboration and support on performing this research.

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Authors and Affiliations

  1. Department of Industrial Engineering, Universidad de los Andes, Bogotá, Colombia

    Sepideh Abolghasem & Santiago Amézquita

  2. Department of Systems Engineering, Faculty of Economics, VŠB-Technical University of Ostrava, Sokolská třida 33, 702 00, Ostrava, Czech Republic

    Mehdi Toloo

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  1. Sepideh Abolghasem
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Appendix

Appendix

Table 4 Benevolent vs. Aggressive
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Table 5 List of countries for different clusters
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Abolghasem, S., Toloo, M. & Amézquita, S. Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems. Health Care Manag Sci 22, 512–533 (2019). https://doi.org/10.1007/s10729-019-09478-0

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